Effectiveness of CT-guided percutaneous cordotomy in intractable cancer pain: Experience in 14 patients.

BACKGROUND: Severe and treatment-resistant pain is a major issue for patients with cancer. Cordotomy is an effective approach for addressing severe cancer-related pain. It is based on blocking the transmission of pain by damaging the lateral spinothalamic tract. METHODS: Computed tomography guided cordotomy was performed on 14 patients who did not respond to medical and interventional pain management methods. RESULTS: Fourteen patients with cancer pain underwent CT-guided percutaneous cordotomy. Pain relief was reported in 86% of the patients. The visual analog scale values before and after cordotomy were compared and a significant difference was found (p = 0.0001). The improvement in the Karnofsky Performance Scale score of the patients was found to be statistically significant (p = 0.0001). CONCLUSION: We believe that CT-guided cordotomy, performed by experienced hands in a team of experienced individuals and applied to the right patients, is an effective treatment. However, it is crucial to exercise extreme caution regarding potential side effects and serious complications during the cordotomy procedure.

Demonstration of the protective effect of propofol in rat model of cisplatin-induced neuropathy.

Cisplatin is commonly used in the treatment of lung, genitourinary, and gastrointestinal cancers. Peripheral neuropathy is the most important side effect, leading to a decrease in the dose of cisplatin or its complete cessation in the early period. 16 rats were given cisplatin at a dose of 2.5 mg/ kg/day twice a week for 4 weeks to induce neuropathy model. The rats taking Cisplatin were divided into 2 groups. Group 1 rats (n = 8) were given 1 ml/kg/day 0.9 % NaCl intraperitoneally, and Group 2 rats were given 10 mg/kg/day Propofol intraperitoneally daily for 4 weeks. The remaining 8 rats served as the control group. At the end of the study, all animals were tested for motor functions. Blood samples were collected for the measurement of plasma lipid peroxidation (malondialdehyde; MDA), tumor necrosis factor (TNF-α), glutathione (GSH), IL-6 and HSP-70 levels. Electromyography findings revealed that compound muscle action potential (CMAP) amplitude was significantly higher in the cisplatin-Propofol group than in the cisplatin-saline group. Also, cisplatin-Propofol treated group showed significantly lower TNF-α, MDA and IL-6 levels and higher GSH and HSP-70 levels than cispalatin-Saline group (p < 0.01, p < 0.001). In addition, while the CMAP latency was decreased in the propofol group, the CMAP amplitude was increased, and a significant improvement was observed in the Inclined test scores. Besides, histological examinations showed an increase in axon diameter and NGF expression with Propofol treatment. This study demonstrated that Propofol exerts protective activity against cisplatin-induced neurotoxicity by increasing endogenous antioxidants and reducing lipid peroxidation and inflammation (Tab. 3, Fig. 4, Ref. 30). Text in PDF www.elis.sk Keywords: cisplatin, neuropathy, propofol, oxidative damage, inflammation.

Efficacy and Safety of Pulsed Radiofrequency of Dorsal Root Ganglion in Elderly Patient Population With Acute and Subacute Zoster-Related Pain.

Background: Herpes zoster (HZ) is typically characterized by a burning, stabbing pain, hyperalgesia, and allodynia. In some patients, despite the lesions resolving, the pain persists and becomes chronic. If the pain continues for more than 6 months after the onset of the pain phase, this condition is called postherpetic neuralgia (PHN). The frequency and severity of PHN increase with advancing age. The pain in PHN can be severe, sometimes resistant to medications, significantly impacting the patients' quality of life. The elderly patient population cannot tolerate the medications due to their side effects. In this situation, interventional pain treatment should be applied in the elderly patient group who have a high risk of developing PHN compared to other age groups. Method: We included patients over 65 years of age with HZ-related pain who underwent dorsal root ganglion (DRG) pulsed radiofrequency (PRF) within the first 6 months from the onset of pain. We divided these patients into 2 groups: patients who underwent intervention within the first 1 month from the onset of pain and patients who underwent intervention between 1 and 6 months. We recorded medication doses and Numeric Rating Scale (NRS) scores before the procedure and at 1 week, 1 month, 3 months, and 6 months after the procedure. Results: After the DRG PRF treatment, NRS scores improved significantly in both groups (p < 0.05). The mean NRS score in the early DRG PRF group was significantly lower than that in the late DRG PRF group (p < 0.05). The medication doses in the early DRG PRF group were significantly lower than those in the other group (p < 0.05). Conclusions: Interventional pain treatment should be applied as soon as possible in the elderly patient group who do not respond to first-line medical treatment or cannot tolerate medical treatment due to its side effects and who have a high risk of developing PHN compared to other age groups. DRG PRF, applied in the early period of medical treatment-resistant acute HZ, is safe and effective, preventing the progression to PHN.

Bilateral percutaneous cervical cordotomy for cancer pain: A case report.

Cancer is a systemic and progressive disease, and pain is a serious problem for patients. Cordotomy is one of the most effective treatments for refractory cancer pain. Bilateral percutaneous cervical cordotomy can be performed in patients with bilateral extremity pain. Accordingly, this case report discusses the use of bilateral cervical percutaneous cordotomy in the treatment of refractory cancer pain based on a 69-year-old woman with soft tissue sarcoma.

Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome.

BACKGROUND: Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS). OBJECTIVES: The purpose of this study was to compare the efficacy and complication rates of the 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to treat PLSS. STUDY DESIGN: This study used a case control, blind study. SETTING: The research took place at the pain clinic and interventional pain practice room at Asyut University Hospital, Assiut, Egypt. METHODS: Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal, S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was performed prior to the procedure to determine the patients' baseline levels of pain severity. Follow-up assessments were performed 1-, 3-, and 6-months after the procedure. RESULTS: Results of the group pairwise analysis indicated that, relative to baseline, there were significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by patients' satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications between the 3 different groups. LIMITATIONS: Our study was limited by the low number of patients and the short duration (6 months) of follow-up. CONCLUSION: The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate. KEY WORDS: Post lumber surgery syndrome, post laminectomy back pain, percutaneous adhesiolysis, Racz catheter, percutaneous neuroplasty.

[Spinal cord stimulation in 62 patients: Retrospective evaluation]. / Spinal kord stimülasyonu uygulanan 62 hastanin retrospektif degerlendirilmesi.

OBJECTIVES: Spinal cord stimulation (SCS) is used for various indications such as Failed Back Surgey Syndrome, peripheral causalgia, neuropathic pain, complex regional pain syndrome, reflex sympathetic dystrophy, peripheral vascular disease, ischemic heart disease and cancer pain. METHODS: This is a retrospective study. 62 patients applied SCS were included in retrospective study from february 2011-january 2015 in Akdeniz University medicine faculty algology department. We asked about patients' VAS values before and after procedure, analgesic medicine usings, sleep disorders, pleasure after procedure, daily activity improvement and time of going back to work. RESULTS: We found that decrease on the patients' pain severity and improvement on quality of sleep and daily activities. CONCLUSION: As a result; our study and the other studies show that SCS is reliable and effective procedure on chronic pain management.