Non-inferiority study assessing the utility of postcervical and lumbar radiofrequency ablation steroid use.

INTRODUCTION: Many physicians administer steroids after radiofrequency ablation (RFA) to mitigate postprocedural inflammation and decrease postprocedural pain. However, robust evidence supporting the benefits of steroids after RFA is lacking and steroids have risks. METHODS: This study was a single-center, prospective, observational study designed to assess whether RFA alone is inferior to RFA with steroids for postprocedure pain. Eligible patients were at least 18 years of age and scheduled to undergo cervical or lumbar RFA. The primary outcome measure was the average pain score on the numeric rating scale (NRS) 7 days after the RFA. The secondary outcome measures included anxiety, depression and physical function, measured via the Patient-Reported Outcomes Measurement Information System short forms. All outcome measures were completed prior to the procedure and at 7 and 60 days postprocedure. RESULTS: Out of the 365 participants who completed baseline assessments, 175 received steroids and 190 did not receive steroids. The pain intensity at 7 days postprocedure was similar between the steroid and non-steroid groups (mean difference (steroid-non-steroid): -0.23). The 95% CI of the estimate (-0.76 to 0.30) was within the prespecified non-inferiority margin of 1.5 NRS points. Similar results were obtained for pain at 60 days (mean difference: 0.09; 95% CI -0.48 to 0.65). No significant differences between groups were observed for anxiety, depression or physical function at either 7 or 60 days. CONCLUSION: This study suggests that the addition of steroids to the RFA procedure does not provide added benefits and is therefore not worth the additional risks that they pose.

Evaluating predictors of pain reduction after genicular nerve radiofrequency ablation for chronic knee pain.

Aim: Radiofrequency ablation (RFA) of genicular nerves can treat refractory chronic knee pain. This study evaluated association between patient and procedural characteristics and pain improvement after genicular nerve RFA. Materials & methods: A retrospective chart review. Data were extracted from patients who underwent thermal or cooled RFA of the knee. Results: A total of 124 patients were included. 81% of patients reported ≥75% pain relief after diagnostic nerve blocks. 35% reported ≥50% pain reduction from the RFA. Predictors of improved pain outcomes included higher baseline pain, no depression and thermal (vs cooled) RFA. Conclusion: Identifying patients who may benefit the most from genicular RFA is still not clear. Pain reduction differences between patients with and without depression and RFA type deserves further exploration.

Lay abstract Aim: Using heat energy to stun the nerves (Radiofrequency ablation) that supply knee joint is a technique that can be used to decrease persistent knee pain. This study was performed to try to see if there are any ways that doctors are able to predict which patients will benefit from this therapy. Materials & methods: The data were collected by reviewing charts. Results: A total of 124 patients were included in this study. The data did not show that good pain relief after diagnostic injection guaranteed success with this technique of stunning of the nerve with heat energy (RFA). The things that can possibly predict success are more severe pain to start with, people who do not suffer from depression and use of higher level of heat energy to stun the nerves. Conclusion: It is still not clear which patients will benefit from this technique of stunning the nerves of the knee with heat energy.

Interventional approaches to pain management.

This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.

Chronic pain perspectives: Treating herpes zoster and postherpetic neuralgia: an evidence-based approach.

When are corticosteroids appropriate for patients with herpes zoster? Which tricyclics are best for frail and elderly patients with PHN pain? And when should you consider opioids?

Post herpetic neuralgia.

BACKGROUND: During the past decade, important advances have been made in understanding the epidemiology, pathogenesis, prevention and treatment of post herpetic neuralgia pain as well as treatment of other neuropathic pain conditions. PHN is accepted as a model for management and clinical trials of neuropathic pain of less clear etiologies. In palliative medicine, where the etiology of pain may be nociceptive, neuropathic, or mixed, it is frequently to the research on PHN that we turn in order to extrapolate the data to the patients at hand. OBJECTIVE: To review and summarize what is known about epidemiology, pathogenesis, clinical features and prevention strategies for post herpetic neuralgia. Discuss the available including the most recent therapeutic options as regards to their mechanism of action, efficacy, safety and tolerability in an attempt to explain the rationale for their use. CONCLUSION: A multidisciplinary and integrative approach has the best chance of success in the management of patients with PHN pain, a problem that can be often frustrating to the patient and challenging to the clinician. Prevention strategies for PHN include administration of zoster vaccine, treatment with antiviral therapy within 72 hours of rash onset and aggressive pain control. First and second line pharmacotherapy include anticonvulsants, antidepressants, topical lidocaine, high dose capsaicin, and opioids either used individually or in combination. Interventional techniques play a limited role in the management of PHN although some data indicate that Intrathecal methylprednisolone and spinal cord stimulation may be effective.

Interventional approaches to pain management.

This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.

In vitro synergy testing of anidulafungin with itraconazole, voriconazole, and amphotericin B against Aspergillus spp. and Fusarium spp.

The in vitro interactions of anidulafungin with itraconazole, voriconazole, and amphotericin B were evaluated by using the checkerboard method. For Aspergillus spp., anidulafungin with amphotericin B showed indifference for 16/26 isolates, while anidulafungin with either azole showed a synergy trend for 18/26 isolates. All drug combinations showed indifference for 7/7 Fusarium sp. isolates.

Syscan3, a kit for detection of anti-Candida antibodies for diagnosis of invasive candidiasis.

Sera from 76 immunocompetent and 293 immunocompromised subjects were assayed for anti-Candida antibodies. The sensitivity, specificity, positive predictive value, and negative predictive value for invasive candidiasis were 74%, 75%, 62%, and 84% in the immunocompetent group and 15%, 60%, 1.7%, and 93% in the immunocompromised group, respectively. Syscan3 has high negative predictive value.