Chronic nonspecific low back pain (CNLBP) is defined as pain or discomfort originating from the waist, which lasts for at least 12 weeks, but no radiculopathy or specific spinal diseases. CNLBP is a complicated medical problem and places a huge burden on healthcare systems. Clinical manifestation of CNLBP includes discogenic LBP, zygapophyseal joint pain, sacroiliac joint pain, and lumbar muscle strain. Further evaluation should be completed to confirm the diagnosis including auxiliary examination, functional assessment, and clinical assessment. The principle of the management is to relieve pain, restore function, and avoid recurrence. Treatment includes conservative treatment, minimally invasive treatment, and rehabilitation. Pharmacologic therapy is the first-line treatment of nonspecific LBP, and it is most widely used in clinical practice. Interventional therapy should be considered only after failure of medication and physical therapy. Multidisciplinary rehabilitation can improve physical function and alleviate short-term and long-term pain. The emphasis should be put on the prevention of NLBP and reducing relevant risk factors.
Background: Trigeminal postherpetic neuralgia is a severe neuropathic pain and often refractory
to existing treatment, it develops secondary to herpes zoster-infected Gasserian ganglion.
Therefore, it is important to prevent the transition of acute/subacute zoster-related pain to
trigeminal postherpetic neuralgia. Despite numerous studies, the optimal intervention that reduces
trigeminal postherpetic neuralgia incidence is still unknown.
Objectives: This study aimed to evaluate the efficacy and safety of high-voltage, long-duration
pulsed radiofrequency (PRF) on the Gasserian ganglion in patients with acute/subacute zosterrelated trigeminal neuralgia.
Study Design: Prospective, randomized, double-blinded study.
Setting: Department of Pain Medicine, the First Affiliated Hospital of China Medical University.
Methods: Ninety-six patients with acute/subacute zoster-related trigeminal neuralgia were
equally randomly assigned into 2 groups. The electrode needle punctured the Gasserian ganglion
guided by computed tomography in every patient. High-voltage, long-duration PRF at 42°C for
900 seconds was applied in the PRF group (n = 48). It was also applied in the sham group (n =
48) without radiofrequency energy output. The therapeutic effects were evaluated using a visual
analog scale (VAS) and the 36-Item Short Form Health Survey (SF-36) at different time points. The
average dosage of pregabalin (mg/d) administrated within the first month after treatment was also
recorded.
Results: The postprocedure VAS scores in the PRF group were significantly lower than those in the
sham group at different time points after treatment (P < 0.01). The SF-36 scores, which included
physical functioning, physical role, bodily pain, general health perceptions, vitality, social function,
emotional role, and the mental health index, were significantly improved at the sixth month
after treatment in the PRF group compared with the sham group (P < 0.01). The average dosage
of pregabalin administered (mg/d) within the first month after treatment was also significantly
reduced in the PRF group compared with the sham group (P < 0.01). There were no bleeding,
infection, or other severe side effects in both groups.
Limitations: Single center study, relatively small number of patients.
Conclusions: High-voltage, long-duration PRF on the Gasserian ganglion is an effective and safe
therapeutic alternative for patients with acute/subacute zoster-related trigeminal neuralgia.
Key words: Pulsed radiofrequency, zoster-related trigeminal neuralgia, visual analog scale, 36-
Item Short Form Health Survey
Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial constrictions. At present, domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS. Due to the lack of specific laboratory indicators and imaging evidence, there is no unified diagnostic criteria for MPS, making it easy to confuse with other diseases. The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS. This article reviews relevant domestic and foreign literature on the definition, epidemiology, pathogenesis, clinical manifestation, diagnostic criteria and treatments of MPS. The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors, including pain physicians to manage patients with MPS.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.