Pain Practice Volume 10 Issue 2, Pages 113 - 123 Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
Maarten van Eerd, MD, FIPP*†; Jacob Patijn, MD, PhD*; Arno Lataster, MSc ‡ ; Richard W. Rosenquist, MD § ; Maarten van Kleef, MD, PhD, FIPP*; Nagy Mekhail, MD, PhD, FIPP ¶ ; Jan Van Zundert, MD, PhD, FIPP*,**
*Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands; † Department of Anesthesiology and Pain Management, Amphia Ziekenhuis, Breda, The Netherlands; ‡ Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; § Department of Anesthesia, Pain Medicine Division, University of Iowa, Iowa City, Iowa, USA; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.; **Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to M. van Eerd, MD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: m.eerd@wxs.nl.
ABSTRACT
More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet-related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. The history should exclude risk factors for serious underlying pathology (red flags). Radiculopathy may be excluded with neurologic testing. Direct correlation between degenerative changes observed with plain radiography, computerized tomography, and magnetic resonance imaging and pain has not been proven.
Conservative treatment options for cervical facet pain such as physiotherapy, manipulation, and mobilization, although supported by little evidence, are frequently applied before considering interventional treatments.
Interventional pain management techniques, including intra-articular steroid injections, medial branch blocks, and radiofrequency treatment, may be considered (0).
At present, there is no evidence to support cervical intra-articular corticosteroid injection. When applied, this should be done in the context of a study.
Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short-term pain relief (2 B+).
Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+).
Showing posts with label evidence-based medicine. Show all posts
Showing posts with label evidence-based medicine. Show all posts
Wednesday, March 17, 2010
Cervicogenic Headache
Pain Practice
Volume 10 Issue 2, Pages 124 - 130 Published Online: 23 Feb 2010Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
Hans van Suijlekom, MD, PhD*; Jan Van Zundert, MD, PhD, FIPP †‡ ; Samer Narouze, MD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ‡ ; Nagy Mekhail, MD, PhD, FIPP §
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands, † Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg Genk, Belgium, ‡ Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands, § Pain Management Department, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to M. van Kleef, MD, PhD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: maarten.van.kleef@mumc.nl
ABSTRACT
Cervicogenic headache is mainly characterized by unilateral headache symptoms which arise from the neck radiating to the fronto-temporal and possibly to the supra-orbital region. Physical examination to find evidence of a disorder known to be a valid cause of headache encompasses movement tests of the cervical spinal column and segmental palpation of the cervical facet joints and soft tissues of the neck.
Injection of the nervus occipitalis major is recommended after unsatisfactory results with conservative treatments (1 B+). In the case of an unsatisfactory outcome after injection of the nervus occipitalis major, radiofrequency treatment of the ramus medialis (medial branch) of the cervical ramus dorsalis can be considered (2 B±).
If the result is unsatisfactory pulsed radiofrequency treatment of the ganglion spinale (dorsal root ganglion) of C2 and/or C3 can be considered in a study context (O).
Volume 10 Issue 2, Pages 124 - 130 Published Online: 23 Feb 2010Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
Hans van Suijlekom, MD, PhD*; Jan Van Zundert, MD, PhD, FIPP †‡ ; Samer Narouze, MD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ‡ ; Nagy Mekhail, MD, PhD, FIPP §
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands, † Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg Genk, Belgium, ‡ Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands, § Pain Management Department, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to M. van Kleef, MD, PhD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: maarten.van.kleef@mumc.nl
ABSTRACT
Cervicogenic headache is mainly characterized by unilateral headache symptoms which arise from the neck radiating to the fronto-temporal and possibly to the supra-orbital region. Physical examination to find evidence of a disorder known to be a valid cause of headache encompasses movement tests of the cervical spinal column and segmental palpation of the cervical facet joints and soft tissues of the neck.
Injection of the nervus occipitalis major is recommended after unsatisfactory results with conservative treatments (1 B+). In the case of an unsatisfactory outcome after injection of the nervus occipitalis major, radiofrequency treatment of the ramus medialis (medial branch) of the cervical ramus dorsalis can be considered (2 B±).
If the result is unsatisfactory pulsed radiofrequency treatment of the ganglion spinale (dorsal root ganglion) of C2 and/or C3 can be considered in a study context (O).
Wednesday, February 24, 2010
Whiplash-Associated Disorders
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
7. Whiplash-Associated Disorders
Hans van Suijlekom, MD, PhD*; Nagy Mekhail, MD, PhD, FIPP † ; Nileshkumar Patel, MD, MBA ‡ ; Jan Van Zundert, MD, PhD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ¶ ; Jacob Patijn, MD, PhD ¶
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands; ¶ Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; † Pain Management Department, Anesthesiology Institute, Cleveland, Ohio, USA; ‡ Pain and Rehabilitation, Coastal Orthopedics, Cleveland Clinic, Bradenton, Florida, U.S.A.; § Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to Maarten van Kleef, MD, PhD, Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl
ABSTRACT
Whiplash-associated disorders are comprised of a range of symptoms of which neck complaints and headaches are the most significant spine related.
In the acute and sub-acute stage of the disorder, conservative treatment for minimally 6 months is recommended, active mobilization is slightly better than passive treatment. Thereafter, interventional treatment may be considered. The available evidence for injection of Botulinum toxin A (2 B−) and intra-articular corticosteroid injections (2 C−) supports a negative recommendation.
Radiofrequency treatment of the ramus medialis (medial branch) of the ramus dorsalis is recommended (2 B+).
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
7. Whiplash-Associated Disorders
Hans van Suijlekom, MD, PhD*; Nagy Mekhail, MD, PhD, FIPP † ; Nileshkumar Patel, MD, MBA ‡ ; Jan Van Zundert, MD, PhD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ¶ ; Jacob Patijn, MD, PhD ¶
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands; ¶ Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; † Pain Management Department, Anesthesiology Institute, Cleveland, Ohio, USA; ‡ Pain and Rehabilitation, Coastal Orthopedics, Cleveland Clinic, Bradenton, Florida, U.S.A.; § Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to Maarten van Kleef, MD, PhD, Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl
ABSTRACT
Whiplash-associated disorders are comprised of a range of symptoms of which neck complaints and headaches are the most significant spine related.
In the acute and sub-acute stage of the disorder, conservative treatment for minimally 6 months is recommended, active mobilization is slightly better than passive treatment. Thereafter, interventional treatment may be considered. The available evidence for injection of Botulinum toxin A (2 B−) and intra-articular corticosteroid injections (2 C−) supports a negative recommendation.
Radiofrequency treatment of the ramus medialis (medial branch) of the ramus dorsalis is recommended (2 B+).
Occipital Neuralgia
Pain Practice Volume 10 Issue 2, Pages 137 - 144
Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
8. Occipital Neuralgia
Pascal Vanelderen, MD, FIPP*†; Arno Lataster, MSc ‡ ; Robert Levy, MD, PhD § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP**; Jan Van Zundert, MD, PhD, FIPP*,**
*Department of Anesthesiology and Pain Management, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Pain and Palliative Care Medicine, University Medical Centre Radboud, Nijmegen, The Netherlands; ‡ Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; § Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.; **Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands
Correspondence to Maarten van Kleef, MD, PhD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl
KEYWORDS
ABSTRACT
Occipital neuralgia is defined as a paroxysmal shooting or stabbing pain in the dermatomes of the nervus occipitalis major and/or nervus occipitalis minor. The pain originates in the suboccipital region and radiates over the vertex. A suggestive history and clinical examination with short-term pain relief after infiltration with local anesthetic confirm the diagnosis. No data are available about the prevalence or incidence of this condition. Most often, trauma or irritation of the nervi occipitales causes the neuralgia. Imaging studies are necessary to exclude underlying pathological conditions. Initial therapy consists of a single infiltration of the culprit nervi occipitales with local anesthetic and corticosteroids (2 C+). The reported effects of botulinum toxin A injections are contradictory (2 C±). Should injection of local anesthetic and corticosteroids fail to provide lasting relief, pulsed radio-frequency treatment of the nervi occipitales can be considered (2 C+). There is no evidence to support pulsed radio-frequency treatment of the ganglion spinale C2 (dorsal root ganglion). As such, this should only be done in a clinical trial setting. Subcutaneous occipital nerve stimulation can be considered if prior therapy with corticosteroid infiltration or pulsed radio-frequency treatment failed or provided only short-term relief (2 C+).
Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
8. Occipital Neuralgia
Pascal Vanelderen, MD, FIPP*†; Arno Lataster, MSc ‡ ; Robert Levy, MD, PhD § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP**; Jan Van Zundert, MD, PhD, FIPP*,**
*Department of Anesthesiology and Pain Management, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Pain and Palliative Care Medicine, University Medical Centre Radboud, Nijmegen, The Netherlands; ‡ Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; § Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.; **Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands
Correspondence to Maarten van Kleef, MD, PhD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl
KEYWORDS
ABSTRACT
Occipital neuralgia is defined as a paroxysmal shooting or stabbing pain in the dermatomes of the nervus occipitalis major and/or nervus occipitalis minor. The pain originates in the suboccipital region and radiates over the vertex. A suggestive history and clinical examination with short-term pain relief after infiltration with local anesthetic confirm the diagnosis. No data are available about the prevalence or incidence of this condition. Most often, trauma or irritation of the nervi occipitales causes the neuralgia. Imaging studies are necessary to exclude underlying pathological conditions. Initial therapy consists of a single infiltration of the culprit nervi occipitales with local anesthetic and corticosteroids (2 C+). The reported effects of botulinum toxin A injections are contradictory (2 C±). Should injection of local anesthetic and corticosteroids fail to provide lasting relief, pulsed radio-frequency treatment of the nervi occipitales can be considered (2 C+). There is no evidence to support pulsed radio-frequency treatment of the ganglion spinale C2 (dorsal root ganglion). As such, this should only be done in a clinical trial setting. Subcutaneous occipital nerve stimulation can be considered if prior therapy with corticosteroid infiltration or pulsed radio-frequency treatment failed or provided only short-term relief (2 C+).
Cervicogenic Headache
Pain Practice Volume 10 Issue 2, Pages 124 - 130
Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
6. Cervicogenic Headache
Hans van Suijlekom, MD, PhD*; Jan Van Zundert, MD, PhD, FIPP †‡ ; Samer Narouze, MD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ‡ ; Nagy Mekhail, MD, PhD, FIPP §
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands, † Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg Genk, Belgium, ‡ Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands, § Pain Management Department, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to M. van Kleef, MD, PhD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: maarten.van.kleef@mumc.nl
ABSTRACT
Cervicogenic headache is mainly characterized by unilateral headache symptoms which arise from the neck radiating to the fronto-temporal and possibly to the supra-orbital region. Physical examination to find evidence of a disorder known to be a valid cause of headache encompasses movement tests of the cervical spinal column and segmental palpation of the cervical facet joints and soft tissues of the neck. Injection of the nervus occipitalis major is recommended after unsatisfactory results with conservative treatments (1 B+). In the case of an unsatisfactory outcome after injection of the nervus occipitalis major, radiofrequency treatment of the ramus medialis (medial branch) of the cervical ramus dorsalis can be considered (2 B±). If the result is unsatisfactory pulsed radiofrequency treatment of the ganglion spinale (dorsal root ganglion) of C2 and/or C3 can be considered in a study context (O).
Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
6. Cervicogenic Headache
Hans van Suijlekom, MD, PhD*; Jan Van Zundert, MD, PhD, FIPP †‡ ; Samer Narouze, MD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ‡ ; Nagy Mekhail, MD, PhD, FIPP §
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands, † Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg Genk, Belgium, ‡ Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands, § Pain Management Department, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to M. van Kleef, MD, PhD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: maarten.van.kleef@mumc.nl
ABSTRACT
Cervicogenic headache is mainly characterized by unilateral headache symptoms which arise from the neck radiating to the fronto-temporal and possibly to the supra-orbital region. Physical examination to find evidence of a disorder known to be a valid cause of headache encompasses movement tests of the cervical spinal column and segmental palpation of the cervical facet joints and soft tissues of the neck. Injection of the nervus occipitalis major is recommended after unsatisfactory results with conservative treatments (1 B+). In the case of an unsatisfactory outcome after injection of the nervus occipitalis major, radiofrequency treatment of the ramus medialis (medial branch) of the cervical ramus dorsalis can be considered (2 B±). If the result is unsatisfactory pulsed radiofrequency treatment of the ganglion spinale (dorsal root ganglion) of C2 and/or C3 can be considered in a study context (O).
Cervical Facet Pain
Pain Practice Volume 10 Issue 2, Pages 113 - 123
Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
5. Cervical Facet Pain
Maarten van Eerd, MD, FIPP*†; Jacob Patijn, MD, PhD*; Arno Lataster, MSc ‡ ; Richard W. Rosenquist, MD § ; Maarten van Kleef, MD, PhD, FIPP*; Nagy Mekhail, MD, PhD, FIPP ¶ ; Jan Van Zundert, MD, PhD, FIPP*,**
*Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands; † Department of Anesthesiology and Pain Management, Amphia Ziekenhuis, Breda, The Netherlands; ‡ Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; § Department of Anesthesia, Pain Medicine Division, University of Iowa, Iowa City, Iowa, USA; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.; **Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to M. van Eerd, MD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: m.eerd@wxs.nl.
ABSTRACT
More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet-related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. The history should exclude risk factors for serious underlying pathology (red flags). Radiculopathy may be excluded with neurologic testing. Direct correlation between degenerative changes observed with plain radiography, computerized tomography, and magnetic resonance imaging and pain has not been proven.
Conservative treatment options for cervical facet pain such as physiotherapy, manipulation, and mobilization, although supported by little evidence, are frequently applied before considering interventional treatments.
Interventional pain management techniques, including intra-articular steroid injections, medial branch blocks, and radiofrequency treatment, may be considered (0).
At present, there is no evidence to support cervical intra-articular corticosteroid injection. When applied, this should be done in the context of a study.
Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short-term pain relief (2 B+).
Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+).
Published Online: 23 Feb 2010
EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
5. Cervical Facet Pain
Maarten van Eerd, MD, FIPP*†; Jacob Patijn, MD, PhD*; Arno Lataster, MSc ‡ ; Richard W. Rosenquist, MD § ; Maarten van Kleef, MD, PhD, FIPP*; Nagy Mekhail, MD, PhD, FIPP ¶ ; Jan Van Zundert, MD, PhD, FIPP*,**
*Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands; † Department of Anesthesiology and Pain Management, Amphia Ziekenhuis, Breda, The Netherlands; ‡ Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; § Department of Anesthesia, Pain Medicine Division, University of Iowa, Iowa City, Iowa, USA; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.; **Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to M. van Eerd, MD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: m.eerd@wxs.nl.
ABSTRACT
More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet-related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. The history should exclude risk factors for serious underlying pathology (red flags). Radiculopathy may be excluded with neurologic testing. Direct correlation between degenerative changes observed with plain radiography, computerized tomography, and magnetic resonance imaging and pain has not been proven.
Conservative treatment options for cervical facet pain such as physiotherapy, manipulation, and mobilization, although supported by little evidence, are frequently applied before considering interventional treatments.
Interventional pain management techniques, including intra-articular steroid injections, medial branch blocks, and radiofrequency treatment, may be considered (0).
At present, there is no evidence to support cervical intra-articular corticosteroid injection. When applied, this should be done in the context of a study.
Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short-term pain relief (2 B+).
Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+).
Thursday, January 7, 2010
Cervical Radicular Pain
Pain Practice
Volume 10 Issue 1, Pages 1 - 17
Jan Van Zundert, MD, PhD, FIPP* † ; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots.
Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks.
Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction.
When conservative treatment fails, interventional treatment may be considered.
For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+).
In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
Volume 10 Issue 1, Pages 1 - 17
Jan Van Zundert, MD, PhD, FIPP* † ; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots.
Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks.
Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction.
When conservative treatment fails, interventional treatment may be considered.
For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+).
In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
Wednesday, November 4, 2009
Cluster Headache
Pain Practice
Volume 9 Issue 6, Pages 435 - 442
Published Online: 27 Oct 2009
© 2009 by World Institute of Pain
EVIDENCE-BASED MEDICINE Evidence-Based Interventional Pain Medicine according to Clinical Diagnoses
Maarten van Kleef, MD, PhD, FIPP*; Arno Lataster, MSc † ; Samer Narouze, MD, MSc, FIPP ‡ ; Nagy Mekhail, MD, PhD, FIPP ‡ ; José W.Geurts, MSc*; Jan van Zundert, MD, PhD, FIPP*§
*Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; † Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; ‡ Pain Management Department, Cleveland Clinic, Cleveland, Anesthesiology Institute, Ohio, U.S.A.; § Department of Anesthesiology and Pain Management, Ziekenhuis Oost Limburg, Genk, BelgiumCorrespondence to Maarten van Kleef, MD, PhD, FIPP, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl.
ABSTRACT
Cluster headache is a strictly unilateral headache that is associated with ipsilateral cranial autonomic symptoms and usually has a circadian and circannual pattern. Prevalence is estimated at 0.5 to 1.0/1,000. The diagnosis of cluster headache is made based on the patient's case history. There are two main clinical patterns of cluster headache: the episodic and the chronic. Episodic is the most common pattern of cluster headache. It occurs in periods lasting 7 days to 1 year and is separated by at least a 1-month pain-free interval. The attacks in the chronic form occur for more than 1 year without remission periods or with remission periods lasting less than 1 month.
Conservative therapy consists of abortive and preventative remedies. Ergotamines and sumatriptan injections, sublingual ergotamine tartrate administration, and oxygen inhalation are effective abortive therapies. Verapamil is an effective and the safest prophylactic remedy. When pharmacological and oxygen therapies fail, interventional pain treatment may be considered. The effectiveness of radiofrequency treatment of the ganglion pterygopalatinum and of occipital nerve stimulation is only evaluated in observational studies, resulting in a 2 C+ recommendation.
In conclusion, the primary treatment is medication. Radiofrequency treatment of the ganglion pterygopalatinum should be considered in patients who are resistant to conservative pain therapy. In patients with cluster headache refractory to all other treatments, occipital nerve stimulation may be considered, preferably within the context of a clinical study.
Wednesday, October 7, 2009
Cervical Radicular Pain
EVIDENCE BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
4. Cervical Radicular Pain
Jan Van Zundert, MD, PhD, FIPP*†; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
Pain Practice
Published Online: 5 Oct 2009
Journal compilation © 2009 World Institute of Pain
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks. Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction. When conservative treatment fails, interventional treatment may be considered. For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
4. Cervical Radicular Pain
Jan Van Zundert, MD, PhD, FIPP*†; Marc Huntoon, MD ‡ ; Jacob Patijn, MD, PhD † ; Arno Lataster, MSc § ; Nagy Mekhail, MD, PhD, FIPP ¶ ; Maarten van Kleef, MD, PhD, FIPP †
*Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; † Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, the Netherlands; § Department of Anatomy and Embryology, Maastricht University, Maastricht, the Netherlands; ‡ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.; ¶ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to Jan Van Zundert, MD, PhD, FIPP, Ziekenhuis Oost-Limburg, Genk, Multidisciplinary Pain Centre, Stalenstraat, 2, 3600 Genk, Belgium. E-mail: jan.van.zundert@zol.be.
Pain Practice
Published Online: 5 Oct 2009
Journal compilation © 2009 World Institute of Pain
ABSTRACT
Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks. Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction. When conservative treatment fails, interventional treatment may be considered. For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B−). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
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