Abstract：
BACKGROUND:Occipital neuromodulation is a promising treatment modality for refractory headache, but lead migration remains a frequent surgical complication. OBJECTIVES:The primary objective was to identify surgical techniques that may minimize adverse events, particularly lead migration. We hypothesized that a surgical technique employing 2-point anchoring of stimulator leads designed to provide a tension-relief loop and the use of ultrasound for lead placement would decrease the complication rate. STUDY DESIGN AND SETTING:A retrospective analysis was performed through electronic medical record chart review in a tertiary referral center. METHODS:Institutional Review Board (IRB) approval was obtained. Eighteen patients had a trial and subsequent permanent occipital nerve stimulator (ONS) implantation between 2004 and 2011 and were included. Adverse events were recorded and efficacy outcome variables analyzed for significance. RESULTS:The cohort was a median (IQR) 45 (37 - 58) in age and 9 (50%) were women. Tension-relief loops placed via a 2-point anchoring technique and ultrasound use for occipital lead placement were evident in 16 (89%) and 13 (72%), respectively. There was one (6%) clinically insignificant lead position change, not definitively a lead migration, which could have been an artifact of fluoroscope positioning. Adverse events included one (6%) battery malfunction, one (6%) lead malfunction, and 2 (12%) post-implantation infections. Following ONS, there were significant reductions in numeric rating scale (NRS) pain scores from a median (IQR) of 9.5 (8.25 - 10) to 2.5 (1 - 4.75) (P < 0.0001), headache days per week from 7 (7 - 7) to 1.5 (0.375 - 1.75) (P = 0.0005), and the number of daily headache medication from 3 (2.25 - 4) to 2.5 (2 - 3.75) (P = 0.0112). LIMITATIONS:Limitations include retrospective study design, investigator bias, and non-standardized intervals of headache burden assessment. CONCLUSIONS:In ONS, utilization of a 2-point anchoring technique with a tension-relief loop may significantly minimize the risk of lead migration, based on the absence of definitive lead migration in our series. Ultrasound use may improve the anatomic accuracy of lead placement with the possibility of improved efficacy. ONS was associated with significantly decreased headache pain, frequency, and medication use. KEY WORDS:Occipital neuromodulation, occipital nerve stimulation, surgical technique, lead migration, tension-relief loop.
journal_name
Pain Physicianjournal_title
Pain physicianauthors
Pittelkow TP,Pagani-Estevez GL,Landry B,Pingree MJ,Eldrige JSsubject
Has Abstractpub_date
2016-09-01 00:00:00pages
E1005-12issue
7eissn
1533-3159issn
2150-1149journal_volume
19pub_type
杂志文章相关文献
Pain Physician文献大全abstract：:Propofol is a common induction agent that is utilized worldwide in the field of anesthesiology. In recent years, its potential therapeutic role in a variety of patient states has been demonstrated. Controversy exists regarding Propofol mediated analgesic and antihyperalgesic properties. Recent studies have suggested a...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2014-03-01 00:00:00
abstract：BACKGROUND:Cervicogenic headache descriptors include its unilateral nature, "signs and symptoms linking it to the neck," and trauma of the neck. Since the pain often occurs over the C2 or C3 nerve root, we used a modification of the deep cervical block technique for treatment of this refractory type headache. OBJECTIV...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2008-11-01 00:00:00
abstract：BACKGROUND:In patients with chronic tension-type headache (CTTH) changes in pressure pain in the cervical region are associated with peripheral or central sensitization. It is hypothesized that an increase of isometric strength of neck flexors would lead to a decrease of pressure pain in CTTH, as an expression of reduc...
journal_title：Pain physician
pub_type： 杂志文章,多中心研究,随机对照试验
doi：
更新日期：2015-03-01 00:00:00
abstract：BACKGROUND:The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain resulting from malignancy in these organs. The ganglion impar (GI) innervats the perineum, distal rectum, anus, distal urethra, vulva, and dista...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2015-01-01 00:00:00
abstract：BACKGROUND:Millions of interventional pain procedures are performed each year in the United States. Interventional pain physicians commonly administer radiocontrast media (RCM) under fluoroscopy for these procedures. However, RCM can cause various types of hypersensitivity or allergic type reactions, in an acute or de...
journal_title：Pain physician
pub_type： 杂志文章,评审
doi：
更新日期：2012-09-01 00:00:00
abstract：:We introduce a new way to engage the patient with chronic pain, Goal-Directed Health Care (G-DHC). Identifying the patient's major life goals during the medical interview is the key element of this approach along with connecting these life goals to specific health-related goals. The implementation of G-DHC is a shift ...
journal_title：Pain physician
pub_type： 杂志文章,评审
doi：
更新日期：2006-10-01 00:00:00
abstract：:Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. Clinical practice guidelines present statements of best practice based on a thorough evaluation of the evidence from published studies ...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2009-07-01 00:00:00
abstract：:Research into interventional techniques in managing chronic spinal pain continues to be challenging, mystifying, confusing, and biased. Insight, or lack thereof, into placebo and nocebo phenomena contributes mightily to these difficulties. Unfortunately, placebo-nocebo responses are the subject of numerous controversi...
journal_title：Pain physician
pub_type： 杂志文章,评审
doi：
更新日期：2017-07-01 00:00:00
abstract：:Chronic low back pain secondary to involvement of the facet joints is a common problem. Facet joints have been recognized as potential sources of back pain since 1911. Multiple authors have described distributions of pain patterns of facet joint pain. The facet joints are paired diarthrodial articulations between the ...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2002-01-01 00:00:00
abstract：:Biochemical mechanisms to explain pain generation began relatively recently. Evaluating pain originating from the spine can be challenging because no historical or physical examination findings are sufficiently sensitive or specific for identifying each of the myriad of potential pain generators. These discrete anatom...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2001-07-01 00:00:00
abstract：BACKGROUND:Before long-term intrathecal analgesic therapy is initiated, patients often undergo a spinal analgesia trial. Ziconotide is a nonopioid intrathecal analgesic used to manage severe chronic pain, and a variety of methods have been used to trial ziconotide. OBJECTIVES:The purpose of this review is to compare a...
journal_title：Pain physician
pub_type： 杂志文章,评审
doi：
更新日期：2010-01-01 00:00:00
abstract：BACKGROUND:Onabotulinumtoxin-A (BoNT-A) is effective for the treatment of interstitial cystitis/painful bladder syndrome (IC/PBS). However, long-term follow-up does not show successful outcome after a single injection. OBJECTIVES:To evaluate the efficacy and safety of repeated intravesical BoNT-A injections for treatm...
journal_title：Pain physician
pub_type： 临床试验,杂志文章
doi：
更新日期：2013-01-01 00:00:00
abstract：OBJECTIVE:To describe management challenges and follow-up data for three years in a case with spontaneous carotid artery dissection (SCAD). CASE REPORT:We present a case of SCAD that presented with Horner's syndrome and headache. The patient developed the SCAD, Horner's syndrome and headache one month after a lumbar e...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2004-10-01 00:00:00
abstract：BACKGROUND:Chronic low back pain (CLBP) incurs huge costs owing to increased healthcare expenditure, disability, insurance, and work absenteeism. Opioid analgesics are commonly used for the management of CLBP. OBJECTIVE:To compare and rank the opioids used in the management of CLBP, in terms of efficacy and safety. S...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2021-01-01 00:00:00
abstract：BACKGROUND:While most trials of thoracic paravertebral nerve blocks (TPVB) for breast surgery show benefit, their effect on postoperative pain intensity, opioid consumption, and prevention of chronic postsurgical pain varies substantially across studies. Variability may result from use of different drugs and techniques...
journal_title：Pain physician
pub_type： 杂志文章,meta分析,评审
doi：
更新日期：2015-09-01 00:00:00
abstract：BACKGROUND:Pain arising from the lumbar facet joints is a common cause of axial back pain in adults. Radiofrequency neurotomy (RFN) of the medial branches of the spinal dorsal rami has been used as a treatment option. The most common side effect is transient, localized, burning, neuritic-type pain, termed post-neurotom...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2019-01-01 00:00:00
abstract：BACKGROUND:Epidural injection is performed for treatment of back and radicular pain in patients with lumbosacral disc herniation (LDH). Steroids are usually administered to effectively remove inflammatory mediators, and local anesthetics or saline also contribute to pain reduction by washing out chemical mediators or b...
journal_title：Pain physician
pub_type： 杂志文章,meta分析
doi：
更新日期：2018-09-01 00:00:00
abstract：BACKGROUND:Pain medicine practices vary across different regions within a country and between countries. OBJECTIVES:The objective of the survey was to study the variation in interventional pain medicine practices in the United Kingdom (UK) and the United States (US). METHODS:A survey was designed in 2019 on Survey Mo...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2020-03-01 00:00:00
abstract：:Proper coding and documentation for evaluation and management services continuously and progressively are becoming not only complicated, but also confusing. Although medical evaluation of patients has been a fact of life since the beginnings of medical history, medicine has been substantially influenced by federal reg...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2000-07-01 00:00:00
abstract：BACKGROUND:Glucocorticoids adversely affect bone mineral density (BMD) and increase the risk of fracture. Yet, the cause-and-effect relationship between epidural steroid injection (ESI) and BMD has not been thoroughly investigated, and available results are inconsistent. This is probably a consequence of differences in...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2018-07-01 00:00:00
abstract：BACKGROUND:Low back pain is a common worldwide health problem and has a significant socioeconomic impact on public health. Internal disc disruption has been considered as the most common cause of low back pain. Various therapies, including interbody fusion, disc replacement, injection therapies, and thermal annular pro...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2016-11-01 00:00:00
abstract：BACKGROUND:Vertebral compression fractures are common among the elderly, which is conditioned by osteoporosis. They cause back pain and limit the patient's activities. The Kiva® VCF Treatment System is a new device to treat vertebral compression fractures. Compared to other methods, the utilization of the Kiva System r...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2013-09-01 00:00:00
abstract：BACKGROUND:Low back pain (LBP) is a heterogeneous disorder including patients with dominant nociceptive (e.g., myofascial low back pain), neuropathic (e.g., lumbar radiculopathy), and central sensitization pain. In order to select an effective and preferably also efficient treatment in daily clinical practice, LBP pati...
journal_title：Pain physician
pub_type： 杂志文章,评审
doi：
更新日期：2015-05-01 00:00:00
abstract：:The increasing use of opioids to manage pain in the United States over the last decade has resulted in a subset of our population developing opioid tolerance. While the management of opioid tolerant patients during acute episodes of care is well known to be a challenge amongst health care providers, there is little in...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2014-07-01 00:00:00
abstract：BACKGROUND:Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) are 2 of the most popular minimally invasive spinal surgery techniques. We are investigating whether minimally invasive early annular closure can achieve a better clinical effect in the treatment of lumbar disc hern...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2020-11-01 00:00:00
abstract：BACKGROUND:Abuse of prescribed controlled substance has become a serious social as well as health care issue over the past decade. A particularly alarming trend exists among patients aged 12 to 17. Common abuse behaviors include doctor shopping, drug theft, feigned pain symptoms to gain health care access, drug sharing...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2009-05-01 00:00:00
abstract：:Clinical outcome data was analyzed for 67 patients with contained disc herniation who underwent percutaneous disc decompression procedure using Coblation(R) technology, also referred to as Nucleoplasty after failing to respond to conservative management. Patients presented with clinical symptoms of discogenic low back...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2002-07-01 00:00:00
abstract：BACKGROUND:A superior hypogastric plexus block is difficult to perform and hampered by bony structures of the iliac crest and transverse process of L5. OBJECTIVE:We report on a fluoroscopically guided posterolateral transdiscal technique for superior hypogastric plexus neurolysis using a single needle. STUDY DESIGN:A...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2018-07-01 00:00:00
abstract：BACKGROUND:Liposomal bupivacaine (LipoB), delivered via intercostal nerve blocks (ICNBs), is increasingly being used for postoperative pain control in thoracic surgery patients, but there is limited data on its effectiveness when compared to standard bupivacaine. OBJECTIVE:We sought to compare postoperative opioid use...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2020-06-01 00:00:00
abstract：BACKGROUND:The growth of interventional pain medicine in recent years has resulted in more procedures being carried out under fluoroscopic guidance. The proximity of the pain physician (PP) to ionization radiation (IR) potentially increases the risk of radiation exposure to the ocular region. A European directive has r...
journal_title：Pain physician
pub_type： 杂志文章
doi：
更新日期：2018-09-01 00:00:00
