Forum

Forum Replies Created

Viewing 6 posts - 1 through 6 (of 6 total)
  • Author
    Posts
  • in reply to: Suboccipital Neuralgia
    Robert RapcanRobert Rapcan
    Participant
    Joined: Dec 6, 2018
    Posts: 7
    #68489

    Sorry for the late answer.In our clinics we prefer cryo if the patient accepts temporary occipital sensory loss. If not, pulsed RF is the choice. In my country both procedures are currently covered by medical insurance.

      in reply to: Suboccipital Neuralgia
      Robert RapcanRobert Rapcan
      Participant
      Joined: Dec 6, 2018
      Posts: 7
      #68229

      Various studies have investigated interventional techniques for the treatment of occipital neuralgia (ON), including local and steroid infiltrations, with limited duration of benefit. With local anaesthetic and steroid injections, most of the patients experience return of pain within 2 weeks. Just a very limited number of patients have longer duration of analgesia than 2 weeks after LA/steroid injections.Use of botulinum toxin type A has also been studied and shown to provide longer duration than LA/steroid injections, with a mean duration of pain relief for 4 months . Pulsed radiofrequency ablation has been studied and has shown some promising results, with benefit in the majority of patients for 6 months. Very few studies have been performed on the topic of cryoanalgesia and ON. Our experience shows that cryoanalgesia provides significant pain relief for those who receive benefit (> 50%) with local anesthetic blocks for no longer than 2 weeks. Duration of pain relief after correctly performed cryoanalgesia is around 6 months with the possibility to repeat the procedure when needed.

        in reply to: Discogenic Pain
        Robert RapcanRobert Rapcan
        Participant
        Joined: Dec 6, 2018
        Posts: 7
        #59026

        Discogenic pain is difficult to diagnose and even more difficult to treat – in my opinion. It is not 100% clear if the pain comes from the disc only, from the inflammation on PLL and anterior epidural space at the affected disc level or a combination.
        1, There are some questions regarding pressure monitoring during your discography – have you done any?
        2, As far as I understand you tried to inject even L5/S1 but it was impossible to inject anything because to high resistence. I guess in both discs you performed some disc decompression and this caused some temporary pain relief (if the discs were really pain generators)
        3, RF protocol you used to treat the disc is a bit strange to me. Thermal for nucleus and pulsed for anulus? Might be better and more logical to do opposite way.
        4, We perform disc fx procedure for confirmed disc/discs, it is a complex procedure ( manual disc decompression with grasper – disc tissue is often red/inflammated, nucleus modulation with RF and finally posterior annulus denervation). With a correct indication and a correct technique – reasonably good results.You can do more levels at one session.
        5, Very often it is important to treat also anterior epidural space at the affected disc level – PRP or steroids.
        6, If symptomps come back – back to the drawing table – you missed something or failed on the treatment technique?

        Keep well!

          Robert RapcanRobert Rapcan
          Participant
          Joined: Dec 6, 2018
          Posts: 7
          #59025

          I like you sharing what pain physicians do when they have pain. I am also a pain physician and here is my experience. Honestly, I do not like patients with central low back pain, degeneration of L5/S1 disc, pain with bending forward and worsening even more when coming back from bending.Modic 1-2. 3 months ago I did cross country skiing – skate and got central low back pain, no radiation to legs, no facets positivity, no SI positivity, bending forward restricted, coming back painful. Resting from sport, pain killers, some own exercises – no help, even worsening the symptoms, rest pain, hard to sleep, pain killers ZERO effect. Radiological image – severe L5/S1 disc degeneration, Modic 1-2 changes, hyperlordosis. I contacted our swedish physio guru Bjorn Aasa – his advice was simple – try correcting your hyperlordosis with exercises focused on abdominal muscles (with special focus on low abdomen, below navel level). And now the interesting part. After 3 month of sufferening, pain killers and incorrect exercises ( my exercises were focused on extension and hyperextension – joga style) – 24 hrs of the correct muscle activation improved my clinical status 80%, within 3 days I come back to sport ( running, cycling, calisthenics) and no pain any more… . To sum up – there are diagnosis where interventions, surgeries, incorrect exercises do not help. Simple correct muscle activation with the correction of the movement disorder can cause a miracle.

            Robert RapcanRobert Rapcan
            Participant
            Joined: Dec 6, 2018
            Posts: 7
            #59024

            Very interesting clinical experience. 2 patients with 100% clinical improvement. I have seen this regarding the topic before:

            Investigators in Germany took a step toward determining a potential novel therapeutic intervention for COVID-19 after identifying a cellular protein that may allow entry of SARS-CoV-2 into lung cells.

            The research, published in the journal Cell, examined how SARS-CoV-2 enters human cells and found that a drug currently approved in Japan to treat pancreatic inflammation could block the COVID-19 infection.

            “Our results show that SARS-CoV-2 requires the protease TMPRSS2, which is present in the human body, to enter cells,” Stefan Pöhlmann, head of the Infection Biology Unit at the German Primate Center, said in a statement. “This protease is a potential target for therapeutic intervention.”

            The research team was led by infection biologists from the German Primate Centre and included investigators from Charité, the University of Veterinary Medicine Hannover Foundation, the BG-Unfallklinik Murnau, the LMU Munich, the Robert Koch Institute and the German Center for Infection Research.

            The novel coronavirus is closely related to SARS-CoV, which emerged in 2002 and was stopped with measures including travel restrictions and patient isolation. The new study compared the 2 viruses and found similar properties and pandemic potential. Investigators noted that the spike protein (S protein) of the coronaviruses facilitates attachment to human cells through a 2-step process. SARS-CoV-2 depends on angiotensin-converting enzyme 2 (ACE2) for entry and serine protease TMPRSS2 for S protein priming. The study also determined that antibody responses raised by the earlier SARS-CoV could potentially provide partial protection against the novel virus, which may help control the outbreak.

            Better understanding of the transmissibility and pathogenesis of SARS-CoV-2 brought investigators closer to a possible therapeutic intervention.

            “We have tested SARS-CoV-2 isolated from a patient and found that camostat mesilate blocks entry of the virus into lung cells,” lead author Markus Hoffmann, PhD, a researcher at the German Primate Center, said in the statement. “Our results suggest that camostat mesilate might also protect against COVID-19. This should be investigated in clinical trials.”

            Camostat mesilate is approved in Japan to treat pancreatic inflammation.

            The study demonstrated that the drug blocked infection of human lung epithelial cells in culture. Human trials are necessary to prove whether the drug would be effective in stopping the infection.

            Here in Slovakia the situation stable, only 2 peaple past away.

              Robert RapcanRobert Rapcan
              Participant
              Joined: Dec 6, 2018
              Posts: 7
              #50764

              Bogduk defined specific criteria for an optimal selection as an anatomically accurate block under guidance with ideally complete relief of pain following an MBDR block. Manchikanti et al. defined at least an 80% reduction of pain and the ability to perform previously painful movements . More liberal criteria have also been reported, such as greater than 50% relief of pain.

              1, 4 to 2 or 2 to 1: It doesnˇt make sense to indicate those patients for diagnostic blocks.

              2,The amount of relief low back pain patients get from facet joint injections can be predicted by psychological factors. Why would that be? Numbing might provide strong enough temporary relief to create an overconfident “eureka!” And that confidence might itself deliver some pain relief, further clouding the issue, and adding up to a false positive: a misleading result that puts a spotlight on the facet joint that is actually innocent, or only part of the problem. …read more at: https://www.painscience.com/articles/do-nerve-blocks-work.php

              Viewing 6 posts - 1 through 6 (of 6 total)