Knee cooled radiofrequency vs continuous radiofrequency for genicular neurotomy: preliminary experience - Crio-radiofrequenza vs radiofrequenza continua per neurotomia dei nervi genicolati: esperienza preliminare

Radiofrequency neurotomy of genicular nerves has been often used as an efficacious treatment option in all patients suffering from chronic osteoarthritis pain to provide long-term pain relief. After providing informed written consent, 80 patients with severe knee chronic osteoarthritis pain had been enrolled; patients had been divided into two groups (Group C, crioneurolysis, vs Group R, traditional radiofrequency, 40 patients for each group). Pain relief in C group was poorer and with shorter time in duration (median NRS reducing from 8 to 5). Radiofrequency can be considered as an effective, minimally invasive treat­ment for these kinds of conditions, and offers the benefit of being a fast procedure with long-term pain relief

Craniofacial pain and high frequency stimulation - Dolore cranio faciale e neurostimolazione ad alta frequenza

Neuromodulation is a treatment modality that shows promise and so far case reports have used peripheral approaches to the trigeminal ganglion and its branches. We describe the use of high frequency spinal cord stimulation at the cervical spine as a novel approach to management of refractory trigeminal neuralgia. We have enrolled 3 patients, suffering from trigeminal neuralgia involving the first branch of nerve. All the patients had been implanted with one octopolar electrode such that the stimulating contacts were placed at the C2-C3 vertebral level; electrodes had been connected to an external trial lead extension, which was removed at the end of the trial with subsequent implantation of the definitive IPG. All the patients completed trial period with successful implantation because pain relief was about 70%. All the patients decreased analgesics consumption, especially for opioids.The application of electrical pulses directly onto the dorsal columns at the C2-C3 vertebral level provide a neuromodulatory effect on the Trigemino-Cervical Complex (TCC) greater than peripheral trigeminal branches stimulation

Cancer- and Non-cancer Related Chronic Pain: From the Physiopathological Basics to Management

The prevalence of chronic pain is between 33% to 64% and is due to cancer pain, but it has also been observed in non-cancer patients. Chronic pain is associated with lower quality of life and higher psychological distress and depressive/anxiety disorders in patients without a history of disorder.In this study we evaluated in clinical practice the effectiveness of the intrathecal pump in 140 patients who underwent pain therapy at our Center. These patients were consecutively enrolled from January 2010 to July 2018.Follow-up was carried out over these eight years regarding the infusion modalities. Pain relief was obtained in 71 (50,7%) patients out of the 140 that experienced satisfactory pain control globally. Intrathecal therapy is one of the best options for chronic severe refractory pain. The greatest advantage of this therapy is due to the possibility of treating the pain with minimal dosages of the drug, avoiding the appearance of troublesome side effects

Cancer- and non-cancer related chronic pain: from the physiopathological basics to management

The prevalence of chronic pain is between 33% to 64% and is due to cancer pain, but it has also been observed in non-cancer patients. Chronic pain is associated with lower quality of life and higher psychological distress and depressive/anxiety disorders in patients without a history of disorder

Differential diagnosis: retroperitoneal fibrosis and oncological diseases

Retroperitoneal fibrosis is a connective disease of the auto-inflammatory/auto-immune type of the retroperitoneum with unknown etiology and pathological mechanism. The manifestations of the pathology can be local or systemic. Amongst the local symptoms, the dull and constant pain in the hips, back or abdomen is the most frequent

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Introduction: An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here. Methods: Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity. Results: Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids. Conclusions: These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients. Funding: Molteni Farmaceutici, Italy