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Jan Van Zundert - One of the best experts on this subject based on the ideXlab platform.

  • intrathecal drug administration in Chronic Pain Syndromes
    Pain Practice, 2013
    Co-Authors: Ann Ver Donck, Jan H Vranken, Martine Puylaert, Salim M Hayek, Nagy Mekhail, Jan Van Zundert
    Abstract:

    Chronic Pain may recur after initial response to strong opioids in both patients with cancer and patients without cancer or therapy may be complicated by intolerable side effects. When minimally invasive interventional Pain management techniques also fail to provide satisfactory Pain relief, continuous intrathecal analgesic administration may be considered. Only 3 products have been officially approved for long-term intrathecal administration: morphine, baclofen, and ziconotide. The efficacy of intrathecal ziconotide for the management of patients with severe Chronic refractory noncancer Pain was illustrated in 3 placebo-controlled trials. A randomized study showed this treatment option to be effective over a short follow-up period for patients with Pain due to cancer or AIDS. The efficacy of intrathecal opioid administration for the management of Chronic noncancer Pain is mainly derived from prospective and retrospective noncontrolled trials. The effect of intrathecal morphine administration in patients with Pain due to cancer was compared with oral or transdermal treatment in a randomized controlled trial, which found better Pain control and fewer side effects with intrathecal opioids. Other evidence is derived from cohort studies. Side effects of Chronic intrathecal therapy may either be technical (catheter or pump malfunction) or biological (infection). The most troublesome complication is, however, the possibility of granuloma formation at the catheter tip that may induce neurological damage. Given limited studies, the evidence for intrathecal drug administration in patients suffering from cancer-related Pain is more compelling than that of Chronic noncancer Pain.

  • radiofrequency and pulsed radiofrequency treatment of Chronic Pain Syndromes the available evidence
    Pain Practice, 2008
    Co-Authors: Koen Van Boxem, Maarten Van Kleef, Maarten Van Eerd, Tjinta Brinkhuize, Jacob Patijn, Jan Van Zundert
    Abstract:

    There are currently 6 reviews on (pulsed) radiofrequency (RF) for the management of spinal Pain. Two reviews on interventional Pain management techniques in general also discuss RF. The outcomes of those reviews depend on the type of studies included and the opinion of the reviewers, which may result in different evidence levels. Radiofrequency denervation at the cervical and lumbar level has produced the most solid evidence. The differences in treatment outcome registered in the 5 randomized controlled trials (RCTs) regarding lumbar facet denervation can be attributed to differences in patient selection and/or inappropriate technique. There is not sufficient evidence supporting the use of RF facet denervation for the management of cervicogenic headache. The studies examining the management of cervical radicular Pain suggest a comparable efficacy for RF and pulsed RF (PRF). The PRF treatment is supposed to be safer and therefore should be preferred. The superiority of RF treatment adjacent to the lumbar dorsal root ganglion for the management of lumbar radicular Pain has not been demonstrated in an RCT. Information regarding RF treatment of sacroiliac joint Pain is accumulating. No randomized sham-controlled trials on the value of RF treatment of the Gasserian ganglion for the management of idiopathic trigeminal neuralgia have been published. One RCT indicates superiority of RF over PRF for the management of idiopathic trigeminal neuralgia. Future research to confirm or deny the efficacy of (P)RF should be conducted in carefully selected patient populations. The tests used for patient inclusion in such a trial could potentially help the clinician in selecting patients for this type of treatment. The value of PRF treatment of the peripheral nerves also needs to be confirmed in well-designed trials.

  • pulsed radiofrequency treatment of the gasserian ganglion in patients with idiopathic trigeminal neuralgia
    Pain, 2003
    Co-Authors: Jan Van Zundert, Steven Brabant, Erik Van De Kelft, Alex Vercruyssen, Jean Pierre Van Buyten
    Abstract:

    Pulsed radiofrequency treatment has been described as a minimal invasive alternative to radiofrequency thermocoagulation for the management of Chronic Pain Syndromes. We present here our first five high-risk patients with idiopathic trigeminal neuralgia who were treated with pulsed radiofrequency after multidisciplinary assessment; with a mean follow-up of 19.2 months (range 10-26). These patients were at high risk due to age, co-morbidities or previous interventional and surgical treatments. An excellent long-term effect was achieved in three of the five patients, a partial effect in one patient and a short-term effect in one patient. No neurological side effects or complications were reported.

Jean Pierre Van Buyten - One of the best experts on this subject based on the ideXlab platform.

  • pulsed radiofrequency treatment of the gasserian ganglion in patients with idiopathic trigeminal neuralgia
    Pain, 2003
    Co-Authors: Jan Van Zundert, Steven Brabant, Erik Van De Kelft, Alex Vercruyssen, Jean Pierre Van Buyten
    Abstract:

    Pulsed radiofrequency treatment has been described as a minimal invasive alternative to radiofrequency thermocoagulation for the management of Chronic Pain Syndromes. We present here our first five high-risk patients with idiopathic trigeminal neuralgia who were treated with pulsed radiofrequency after multidisciplinary assessment; with a mean follow-up of 19.2 months (range 10-26). These patients were at high risk due to age, co-morbidities or previous interventional and surgical treatments. An excellent long-term effect was achieved in three of the five patients, a partial effect in one patient and a short-term effect in one patient. No neurological side effects or complications were reported.

Teresa Catarci - One of the best experts on this subject based on the ideXlab platform.

  • amitriptyline is effective in Chronic but not in episodic tension type headache pathogenetic implications
    Headache, 1998
    Co-Authors: Rosanna Cerbo, Maria Paola Pascali, Piero Barbanti, Giovanni Fabbrini, Teresa Catarci
    Abstract:

    : The tricyclic antidepressant, amitriptyline, is an effective drug for the treatment of Chronic tension-type headache and for other Chronic Pain Syndromes, but it is also effective in the prophylaxis of an episodic type of headache such as migraine. However, its efficacy in episodic tension-type headache has not yet been clarified. We compared the efficacy of amitriptyline (25 mg/day) in 82 nondepressed patients with either Chronic or episodic tension-type headache in an open-label study. Amitriptyline significantly reduced (P < 0.05) frequency and duration of headache as well as analgesic consumption in Chronic, but not in episodic, tension-type headache. Further placebo-controlled trials, possibly with higher doses of amitriptyline, might confirm if the different pattern of response to amitriptyline can be explained in terms of different involvement of central nociception and of peripheral myofascial factors in the Chronic and in the episodic forms of tension-type headache.

  • Amitriptyline Is Effective in Chronic But Not in Episodic Tension‐Type Headache: Pathogenetic Implications
    Headache, 1998
    Co-Authors: Rosanna Cerbo, Maria Paola Pascali, Piero Barbanti, Giovanni Fabbrini, Teresa Catarci
    Abstract:

    : The tricyclic antidepressant, amitriptyline, is an effective drug for the treatment of Chronic tension-type headache and for other Chronic Pain Syndromes, but it is also effective in the prophylaxis of an episodic type of headache such as migraine. However, its efficacy in episodic tension-type headache has not yet been clarified. We compared the efficacy of amitriptyline (25 mg/day) in 82 nondepressed patients with either Chronic or episodic tension-type headache in an open-label study. Amitriptyline significantly reduced (P < 0.05) frequency and duration of headache as well as analgesic consumption in Chronic, but not in episodic, tension-type headache. Further placebo-controlled trials, possibly with higher doses of amitriptyline, might confirm if the different pattern of response to amitriptyline can be explained in terms of different involvement of central nociception and of peripheral myofascial factors in the Chronic and in the episodic forms of tension-type headache.

Maarten Van Kleef - One of the best experts on this subject based on the ideXlab platform.

  • radiofrequency and pulsed radiofrequency treatment of Chronic Pain Syndromes the available evidence
    Pain Practice, 2008
    Co-Authors: Koen Van Boxem, Maarten Van Kleef, Maarten Van Eerd, Tjinta Brinkhuize, Jacob Patijn, Jan Van Zundert
    Abstract:

    There are currently 6 reviews on (pulsed) radiofrequency (RF) for the management of spinal Pain. Two reviews on interventional Pain management techniques in general also discuss RF. The outcomes of those reviews depend on the type of studies included and the opinion of the reviewers, which may result in different evidence levels. Radiofrequency denervation at the cervical and lumbar level has produced the most solid evidence. The differences in treatment outcome registered in the 5 randomized controlled trials (RCTs) regarding lumbar facet denervation can be attributed to differences in patient selection and/or inappropriate technique. There is not sufficient evidence supporting the use of RF facet denervation for the management of cervicogenic headache. The studies examining the management of cervical radicular Pain suggest a comparable efficacy for RF and pulsed RF (PRF). The PRF treatment is supposed to be safer and therefore should be preferred. The superiority of RF treatment adjacent to the lumbar dorsal root ganglion for the management of lumbar radicular Pain has not been demonstrated in an RCT. Information regarding RF treatment of sacroiliac joint Pain is accumulating. No randomized sham-controlled trials on the value of RF treatment of the Gasserian ganglion for the management of idiopathic trigeminal neuralgia have been published. One RCT indicates superiority of RF over PRF for the management of idiopathic trigeminal neuralgia. Future research to confirm or deny the efficacy of (P)RF should be conducted in carefully selected patient populations. The tests used for patient inclusion in such a trial could potentially help the clinician in selecting patients for this type of treatment. The value of PRF treatment of the peripheral nerves also needs to be confirmed in well-designed trials.

  • radiofrequency lesions of the stellate ganglion in Chronic Pain Syndromes retrospective analysis of clinical efficacy in 86 patients
    The Clinical Journal of Pain, 2000
    Co-Authors: Tymour Forouzanfar, Maarten Van Kleef, Wilhelm E J Weber
    Abstract:

    Objective: Stellate ganglion (SG) blockade is used for the treatment of Chronic Pain Syndromes in which the sympathetic nervous system is hypothesized to be involved. A possible treatment modality to achieve long-term Pain reduction is blockade of the SG by means of a radiofrequency lesion (RF-SG). To evaluate the outcome of RF-SG as a therapy for different Chronic Pain Syndromes, we reviewed 86 RF-SG procedures. Design: Medical records containing treatment information were reviewed systematically. A systematic MEDLINE literature review search on SG blockade was also performed. Results: In our clinic, 39.5% of 221 patients who received a prognostic SG block subsequently underwent RF-SG. Of these patients, 40.7% noted a more than 50% reduction of Pain, 54.7% reported no effect on Pain, and 4.7% showed worsening of Pain. The mean follow-up interval was 52 weeks. The computer-assisted literature search resulted in 31 studies: 12 about complications and 19 about the efficacy of SG blockade. A review of these studies showed partial Pain relief in 41.3% of patients, complete Pain relief in 37.8%, and no Pain relief in 20.9%. Conclusions: The efficacy of RF-SG blockade seems to be in line with that of other SG blockade procedures reported in the literature. Our retrospective study shows that an RF-SG block is most likely to be of benefit for patients suffering from complex regional Pain syndrome type 2, ischemic Pain, cervicobrachialgia, or postthoracotomy Pain. Clinical efficacy remains to be proven in a randomized controlled trial, however.

Ye Jung Choi - One of the best experts on this subject based on the ideXlab platform.

  • Bilateral Horner's Syndrome after a Stellate Ganglion Block
    Korean Journal of Anesthesiology, 2002
    Co-Authors: Ye Jung Choi
    Abstract:

    A stellate ganglion block (SGB) is a widely used procedure in the treatment of Chronic Pain Syndromes in the facial and cervicobrachial regions as well as in nonPainful conditions. The complications of a stellate ganglion block include intra-arterial or intracranial injection of local anesthetic, Horner's syndrome, phrenic nerve block, recurrent laryngeal nerve paralysis, brachial plexus block, and pneumothorax. Horner's syndrome after the performance of a stellate ganglion block is a valuable sign of a successful block, but contralateral or bilateral Horner's syndrome remains an unusual and poorly explained phenomenon. We experienced a case of a 56 year-old female patient who had developed ipsilateral and contralateral Horner's syndrome after a stellate ganglion block. The ipsilateral Horner's syndrome was resolved after several hours but the contralateral side lasted for a week.