The Experts below are selected from a list of 9492 Experts worldwide ranked by ideXlab platform
Jan Van Zundert - One of the best experts on this subject based on the ideXlab platform.
-
predictive factors for successful outcome of pulsed radiofrequency treatment in patients with intractable lumbosacral Radicular Pain
Pain Medicine, 2016Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Jan Van Zundert, Nelleke De Meij, J T Wilmink, Alfons G H KesselsAbstract:Background. In a previous prospective study on pulsed radiofrequency (PRF) treatment adjacent to the lumbar dorsal root ganglion (DRG) for patients with chronic lumbosacral Radicular Pain, we reported success in 55.4% of the patients at 6 months. Identification of predictors for success after PRF may improve outcome. We assessed the predictors of PRF in patients with chronic intractable lumbosacral Radicular Pain. Methods. Patients with monosegmental chronic lumbosacral Radicular Pain of L5 or S1 first received a selective nerve root block at the corresponding level. Independent of the result of this block a PRF treatment at the same level was performed. At 6 weeks, 3 months, and 6 months after the procedure the outcome was evaluated. Results. A positive diagnostic nerve root block and age ≥ 55 were predictive factors for successful outcome at 6 months, while disability was a negative predictor. The use of failed back surgery syndrome, gender, duration of Pain, Numerical Rating Scale, level and side of treatment, DN4, and RAND-36 as predictors for success was not supported. Conclusions. Successful outcome after PRF adjacent to the DRG, in patients with intractable chronic lumbosacral Radicular Pain, is more likely in patients ≥ 55 years, with limited disability and after a positive diagnostic nerve root block. A combination of all these factors creates a fair predictive value (AUC: 0.73).
-
epiduroscopy for patients with lumbosacral Radicular Pain
Pain Practice, 2014Co-Authors: Jan Willem Kallewaard, Jan Van Zundert, Pascal Vanelderen, Jonathan Richardson, James E Heavner, Gerbrand J GroenAbstract:Lumbosacral Radicular Pain is a Pain in the distribution area of one of the nerves of the lumbosacral plexus, with or without sensory and/or motor impairment. A major source of lumbosacral Radicular Pain is failed back surgery, which is defined as persistent or recurrent Pain, mainly in the region of the lower back and legs even after technically, anatomically successful spine surgeries. If lumbosacral Radicular neuropathic Pain fails to respond to conservative or interventional treatments, epiduroscopy can be performed as part of a multidisciplinary approach. Epiduroscopy aids in identifying Painful structures in the epidural space, establishing a diagnosis and administering therapy. The novelty consists in the use of an epiduroscope to deliver therapies such as adhesiolysis and targeted administration of epidural medications. Clinical trials report favorable treatment outcomes in 30% to 50% of patients. Complications are rare and related to the rate or volume of epidural fluid infusion or inadvertent dural puncture. In patients with lumbosacral Radicular Pain, especially after back surgery, epiduroscopy with adhesiolysis may be considered (evidence rating 2 B+).
-
pulsed radiofrequency a review of the basic science as applied to the pathophysiology of Radicular Pain a call for clinical translation
Regional Anesthesia and Pain Medicine, 2014Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Jan Van Zundert, Marc A Huntoon, Elbert A.j. JoostenAbstract:Abstract Radicular Pain is an important health care problem, with only limited evidence-based treatments available. Treatment selection should ideally target documented pathophysiological pathways. In herniated discs, a sequence in the inflammatory cascade can be observed that initiates and maintains increased nociceptive signal input. Inflammatory mediators including tumor necrosis factor α are released from the nucleus pulposus and the degenerating peripheral nerve, which, in turn, induces production of neurotrophins like nerve growth factor and brain-derived neurotrophic factor. Neurotrophins interfere not only with the generation of ectopic firing of nociceptive neurons in the dorsal root ganglion but also with the excitability and sensitization of neuronal transmission in the dorsal spinal horn. Radicular Pain is further characterized by the electrophysiological spreading of the afferent nociceptive input over different spinal nerve roots. Both the complex pathophysiological pathways involved and the spreading of the nociceptive signal make Radicular Pain difficult to treat. Pulsed radiofrequency (PRF) is considered an option in treatment of Radicular Pain. To understand and increase the efficiency of PRF interventional treatments in Radicular Pain, both in vitro and in vivo studies aiming at elucidating part of the mechanism of action of PRF are described. Potential factors that may improve the efficacy of PRF treatment in Radicular Pain are discussed.
-
Pulsed Radiofrequency Treatment for Radicular Pain: Where Do We Stand and Where to Go?
Pain Medicine, 2012Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Elbert A.j. Joosten, Jan Van ZundertAbstract:In this issue of Pain Medicine , Choi et al. report a retrospective case series of pulsed radiofrequency (PRF) treatment adjacent to the cervical dorsal root ganglion (DRG) for the management of patients with chronic cervical Radicular Pain. Out of 112 patients who received repeated transforaminal epidural steroid injections, 29 continued with persistent Radicular Pain. Twenty-one patients were treated with PRF on the symptomatic cervical level. Up to 1 year after a single PRF treatment, a positive long-term effect was found in 14 out of 21 patients. This is in line with the positive effect of PRF for carefully selected patients with chronic cervical Radicular Pain found in a small randomized controlled trial comparing PRF with sham intervention [1]. In the latter study, a significant difference in favor of the PRF group was reported at 3 months, whereas a nonsignificant reduction in Pain was noted at the 6 months follow-up evaluation, probably due to a lack of power of the test population. At present, this is the only study with evidence of effectiveness of PRF in clinical practice, leading to a positive recommendation but limited to chronic cervical Radicular Pain [2]. To improve the evidence and justification for this procedure, we need more high-quality prospective (randomized) outcome studies. Unfortunately, the present study of Choi et al. does not meet these criteria because of methodological flaws, e.g., patient selection is not clear and the study is a retrospective evaluation with consequently a limited number of outcome measures. An important concern is furthermore the use of transforaminal injection of corticosteroids for patients with cervical Radicular Pain, which the authors claim to have a moderate to strong effect. However, the efficacy of transforaminal epidural steroid administration was found not to be different from the efficacy of transforaminal administration of local anesthetic …
-
11 lumbosacral Radicular Pain
Pain Practice, 2010Co-Authors: Koen Van Boxem, Jianguo Cheng, Jacob Patijn, Maarten Van Kleef, Arno Lataster, Nagy Mekhail, Jan Van ZundertAbstract:Lumbosacral Radicular Pain is characterized by a radiating Pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other Radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back Pain with leg Pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic Pain. The patient's history may give a suggestion of lumbosacral Radicular Pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral Radicular Pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral Radicular Pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral Radicular Pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral Radicular Pain, adhesiolysis and epiduroscopy can be considered (2 B±), preferentially study-related. In patients with a therapy-resistant Radicular Pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers.
Maarten Van Kleef - One of the best experts on this subject based on the ideXlab platform.
-
predictive factors for successful outcome of pulsed radiofrequency treatment in patients with intractable lumbosacral Radicular Pain
Pain Medicine, 2016Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Jan Van Zundert, Nelleke De Meij, J T Wilmink, Alfons G H KesselsAbstract:Background. In a previous prospective study on pulsed radiofrequency (PRF) treatment adjacent to the lumbar dorsal root ganglion (DRG) for patients with chronic lumbosacral Radicular Pain, we reported success in 55.4% of the patients at 6 months. Identification of predictors for success after PRF may improve outcome. We assessed the predictors of PRF in patients with chronic intractable lumbosacral Radicular Pain. Methods. Patients with monosegmental chronic lumbosacral Radicular Pain of L5 or S1 first received a selective nerve root block at the corresponding level. Independent of the result of this block a PRF treatment at the same level was performed. At 6 weeks, 3 months, and 6 months after the procedure the outcome was evaluated. Results. A positive diagnostic nerve root block and age ≥ 55 were predictive factors for successful outcome at 6 months, while disability was a negative predictor. The use of failed back surgery syndrome, gender, duration of Pain, Numerical Rating Scale, level and side of treatment, DN4, and RAND-36 as predictors for success was not supported. Conclusions. Successful outcome after PRF adjacent to the DRG, in patients with intractable chronic lumbosacral Radicular Pain, is more likely in patients ≥ 55 years, with limited disability and after a positive diagnostic nerve root block. A combination of all these factors creates a fair predictive value (AUC: 0.73).
-
pulsed radiofrequency a review of the basic science as applied to the pathophysiology of Radicular Pain a call for clinical translation
Regional Anesthesia and Pain Medicine, 2014Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Jan Van Zundert, Marc A Huntoon, Elbert A.j. JoostenAbstract:Abstract Radicular Pain is an important health care problem, with only limited evidence-based treatments available. Treatment selection should ideally target documented pathophysiological pathways. In herniated discs, a sequence in the inflammatory cascade can be observed that initiates and maintains increased nociceptive signal input. Inflammatory mediators including tumor necrosis factor α are released from the nucleus pulposus and the degenerating peripheral nerve, which, in turn, induces production of neurotrophins like nerve growth factor and brain-derived neurotrophic factor. Neurotrophins interfere not only with the generation of ectopic firing of nociceptive neurons in the dorsal root ganglion but also with the excitability and sensitization of neuronal transmission in the dorsal spinal horn. Radicular Pain is further characterized by the electrophysiological spreading of the afferent nociceptive input over different spinal nerve roots. Both the complex pathophysiological pathways involved and the spreading of the nociceptive signal make Radicular Pain difficult to treat. Pulsed radiofrequency (PRF) is considered an option in treatment of Radicular Pain. To understand and increase the efficiency of PRF interventional treatments in Radicular Pain, both in vitro and in vivo studies aiming at elucidating part of the mechanism of action of PRF are described. Potential factors that may improve the efficacy of PRF treatment in Radicular Pain are discussed.
-
Pulsed Radiofrequency Treatment for Radicular Pain: Where Do We Stand and Where to Go?
Pain Medicine, 2012Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Elbert A.j. Joosten, Jan Van ZundertAbstract:In this issue of Pain Medicine , Choi et al. report a retrospective case series of pulsed radiofrequency (PRF) treatment adjacent to the cervical dorsal root ganglion (DRG) for the management of patients with chronic cervical Radicular Pain. Out of 112 patients who received repeated transforaminal epidural steroid injections, 29 continued with persistent Radicular Pain. Twenty-one patients were treated with PRF on the symptomatic cervical level. Up to 1 year after a single PRF treatment, a positive long-term effect was found in 14 out of 21 patients. This is in line with the positive effect of PRF for carefully selected patients with chronic cervical Radicular Pain found in a small randomized controlled trial comparing PRF with sham intervention [1]. In the latter study, a significant difference in favor of the PRF group was reported at 3 months, whereas a nonsignificant reduction in Pain was noted at the 6 months follow-up evaluation, probably due to a lack of power of the test population. At present, this is the only study with evidence of effectiveness of PRF in clinical practice, leading to a positive recommendation but limited to chronic cervical Radicular Pain [2]. To improve the evidence and justification for this procedure, we need more high-quality prospective (randomized) outcome studies. Unfortunately, the present study of Choi et al. does not meet these criteria because of methodological flaws, e.g., patient selection is not clear and the study is a retrospective evaluation with consequently a limited number of outcome measures. An important concern is furthermore the use of transforaminal injection of corticosteroids for patients with cervical Radicular Pain, which the authors claim to have a moderate to strong effect. However, the efficacy of transforaminal epidural steroid administration was found not to be different from the efficacy of transforaminal administration of local anesthetic …
-
11 lumbosacral Radicular Pain
Pain Practice, 2010Co-Authors: Koen Van Boxem, Jianguo Cheng, Jacob Patijn, Maarten Van Kleef, Arno Lataster, Nagy Mekhail, Jan Van ZundertAbstract:Lumbosacral Radicular Pain is characterized by a radiating Pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other Radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back Pain with leg Pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic Pain. The patient's history may give a suggestion of lumbosacral Radicular Pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral Radicular Pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral Radicular Pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral Radicular Pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral Radicular Pain, adhesiolysis and epiduroscopy can be considered (2 B±), preferentially study-related. In patients with a therapy-resistant Radicular Pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers.
-
4 cervical Radicular Pain
Pain Practice, 2010Co-Authors: Jan Van Zundert, Jacob Patijn, Arno Lataster, Nagy Mekhail, Marc A Huntoon, Maarten Van KleefAbstract: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.
Jacob Patijn - One of the best experts on this subject based on the ideXlab platform.
-
predictive factors for successful outcome of pulsed radiofrequency treatment in patients with intractable lumbosacral Radicular Pain
Pain Medicine, 2016Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Jan Van Zundert, Nelleke De Meij, J T Wilmink, Alfons G H KesselsAbstract:Background. In a previous prospective study on pulsed radiofrequency (PRF) treatment adjacent to the lumbar dorsal root ganglion (DRG) for patients with chronic lumbosacral Radicular Pain, we reported success in 55.4% of the patients at 6 months. Identification of predictors for success after PRF may improve outcome. We assessed the predictors of PRF in patients with chronic intractable lumbosacral Radicular Pain. Methods. Patients with monosegmental chronic lumbosacral Radicular Pain of L5 or S1 first received a selective nerve root block at the corresponding level. Independent of the result of this block a PRF treatment at the same level was performed. At 6 weeks, 3 months, and 6 months after the procedure the outcome was evaluated. Results. A positive diagnostic nerve root block and age ≥ 55 were predictive factors for successful outcome at 6 months, while disability was a negative predictor. The use of failed back surgery syndrome, gender, duration of Pain, Numerical Rating Scale, level and side of treatment, DN4, and RAND-36 as predictors for success was not supported. Conclusions. Successful outcome after PRF adjacent to the DRG, in patients with intractable chronic lumbosacral Radicular Pain, is more likely in patients ≥ 55 years, with limited disability and after a positive diagnostic nerve root block. A combination of all these factors creates a fair predictive value (AUC: 0.73).
-
pulsed radiofrequency a review of the basic science as applied to the pathophysiology of Radicular Pain a call for clinical translation
Regional Anesthesia and Pain Medicine, 2014Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Jan Van Zundert, Marc A Huntoon, Elbert A.j. JoostenAbstract:Abstract Radicular Pain is an important health care problem, with only limited evidence-based treatments available. Treatment selection should ideally target documented pathophysiological pathways. In herniated discs, a sequence in the inflammatory cascade can be observed that initiates and maintains increased nociceptive signal input. Inflammatory mediators including tumor necrosis factor α are released from the nucleus pulposus and the degenerating peripheral nerve, which, in turn, induces production of neurotrophins like nerve growth factor and brain-derived neurotrophic factor. Neurotrophins interfere not only with the generation of ectopic firing of nociceptive neurons in the dorsal root ganglion but also with the excitability and sensitization of neuronal transmission in the dorsal spinal horn. Radicular Pain is further characterized by the electrophysiological spreading of the afferent nociceptive input over different spinal nerve roots. Both the complex pathophysiological pathways involved and the spreading of the nociceptive signal make Radicular Pain difficult to treat. Pulsed radiofrequency (PRF) is considered an option in treatment of Radicular Pain. To understand and increase the efficiency of PRF interventional treatments in Radicular Pain, both in vitro and in vivo studies aiming at elucidating part of the mechanism of action of PRF are described. Potential factors that may improve the efficacy of PRF treatment in Radicular Pain are discussed.
-
Pulsed Radiofrequency Treatment for Radicular Pain: Where Do We Stand and Where to Go?
Pain Medicine, 2012Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Elbert A.j. Joosten, Jan Van ZundertAbstract:In this issue of Pain Medicine , Choi et al. report a retrospective case series of pulsed radiofrequency (PRF) treatment adjacent to the cervical dorsal root ganglion (DRG) for the management of patients with chronic cervical Radicular Pain. Out of 112 patients who received repeated transforaminal epidural steroid injections, 29 continued with persistent Radicular Pain. Twenty-one patients were treated with PRF on the symptomatic cervical level. Up to 1 year after a single PRF treatment, a positive long-term effect was found in 14 out of 21 patients. This is in line with the positive effect of PRF for carefully selected patients with chronic cervical Radicular Pain found in a small randomized controlled trial comparing PRF with sham intervention [1]. In the latter study, a significant difference in favor of the PRF group was reported at 3 months, whereas a nonsignificant reduction in Pain was noted at the 6 months follow-up evaluation, probably due to a lack of power of the test population. At present, this is the only study with evidence of effectiveness of PRF in clinical practice, leading to a positive recommendation but limited to chronic cervical Radicular Pain [2]. To improve the evidence and justification for this procedure, we need more high-quality prospective (randomized) outcome studies. Unfortunately, the present study of Choi et al. does not meet these criteria because of methodological flaws, e.g., patient selection is not clear and the study is a retrospective evaluation with consequently a limited number of outcome measures. An important concern is furthermore the use of transforaminal injection of corticosteroids for patients with cervical Radicular Pain, which the authors claim to have a moderate to strong effect. However, the efficacy of transforaminal epidural steroid administration was found not to be different from the efficacy of transforaminal administration of local anesthetic …
-
11 lumbosacral Radicular Pain
Pain Practice, 2010Co-Authors: Koen Van Boxem, Jianguo Cheng, Jacob Patijn, Maarten Van Kleef, Arno Lataster, Nagy Mekhail, Jan Van ZundertAbstract:Lumbosacral Radicular Pain is characterized by a radiating Pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other Radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back Pain with leg Pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic Pain. The patient's history may give a suggestion of lumbosacral Radicular Pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral Radicular Pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral Radicular Pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral Radicular Pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral Radicular Pain, adhesiolysis and epiduroscopy can be considered (2 B±), preferentially study-related. In patients with a therapy-resistant Radicular Pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers.
-
4 cervical Radicular Pain
Pain Practice, 2010Co-Authors: Jan Van Zundert, Jacob Patijn, Arno Lataster, Nagy Mekhail, Marc A Huntoon, Maarten Van KleefAbstract: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.
Koen Van Boxem - One of the best experts on this subject based on the ideXlab platform.
-
predictive factors for successful outcome of pulsed radiofrequency treatment in patients with intractable lumbosacral Radicular Pain
Pain Medicine, 2016Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Jan Van Zundert, Nelleke De Meij, J T Wilmink, Alfons G H KesselsAbstract:Background. In a previous prospective study on pulsed radiofrequency (PRF) treatment adjacent to the lumbar dorsal root ganglion (DRG) for patients with chronic lumbosacral Radicular Pain, we reported success in 55.4% of the patients at 6 months. Identification of predictors for success after PRF may improve outcome. We assessed the predictors of PRF in patients with chronic intractable lumbosacral Radicular Pain. Methods. Patients with monosegmental chronic lumbosacral Radicular Pain of L5 or S1 first received a selective nerve root block at the corresponding level. Independent of the result of this block a PRF treatment at the same level was performed. At 6 weeks, 3 months, and 6 months after the procedure the outcome was evaluated. Results. A positive diagnostic nerve root block and age ≥ 55 were predictive factors for successful outcome at 6 months, while disability was a negative predictor. The use of failed back surgery syndrome, gender, duration of Pain, Numerical Rating Scale, level and side of treatment, DN4, and RAND-36 as predictors for success was not supported. Conclusions. Successful outcome after PRF adjacent to the DRG, in patients with intractable chronic lumbosacral Radicular Pain, is more likely in patients ≥ 55 years, with limited disability and after a positive diagnostic nerve root block. A combination of all these factors creates a fair predictive value (AUC: 0.73).
-
pulsed radiofrequency a review of the basic science as applied to the pathophysiology of Radicular Pain a call for clinical translation
Regional Anesthesia and Pain Medicine, 2014Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Jan Van Zundert, Marc A Huntoon, Elbert A.j. JoostenAbstract:Abstract Radicular Pain is an important health care problem, with only limited evidence-based treatments available. Treatment selection should ideally target documented pathophysiological pathways. In herniated discs, a sequence in the inflammatory cascade can be observed that initiates and maintains increased nociceptive signal input. Inflammatory mediators including tumor necrosis factor α are released from the nucleus pulposus and the degenerating peripheral nerve, which, in turn, induces production of neurotrophins like nerve growth factor and brain-derived neurotrophic factor. Neurotrophins interfere not only with the generation of ectopic firing of nociceptive neurons in the dorsal root ganglion but also with the excitability and sensitization of neuronal transmission in the dorsal spinal horn. Radicular Pain is further characterized by the electrophysiological spreading of the afferent nociceptive input over different spinal nerve roots. Both the complex pathophysiological pathways involved and the spreading of the nociceptive signal make Radicular Pain difficult to treat. Pulsed radiofrequency (PRF) is considered an option in treatment of Radicular Pain. To understand and increase the efficiency of PRF interventional treatments in Radicular Pain, both in vitro and in vivo studies aiming at elucidating part of the mechanism of action of PRF are described. Potential factors that may improve the efficacy of PRF treatment in Radicular Pain are discussed.
-
Pulsed Radiofrequency Treatment for Radicular Pain: Where Do We Stand and Where to Go?
Pain Medicine, 2012Co-Authors: Koen Van Boxem, Jacob Patijn, Maarten Van Kleef, Elbert A.j. Joosten, Jan Van ZundertAbstract:In this issue of Pain Medicine , Choi et al. report a retrospective case series of pulsed radiofrequency (PRF) treatment adjacent to the cervical dorsal root ganglion (DRG) for the management of patients with chronic cervical Radicular Pain. Out of 112 patients who received repeated transforaminal epidural steroid injections, 29 continued with persistent Radicular Pain. Twenty-one patients were treated with PRF on the symptomatic cervical level. Up to 1 year after a single PRF treatment, a positive long-term effect was found in 14 out of 21 patients. This is in line with the positive effect of PRF for carefully selected patients with chronic cervical Radicular Pain found in a small randomized controlled trial comparing PRF with sham intervention [1]. In the latter study, a significant difference in favor of the PRF group was reported at 3 months, whereas a nonsignificant reduction in Pain was noted at the 6 months follow-up evaluation, probably due to a lack of power of the test population. At present, this is the only study with evidence of effectiveness of PRF in clinical practice, leading to a positive recommendation but limited to chronic cervical Radicular Pain [2]. To improve the evidence and justification for this procedure, we need more high-quality prospective (randomized) outcome studies. Unfortunately, the present study of Choi et al. does not meet these criteria because of methodological flaws, e.g., patient selection is not clear and the study is a retrospective evaluation with consequently a limited number of outcome measures. An important concern is furthermore the use of transforaminal injection of corticosteroids for patients with cervical Radicular Pain, which the authors claim to have a moderate to strong effect. However, the efficacy of transforaminal epidural steroid administration was found not to be different from the efficacy of transforaminal administration of local anesthetic …
-
11 lumbosacral Radicular Pain
Pain Practice, 2010Co-Authors: Koen Van Boxem, Jianguo Cheng, Jacob Patijn, Maarten Van Kleef, Arno Lataster, Nagy Mekhail, Jan Van ZundertAbstract:Lumbosacral Radicular Pain is characterized by a radiating Pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other Radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back Pain with leg Pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic Pain. The patient's history may give a suggestion of lumbosacral Radicular Pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral Radicular Pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral Radicular Pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral Radicular Pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral Radicular Pain, adhesiolysis and epiduroscopy can be considered (2 B±), preferentially study-related. In patients with a therapy-resistant Radicular Pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers.
Gyu Sik Choi - One of the best experts on this subject based on the ideXlab platform.
-
long term effect of pulsed radiofrequency on chronic cervical Radicular Pain refractory to repeated transforaminal epidural steroid injections
Pain Medicine, 2012Co-Authors: Gyu Sik ChoiAbstract:Objective. The article aims to evaluate the long-term effectiveness and safety of pulsed radiofrequency (PRF) on the dorsal root ganglion (DRG) in patients with chronic cervical Radicular Pain refractory to repeated transforaminal epidural steroid injections (TFESIs). Design. This is a prospective observational study. Methods. We retrospectively reviewed data on 112 subjects who had received repeated TFESIs for cervical Radicular Pain. Twenty-nine of those 112 patients continued to complain of persistent cervical Radicular Pain, despite an average of three repeated TFESIs. Among 29 patients with sustained arm Pain of over 4 on the numerical rating scale (NRS), a total of 21 patients were included prospectively. Those 21 patients underwent PRF on the symptomatic cervical DRG and were evaluated carefully for neurologic deficits and side effects. The clinical outcomes were measured via NRS for arm Pain before treatment, and 1, 3, 6, and 12 months after treatment. Successful Pain relief was defined as a 50% or more reduction in the NRS score as compared with the pretreatment score. After 12 months, patients' satisfaction levels with treatment were determined. Results. Fourteen of the 21 patients (66.7%) after cervical PRF stimulation reported Pain relief of 50% or more at the 3-month and 12-month follow-up periods, respectively. Fifteen of the 21 patients (71.4%) were satisfied with their outcome at 12 months' posttreatment. No serious adverse effects were observed. Conclusion. Application of PRF to the DRG appears to be an effective and relatively safe intervention technique for chronic cervical Radicular Pain refractory to repeated TFESIs.
-
Short-Term Effects of Pulsed Radiofrequency on Chronic Refractory Cervical Radicular Pain
Annals of Rehabilitation Medicine, 2011Co-Authors: Gyu Sik ChoiAbstract:Objective To evaluate the short-term effectiveness of pulsed radiofrequency on the dorsal root ganglion (DRG) in patients with chronic refractory cervical Radicular Pain.
