Are cervical nerve root blocks "safe and effective"?
Explore the source record for details and available documents.
Cervical Vertebrae↗
Biomedical subjects
Craig Kornick
Publications and source records attributed to Craig Kornick.
Complications of lumbar facet radiofrequency denervation.
STUDY DESIGN: Retrospective. OBJECTIVE: To assess the incidence of complications associated with fluoroscopically guided percutaneous radiofrequency denervation of the lumbar facet joints. SUMMARY OF BACKGROUND DATA: Based on the results of previous efficacy studies, complications associated with facet joint radiofrequency denervation procedures appear to be rare. No formal safety assessment for this procedure has been performed to date. METHODS: We conducted retrospective chart reviews to identify complications that occurred within 8 weeks of facet joint radiofrequency denervation procedures performed at the Mayo Clinic in Jacksonville during a 5-year period. Only procedures that included radiofrequency electrode placement between the L1 transverse process and the sacral ala were included. The chart of each patient was reviewed and adjudicated by a panel of 4 physicians before being classified as a complication. RESULTS: Ninety-two patients received a total of 616 radiofrequency lesions during 116 separate denervation procedures. An average of 5 +/- 3 lesions were performed during each radiofrequency denervation procedure. Six minor complications were identified, yielding a 1.0% overall incidence of minor complications per radiofrequency site. Complications included: 3 cases of localized pain lasting more than 2 weeks (0.5%) and 3 cases of neuritic pain lasting less than 2 weeks (0.5%). No cases of infection, new motor deficits, or new sensory deficits were identified. CONCLUSIONS: Fluoroscopically guided percutaneous radiofrequency denervation of the lumbar facets is associated with an overall 1.0% incidence of minor complications per lesion site.
Aged↗
Pitfalls of opioid rotation: substituting another opioid for methadone in patients with cancer pain.
The successful use of methadone in cancer pain has been supported by numerous case reports and clinical studies. Methadone is usually used as a second or third line opioid medication. As the use of methadone increases we are facing the challenge of converting methadone to other opioids as part of sequential opioid trials. Data on the equianalgesic ratios for the substitution of other opioids for methadone are lacking. We present prospective data on 13 consecutive rotations from methadone to a different opioid. The opioid rotation was followed by escalation of pain and/or severe dysphoria, not controlled by a rapid increase in the dose of the second opioid, in 12 of the 13 patients. Only one patient was successfully maintained on the second opioid after the discontinuation of methadone, while 12 patients required a switch back to methadone. We conclude that opioid rotation from methadone to another opioid is often complicated by worsening pain and dysphoria. These symptoms may not improve despite upward titration of the second opioid. A uniformly accepted conversion ratio for substituting methadone with another opioid is currently not available. More data on the rotation from methadone to other opioids are needed.
Adult↗
Olanzapine in the management of cancer pain.
In cancer patients, cognitive impairment, psychological distress, and anxiety may accompany and aggravate pain. Neuroleptics are frequently used to control these symptoms and may be used to treat pain that has been unresponsive to more conventional approaches. Because of prominent side effects of traditional neuroleptics and conflicting data regarding their analgesic efficacy, their use in the treatment of pain remains controversial. Olanzapine, an atypical neuroleptic, might offer advantages because of its safer side effect profile. It has also been shown to have an independent antinociceptive activity in animals. The use of olanzapine in the management of cancer pain has not been previously described. We prospectively collected the data on 8 cancer patients with severe pain, uncontrolled in spite of aggressive opioid titration, who received olanzapine to treat severe anxiety and mild cognitive impairment. Patients did not meet criteria for delirium and their cognitive impairment was defined as cognitive disorder not otherwise specified (NOS) according to DSM-IV. Patients received 2.5 to 7.5 mg of olanzapine daily. In all patients, opioid requirements had escalated rapidly prior to starting olanzapine. Levels of pain, sedation, and opioid use were measured 2 days before and 2 days after olanzapine was started. Cognitive state was assessed daily. All 8 patients had marked reduction of the daily pain scores. The average daily opioid use decreased significantly in all patients. Cognitive impairment and anxiety resolved within 24 hours of initiating olanzapine. In these 8 patients, decreased pain scores and opioid requirements may have resulted from improvement in cognitive function and the known anxiolytic effect of olanzapine. Other mechanisms may include independent or adjuvant analgesic effects of olanzapine. We conclude that olanzapine may be useful in the treatment of patients with uncontrolled cancer pain associated with cognitive impairment or anxiety. Further studies to evaluate possible analgesic effect of olanzapine are needed.
Adolescent↗