Tag: chronic pain

  • Caudal Epidural

    The caudal epidural procedure is a medical treatment commonly used to manage lower back pain. This minimally invasive technique involves injecting an anesthetic and/or steroid medication into the epidural space in the lower back region. By doing so, the medication can help relieve inflammation and pain in the nerves, muscles, and tissues in the area.

    Pulsed radiofrequency (PRF) is a newer technique that can also be used to manage chronic lower back pain. Unlike traditional radiofrequency ablation, which uses high-frequency currents to destroy problematic nerves, PRF instead sends short pulses of electrical signals to the targeted nerves to interrupt and decrease pain signals. PRF has been shown to be a safe and effective way to manage lower back pain, especially in patients who have not responded well to other treatments. In some cases, PRF may be used in addition to a caudal epidural procedure to provide longer-lasting relief of lower back pain.

    I have included some studies about caudal epidural PRF which I have used in my practice with quite good result. 

  • Medial Branch Block and Radiofrequency Ablation

    Medial branch blocks and radiofrequency ablation are two types of procedures used to diagnose and manage pain in the spine, particularly in the back and neck. Medial branch blocks involve the injection of an anesthetic near the medial branches of spinal nerves, which supply sensation to the facet joints. The goal is to temporarily block the pain signals to determine if it is originating from the facet joints. If the test is positive, then radiofrequency ablation may be indicated. This procedure involves the use of radiofrequency energy to destroy the medial branches, thus interrupting the pain signals and providing pain relief for longer periods

    This is a presentation I presented at “Ultrasound and C-Arm Guided Radiofrequency Ablation Pain Management Course” at University Kebangsaan Malaysia in 2022. I summarized and made a step-by-step guide for C-arm medial branch block and RFA.  

  • Common Upper Extremity Pain Syndromes

    Ultrasound guided upper extremity pain refers to the use of ultrasound technology to diagnose and treat pain in the arms, shoulders, and hands. Ultrasound imaging allows for a clear view of the soft tissue, nerves, and blood vessels in the affected area, which can help us accurately identify any issues or injuries.

    Ultrasound guided upper extremity pain procedures can be a quick and effective way to diagnose and treat discomfort in the arms, shoulders, or hands. They are minimally invasive and can be performed in a doctor’s office or outpatient setting.

    This is a presentation I presented at a workshop by Perdatin Nusa Tenggara Barat. It has some basic diagnosis and treatment for common shoulder, elbow and wrist pain syndromes. 

  • Prolotherapy

    Prolotherapy is a type of pain management therapy that involves the injection of dextrose (a type of sugar) and sometimes other substances into injured or painful areas of the body. It is used to treat musculoskeletal pain, such as arthritis, tendinitis, and back pain. The injections are designed to promote the growth and healing of damaged tissue, strengthening and stabilizing joints and reducing pain in the process. Prolotherapy is considered a natural alternative to surgery, and is generally safe and well-tolerated. While it is still considered an emerging therapy, many people have experienced significant pain relief from treatment, often with fewer side effects than traditional pain management approaches.

    Here is my study notes on Prolotherapy

  • Patient Safety for C-Arm Guided Interventional Pain Management

    C-arm guided interventional pain management procedures, such as epidural injections and nerve blocks, can be effective in relieving chronic pain, but they also carry potential risks for patient safety. To minimize these risks, healthcare providers should follow best practices for patient safety.

  • Pain Intervention for Low Back Pain

    This is a presentation I made for an introduction about pain intervention. It has some basic general information about some common low back pain condition and the role of interventional pain management. 

  • Practical Low Back Pain Examination & Diagnosis

    Low back pain is a common problem that affects many people. A thorough examination is important for identifying the underlying cause of the pain. The examination should include taking a detailed history of the patient’s symptoms, including how the pain started, the location of the pain, the duration of the pain, and any related symptoms such as leg pain, numbness or tingling.

    I have summarized some of the most common LBP conditions found in practice: lumbar facet pain, sacroiliac joint pain, discogenic pain, and lumbosacral radicular pain. I hope this can be a practical guide to diagnose the patient’s source of pain. 

  • Genicular Radiofrequency Ablation for Knee Osteoarthritis

    Genicular radiofrequency ablation (GRF) is a minimally invasive procedure used to alleviate pain associated with knee osteoarthritis. The procedure involves targeting specific nerves that transmit pain signals to the knee joint with a small electrode that delivers radiofrequency energy to create heat and destroy the targeted nerves. This can provide long-term relief by interrupting the pain signals to the brain.

    GRF is typically performed as an outpatient procedure, with patients typically experiencing minimal pain or discomfort during and after the procedure. It is considered a safe and effective treatment option for those who have not responded well to other treatments such as medication or physical therapy. However, as with any medical procedure, there are potential risks and complications that should be discussed with a healthcare provider, including infection, bleeding, and nerve damage.

    Overall, GRF provides a promising alternative for those seeking relief from knee osteoarthritis symptoms without the need for invasive surgery.

    This is a topic I presented for a webinar “All You Need to Know About Knee Osteoarthritis” on 16 April 2023, by PERDOSRI JATIM. 

  • Discogenic Lumbar Pain

    Discogenic lumbar pain refers to lower back pain caused by damage or injury to the intervertebral discs, which are the flexible, fibrous cushions that separate each vertebrae of the spine. Discogenic lumbar pain can occur due to degenerative changes to the discs or acute injury, leading to herniation or bulging of the disc. This can put pressure on the nerves in the spinal cord or cause inflammation, leading to pain, stiffness, weakness, and numbness in the lower back, buttocks, and legs. Discogenic lumbar pain often presents as chronic and persistent discomfort that may worsen with movement or physical activity.

    This file is a summary I made from one of the pain textbook “Evidence-based  Interventional Pain Medicine according to Clinical Diagnoses” which I would recommend to anyone interested in pain intervention. I’ve summarized the basic patophysiology, diagnosis and interventional treatment, but the book only covers rami communican block technique. I’ve had many questions asking about intradiscal radiofrequency and injections, which some journals show promising results, I might make some notes on that in the future. 

  • Sacroiliac Joint Pain Diagnosis & Interventional Pain Management

    Sacroiliac joint pain is a common cause of low back pain and can be challenging to diagnose due to its complex anatomy and variable symptoms. A thorough medical history and physical examination, imaging studies, and diagnostic injections are crucial components of a comprehensive evaluation for sacroiliac joint pain. Interventions for the diagnosis and management of sacroiliac joint pain include corticosteroid and anesthetic injections, radiofrequency ablation, and minimally invasive surgical techniques.

    I have made a basic summary for sacroiliac joint pain diagnosis and the interventional pain techniques for intraarticular injection and radiofrequency ablation.

    SIJ Diagnosis & IPM