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Steroid Injection (steroid + injection)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Pain Medicine	32%
Dermatology	14%

Kinds of Steroid Injection

epidural steroid injection

intralesional steroid injection

Selected Abstracts

Treatment of a Recurrent Auricular Pseudocyst with Intralesional Steroid Injection and Clip Compression Dressing

DERMATOLOGIC SURGERY, Issue 2 2009
TAE YOON KIM MD
No abstract is available for this article. [source]

Epidural Steroid Injection,How Should the Indications for Use be Derived: Systematic Review or Basic Science?

PAIN PRACTICE, Issue 3 2009
Craig T. Hartrick MD, FIPP Editor in Chief, Pain Practice Editorial Board
No abstract is available for this article. [source]

The "Swimmer's View" as Alternative When Lateral View Is Inadequate During Interlaminar Cervical Epidural Steroid Injections

PAIN MEDICINE, Issue 5 2010
Arjang Abbasi DO
Abstract Objective., To present a technique that better visualizes the needle during interlaminar cervical epidural steroid injection (ICESI) in patients where the lateral view is inadequate. Design., Case report. Setting., Private group practice. Subject., A 57-year-old morbidly obese male presenting for ICESI for left neck and upper limb pain after a motor vehicle accident. Magnetic resonance imaging revealed left C6-7 herniated nucleus pulposis and C4-5 osteophytic disc-ridge complex. Electrodiagnostic evaluation revealed activity consistent with a left C7 radiculopathy. Intervention., Left C7-T1 ICESI. Needle was obscured in the lateral view by the patient's shoulders. Needle was made visible by positioning the patient for Swimmer's view. Results., Full resolution of symptoms without associated complications. Conclusions., Grave complications have been associated with ICESI necessitating impeccable and systematic technique with substantial knowledge of anatomy. Although injection at lower levels is advocated for safety concerns, the needle during lateral view may be obscured by the shoulders in some patients. The "Swimmer's View" position may be attempted when lateral view is insufficient to visualize needle during ICESI. [source]

Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance

JOURNAL OF CLINICAL ULTRASOUND, Issue 1 2006
Wen-Chung Tsai MD
Abstract Purpose To compare the effectiveness of sonographically guided and palpation-guided steroid injection for the treatment of proximal plantar fasciitis. Patients and Methods Twenty-five consecutive patients with unilateral proximal plantar fasciitis were recruited and randomly divided into a sonographically guided group (n = 12) and palpation-guided group (n = 13). Proximal plantar fascia was assessed with a 5- to 12-MHz linear-array transducer. Pain intensity was quantified using a "tenderness threshold" (TT) and a visual analog scale (VAS). Injection of 7 mg (1 ml) of betamethasone and 0.5 ml of 1% lidocaine into the inflamed proximal plantar fascia was performed under the guidance of sonography or palpation. Patients were evaluated clinically and sonographically before injection and at 2 weeks, 2 months, and 1 year after injection. VAS- and TT-measured pain intensity, thickness, and echogenicity of the proximal plantar fascia, as well as the recurrence of heel pain, were assessed. Results Both VAS- and TT-measured levels of pain improved significantly after steroid injection in both groups (p < 0.001). Also, the thickness decreased significantly after injection (p < 0.01 in the palpation-guided group; p < 0.001 in the sonographically guided group). The number of patients with hypoechogenicity at the proximal plantar fascia decreased after steroid injection in both groups (p < 0.01 for both groups). The recurrence rate of plantar fasciitis in patients of the palpation-guided group (6/13) was significantly higher than that of the sonographically guided group (1/12) (p < 0.05). Conclusions Steroid injection can be an effective way to treat plantar fasciitis, and injection under sonographic guidance is associated with lower recurrence of heel pain. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound34:12,16, 2006 [source]

Steroid injection in addition to macular laser grid photocoagulation in diabetic macular oedema: a systematic review

ACTA OPHTHALMOLOGICA, Issue 4 2010
Daan Steijns
Abstract. Objectives:, This study aimed to evaluate the evidence for the effects of steroid injection in addition to macular laser grid (MLG) photocoagulation versus those of MLG photocoagulation alone on visual acuity (VA) in patients with diabetic macular oedema (DMO). Methods:, An extensive literature search in Medline (PubMed), Experta Medica (EMBASE) and the Cochrane Library (CENTRAL) using synonyms for MLG photocoagulation, steroid injection and DMO found 181 articles. Of the articles that met selection criteria, three studies in which patients receiving MLG photocoagulation were randomized to additional pretreatment with steroids provided the best available evidence. In addition to VA, central foveal thickness (CFT) was measured at baseline and at 6 months in all three studies. Results:, Two studies, with total populations of 73 and 42 eyes, respectively, reported no additional effect of steroid injection on VA. One study, with a total of 41 eyes, reported a beneficial effect of pretreatment with steroids on VA of , 0.21 ETDRS logMAR units. All three studies reported larger reductions in CFT in eyes pretreated with steroids, the smallest of which was 64 ,m. Conclusions:, Although there is a greater reduction in CFT in eyes pretreated with steroids, this does not consistently result in higher VA. The literature search does not provide sufficiently strong evidence to recommend steroid injection before MLG photocoagulation in DMO. [source]

Prospective randomised single blind study of epidural steroid injection comparing triamcinalone acetonide with methylprednisolone acetate

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 1 2005
A. ANWAR
Abstract Aim:, This study aims to assess the effectiveness of epidural steroid injection as well as comparing two agents commonly used in these procedures, namely triamcinalone acetonide and methylprednisolone acetate. Method:, Twenty subjects were recruited into each group receiving either agent. Results:, Overall result showed that there were marked improvement in symptoms in both agents but there were no differences in terms of superiority from one agent to another. Conclusion:, Epidural steroid injection is effective and both agents are equipotent. [source]

Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance

The "Swimmer's View" as Alternative When Lateral View Is Inadequate During Interlaminar Cervical Epidural Steroid Injections

Periradicular infiltration for sciatica: a randomized controlled trial. (University Hospital of Oulu, Helsinki, Finland).

PAIN PRACTICE, Issue 4 2001
Spine.
In this study, 160 consecutive, eligible patients with sciatica who had unilateral symptoms of 1 to 6 months duration, and who never underwent surgery were randomized for a double-blinded injection with methylprednisolone bupivacaine combination or saline. Objective and self-reported outcome parameters and costs were recorded at baseline, at 2 and 4 weeks, at 3 and 6 months, and at 1 year. Recovery was better in the steroid group at 2 weeks for leg pain, straight leg raising, lumbar flexion, and patient satisfaction. Back pain was significantly lower in the saline group at 3 and 6 months. Sick leave and medical costs were similar for both treatments, except for cost of therapy visits and drugs at 4 weeks, which were in favor of the steroid injection. By 1 year, 18 patients in the steroid group and 15 in the saline group underwent surgery. Conclude improvement during the follow-up was found in both the methylprednisolone and saline groups. The combination of methylprednisolone and bupivacaine seems to have a short-term effect, but at 3 and 6 months, the steroid group seems to experience a "re-bound" phenomenon. [source]

Intratympanic Dexamethasone for Sudden Sensorineural Hearing Loss After Failure of Systemic Therapy

THE LARYNGOSCOPE, Issue 1 2007
David S. Haynes MD
Abstract Objective: Intratympanic steroids are increasingly used in the treatment of inner ear disorders, especially in patients with sudden sensorineural hearing loss (SNHL) who have failed systemic therapy. We reviewed our experience with intratympanic steroids in the treatment of patients with sudden SNHL to determine overall success, morbidity, and prognostic factors. Hypothesis: Intratympanic steroids have minimal morbidity and the potential to have a positive effect on hearing recovery in patients with sudden SNHL who have failed systemic therapy. Study Design: The authors conducted a retrospective review. Methods: Patients presenting with sudden SNHL defined as a rapid decline in hearing over 3 days or less affecting 3 or more frequencies by 30 dB or greater who underwent intratympanic steroids therapy (24 mg/mL dexamethasone) were reviewed. Excluded were patients with Meniere disease, retrocochlear disease, autoimmune HL, trauma, fluctuating HL, radiation-induced HL, noise-induced HL, or any other identifiable etiology for sudden HL. Patients who showed signs of fluctuation of hearing after injection were excluded. Pretreatment and posttreatment audiometric evaluations including pure-tone average (PTA) and speech reception threshold (SRT) were analyzed. Patient variables as they related to recovery were studied and included patient age, time to onset of therapy, status of the contralateral ear, presence of diabetes, severity of HL, and presence of associated symptoms (tinnitus, vertigo). A 20-dB gain in PTA or a 20% improvement in SDS was considered significant. Results: Forty patients fit the criteria for inclusion in the study. The mean age of the patients was 54.8 years with a range from 17 to 84 years of age. Overall, 40% (n = 16) showed any improvement in PTA or SDS. Fourteen (35%) men and 26 (65%) women were included. Using the criteria of 20-dB improvement in PTA or 20% improvement in SDS for success, 27.5% (n = 11) showed improvement. The mean number of days from onset of symptoms to intratympanic therapy was 40 days with a range of 7 days to 310 days. A statistically significant difference was noted in those patients who received earlier injection (P = .0008, rank sum test). No patient receiving intratympanic dexamethasone after 36 days recovered hearing using 20-dB PTA decrease or a 20% increase in discrimination as criteria for recovery. Twelve percent (n = 5) of patients in the study had diabetes with 20% recovering after intratympanic dexamethasone (not significantly different from nondiabetics at 28.6%, Fisher exact test, P = 1.0). Comparison to other studies that used differing steroid type, concentration, dosing schedule, inclusion criteria, and criteria for success revealed, in many instances, a similar overall recovery rate. Conclusions: Difficulty in proving efficacy of a single modality is present in all studies on SNHL secondary to multiple treatment protocols, variable rates of recovery, and a high rate of spontaneous recovery. Forty percent of patients showed some improvement in SDS or PTA after treatment failure. When criteria of 20-dB PTA or 20% is considered to define improvement, the recovery rate was 27.5%. Modest improvement is seen with the current protocol of a single intratympanic steroid injection of 24 mg/mL dexamethasone in patients who failed systemic therapy. Dramatic hearing recovery in treatment failures was rarely encountered. No patient showed significant benefit from intratympanic steroids after 36 days when using this protocol for idiopathic sudden SNHL. If patients injected after 6 weeks are excluded from the study, the improvement rate increases from 26.9% to 39.3%. Earlier intratympanic injection had a significant impact on hearing recovery, although with any therapeutic intervention for sudden SNHL, early success may be attributed to natural history. If we further exclude seven patients treated with intratympanic steroids within 2 weeks of the onset of symptoms (i.e., study only those patients treated with intratympanic dexamethasone between 2 and 6 weeks after onset of symptoms), still, 26% improved by 20 dB or 20% SDS. The recovery rates after initial systemic failure are higher than would be expected in this treatment failure group given our control group (9.1%) and literature review. These findings indicate a positive effect from steroid perfusion in this patient population. [source]

Management of recurrent anastomotic stenosis following radical prostatectomy using holmium laser and steroid injection

BJU INTERNATIONAL, Issue 7 2008
Ehab Eltahawy
OBJECTIVE To present our experience with the management of recurrent and resistant anastomotic stenosis following radical prostatectomy (RP) using transurethral laser incision of the stenotic area and injection of steroids. PATIENTS AND METHODS Between January 1999 and April 2006, we evaluated 24 patients with anastomotic stenosis that would not allow the passage of the flexible cystoscope (17 F). Using the paediatric 7.5 F Olympus scope and a 550-µm fibre holmium laser, deep incisions were cut at the 3 and 9 o'clock positions at the bladder neck, and then triamcinolone was injected at the incision sites. Another session was then scheduled for office cystoscopy 6 weeks later, and if that showed evidence of annularity, another incision was made, as described above. RESULTS All 24 patients had RP for localized disease, 21 were retropubic and two were perineal, and one laparoscopic. Five patients had adjuvant radiotherapy. The mean patient age was 64 years. Nineteen (79%) patients had previous attempts to open the bladder neck: eight patients had dilatation, eight patients had internal urethrotomy, five patients underwent transurethral resection of the bladder neck, and six patients had open surgical intervention. The procedure was done once in 17 patients, and twice in seven patients. After a mean (range) follow up of 24 (6,72) months, 19 patients (83%) had a well-healed and widely patent bladder neck. Of the 24 patients, 17 had urinary incontinence (UI) associated with the bladder neck contracture. An artificial urinary sphincter was implanted in 11 patients, three of which had to be explanted for malfunction in two, and erosion in one. CONCLUSION Holmium laser bladder neck incision and steroid injection for anastomotic stenosis after RP had a success rate of 83% in this small series. It can be used safely as a primary treatment, or in some cases, for resistant and recurrent stenosis. It appears that insertion of an artificial sphincter can be done in patients with UI when the bladder neck remains patent for at least 8 weeks. [source]

Steroid injection in addition to macular laser grid photocoagulation in diabetic macular oedema: a systematic review

Macular edema in epiretinal membrane and vitreomacular traction

ACTA OPHTHALMOLOGICA, Issue 2009
C CREUZOT
Purpose Macular edema occuring during macular diseases is a frequent situation. The purpose of this course is to highlight the clinical signs and the different treatments which can be used to treat macular edema occuring during epiretinal membrane and vitreomacular traction syndrome. Methods Macular edema is frequently associated with epiretinal membranes and vitreomacular traction. Up to now, no specific preoperative macular edema phenotype can predict the postoperative recovery. Different methods were proposed to improve functional results: ILM peeling, intravitreal steroid injection, intravitreal antiangiogenic injections, Results The widespread use of transconjunctival vitrectomy, the combination of cataract and macular surgeries will probably change the indication of macular surgery leading to sooner surgical indications for better recovery. By contrast, vitreomacular traction often leads to a rapidly progressive visual loss. The analysis should distinguish diffuse diabetic macular edema which remains the only validated surgical indication of macular edema in diabetes and the vitreomacular traction without diabetes. This latter needs a rapid surgical management as macular edema is often severe. Conclusion Macular edema is a frequent situation associated to macular disease. It can compromise the outcomes after macular surgeriy. Attempts to define the best moment to consider surgery should improve the functional results. [source]

Foveal serous detachment in juvenile idiopathic arthritis(JIA)-associated uveitis

ACTA OPHTHALMOLOGICA, Issue 2009
F LIANG
Purpose To characterize the foveal serous detachment(FSD) in JIA-associated uveitis. To investigate the correlation with visual acuity (VA) and ocular inflammation. Methods 9 children having FSD with JIA-associated uveitis were identified between 2005-2007. All were treated with periocular steroid injection and systemic anti-TNF , antibody.Outcome measures included VA,ocular inflammation quantified by laser flare photometry and the macular profile analyzed by OCT. Results All patients(8 female,1 male) had bilateral uveitis and 6 had bilateral SRD. All patients had risk factors to develop severe anterior uveitis. The mean age at the onset of uveitis and at the onset of FSD was 4.1±1.1years and 7.6±2.2years. At the onset of FSD 6 children were refractory to methotrexate and systemic corticosteroids. It had a high frequency of ocular complications:87% posterior synechiae, 80% cataract, 60% band keratopathy and 20% glaucoma.FSD appeared isolated in 21% of eyes,it was associated with diffuse macular edema in 46% and with cystoid macular edema in 12% of cases. Before therapeutic intensification,the mean VA was 0.46logMAR,the mean foveal thickness(FT) was 261,m. At 6 months follow-up:VA increased to 0.22logMAR(p=0.017),the reduction of flare was 41%(p=0.003),the mean FT was 229,m(p=0.59). At 12 months follow-up,the mean VA was 0.19logMAR(p=0.0029),the mean FT was 196,m(p=0.009),only 1 eye showed persistant SRD. Conclusion FSD is a late-stage complication of sustained and insufficiently treated anterior uveitis in JIA-associated uveitis and must be considered for the long-term visual outcome. An agressive immunomodulatory strategy is mandatory in order to achieve strict control of ocular inflammation and improve the visual function. [source]

Capillary haemangioma of the eyelids and orbit: a clinical review of the safety and efficacy of intralesional steroid

ACTA OPHTHALMOLOGICA, Issue 3 2003
Michael O'Keefe
Abstract. Purpose:, To describe the presenting features, investigations, treatment and outcome of a series of patients with capillary haemangioma of the eyelids and orbit. Methods:, A retrospective analysis of 21 patients, presenting between the years 1985 and 2000. Effectiveness of treatment was determined by final visual acuity and cosmetic result. Results:, Lesions were more common in females and the upper eyelid was a definite site of predilection. A total of 87.5% of lesions presented within 6 weeks of birth. Intralesional steroid injections were received by 79% of patients. Amblyopia was a definite complication. No local or systemic complications were associated with intralesional steroid injection. Surgery and laser treatment were reserved for persistent lesions. Conclusion:, Early recognition and prompt treatment with intralesional steroid prevents early occlusion amblyopia, but follow-up and management of refractive amblyopia with glasses and patching is necessary in the longer term. In this series, intralesional steroid proved to be a safe effective treatment. [source]

Cutaneous abscess by Trichosporon asahii developing on a steroid injection site in a healthy adult

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 4 2006
S. J. Yun
Summary We report a rare case of cutaneous abscess by Trichosporon asahii in an immunocompetent adult. A 31-year-old Korean woman presented to our hospital with a cutaneous abscess. She had received an intralesional steroid injection 4 months earlier on the site of a hypertrophic scar. Direct sequencing of the intergenic spacer regions of the rRNA genes identified T. asahii. The decreased local immunity after the steroid injection might have triggered the infection by T. asahii. A cutaneous abscess formation by T. asahii in an immunocompetent patient is an unusual cutaneous finding that to our knowledge has not been reported previously. The local immune reaction of the skin is important for the prevention of Trichosporon infection. [source]

Late intraocular pressure rise following intravitreal triamcinolone injection

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2007
Christopher PR Williams FRCOphth
Abstract Most ophthalmologists are aware of the risk of elevated intraocular pressure developing 1 or 2 months after an intravitreal injection of triamcinolone. However, the two cases reported here demonstrate that such a rise can occur significantly later than this. All patients who have had intravitreal steroid injection should therefore have prolonged intraocular pressure monitoring. [source]

Complications from Injectable Polyacrylamide Gel, a New Nonbiodegradable Soft Tissue Filler

DERMATOLOGIC SURGERY, Issue 12p2 2004
Snehal P. Amin
Background. Polyacrylamide gels, containing a hydrogel composed of polyacrylamide and water, are used for soft tissue augmentation and contour correction. There are no reports of significant complications after injection of this material into the face. Objective. We report an inflammatory reaction after injection of polyacrylamide gels for zygomatic facial augmentation. Methods. A retrospective chart review of single case is presented. Results. An inflammatory reaction at the sites of polyacrylamide gels injection was noted at 1 month after initial injection. Despite two ensuing courses of broad-spectrum antibiotics, the patient presented to us with persistent draining nodules. Intralesional steroid injections resulted in prompt resolution and no recurrence. Conclusion. Inflammatory reactions have been noted in patients receiving polyacrylamide gels for breast augmentation. Facial polyacrylamide gels injections may also be associated with an inflammatory reaction that responds to intralesional steroids. With increasing availability of a variety of soft tissue fillers, dermatologists should be aware of this delayed complication from polyacrylamide gels. [source]

EPIDUROGRAPHY: CHARACTERISTICS OF EPIDURALGRAMS PERFORMED DURING LESI

PAIN MEDICINE, Issue 2 2002
Article first published online: 4 JUL 200
David C. Miller MD, DABPM Woodland Pain Center, Michigan City, IN Fluoroscopically guided, contrast enhanced lumbar epidural steroid injections are commonly performed for persistent or sever lumbar radicular pain. An epiduralgram is a real-time fluoroscopic image of contrast injected into the epidural space prior to the injection of local anesthetic and steroid. This report details the results of one hundred consecutive epiduralgrams. The epidural needle was placed under continuous multiplainer fluoroscopic guidance using ISIS protocol. Three ml. of Omnipaque 300 were injected after initial insertion to obtain the epiduralgram. This was followed by injection of 3 ml. of Celestone diluted with 4 ml. of preservative-free 1% lidocaine to obtain the epiduralgram. The epidural needle was placed at the predetermined spinal level and appropriate side 100% of the time. Needles were successfully placed into the epidural space on the first attempt in 95%. One needle was subarachnoid, one was intra vascular, three were in tissue plains superficial to the epidural space and were apparent only with contrast injection. Three ml. of contrast flowed unilaterally in 74% of lumbar epidural injections. The contrast flowed cephalad only in 20%, caudad only in 28%, and bidirectional in 52%. Contrast spread less than three spinal levels 64% of the time. The desired nerve root was visualized in 62%. Contrast was seen in the ventral epidural space on lateral views 88% of the time. Ventral spread was always fewer levels than the dorsal spread. Epidurography provides essential information for the accurate performance of lumbar epidural steroid injections. One out of every twenty presumed epidural injections were inaccurately placed even by an experienced operator. One out of every fifty was dangerously positioned and identified only by performance of an epiduralgram. [source]

(613) Radiculopathy Treatment Assessment Using Pain Tolerance Test

PAIN MEDICINE, Issue 2 2000
Article first published online: 25 DEC 200
Authors: Y. Eugene Mironer, Carolinas Center for Advanced Management of Pain; Judson J. Somerville, The Pain Management Clinic of Laredo Current measurements of the outcomes of chronic radiculopathy treatment are limited to subjective criteria: level of pain, range of motion, etc. Our previous study showed that nerve conductivity does not correlate well with the intensity of pain after treatment of radiculopathy (1). In the current study we looked at the Pain Tolerance Threshold (PTT) as a possible measurement of the results of radiculopathy treatment. Twenty patients with chronic radiculopathy (13 lumbar and 7 cervical) underwent epidural steroid injections at the level of involvement. Before, and approximately one week after the procedure, we measured PTT in both the involved and contralateral extremity at 3 different frequencies (5Hz, 250Hz, and 2000 Hz) using Neurometer. Level of pain was also assessed using a Visual Analog Scale (VAS). Initial PTT results showed great interpersonal variability. Nearly half of the patients did not show significant differences in PTT between affected and unaffected sides. Of interest, the majority experienced intolerable pain at 2000 Hz stimulation at lower than maximal intensity output, which contradicts previous findings (2). Dynamics of the PTT measurements after treatment did not directly correlate with changes in the level of pain. Nevertheless, in 7 out of 8 patients with low PTT (relative to the unaffected side) it increased significantly, with noticeable decrease of VAS score. Similar results were not found in patients with either normal initial PTT score or minimal improvement of pain. 1. Mironer YE, Somerville JJ The current perception threshold evaluation in radiculopathy: efficacy in diagnosis and assessment of treatment results. Pain Digest 1998;8:37,38. 2. Liu SS, Gerancher JC, Bainton BG, et al. The effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl. Anesth Analg 1996;82:98,102. [source]

(615) Combined Use of Cervical Spinal Cord Stimulator (SCS) and Occipital Nerve Stimulator (ONS)

PAIN MEDICINE, Issue 2 2000
Article first published online: 25 DEC 200
Author: Y. Eugene Mironer, Carolinas Center for Advanced Management of Pain A 51-year-old female patient was referred to the clinic in March 1997 with severe cervicalgia and right shoulder girdle pain. She rated her pain at 9/10 on a Visual Analog Scale (VAS). MRI showed multilevel severe spondylosis with significant neural foraminal stenosis at 3 levels. Multiple modalities of treatment (physiotherapy, epidural steroid injections, cervical plexus blocks) and a variety of medications (opioids, NSAIDs, anticonvulsants, antidepressants, etc.) failed to provide any improvement. The patient twice consulted neurosurgeons but was considered a poor surgical candidate. Finally, in July 1997, after a successful trial, a cervical SCS was implanted with the tip of the lead at level C2, achieving excellent coverage of the pain area. For the next 18 months the patient continued to do well, having minimal neck and shoulder discomfort and using only occasional oral analgesics. However, by January 1999, she developed intractable right-sided occipital neuralgia. Occipital nerve blocks were providing extremely short-term relief and the intake of different analgesics, including opioids, started to increase. In March 1999, after successful trial, an ONS was implanted. Unfortunately, it migrated shortly after implantation and had to be revised and re-anchored. After this procedure all headaches were completely controlled without medications. The patient continues to be very active, uses both stimulators daily, does not take any analgesics and rates her pain at 0/10 to 1/10 on VAS. [source]

MULTIDISCIPLINARY PAIN ABSTRACTS: 12

PAIN PRACTICE, Issue 1 2004
Article first published online: 15 MAR 200
The purpose of this study was to investigate whether selective nerve fiber dysfunction, as assessed by quantitative sensory testing (QST), correlates with the effectiveness of epidural steroid injections (ESI) in patients with lumbar radiculopathy. Twenty patients with unilateral painful sciatica caused by disc herniation participated in this open study. Before ESI, quantitative thermal and mechanical sensory testing was conducted at the most painful dermatome and the contralateral dermatome. The primary outcome measure used was the self-recording of pain intensity twice daily with a 0,10 numerical pain scale (NPS). Secondary efficacy measures included the Short Form of the McGill Pain Questionnaire, the straight leg raising test, and the lumbar range of motion. A significant difference in all types of sensory thresholds between the affected and the contralateral dermatomes was detected at baseline. All outcome measures improved subsequent to the ESI. A significant positive correlation was found between the increase in cold sensation thresholds of the affected dermatome (Adelta-fiber dysfunction) and the improvement in NPS. The increase in touch and vibration thresholds (Abeta-fiber dysfunction) was found to be inversely correlated with the improvement in NPS. No correlation was found between heat sensation thresholds and any of the outcome measures. These results suggest that QST has the potential to be an important tool in the selection of the appropriate treatment for patients with sciatica and may assist in identifying the mechanisms of pain generation in these patients. [source]

Herpes zoster in older adults. (Duke University Medical Center, Durham, NC) Clinical Infectious Diseases.

PAIN PRACTICE, Issue 4 2001
1486., 2001;32:148
Herpes zoster (HZ) strikes millions of older adults annually worldwide and disables a substantial number of them via postherpetic neuralgia (PHN). Key aged-related clinical, epidemiological, and treatment features of zoster and PHN are reviewed in this article. HZ is caused by renewed replication and spread of the varicella-zoster virus (VZV) in sensory ganglia and afferent peripheral nerves in the setting of age-related, disease-related, and drug-related decline in cellular immunity to VZV. VZV-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities in daily living, and reduced quality of life in elderly patients. Recently, attempts to reduce or eliminate HZ pain have been bolstered by the findings of clinical trials that antiviral agents and corticosteroids are effective treatment for HZ and that tricyclic antidepressants, topical lidocaine, gabapentin, and opiates are effective treatment for PHN. Although these advances have helped, PHN remains a difficult condition to prevent and treat in many elderly patients. Comment by Miles Day, M.D. This article reviews the epidemiology clinical features diagnosis and treatment of acute herpes zoster. It also describes the treatment of postherpetic neuralgia. While this is a good review for the primary care physician, the discussion for the treatment for both acute herpes zoster and postherpetic neuralgia do not mention invasive therapy. It is well documented in pain literature that sympathetic blocks with local anesthetic and steroid as well as subcutaneous infiltration of active zoster lesions not only facilitate the healing of acute herpes zoster but also prevents or helps decrease the incidence of postherpetic neuralgia. All patients who present to the primary care physician with acute herpes zoster should have an immediate referral to a pain management physician for invasive therapy. The treatment of postherpetic neuralgia is a challenging experience both for the patient and the physician. While the treatments that have been discussed in this article are important, other treatments are also available. Regional nerve blocks including intercostal nerve blocks, root sleeve injections, and sympathetic blocks have been used in the past to treat postherpetic neuralgia. If these blocks are helpful, one can proceed with doing crynourlysis of the affected nerves or also radio-frequency lesioning. Spinal cord stimulation has also been used for those patients who are refractory to noninvasive and invasive therapy. While intrathecal methylprednisolone was shown to be effective in the study quoted in this article one must be cautious not to do multiple intrathecal steroid injections in these patients. Multilple intrathecal steroid injections can lead to archnoiditis secondary to the accumulation of the steroid on the nerve roots and in turn causing worsening pain. [source]

The present role of corticosteroids in uveitis

ACTA OPHTHALMOLOGICA, Issue 2009
M KHAIRALLAH
Corticosteroids are the most widely used anti-inflammatory and immunosuppressant drugs in ophthalmology in general, and remain the mainstay of therapy for patients with uveitis. An infectious etiology for intraocular inflammation should be adequately excluded or appropriately covered with anti-infectious therapy before administration of corticosteroid therapy. Topical corticosteroids alone are usually effective in the management of anterior uveitis and have little activity against intermediate or posterior uveitis. Ocular adverse effects of topical steroid therapy mainly include ocular hypertension and cataract. The use of periocular steroid injections (subconjunctival, anterior or posterior subtenon, orbital floor) are important modalities in the management of anterior uveitis refractory to topical treatment and intermediate or posterior uveitis, particularly unilateral cases. Systemic corticosteroids remain the initial drug of choice for most patients with severe bilateral intermediate or posterior uveitis. Therapy is initiated with 1.0 to 2.0 mg/Kg of oral prednisone or prednisolone as a single morning dose, followed by a slow taper. Use of intravenous pulse steroid therapy is an important option in acute, severe, bilateral posterior segment inflammation. In several cases, the level of systemic steroid required to control the inflammation is too high and unacceptable. Immunosuppressive drugs as steroid-sparing agents are indicated is such cases. Intravitreal injection of triamcinolone acetonide and slow-release intraocular devices are therapeutic options that can be used in selected uveitis cases refractory to conventional therapy and biologic agents. [source]