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Thoracic radiofrequency ablation
Thoracic spine pain is a relatively common condition. Pain in this region may be attributable to dysfunction of the thoracic facet joint. The true prevalence of thoracic facet pain remains somewhat elusive. Although challenging to diagnose at times, this joint is amenable to several therapeutic options. Radiofrequency neurotomy and thoracic medial branch blocks are normally used to treat facetogenic pain originating in the thoracic spine. Although demonstrating promise, larger, robustly designed trials are needed to further elucidate the appropriate treatment of this disorder. (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - December 11, 2016 Category: Anesthesiology Authors: Mehul J. Desai Source Type: research

Technical aspects of conventional and water-cooled monopolar lumbar radiofrequency rhizotomy
Radiofrequency ablation (RFA) is a safe and effective pain therapy with efficacy principally reliant upon induced thermal damage of neural sensory afferents. Most peripheral RFA involves induced axonal damage but cell bodies may be involved indirectly. Radiofrequency electrodes (RFE) are not simple high-temperature probes and better insight regarding RFE function from an electrical engineering viewpoint may improve clinical outcomes by reducing the risk of poor or inadequate heating of the target nerves. (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - December 8, 2016 Category: Anesthesiology Authors: Richard D. Ball Source Type: research

Radiofrequency ablation of splanchnic nerves for control of chronic abdominal pain
Chronic abdominal pain is a complex physical and psychological problem that requires comprehensive treatment options tailored to the needs of patients. Splanchnic nerve blocks and radiofrequency denervation of greater and lesser splanchnic nerves may provide prolonged treatment effect that still needs to be studied in a randomized prospective fashion. Here we describe improved fluoroscopy-guided technique for the radiofrequency ablation of splanchnic nerves, details on approach, technique, and potential complications. (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - December 8, 2016 Category: Anesthesiology Authors: Leonardo Kapural Source Type: research

Basic science of regenerative biology and application to regenerative medicine: Past, present, and future
The concept of tissue regeneration is ancient; the earliest known written reference to it is found in Hesiod ’s Theogony. Prometheus’ liver regenerated after being consumed. This type of tissue regeneration is known as regenerative hypertrophy. Regenerative biology advanced significantly in the 18th and 19th centuries and it was during this period that the first reference to the term “stem cell” wa s recorded; however, the term was used significantly differently than the definition it contains today (a clonal entity able to self-renew and displays asymmetric division). (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - December 4, 2016 Category: Anesthesiology Authors: David B. Harrell Source Type: research

Regenerative medicine: Invigorating pain management practice
After decades of basic research, regenerative medicine is entering the clinical realm, becoming one of the most innovative and extraordinary trends in medicine today. A key factor that has made this transition possible is a new understanding of the mechanisms of tissue repair. In the past, adequate tissue restoration was believed to require primarily the presence of polypotent cellular material. Recently, however, the role of mesenchymal stem cells (MSCs), which are highly important in tissue regeneration, was found to differ substantially from what was initially taught. (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - December 1, 2016 Category: Anesthesiology Authors: Dmitri Souzdalnitski Tags: EDITORIAL Source Type: research

Cervical spine pain related to the facet joints
Neck pain is a common diagnostic entity, with a lifetime prevalence of between 65% and 80%. Appreciation of the role of the cervical facet joints in the etiology of cervical spine pain is paramount to providing sustained pain relief for individuals suffering from degenerative and posttraumatic neck pain. Studies have demonstrated that approximately 60% of patients who sustain whiplash-type rear-end motor vehicle collisions would have pain that results from the facet joints alone, or in conjunction with the cervical intervertebral disks. (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - December 1, 2016 Category: Anesthesiology Authors: Kenneth D. Candido, Bryant England Source Type: research

Radiofrequency strategies to target peripheral large joint orthopedic pain
Partial neurotomy of painful large joints may be accomplished by radiofrequency (RF) lesioning of the articular branch innervation of these joints. Successful RF lesions of the knee and the hip are clinically useful procedures whose success depends upon the knowledge of articular branch neuro anatomy and the practitioner ’s optimized choice of RF probe for the procedure. Although clearly indicated for patients who may not be medically suitable for arthroplasty, the procedures may be invaluable in preserving functional mobility and providing non-opiate pain relief for many patients with articular pain including tho se wit...
Source: Techniques in Regional Anesthesia and Pain Management - November 30, 2016 Category: Anesthesiology Authors: Jeffrey D. Petersohn Source Type: research

Introduction
In preparing this issue, the overarching purpose was not to provide a comprehensive review of radiofrequency (RF) lesioning techniques nor to summarize the burgeoning literature in the field in order to battle with the arrogant parties who insist that the efficacy of every interventional technique must be proven by large multiple randomized controlled trials before it can be used. Regrettably, there are simply insufficient resources to prove that all interventional RF procedures are efficacious, and as Dr Nik Bogduk is fond of quoting, “Absence of proof is not the proof of absence.” So, instead of focusing on the exter...
Source: Techniques in Regional Anesthesia and Pain Management - November 30, 2016 Category: Anesthesiology Authors: Jeffrey D. Petersohn Source Type: research

Treatment of annular disc tears and “leaky disc syndrome” with fibrin sealant
The surfaces of annulus fibrosus tears are known harbingers of inflammatory constituents within intervertebral discs, stimulating sensitized nocioceptors within those tears. Other current treatment options of internal disc disruption neglect to specifically address the surface of these tears. Therefore, this investigation answers the question: does nonautologous fibrin sealant applied to the surface of annulus fibrosus tears mechanically glue and seal annular tears? Regarding this query, results suggest nonautologous concentrated fibrin successfully seals annulus fibrosus tears with a “suture-like mechanical sealant,” ...
Source: Techniques in Regional Anesthesia and Pain Management - November 23, 2016 Category: Anesthesiology Authors: Kevin Pauza, Carrie Wright, Adam Fairbourn Source Type: research

Current understanding of safety and efficacy of stem cell therapy for discogenic pain —A systematic review of human studies
This study is a systematic review of human clinical studies of stem cell therapy for discogenic pain. To summarize the current human trials and feasibility studies involving mesenchymal stem cell (MSC) therapy for treatment of discogenic pain. A search of Ovid databases and Clinicaltrials.gov was conducted from inception through July 2016. We included human clinical trials and case reports that evaluated treatment with injected MSCs for patients with discogenic back pain. The outcomes of interest for published studies included pain score, Oswestry Disability Index, and T2-weighted magnetic resonance imaging signal intensit...
Source: Techniques in Regional Anesthesia and Pain Management - November 21, 2016 Category: Anesthesiology Authors: Christine L. Hunt, Stephanie Shen, Ahmad Nassr, Andre J. van Wijnen, A. Noelle Larson, Jason S. Eldrige, William D. Mauck, Mathew J. Pingree, Patricia J. Erwin, Mohamad Bydon, Wenchun Qu Source Type: research

Bone marrow concentrate and platelet-rich plasma acquisition and preparation: Why technique matters
Current best practices in regenerative medicine use cell and platelet preparations derived from a patient ׳s blood or bone marrow aspirate, concentrated at the point of care, and returned to the patient during a single surgical or clinical event. As a field in its infancy, there is great confusion among many physicians, patients, regulatory agencies, and the media about what these therapies represent, their safety and efficacy, and how they are properly administered. Advances in bone marrow aspiration technique and concentration technologies have resulted in consistent significant increases in mesenchymal stem cell conten...
Source: Techniques in Regional Anesthesia and Pain Management - November 20, 2016 Category: Anesthesiology Authors: Matthew B. Murphy, Jessica A. Terrazas, Don A. Buford Source Type: research

Regenerative medicine for muscle and ligament problems: Technical aspects and evidence
Interest in regenerative medicine for treating musculoskeletal pathology has grown tremendously over the past decade. Part of its appeal lies in the ability to use a patient ׳s own cells to potentially heal acute and chronic injuries. While evidence grows supporting its use in certain injuries, a perception exists that regenerative medicine may be a panacea. In this article, we review the evidence for platelet-rich plasma and bone marrow aspirate concentrate in treatin g muscle, ligament, and fibrocartilage injuries. (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - November 20, 2016 Category: Anesthesiology Authors: Sean Colio, Matthew McAuliffe, Yvette Uribe, Marko Bodor Source Type: research

Interventional orthopedics in pain medicine practice
Interventional pain physicians are in a unique place to take advantage of regenerative medicine technology to improve patient outcomes and decrease the invasiveness of orthopedic procedural care. However, that sea of change would take significant changes to the educational system similar to those established when interventional spine was first introduced as a subspecialty. The tenets of interventional orthopedics are as follows: injectates that can facilitate healing of musculoskeletal tissues, precise placement of those injectates into damaged structures using imaging guidance, and the eventual development of new tools to...
Source: Techniques in Regional Anesthesia and Pain Management - November 17, 2016 Category: Anesthesiology Authors: Christopher J. Centeno, Christopher J. Williams, Matthew Hyzy Source Type: research

Radiofrequency ablation of the sacral lateral branches
The objective of this article is to recommend an approach to radiofrequency ablation (RFA) of the sacral lateral branches that is safe, effective, and simple to perform. To do so, one must identify the proper patient, perform a diagnostic block to confirm the sacroiliac joint as the pain generator, and then, after 2 successful blocks, move to RFA of the sacral lateral branches as the next step in treatment. The choice of an RFA technique is controversial. Here, an argument is made for moving to bipolar RFA of the lateral branches of S1-S3. (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - November 17, 2016 Category: Anesthesiology Authors: Bruce Vrooman, Victor Foorsov Source Type: research

Regenerative medicine modalities for nondiscal spinal disorders
Regenerative medicine has demonstrated to have significant positive clinical outcomes. Its applications to multiple conditions, and potential for a healing result has caused some patients to seek out regenerative treatment options rather than considering surgical interventions once other conservative and interventional options have not been successful. In particular to the spine, much of the literature and attention has been on discogenic pain in the spine, followed by sacroiliac joint pain or syndrome. (Source: Techniques in Regional Anesthesia and Pain Management)
Source: Techniques in Regional Anesthesia and Pain Management - November 15, 2016 Category: Anesthesiology Authors: Steve M. Aydin Source Type: research