Methods In a randomized, double-blind trial, we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80°C with a control treatment using an identical procedure except that the radio-frequency current was not turned on. We studied 24 patients (9 men and 15 women; mean age, 43 years) who had pain in one or more cervical zygapophyseal joints after an automobile accident (median duration of pain, 34 months). The source of their pain had been identified with the use of double-blind, placebo-controlled local anesthesia. Twelve patients received each treatment.

In a randomized, double-blind trial, we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the. Textbook Of Neurology For Physiotherapists has 12 ratings and 1 review. Download Album The Best Anggun C Sasmi on this page.

The patients were followed by telephone interviews and clinic visits until they reported that their pain had returned to 50 percent of the preoperative level. Chronic neck pain after whiplash injury has defied diagnosis and treatment. The Quebec Task Force on Whiplash-Associated Disorders found almost no literature to substantiate the use of commonly practiced treatments for this condition.

In about half of patients with chronic neck pain of this type, the pain originates in the cervical zygapophyseal joints. It cannot be diagnosed clinically or radiographically but can be identified by using local anesthesia to block the nerves supplying the painful joint. However, treatment has remained problematic. A controlled trial showed that intraarticular injections of corticosteroids offer no particular benefit. The only other treatment that has been advocated is percutaneous radio-frequency neurotomy. This operation offers temporary relief of pain by denaturing the nerves that innervate the painful joint. The pain returns when the axons regenerate, but relief can be reinstated by repeating the procedure.

The Hare Psychopathy Checklist Revised Pdf Download. Previous studies of percutaneous radio-frequency neurotomy have been hampered by poor selection of patients, inaccurate techniques, poor outcome measures, and the lack of controls. We report the results of a controlled trial of the procedure.

Study Patients We conducted this study at the Cervical Spine Research Unit, a tertiary referral center at the Mater Misericordiae Hospital in Newcastle, Australia, that treats only patients with neck pain lasting more than three months after the motor vehicle accident to which the pain is attributed. To enter the study, the patients had to have already been assessed by a specialist, had to have tried conventional therapy without success, and had to have been referred by a medical practitioner. Conventional therapy typically involved using some combination of analgesics, nonsteroidal antiinflammatory drugs, opioids, physiotherapy, traction, acupuncture, chiropractic, transcutaneous electrical nerve stimulation, locally applied heat, and exercise. The study patients were selected from among patients whose cervical zygapophyseal-joint pain had been confirmed with the use of local anesthetic blocks at either the unit or a private radiology practice in Newcastle. Patients with c2–3 zygapophyseal-joint pain were excluded, because the pilot study had shown that treatment at this level by radio-frequency neurotomy was technically difficult.

Patients with painful c3–4 to c6–7 zygapophyseal joints were included. To be eligible for the trial, patients had to have their perception of pain confirmed by placebo-controlled, diagnostic blocks. Free Download Adobe Photoshop Cs3 Portable Full Version.

For such confirmation to be made, each patient underwent three blocks of the medial branches of the two dorsal rami supplying the putatively symptomatic joint. On the first occasion, one of two local anesthetics (2 percent lidocaine or 0.5 percent bupivacaine) was randomly used. On the second occasion, either normal saline or the other local anesthetic was used. On the third occasion, the agent that was not used in the second test (that is, normal saline or the remaining anesthetic) was used. All the blocks were performed under strict double-blind conditions, with the use of a lateral approach guided by an image intensifier, and with 0.5 ml of the assigned agent.