http://www.donlinlong.com/diagnosticcenter/tarlovcysts.html a Paragraph from the above Link from Dr Long
The history of Tarlov cysts is quite interesting. Tarlov first thought they did not cause symptoms, but by the 1950’s he had identified patients with these cysts who could be cured by surgery, and other surgeons began to report the same kinds of patients successfully treated by surgery. Over the next 50 years or so, there have been a number of reports of individual patients and small groups of patients benefited significantly by surgical repair of symptomatic cysts. For reasons which are unclear from the literature, the mythology has grown up over the past 20 years that these cysts never cause symptoms. There is no paper which I can find published in the medical literature which supports this statement. However, two generations of physicians have been taught that these cysts do not cause symptoms and radiologists often make the statement that the cysts do not cause symptoms in their reports without any knowledge of the individual patient. How this all came about in the absence of any papers supporting the position is uncertain. It is true that many cysts occur in patients without symptoms. However, it is equally true that some cysts are symptomatic, injure nerves, and can cause serious neurological deficits with time. The key issue is to determine when the cysts are symptomatic and when they are not. It is the experience from many reports that some of these cysts are symptomatic and can be successfully treated. These cysts occur most frequently in women,7-9 to 1.
Friday 28 February 2014
Thursday 27 February 2014
Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080496/
a couple Paragraph from the article the Full article in above link xx sharon xxsoft hugs xx
a couple Paragraph from the article the Full article in above link xx sharon xxsoft hugs xx
The second category of patients is those with chronic non-malignant pain, for example, failed low back surgery syndrome. The use of intrathecal drug delivery systems in chronic non-malignant pain is more controversial. One has to recognize that chronic non-malignant pain is complicated by physical, psychological, and behavioral factors. To be successful, a treatment must include a multidimensional approach that takes into account each of the elements of the biopsychosocial model. Clearly, treatment for chronic pain should consider conservative approaches before more invasive treatments are considered. These approaches include but are not limited to physical therapy and rehabilitation, psychological and behavioral intervention such as self-relaxation cognitive and behavioral therapies (eg, biofeedback), pharmacotherapy, minimally invasive interventions (such as epidural and transforaminal injections), and alternative therapies such as acupuncture.
Intrathecal drug delivery systems are implanted for chronic pain when conservative therapies have failed, surgery is ruled out, no active or untreated addiction exists, psychological testing indicates appropriateness for implantable therapy, medical contraindications have been eliminated (coagulopathies, infections), and a successful intrathecal drug trial has been completed (22).
Intrathecal pumps
Intrathecal pumps deliver small doses of medication directly to the spinal fluid. It consists of a small battery-powered, programmable pump (Figure 1) that is implanted under the subcutaneous tissue of the abdomen and connected to a small catheter tunneled to the site of spinal entry (Figure 2). Sophisticated drug dose regimens can be instituted. Implanted pumps need to be refilled every 1 to 3 months. There is no evidence showing whether it is more clinically effective to use bolus or continuous dosing. injury
Neurologic injury can result from the actual catheter placement, as well as from an inflammatory response that occurs at the catheter tip and is associated with drug delivery.
The implantation of spinal catheters for intrathecal drug delivery is done under fluoroscopy. The catheters are inserted through a spinal needle into the spinal canal. Damage to the nerve roots or the spinal cord itself during catheter insertion could occur, resulting in pain, sensory loss, and/or weakness. The deficits would present in the dermatomal distribution of the damaged nerve root. Damage to the spinal cord would lead to dysesthesias or myelopathies below the level of the damaged spinal cord. Also, intraparenchymal injury can occur (42,43), as well as cauda equina syndrome with pain, sensory loss, weakness, and bowel and bladder dysfunction. The deficits would present in multiple dermatomes in a saddle distribution. Neurologic injury can also develop later. One patient developed progressive necrotic myelopathy leading to paraplegia, a rare form of transverse myelitis (44). It is important for the surgeon to obtain pre-operative CT or MRI to check for canal stenosis, arachnoiditis, or other intraspinal abnormalities that would make insertion of the catheter more difficult.
Study Questions Use of Steroids in Spinal Shots
Study Questions Use of Steroids in Spinal Shots
Another study is raising questions about the value of epidural steroid injections. New research at the Johns Hopkins University School of Medicine suggests that it may not be the steroids in spinal shots that provide relief from lower back pain, but the introduction of any fluid – even just saline solution — in the space around the spinal cord.
In recent decades, epidural steroid injections (ESI) have become one of the most common treatments for back pain, with nearly 9 million spinal injections in the U.S. in 2011. Studies have shown the procedure often gives only short term pain relief and have high failure rates for conditions such as sciatica.
In addition, questions have also been raised about the safety of steroids, particularly after a fungal meningitis outbreak caused by contaminated steroids killed 64 people and sickened hundreds in 2012. Steroid injections have also been found to increase the risk of spinal fractures.
Johns Hopkins anesthesiologist Steven Cohen, MD, and his colleagues reviewed dozens of published studies on epidural steroid shots and found something unexpected. Epidural injections of any liquid — such as saline solution or a local anesthetic like Lidocaine — work just as well as steroids.
“Just injecting liquid into the epidural space appears to work,” says Cohen, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. “This shows us that most of the relief may not be from the steroid, which everyone worries about.”
The Johns Hopkins review covered medical records of over 3,600 patients from 43 studies comparing ESI’s to other sorts of epidural and intramuscular injections. The Johns Hopkins study is being published in the October issue of the journal Anesthesiology.
The researchers say they’re not recommending that patients stop receiving epidural steroids, but their analysis suggests that smaller steroid doses could be just as beneficial.
“Our evidence does support the notion that, for now, reducing the amount of steroids for patients at risk may be advisable,” said lead author Mark Bicket, MD, an anesthesiology and critical care medicine chief resident at The Johns Hopkins Hospital.
Cohen says the new analysis also raises questions about the value of many clinical studies on epidural steroid injections, because saline or anesthetic injections were commonly used as a placebo treatment during the studies.
“It’s likely that those studies were actually comparing two treatments, rather than placebo versus treatment,” Cohen said. “Researchers may be wasting millions of dollars and precious time on such studies.”
Patient advocates say the Johns Hopkins study ads to the growing body of evidence that epidural steroid injections can be risky.
“ESI’s are dangerous and overused, and a lot of new studies are coming out that state this,” said Walt Davis, who has suffered from back pain for 30 years and is a patient advocate for theArachnoiditis Society for Awareness and Prevention (ASAP).
“I am not saying that all ESI’s are bad. There is a very small patient population that actually benefit from their use, but that percentage is as low as 20 percent, and even those that might benefit still run the very real risk of complications like arachnoiditis,” Davis wrote in an email toNational Pain Report.
“And honestly, I have had well over 20 epidural injections, and the very first one caused my pain to get worse. None of them ever relieved any pain ever. I had blown disks and a fractured spine. The placebo effect is a very real factor here, if you tell a patient that it will help, then to some it does.”
Davis and Terri Anderson, another patient advocate for ASAP, believe any type of injection into the spinal area is risky and can cause complications. One of the most severe is arachnoiditis, an inflammation of the spinal membrane that they both suffer from.
“I had a ruptured lumbar disc and the dozens of ESI’s that I endured never ever helped me to avoid back surgery, in fact I believe they screwed up the surgical results, as the surgeon reported to me that the nerve rootlets ‘were a mess’ following dozens of steroid injections,” Anderson said.
Wednesday 19 February 2014
Rare Disease Day Worldwide
Hi everyone
Click on any link and you can find out what might be happening for Rare disease day near you,
Maybe you could attend, or even send some information to the organisers of the event,
Love Sharon xx soft hugs xx
The USA joined Rare Disease Day in 2009 with participation from NORD, the National Organization for Rare Disorders, making the campaign a truly international affair. Diverse events and campaigns have been organised since then, including a collection of photographs with the Rare Disease logo across the USA, “Handprints across America”, and educational programmes in schools. In 2013 President Barack Obama sent a letter proclaiming his support of the day.
NORD, the National Organization for Rare Disorders, is committed to the identification, treatment, and cure of rare diseases through programmes of education, advocacy, research and patient services. They can be contacted directly to help you find a patient organisation locally which may have more information about a specific rare disease or disorder. Find their contact information on the bottom of this page.
Below you will find more information about what is happening in 2014 for Rare Disease Day along with contact information of the organisations holding the event. You can also get involved! Let us know if you know of any events that are not listed here. Write to us at rarediseaseday@eurordis.org.
Rare Disease Dayin Canada
Patient organisations in Canada have engaged in Rare Disease Day since its first year in 2008, arranging gala dinners and exchanges between researchers and patients, as well as regional events across Canada.
The Canadian National Alliance, the Canadian Organization for Rare Disorders (CORD), serves as the voice for the estimated 1 in 12 Canadians affected by a rare disease. They can be contacted directly to help you find a patient organisation locally which may have more information about a specific rare disease or disorder. Find their contact information on the bottom of this page.
Below you will find more information about what is happening in 2014 for Rare Disease Day along with contact information of the organisations holding the event.
You can also get involved! Let us know if you know of any events that are not listed here. Write to us at rarediseaseday@eurordis.org.
You can also get involved! Let us know if you know of any events that are not listed here. Write to us at rarediseaseday@eurordis.org.
Subscribe to:
Posts (Atom)