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Van Zundert J, Vanderdonckt M, Buyse K, Mestrum R, Mesotten D, Van Boxem K. Response to comments on: pulsed radiofrequency treatment of the Gasserian ganglion for trigeminal neuralgia - a retrospective study (PROGRESS). Reg Anesth Pain Med 2023:rapm-2023-104898. [PMID: 37709510 DOI: 10.1136/rapm-2023-104898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Jan Van Zundert
- Dept. of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Dept. of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Matthias Vanderdonckt
- Dept. of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Dept. Of Anesthesiology, Leuven, Leuven, Belgium
| | - Klaas Buyse
- Anesthesiology and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Belgium
| | - Roel Mestrum
- Dept. of Anesthesiology, Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
- Dept of Anesthesiology, Intensive Care and Pain Medicine, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Dieter Mesotten
- Anesthesiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
| | - Koen Van Boxem
- Anesthesiology and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Belgium
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Van Zundert J, Vanderdonckt M, Buyse K, Mestrum R, Mesotten D, Van Boxem K. Pulsed radiofrequency treatment of the Gasserian ganglion for trigeminal neuralgia: a retrospective study (PROGRESS). Reg Anesth Pain Med 2023:rapm-2022-104310. [PMID: 37429618 DOI: 10.1136/rapm-2022-104310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Jan Van Zundert
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthias Vanderdonckt
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Klaas Buyse
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Roel Mestrum
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology, Intensive Care, Pain Medicine Heilig Hart Ziekenhuis, Tienen, Belgium
| | - Dieter Mesotten
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Koen Van Boxem
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Belba A, Vanneste T, Van Kuijk SMJ, Mesotten D, Mestrum R, Van Boxem K, Van Lantschoot A, Bellemans J, Van de Velde M, Van Zundert J. A retrospective study on patients with chronic knee pain treated with ultrasound-guided radiofrequency of the genicular nerves (RECORGEN trial). Pain Pract 2021; 22:340-348. [PMID: 34716965 PMCID: PMC9299475 DOI: 10.1111/papr.13088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Radiofrequency (RF) treatment of the genicular nerves is a promising treatment for chronic osteoarthritic and persistent postsurgical knee pain (PPSP), refractory to conventional medical management. METHODS The RECORGEN study is a retrospective single-center cohort study of patients treated with ultrasound-guided conventional RF of the genicular nerves for chronic knee pain in Hospital Oost-Limburg, Genk from September 2017 to June 2020. Subgroup analysis based on etiology of pain (PPSP and degenerative knee pain) was performed in addition to the total study population analysis. Outcome parameters were global perceived effect (GPE), Numeric Rating Scale for pain, consumption of strong opioids, and safety of the treatment at 6 weeks and cross-sectionally at a variable time point. Treatment success was defined as GPE≥50%. RESULTS Sixty-eight cases were screened of which 59 (46 diagnosed with PPSP and 13 with degenerative knee pain) were included in the study. Treatment success at 6 weeks was achieved in 19 of 59 interventions (32.2%) and was similar in both groups. Seventeen responders were evaluated at follow-up. 45.1% (8/17) continued to have a positive effect at the second time point. The mean duration of effect of the RF treatment was 8.3 months. Safety analysis at 6 weeks and at the second time point showed a good safety profile of the treatment. CONCLUSION Conventional RF of the genicular nerves was clinically successful in more than 30% of the study population refractory to conventional medical management. Overall, the treatment was well tolerated. The mean duration of effect was 8.3 months.
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Affiliation(s)
- Amy Belba
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Thibaut Vanneste
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology & Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dieter Mesotten
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Roel Mestrum
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.,Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Regional Hospital Heilig Hart Tienen, Tienen, Belgium
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
| | - Astrid Van Lantschoot
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
| | - Johan Bellemans
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,GRIT Belgian Sports Clinic, Leuven, Belgium.,Department of Orthopedic Surgery, Hospital Oost-Limburg, Genk, Belgium
| | - Marc Van de Velde
- Department of Anesthesiology, UZ Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.,Department of Anesthesiology and Pain Medicine, University Medical Centre Maastricht, Maastricht, The Netherlands
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Vandervennet W, Van Boxem K, Peene L, Mesotten D, Buyse K, Devooght P, Mestrum R, Puylaert M, Vanlantschoot A, Vanneste T, Van Zundert J. Does the presence of cranial contrast spread during a sacroiliac joint injection predict short-term outcome? Reg Anesth Pain Med 2020; 46:217-221. [PMID: 33328268 DOI: 10.1136/rapm-2020-101673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The innervation of the sacroiliac joint (SIJ) is complex, with a dual innervation originating from the lumbosacral plexus anteriorly as well as the sacral lateral branches posteriorly. Nociceptors are found in intra-articular structures as well as periarticular structures. In patients with SIJ pain, a fluoroscopy-guided SIJ injection is usually performed posteriorly into the bottom one-third of the joint with local anesthetic and corticosteroids, but this does not always reach all intra-articular structures. The correlation between a cranial contrast spread and clinical success is undetermined in patients with SIJ pain. METHODS In a tertiary referral pain center, electronic medical records of patients who underwent an SIJ injection were retrospectively analyzed. Only patients with at least three positive provocation maneuvers for SIJ pain were selected. Contrast images of the SIJ were classified as with or without cranial spread on fluoroscopy as a marker of intra-articular injection. Clinical success was defined as ≥50% improvement in the patient's global perceived effect after 3-4 weeks. The primary outcome was defined as the correlation between cranial contrast spread and clinical success after an SIJ injection. RESULTS 128 patients in total were included. In 68 patients (53.1%) fluoroscopy showed cranial contrast spread. Clinical success was higher in patients with cranial spread of contrast (55 of 68, 81%) versus those without (35 of 60, 58%) (p=0.0067). In a multivariable analysis with age, gender, presence of rheumatoid arthritis, side, and number of positive provocation maneuvers, the cranial spread of contrast remained the only independent factor of clinical success (p=0.006; OR 3.2, 95% CI 1.4 to 7.7). CONCLUSION In patients with SIJ pain, identified by positive pain provocation maneuvers, cranial contrast spread as a marker of intra-articular injection, with subsequent injection of 3 mL of local anesthetic and methylprednisolone 40 mg, was significantly correlated with clinical success up to 4 weeks. Therefore, attempts should be made to reach this final needle position before injecting local anesthetic and corticosteroids. This result needs to be confirmed in a high-quality prospective trial.
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Affiliation(s)
- Wout Vandervennet
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Koen Van Boxem
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Laurens Peene
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Dieter Mesotten
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium.,Hasselt University, Faculty of Medicine and Life Sciences and Limburg Clinical Research Center, Diepenbeek, Belgium
| | - Klaas Buyse
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Pieter Devooght
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Roel Mestrum
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Martine Puylaert
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Astrid Vanlantschoot
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Thibaut Vanneste
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium
| | - Jan Van Zundert
- Anesthesiology, and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Limburg, Belgium.,Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Tuijp SJ, Van Zundert J, De Vooght P, Puylaert M, Mestrum R, Heylen R, Vanelderen P. Does the Use of Epiduroscopic Lysis of Adhesions Reduce the Need for Spinal Cord Stimulation in Failed Back Surgery Syndrome? A Short-Term Pilot Study. Pain Pract 2018; 18:839-844. [PMID: 29345843 DOI: 10.1111/papr.12681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Persistent low back pain after initially successful surgery that is not attributed to structural deficits is called failed back surgery syndrome (FBSS). When conservative and minimal invasive therapy fail, the recommended treatment is spinal cord stimulation (SCS). Because epidural fibrosis can be a contributing factor in the majority of FBSS patients, lumbosacral epiduroscopic lysis of adhesions may be considered as a less invasive alternative treatment option. We hypothesized that the use of epiduroscopic lysis of adhesions could reduce the need for SCS. METHODS A pilot study was performed in 35 consecutive patients with FBSS who underwent epiduroscopic lysis of adhesions. SCS was considered if epiduroscopic lysis of adhesions gave less than 50% global perceived effect (GPE) improvement after 15 months of follow-up. The GPE was measured 1 week and 6 months after the procedure. RESULTS Over a period of 69 months, 35 patients were included. After 15 months of follow-up, 43% of patients required SCS. Eight of the 15 patients who reported no short-term improvement needed SCS; those patients had severe epidural fibrosis. One week after epiduroscopic lysis of adhesions, 34%, 23%, and 43% of patients reported GPE improvement of > 50%, 20% to 50%, and < 20%, respectively. After 6 months, 5 patients were lost to follow-up, and 30%, 17%, and 16% of patients reported improvement of > 50%, 20% to 50%, and < 20%, respectively. CONCLUSIONS In this pilot study we observed a reduced need for SCS when lumbosacral epiduroscopic lysis of adhesions was used for patients with FBSS and magnetic resonance imaging-proven adhesions. These observations justify the evaluation of both treatment options in a prospective observational trial.
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Affiliation(s)
- Steven J Tuijp
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, Ziekenhuis Oost-Limburg, Lanaken, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, Ziekenhuis Oost-Limburg, Lanaken, Belgium.,Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pieter De Vooght
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, Ziekenhuis Oost-Limburg, Lanaken, Belgium
| | - Martine Puylaert
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, Ziekenhuis Oost-Limburg, Lanaken, Belgium
| | - Roel Mestrum
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, Ziekenhuis Oost-Limburg, Lanaken, Belgium
| | - René Heylen
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, Ziekenhuis Oost-Limburg, Lanaken, Belgium
| | - Pascal Vanelderen
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, Ziekenhuis Oost-Limburg, Lanaken, Belgium.,Department of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
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Van Zundert J, Van Boxem K, Vanelderen P, Puylaert M, De Vooght P, Mestrum R, Heylen R, Vissers K, van Kleef M. Establishing the diagnosis of low back pain: patient selection for interventional pain medicine. Pain Manag 2014; 3:129-36. [PMID: 24645997 DOI: 10.2217/pmt.13.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Low back pain is one of the most prominent healthcare problems but there is no gold standard for its diagnosis. Aspecific low back pain can be subdivided into radicular and mechanical pain. The diagnosis mainly relies on a combination of elements, such as medical history, physical examination, medical imaging and other possible additional tests. Once a working diagnosis has been established, confirmation of the causative structure and level is sought by means of diagnostic blocks. The use of the different diagnostic tests and blocks should be guided by the balance between the potential benefit (mainly in terms of improved treatment outcome, the possible burden for the patient and the chances of withholding potential effective treatment to patients) with false-negative test results.
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Affiliation(s)
- Jan Van Zundert
- Department of Anesthesiology, Critical Care & Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
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Mestrum R, Vooght P, Vanelderen P, Puylaert M, Hans G, Heylen R, Vercauteren M, Zundert J. 464 CAUDA EQUINA SYNDROME SECONDARY TO LUMBAR DISC HERNIATION: PITFALLS IN CLINICAL PAIN MANAGEMENT. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R. Mestrum
- Ziekenhuis Oost‐Limburg Anaesthesiology & Multidisciplinary Pain Centre, Genk, Belgium
- University Hospital Antwerp Anaesthesiology & Multidisciplinary Pain Centre, Edegem, Belgium
| | - P. Vooght
- Ziekenhuis Oost‐Limburg Anaesthesiology & Multidisciplinary Pain Centre, Genk, Belgium
| | - P. Vanelderen
- Ziekenhuis Oost‐Limburg Anaesthesiology & Multidisciplinary Pain Centre, Genk, Belgium
| | - M. Puylaert
- Ziekenhuis Oost‐Limburg Anaesthesiology & Multidisciplinary Pain Centre, Genk, Belgium
| | - G. Hans
- University Hospital Antwerp Anaesthesiology & Multidisciplinary Pain Centre, Edegem, Belgium
| | - R. Heylen
- Ziekenhuis Oost‐Limburg Anaesthesiology & Multidisciplinary Pain Centre, Genk, Belgium
| | - M. Vercauteren
- University Hospital Antwerp Anaesthesiology & Multidisciplinary Pain Centre, Edegem, Belgium
| | - J. Zundert
- Ziekenhuis Oost‐Limburg Anaesthesiology & Multidisciplinary Pain Centre, Genk, Belgium
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