This study demonstrated that radiofrequency lesioning to treat symptomatic facet joint pain in patients who have adjacent posterior lumbar fusion hardware may result in heat energy being transferred to the adjacent hardware. This may increase the risk of injury to the patient. Monitoring for a temperature increase is easily accomplished by inserting a temperature probe onto the surface of the hardware.

BackgroundInjection of fibrin glue mixed with blood into the epidural space to reliably and effectively treat medically refractory orthostatic headache caused by spinal cerebrospinal fluid (CSF) leaks and subsequent intracranial hypotension has recently been described. The study described in this article utilizes an analogous technique to gauge the therapeutic reproducibility of this novel technique.MethodsEight patients with medically refractory headache resulting from intracranial hypotension caused by spinal CSF leaks received epidural injections of combined fibrin glue, autologous blood, and Isovue contrast at the L1—2 vertebral level using intermittent fluoroscopic guidance. Pre-procedure, 1-week post-procedure, and 3-month post-procedure headache pain scores were collected and used for comparison.ResultsThree out of 8 patients reported relief at 1 week, although 1 of these 3 patients had returned to their baseline pain intensity at 3 months. Four patients reported no change at 1 week, though 2 of these patients had reduction of their chronic headache pain at 3 months. A single patient reported increased pain 1 week after the procedure, which persisted at 12 weeks. Overall, 4 out of the 8 patients had decreased pain scores at 3-month follow-up.ConclusionsWe did not achieve a similar frequency of headache resolution as reported in prior original studies. However, a subset of patients did appear to receive substantial benefit from the combined fibrin glue-blood patching procedure. This technique may prove to be useful in medically refractory cases, including those patients who continue to have symptoms despite the prior administration of conventional epidural blood patches.

BackgroundThe associations between pain, lower extremity strength, and aerobic conditioning have not been widely investigated in adults with fibromyalgia (FM). The principle objective of this study was to investigate the relationship between pain severity and knee strength in patients seeking treatment for FM. A secondary objective was to investigate the relationship between pain scores and aerobic conditioning.MethodsThree measures of knee strength (isokinetic extensor, isokinetic flexor, isometric extensor) were quantified in the dominant leg of 69 adults with FM using a dynamometer at speeds of 60 degrees per second (60°/s) and 180°/s. Peak oxygen uptake (VO2) was assessed using a cycle ergometer, and pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory.ResultsIn univariable linear regression analyses using pain severity as the dependent variable, lesser values of isokinetic knee extensor strength at 60°/s (P=0.041) and 180°/s (P=0.010), isokinetic knee flexor strength at 60°/s (P=0.028) and 180°/s (P=0.003), and peak VO2 uptake (P=0.031) were predictive of greater pain severity scores. In multiple variable linear regression models adjusted for age, sex, body mass index, and opioid use, the following associations retained statistical significance; isokinetic knee extensor strength at 60°/s (P=0.020) and 180°/s (P=0.003), isokinetic knee flexor strength at 60°/s (P=0.015) and 180°/s (P=0.001), and peak VO2 uptake (P=0.014). However, no significant associations were found between pain severity and isometric knee extensor strength.ConclusionThe main findings from this study were that lesser values of isokinetic knee strength and peak VO2 uptake were predictive of greater pain severity scores. These results build on the findings of previous investigations, but ongoing research is needed to further characterize the effects of strength and peak VO2 uptake on the pathophysiology of FM.

A 33-year-old woman with a history of depression was admitted to the Mayo Clinic for evaluation of epigastric pain. The pain, which the patient described as "severe," began suddenly while sitting at work 1 week before admission. The pain was constant (although it had periods of worsening) and radiated to her back. It did not vary with position or dietary intake and was not responsive to acetaminophen, hydrocodone, or omeprazole, which had been prescribed by her local physician, who evaluated her 3 times for this symptom. On the day before admission, she had 2 episodes of vomiting "dark, maroon blood with clots," which was not preceded by emesis without blood. She denied the former or current use of alcohol, tobacco, nonsteroidal anti-inflammatory drugs, or herbal supplements and also had experienced no early satiety or weight loss. There was no family history of gastrointestinal malignant tumors or ulcer disease. Results of a review of systems were otherwise negative. The only medication she was taking was citalopram.On admission, the patient appeared comfortable. She was afebrile, with a blood pressure of 127/64 mm Hg, pulse of 92/min, respiratory rate of 24/min, and a body mass index (calculated as weight in kilograms divided by height in meters squared) of 35.5. There was no orthostatic change in her blood pressure or pulse. Physical examination revealed normal bowel sounds and tenderness in the epigastrium without guarding or rebound. The Murphy sign was absent, and there was no organomegaly. The results of the rest of the physical examination were unremarkable.Initial laboratory evaluation of this patient revealed the following: hemoglobin, 10.7 g/dL; mean corpuscular volume, 87.9 fL; red cell distribution width, 13.0%; platelets, 325 ϫ 10 9 /L; leukocytes, 8.8 ϫ 10 9 /L; creatinine, 0.7 mg/dL; blood urea nitrogen, 12 mg/dL; lipase, 15 U/L; amylase, 34 U/L; bilirubin, 0.7 mg/dL; aspartate, 15 U/L; and alanine, 22 U/L.