Modification of therapeutic temperature range in cryotherapy could improve clinical efficacy in tension type headache.

BACKGROUND: Cold pack therapy is not used frequently in clinics in spite of its effectiveness in clinical reports. Low compliance due to cold intolerance may be a disturbance factor that hinders patients from using the modality. OBJECTIVE: To demonstrate the improved compliance and clinical efficacy as new devised cold modality with a different composition is applied to target different therapeutic temperature range in tension-type headache (TTH) patients. METHODS: A randomized, controlled, comparative trial involving 53 patients with tension-type headache was conducted. A new cold modality that targets upper normal therapeutic temperature range was devised and applied to one group (n= 27) and ice pack was applied to the other group (n= 26). RESULTS: After application of two modalities for 4 weeks, the amount of analgesics intake, modality use per week, and Likert survey of cold intolerance were significantly different between the two groups. CONCLUSIONS: Rather than focusing on lowering the skin temperature indefinitely, optimizing tolerability by targeting the temperature at the upper therapeutic range could be more effective in cold modality application.

Clinical Efficacy of Selective Focal Ablation by Navigable Percutaneous Disc Decompression Device in Patients With Cervical Herniated Nucleus Pulposus.

OBJECTIVE: To evaluate the clinical efficacy and safety following percutaneous disc decompression, using navigable disc decompression device for cervical herniated nucleus pulposus (HNP). METHODS: Twenty subjects diagnosed with cervical HNP and refractory to conservative management were enrolled for the study. The herniated discs were decompressed under fluoroscopic guidance, using radiofrequency ablation device with navigable wand. The sagittal and axial plain magnetic resonance images of the clinically significant herniated disc, decided the space between the herniated base and outline as the target area for ablation. Clinical outcome was determined by Numeric Rating Scale (NRS), Neck Disability Index (NDI), and Bodily Pain scale of Short Form-36 (SF-36 BP), assessed after 48 weeks. After the procedure, we structurally matched the magnetic resonance imaging (MRI) and C-arm images through bony markers. The wand position was defined as being 'correct' if the tip was placed within the target area of both AP and lateral views; if not, the position was stated as 'incorrect'. RESULTS: The average NRS fell from 7 to 1 at 48 weeks post procedure (p<0.05). In addition, statistically significant improvement was noted in the NDI and SF-36BP (p<0.05). The location of the wand tip resulted in 16 correct and 4 incorrect placements. Post-48 weeks, 3 of the incorrect tip cases and 1 correct tip case showed unsuccessful outcomes. CONCLUSION: The study demonstrated the promising results and safety of the procedure. Thus, focal plasma ablation of cervical HNP with navigable wand can be another effective treatment option.