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10 Articles in Volume 17, Issue #5
Cross-Linked Hyaluronic Acid Injection for Neuropathic Pain
Discussing Migraine: What to Try When Nothing Is Working
IV Propofol for Treatment of Chronic Intractable Cluster Headache: A Case Series
Letters to the Editor: Rapid Opioid Metabolizer, Intractable Pain, Adrenal Suppression, Traumatic Brain Injury
Migraine Treatment: What’s Old, What’s New
Schizophrenia Spectrum and Chronic Pain: Is Pain Insensitivity a Myth?
Spinal Fluid Flow and Pain Management
Step-by-Step Technique for Targeting Superficial Radial Nerve Pain
The Primary Care Provider’s Role in Diagnosing and Treating Rheumatoid Arthritis
What is the appropriate use of phone texting between physicians and patients?

Step-by-Step Technique for Targeting Superficial Radial Nerve Pain

Description of the steps taken to treat radial nerve pain using injection of cross-lined hyaluronic acid (Restylane or Juvéderm).
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Step 10. Post-Procedure Doppler Arterial Patency Confirmation

At the end of the procedure, again confirm that arterial patency is maintained to exclude inadvertent intra- or extra-arterial tamponade (Figure 5). Sudden onset of pain distally suggests this may have occurred. Remember that with increasing doses per site (0.5-1.0 mL), the risk of extra-arterial tamponade increases. In this circumstance, hyaluronidase should be administered immediately (eg, Hylenex or recombinant hyaluronidase) to dissolve the injectate, along with other supportive measures to ensure restoration and maintenance of arterial blood flow.

Step 11. Patient Follow-up and Expected Pain Relief

After the procedure, the patient should be contacted at 24 hours and 1 week to assess pain relief and the need for additional treatment. Expected pain relief should result in a VAS pain score of 0-4 out of 10, with a duration from 8 weeks to 4 months—and, in some cases, permanently—depending on the underlying pathology.

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All images are courtesy of John A. Campa III, MD.

Last updated on: June 15, 2017
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Spinal Fluid Flow and Pain Management

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