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## Meet the editors

Professor Dr. Vicente Vanaclocha received his medical degree from the University of Valencia and did his training as a neurosurgeon in the hospital affiliated with it. From the beginning of his professional career, he put great effort into continuous training, resulting in 15 long-term residencies in hospitals around the world, and the completion of 188 courses of medical training. He is always eager to learn and is devoted to teaching. He has

published 80 articles in peer-reviewed journals with close to 3000 citations, written 15 book chapters, and served as the editor of 2 books. He has also been involved in humanitarian work in Syria and Egypt. He is a devoted husband and the father of three lovely daughters.

Nieves Saiz-Sapena is a Doctor of Medicine and Surgery at the University of Valencia and obtained her Ph.D. from the University of Navarra, both in Spain. She has over 25 years of professional experience, with an emphasis in neurosurgical anesthesia, anesthesia in a hostile environment, bariatric anesthesia, and occluded airway anesthesia. After a short stay at the Groote Schuur Hospital in Cape Town (South Africa), she specialized in

Anaesthesia and Critical Care at Clinica Universidad de Navarra (Spain). She was an associate professor at the University of Navarra, the head of the Department of Anaesthesiology at Hospital San Jaime (Torrevieja, Alicante), and an associate professor at Universidad Católica San Vicente Martir, Valencia. Currently, she is an active member of several scientific societies including ESA, ASA, SOBA, and SEDAR, with a role in Neurosciences and in Safety and Quality Sections. She also serves as a reviewer for a number of national and international scientific journals and combines her job at the General University Hospital in Valencia (Spain) with her participation in professional books, education, and basic and specialist training in Anesthesia and Critical Care.

Contents

**Section 1**

**Section 2**

Fibromyalgia

**Section 3**

*and Leyre Vanaclocha*

**Preface XI**

**Acknowledgements XV**

Introduction **1**

**Chapter 1 3**

Physiopathology Chronic Pain **17**

**Chapter 2 19**

Radiofrecuency Treatment of Chronic Pain **31**

**Chapter 3 33**

**Chapter 4 45**

**Chapter 5 57**

Where We Come From and Are We Aware of Where We Are Going To? *by Vicente Vanaclocha, Nieves Saiz-Sapena, José María Ortiz-Criado* 

Chronic Pain, Dopamine and Depression: Insights from Research on

Radio Frequency in the Treatment of Lumbar Facet Joint Arthropathy:

Chronic Pain Associated with Lateral Epicondylitis: Treatment

*by Vicente Vanaclocha, Nieves Saiz-Sapena, José María Ortiz-Criado* 

*by Nieves Saiz-Sapena, Vicente Vanaclocha, José María Ortiz-Criado* 

*by Katharina Ledermann and Chantal Martin-Sölch*

*by Antonios El Helou, Charbel Fawaz, Robert Adams* 

Percutaneous Radiofrequency Hip Joint Denervation

Indications and Technical Notes

*and Dhany Charest*

with Radiofrequency

*and Leyre Vanaclocha*

*and Leyre Vanaclocha*

## Contents


*and Leyre Vanaclocha*

### **Chapter 6 79**

Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women *by Funda Gungor Ugurlucan and Cenk Yasa*

Preface

Pain is a primary defensive mechanism existing in all living animals. As such, it helps to prevent or abort any harmful activity or stimulus, thereby stopping and avoiding further damage. But it can also be a source of immense trouble. Once the pain becomes chronic, it can lose this defensive aspect and transform itself into a new problem. Controlling chronic pain is the aim and purpose of many of our currently existing treatment strategies, significantly when the pain's original cause cannot be corrected any longer. How this chronic pain can be controlled is another source of concern.

People often take over-the-counter drugs, opioids, and other pain-management medications without in-depth knowledge of their long-term consequences. Examples include kidney damage that can be induced by NSAIDs or the strong addictive properties of opioids. As a result, our developed societies currently face an opioid epidemic, yet we often see many of these drugs being advertised on the TV

Drugs have a significant advantage in that their use can be stopped if side effects appear, but chronic pain is not like other diseases. Once patients start with pain killers, particularly with opioids, all that can be expected is a progressive escalation in the dose and the drugs' analgesic power. In case of adverse effects, it is possible to

Over the years, many invasive procedures have been devised, aimed at controlling chronic pain. They can be broadly divided into reversible and disruptive. Generally, reversible treatments are preferred as no bridge is burnt, allowing other possibilities to be explored in case of failure. Among these reversible procedures, a wide array of neurostimulation options are available to control pain by inhibiting the chronic pain pathways. By modifying stimulation parameters or the location where stimulation is applied, different options can be explored. Ultimately, if there is no success, the equipment can always be disconnected and

In comparison, disruptive procedures are not reversible, but they are beneficial in treating some forms of chronic pain (i.e., DREZ procedure for brachial plexus avulsion

Unfortunately, at times, the economic cost of these procedures comes into play. For example, reversible stimulation procedures require very costly electronic equipment that is not always affordable, particularly in low-income countries. Conversely, disruptive procedures (i.e., cordotomy, DREZ, and zygapophyseal joint rhizotomy) are not that expensive and are available to a more significant range of economies. Unfortunately, not all pain-treating physicians have expertise with all of these techniques. Some are clinicians with a better understanding of drugs and their management, some are anesthetists that can perform certain invasive procedures (particularly neurostimulation), and others can fully perform disruptive operations. Today's pain clinics coordinate all of these players into a single treating group;

pain), but these procedures are not devoid of problems and complications.

as if they were a commodity to be used ad libitum.

something else attempted.

change the drug but, in general, not to stop them altogether.
