Pain physician最新文献

{"title":"Composite Treatment Response from a Prospective, Multi-Center Study (US-nPower) Evaluating a Miniature Spinal Cord Stimulator for the Management of Chronic, Intractable Pain.","authors":"Mehul J Desai, Tejal Raju, Cheanny Ung, Sailesh Arulkumar, Leonardo Kapural, Mayank Gupta, Kasra Amirdelfan, David Rosenfeld, Aaron Calodney, Dawood Sayed, Ajay Antony, Sean Li, Ramana K Naidu, Joel Ackerman, Robert Ball, Michael Fishman, Peter Staats, Gary Heit, Shilpa Kottalgi, James Makous","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Measures of therapeutic efficacy in pain studies have historically focused on pain scores, such as the Visual Analog Scale (VAS) or the Numeric Rating Scale. However, pain scores capture a univariate measure of a multivariate condition present in patients with chronic pain, where the pain condition can affect activities of daily living, sleep, quality of life, and mood. Hence, examining composite endpoints, which incorporate outcomes from multiple facets of pain, may allow investigators to better assess improvements in chronic pain patients with various new treatments.</p><p><strong>Objectives: </strong>This trial was designed to evaluate the performance of the Nalu™ Neurostimulation System (Nalu Medical, Inc.), a miniature implanted pulse generator (micro-IPG), in the treatment of low-back pain and leg pain with spinal cord stimulation therapy.</p><p><strong>Study design: </strong>This was a prospective, single arm, multicenter, open-label, postmarket study that followed patients for 90 days postimplantation of the Nalu Neurostimulation System.</p><p><strong>Setting: </strong>Patients were recruited from, and treated at, 15 US-based comprehensive pain centers.</p><p><strong>Methods: </strong>Patients with chronic, intractable, neuropathic pain of the back and/or leg(s), with a VAS pain score of at least 6 at the time of screening, were included. The micro-IPG was implanted per standard clinical practice. Patient-reported outcomes (PROs), including VAS pain scores, Oswestry Disability Index (ODI), Beck Depression Inventory, quality-of-life metric (EQ-5D-5L), Patient Global Impression of Change (PGIC), and sleep disturbance Patient-reported Outcomes Measurement Information System (PROMIS) were recorded. Literature-based minimal clinically important differences (MCIDs) were used to define the MCID responder rates as well as a composite endpoint analysis.</p><p><strong>Results: </strong>Ninety-four percent (94%) of the study patients reached the MCID in at least 2 of the PROs. Five out of 6 PROs demonstrated a responder rate of > 75%. Forty-nine percent (49%) of the patients were holistic responders, meaning they responded in each of the 6 outcome measures under consideration. Overall VAS pain scores reached the MCID in 86% of the patients. PGIC demonstrated the largest MCID responder rate: 100%. The ODI score reached the MCID in 94% of the patients; the BDI score reached the MCID rate in 84% of the patients; the EQ-5D-5L score reached the MCID in 77% of the patients; and the PROMIS score reached the MCID in 67% of the patients.</p><p><strong>Limitations: </strong>While this was a multicenter, prospective study, it was also a single arm, nonrandomized trial. The 35 study patients were only followed for 90 days post micro-IPG implant.</p><p><strong>Conclusion: </strong>In the face of improving spinal cord stimulation pain outcomes, composite PROs are likely to become more common in evaluating therapeutic response. Resp","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E881-E889"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Kyphoplasty Alleviates Pain Occurring Distal to the Fracture Area Caused by Stage I and II Kümmell Disease.","authors":"Yuye Zhang, Wenhong Yang, Wenxiang Tang, Xiaomei Song, Jun Hua, Yongming Sun, Xiaozhong Zhou, Fanguo Lin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Kümmell disease (KD)-a rare and relatively complex spinal condition-is a type of posttraumatic osteoporotic vertebral compression fracture manifesting as a delayed collapse of a vertebral body. Although most patients with KD present with pain in the fracture area, some present with pain in the rib region or distal lumbosacral region, without pain in the fracture area, which poses challenges for diagnosing and treating KD.</p><p><strong>Objective: </strong>We aimed to explore whether percutaneous kyphoplasty can alleviate pain distal to the fracture area caused by either Stage I or Stage II KD.</p><p><strong>Study design: </strong>A retrospective study.</p><p><strong>Setting: </strong>This study was conducted at a university-affiliated hospital.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on patients with Stage I or Stage II KD who underwent surgical treatment in our hospital from December 2021 through October 2023. All patients were accompanied by pain distal to the fracture area (i.e., pain in the rib region or the distal lumbosacral region). All patients underwent percutaneous kyphoplasty. Postoperative follow-up thoracic or lumbar x-rays confirmed polymethylmethacrylate diffusion and vertebral reduction. Pain distal to the fracture area and functional impairment were evaluated at presurgery and at postsurgery one day, one week, and one month. In addition, the anterior, middle, and posterior vertebral heights and the Cobb angle were measured at pre- and postsurgery.</p><p><strong>Results: </strong>A total of 42 patients were enrolled; 39 (92.9%) were women. Their average age was 73.48 ± 8.81 years. The fracture segments with KD and pain distal to the fracture area were as follows: T7 (9 cases, 21.4%); T10 (9 cases, 21.4%); and T8 (8 cases, 19.0%). The common location of pain distal to the fracture area was the rib region (30 cases, 71.4%). The preoperative Visual Analog Scale score of pain distal to the fracture area and the Oswestry Disability Index scores were significantly higher than those at postsurgery one day, one week, and one month. The heights of the anterior, middle, and posterior edges of the vertebrae on x-ray were significantly higher postoperatively than preoperatively. The Cobb angle of the fractured vertebrae was also higher postoperatively than preoperatively.</p><p><strong>Limitations: </strong>Our study was conducted at a single center; single-center studies may introduce bias. Our study also had a relatively short follow-up time.</p><p><strong>Conclusion: </strong>Patients with Stage I or Stage II KD may experience pain distal to the fracture area, which may effectively be alleviated by percutaneous kyphoplasty.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E829-E834"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Quadrant Localization Technique for Percutaneous Balloon Compression Surgery is Beneficial for Patients with Classic Trigeminal Neuralgia: A Retrospective Study.","authors":"Yuchen Tian, Yanmeng Tan, Wei Gao, Lin Yang, Wei Zhang, Xinghua Jiang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The Hartel anterior approach is a commonly used puncture method in percutaneous balloon compression (PBC) surgery. However, anatomical variations along the puncture path, and visual errors on x-ray 2-dimensional imaging, may increase the difficulty of a successful first attempt. Our clinical practice has shown that employing the quadrant localization technique to plan puncture points and angles can enhance the puncture success rate.</p><p><strong>Objectives: </strong>We will demonstrate that the quadrant localization technique increases the success rate of the first puncture of the foramen ovale and the initial placement of the balloon catheter, thereby improving the efficiency of PBC surgery.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>A single center, tertiary general hospital.</p><p><strong>Methods: </strong>This study included a total of 371 patients with classic trigeminal neuralgia who underwent PBC surgery from January 2019 through May 2023. All patients received general anesthesia and underwent PBC surgery under radiographic guidance. In total, 170 patients underwent a puncture using the quadrant localization technique (Group Q), and 201 underwent a puncture using the conventional Hartel anterior approach (Group P).</p><p><strong>Results: </strong>Group Q demonstrated higher success rates for the first puncture and insertion of the balloon catheter, along with a lower total radiographic radiation dose, shorter surgical duration, and shorter hospital stay (P < 0.05). However, there were no significant differences in PBC success rates or the incidence of puncture-related side effects and complications between the 2 groups (P > 0.05).</p><p><strong>Limitations: </strong>This study lacked information on long-term complications and pain recurrence rates. Also, single-center results may be influenced by institution-specific practices and physician-related biases.</p><p><strong>Conclusion: </strong>In PBC surgery, the quadrant localization technique improves efficiency and reduces hospital stay compared with the conventional Hartel anterior approach, without increasing the risk of complications.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E891-E898"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Endoscopic Resection of Lumbar Discal Cyst.","authors":"Shuai Ding, Guangquan Zhang, Yanzheng Gao, Zhiqiang Hou, Fuqiang Shao","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Discal cysts, an uncommon condition, can replicate the characteristic signs typically linked to a herniated lumbar disc, encompassing discomfort in the lumbar region and neuralgia that extends along the nerve paths, thereby complicating the process of distinguishing the discal cyst from other conditions. Consensus on the treatment of this disease remains elusive, and the best treatment for it is still a matter of controversy. In numerous past reports, this disease has been treated through either open or microscopic surgical approaches.</p><p><strong>Objectives: </strong>The aim of this study is to assess the therapeutic efficacy and safety of a minimally invasive endoscopic surgery technique in the treatment of lumbar discal cysts.</p><p><strong>Study design: </strong>We conducted a retrospective observational analysis.</p><p><strong>Setting: </strong>This research was initiated with a group of patients selected from the Spinal Surgery Unit at the Henan Provincial People's Hospital.</p><p><strong>Methods: </strong>From March 2017 to May 2021, a minimally invasive endoscopic procedure was executed on a cohort of 7 male patients (average age: 30.86 ± 5.24 years), each diagnosed with discal cysts, within our spinal surgery division. The efficacy of the treatment was gauged by pre- and postoperative assessments that used the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Furthermore, the ultimate clinical efficacy of the procedure was appraised in accordance with the revised Macnab criteria.</p><p><strong>Results: </strong>The patients reported a prompt and significant relief of symptoms after the surgical removal of the lumbar disc lesions, with no cases of recurrence noted during the follow-up period. A significant drop was observed in the VAS score for lower limb pain, declining from a preoperative mean of 6.86 ± 1.35 to 1.57 ± 0.53 at the final evaluation (P < 0.05). In tandem with this finding, a marked decrease in the ODI score was noted, with a reduction from 69.14 ± 10.76 before surgery to 10.29 ± 5.59 at the concluding review (P < 0.05). The postoperative VAS and ODI scores collectively pointed toward substantial improvements in patients' conditions. When assessed according to the revised Macnab criteria, the outcomes were distributed as follows: 4 patients (57.1%) achieved excellent results, 2 (28.6%) had very good results, and one (14.3%) had a fair result, totaling 6 patients (85.7%) with satisfactory outcomes. No severe complications or recurrences were identified during the postoperative monitoring phase.</p><p><strong>Limitations: </strong>This observational retrospective study was based on a convenience sampling that involved a limited number of patients.</p><p><strong>Conclusions: </strong>Percutaneous endoscopic resection emerged as a micro-invasive and secure surgical approach for the management of lumbar discal cysts.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E873-E879"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Versus Peribulbar Dexmedetomidine as an Adjunct to Local Anesthetics in Strabismus Surgery: A Randomized, Double-blinded Clinical Trial.","authors":"Huda F Ghazaly, Ibrahim E Hassan, Ahmed F Gabr, Taha T Dardeer, Mohamed A Alazhary","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dexmedetomidine has not been adequately studied as an adjuvant to peribulbar anesthesia in strabismus surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We investigated how different routes of dexmedetomidine administration affect the peribulbar block characteristics in adults undergoing strabismus surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A randomized, double-blind clinical trial. The study was approved by the Institutional Ethics Committee (approval number: 520/3/2021) and registered at ClinicalTrials.gov (NCT05215158).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The trial included 46 patients aged 20-60 years with an American Society of Anesthesiologists Physical Status Classification System of  I or II who were scheduled for unilateral strabismus surgery at a university hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients were randomly assigned to an intravenous dexmedetomidine group (n = 15) who received 50 µg dexmedetomidine in 50 mL normal saline intravenously over 10 minutes, followed by a peribulbar block using a 10 mL mixture of 4 mL lidocaine 2%, 4 mL bupivacaine 0.5%, and 2 mL normal saline containing 150 international units (IU) hyaluronidase. The peribulbar dexmedetomidine group (n = 31) received 50 mL normal saline intravenously over 10 minutes, followed by a peribulbar block using a 10 mL mixture of 4 mL lidocaine 2%, 4 mL bupivacaine 0.5%, 1 mL normal saline with 150 IU hyaluronidase, and 1 mL normal saline containing 50 µg dexmedetomidine. Sensory and motor block onset and duration, analgesia duration, and patient and surgeon satisfaction were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Peribulbar dexmedetomidine prolonged the median duration of postoperative analgesia by 3.2 hours. Patients who received peribulbar dexmedetomidine benefitted from a longer time to request postoperative analgesia than those who got intravenous dexmedetomidine (7.17 ± 2.0 hours vs 5.79 ± 2.1 hours; P = 0.048). Motor block duration was longer in the peribulbar group compared to the intravenous group (198.34 ± 17.3 minutes vs 148.93 ± 13.7 minutes; P = 0.001). Patient and surgeon satisfaction was higher in the peribulbar dexmedetomidine group compared to the intravenous dexmedetomidine group (P = 0.048, P = 0.016, respectively). Strabismus surgery duration was shorter in the intravenous dexmedetomidine group than in the peribulbar group (38.01 ± 8.3 minutes vs 55.01 ± 11.9 minutes; P &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our study took place at a single-center with a small sample size limited to adult patients undergoing strabismus surgery. The study was not powered to identify differences in speed of sensory block onset and duration, or speed of motor block onset. However, peribulbar dexmedetomidine prolonged the motor block's duration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Peribulbar dexmedetomidine outperforms intravenous dexmedetomidine in terms of postoperative analgesia and motor block duration when used as an adjunct to peri","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E819-E827"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Comparing the Effectiveness and Safety of Dexamethasone, Methylprednisolone and Betamethasone in Lumbar Transforaminal Epidural Steroid Injections\".","authors":"Gozde Dagistan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E965"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exponential Decline of 28.9% in Utilization of Interventional Pain Management Techniques Among Medicare Beneficiaries From 2019 to 2022: Updated Analysis on the Ongoing Effects of COVID-19, Economic Decline, the Affordable Care Act (ACA), and Medical Policies.","authors":"Laxmaiah Manchikanti, Vidyasagar Pampati, Mahendra R Sanapati, Devi E Nampiaparampil, Nebojsa Nick Knezevic, Alan D Kaye, Amol Soin, Christopher G Gharibo, Alaa Abd-Elsayed, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have highlighted the escalating costs associated with managing low back and neck pain, as well as other musculoskeletal disorders. In the past, there was a notable increase in the use of interventional techniques to address these disorders. However, the COVID-19 pandemic disrupted various chronic pain treatment approaches, including interventional procedures and opioid use, following a broader trend of reduced healthcare services. Consequently, there was an 18.7% decline in the use of interventional techniques per 100,000 Medicare beneficiaries between 2019 and 2020, a stark contrast to the previous growth patterns, despite some initial declines observed starting in 2017.</p><p><strong>Objectives: </strong>This analysis aims to provide an updated evaluation of the utilization of interventional techniques for chronic pain management in the U.S. Medicare population.</p><p><strong>Study design: </strong>A retrospective cohort study examining utilization patterns and factors affecting interventional techniques for chronic pain management in the FFS Medicare population in the United States from 2000 to 2022.</p><p><strong>Methods: </strong>Data for this analysis was obtained from the Centers for Medicare & Medicaid Services (CMS) master database, specifically the physician/supplier procedure summary, spanning the years 2000 to 2022.</p><p><strong>Results: </strong>This retrospective cohort study found that the rate of interventional pain management services per 100,000 Medicare beneficiaries showed a cumulative decline between 2019 and 2022 of 28.9%, with an annual decrease of 10.7%. This contrasts sharply with the 2010-2019 period, which saw a small annual decline of 0.4%. Particularly significant was the sharp reduction of 18.7% from 2019 to 2020, coinciding with the pandemic. From 2020 to 2021, the decline slowed to 1.1%, before accelerating again with an 11.5% drop between 2021 and 2022.</p><p><strong>Limitations: </strong>Data were available only through 2022 and were limited to the FFS Medicare population; utilization patterns for Medicare Advantage Plans, which accounted for nearly 50% of Medicare enrollment in 2022, were not included. Additionally, this analysis shares the inherent limitations of all retrospective reviews based on claims data.</p><p><strong>Conclusion: </strong>This retrospective analysis demonstrates a significant reduction in the use of interventional pain management techniques from 2019 to 2022. Contributing factors to this decline likely include the lasting effects of COVID-19, economic challenges, the Affordable Care Act (ACA), and evolving local coverage determination policies.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"455-467"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Investigation of Annulargrams and Intra-annular Fibrin to Treat Chronic Discogenic Low Back Pain and Radiculopathy: 1-, 2-, and 3-Year Outcome Comparisons of Patients with and without Prior Surgery.","authors":"Kevin Pauza, Kwadwo Boachie-Adjei, Joseph T Nguyen, Francis Hussey Iv, Jacob Sutton, Akua Serwaa-Sarfo, Patrick M Ercole, Carrie Wright, William D Murrell","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Discogenic chronic low back pain (cLBP) and radiculopathy are the most prevalent causes of disability worldwide. Older spine treatments often lack reliability and are associated with adverse events. Among surgical treatment options, discectomies weaken discs, and fusions cause direct damage to adjacent discs, so both treatments accelerate disc degeneration. Other regenerative medicine treatments, including \"stem cell\" (centrifuged bone marrow aspirate, BMC), and platelet-rich plasma (PRP), lack fibrin's bio-adhesive properties. Specifically, fibrin is a strong bio-adhesive, so it immediately integrates into disc defects and binds there, becoming a part of the disc and facilitating new disc tissue growth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the safety and efficacy of this new pragmatic algorithm that both diagnoses and treats cLBP by (i) first identifying annulus fibrosus tears (fissures) in the region of symptoms and (ii) subsequently treating those tears by introducing fibrin to seal them and facilitate new tissue growth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study that prospectively reported validated measures in a registry.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Private, single-center, specialized, interventional pain management institution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The patients we decided to observe had suffered from cLBP with or without radiculopathy symptoms in their legs for greater than 6 months. Prior to enrollment, all patients underwent physical therapy and at least 4 invasive treatments without relief. Failed treatments included BMC or PRP injections, intradiscal or intraarticular zygapophyseal joints, or combinations of both. Fluoroscopically guided epidural injections of corticosteroids or PRP were additional failed treatments, as were radiofrequency neurotomies in the medial branch. Candidacy for enrollment was based on meeting the aforementioned criteria and by having magnetic resonance image (MRI) screenings (1.5 T) and plain-film radiographs performed 6 months before treatment. In addition, those MRI screenings and radiographs had to rule out the following concomitant conditions: (i) carcinoma, (ii) fracture, (iii) instability, or (iv) severe vertebral canal or intervertebral foramen stenosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Significant improvement was demonstrated at one, 2, and 3 years after treatment in all outcome measures. The mean duration of low back pain prior to treatment was 11.2 years. Patients' mean age was 56 years. Thirty percent of the patients were female, and 70% were male. Both the failed surgery cohort and nonsurgery cohort demonstrated significant improvement after fibrin treatment, with the failed surgery cohort realizing greater relative improvement. Significant improvements in the Oswestry disability index (ODI), visual analog scale, and PROMIS® (mental and physical) scores were consistent across age, gender, comorbidity, and exposure status. A","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"537-553"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Status of Different Adjuvants on Nerve Block's Effect.","authors":"Jian Luo, Guangyou Duan, He Huang, Guizhen Chen","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute postoperative pain is one of the most common challenges faced by patients who undergo surgery. Multimodal analgesia has been recommended in recent years to effectively control this condition. Nerve blocks are an important part of multimodal analgesia; a single peripheral nerve block is widely used in clinical practice. To prolong the analgesic duration of a single nerve block, adjuvants with different mechanisms, dosages, or administration routes are added to local anesthetics; however, it is not clear which adjuvant or combination is better.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to provide a comprehensive review of the current utilization of diverse adjuvants in single peripheral nerve block analgesia and to recommend optimal adjuvants for single peripheral nerve blocks based on current literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A narrative review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed was searched using the terms \"postoperative analgesia,\" \"nerve block,\" \"adjuvant,\" \"epinephrine,\" \"clonidine,\" \"dexmedetomidine,\" \"dexamethasone,\" \"buprenorphine,\" \"morphine,\" \"magnesium sulfate,\" and \"ketamine.\" The mechanisms of action of different adjuvants were investigated and clinical trials of different adjuvants for postoperative analgesia were determined and reviewed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;According to current literature, there are 4 main types of adjuvants added to local anesthetics to prolong analgesic effects: adrenergic receptor agonists, anti-inflammatory agents, opioids, and N-methyl-D-aspartic acid (NMDA) receptor antagonists. As a single adjuvant, adrenergic agonists, dexmedetomidine, and anti-inflammatory agents are more effective than opioids and NMDA receptor antagonists. When added to local anesthetics, intravenous dexamethasone (10 mg) had an effect similar to that of perineural dexamethasone (8 mg). However, considering the side effects of perineural dexamethasone, intravenous injection of dexamethasone is preferable.Magnesium sulfate is a suitable NMDA receptor antagonist for peripheral nerve blocks. The combination of adjuvants with different mechanisms can further prolong local anesthetic duration.When more than one adjuvant was used, the combination of dexmedetomidine and dexamethasone was determined to be excellent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Additional compatibility tests with different adjuvants are required to completely determine the curative effect and optimal dosage parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Adjuvants with diverse mechanisms of action can variably extend the duration of local anesthetic effects. When utilizing adjuvants in conjunction with local anesthetics, perineural dexmedetomidine (1 mu-g/kg) or intravenous dexamethasone (10 mg) may be preferable, considering their efficacy and side effects. Current research suggests that the combination of perineural dexmedetomidine (1 mu-g/kg) and intravenous dexamethasone (10 mg) is more effec","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"507-519"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Term Trigeminal Ganglion Stimulation in Patients with Multi-Branch Trigeminal Herpetic Neuralgia: A Pilot Study.","authors":"Yong Zhang, Yanqing Wu, Cuihua Jiang, Ziwei Yang, Xuexue Zhang, Daying Zhang, Fan Yang, Yi Yan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal herpetic neuralgia (THN) presents with severe pain hyperalgesia and is a high-risk factor for postherpetic neuralgia (PHN). The current clinical treatments for THN are unsatisfactory, and new treatments are desperately required.</p><p><strong>Objectives: </strong>This pilot study aimed to evaluate the efficacy of short-term trigeminal ganglion stimulation in treating patients with multi-branch THN.</p><p><strong>Study design: </strong>A prospective pilot study.</p><p><strong>Setting: </strong>Multi-center study in 3 academic hospitals.</p><p><strong>Methods: </strong>From July 2021 to October 2022, we enrolled 20 patients with multi-branch THN who received short-term trigeminal ganglion stimulation under general anesthesia from 3 hospitals. All patients completed a 12-month follow-up. The visual analog scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess patients' pain and quality of sleep. The Barrow Neurological Institute (BNI) score was used to determine the global outcome of pain relief, and complications were recorded.</p><p><strong>Results: </strong>Significant and sustained pain relief and sleep improvement were achieved by all the patients who underwent trigeminal ganglion electrode stimulation in the present study. Respective BNI scores of 80% and 85% at 3 and 12 months after surgery were considered good. There were no other serious complications except for 2 patients' experiences of transient trigeminal cardiac reflex during the surgery and transient numbness deterioration in one patient's V3 sensory area.</p><p><strong>Limitations: </strong>The present study is a pilot study. We expect prospective multi-center, large-sample studies in the future.</p><p><strong>Conclusion: </strong>Short-term trigeminal ganglion stimulation can be used safely and effectively to treat patients with multi-branch THN and significantly reduce the occurrence of PHN.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 7","pages":"E775-E784"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}