Pain physician最新文献

{"title":"Iliotibial-Band and Gluteus Medius Percutaneous Ultrasound Tenotomy for Refractory Trochanteric Pain Syndrome: A Longitudinal Observational Study with One-Year Durability Results.","authors":"Sandeep Yerra, Tahereh Naeimi, Alan D Kaye, Ferdinand J Chan, David Gonzalez, Ugur Yener, Sayed Emal Wahezi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain that affects patients' quality of life and functioning. The condition is often associated with tightness of the iliotibial band (ITB) and tendinopathy of the gluteus medius (GMed) tendon, which are subjected to excessive stress and inflammation. A traditional treatment for GTPS is conservative medical management (CMM), which includes but is not limited to physiotherapy, oral anti-inflammatory medication, and/or local steroid injections. Surgery is performed when these treatments fail. The failure of these techniques indicates that some treatments classified as CMM may not be feasible for some patients.</p><p><strong>Objectives: </strong>This study aimed to evaluate the efficacy and safety of combined GMed and ITB injections for a cohort of CMM-refractory GTPS patients.</p><p><strong>Study design: </strong>A retrospective chart review.</p><p><strong>Setting: </strong>Single-center, academic hospital.</p><p><strong>Methods: </strong>Between 01/01/2022 and 12/31/2022, a retrospective analysis of 68 hips that underwent combination GMed-ITB percutaneous ultrasound tenotomy (PUT) was performed. The primary outcome measure was a numeric rating scale (NRS) for hip pain, and the secondary outcome measures were VISA-G (Victorian Institute of Sports Assessment-Gluteal Tendinopathy) scores, sitting-to-standing and walking tolerance, and side-lying tolerance.</p><p><strong>Results: </strong>The patients' NRS scores decreased, and the VISA-G scores and all functional measures increased one year after the procedure, indicating significant improvement in pain and functioning (P < 0.001). Treatment success, defined as 50% reduction in pain and side-lying tolerance, was achieved by 83% of the patients. No major complications were reported.</p><p><strong>Limitations: </strong>The lack of a comparable cohort reduces the data's interpretative significance. Having a control arm would have enabled a statistical comparison between treated and untreated patients to provide a valid assessment of the procedure's benefit.</p><p><strong>Conclusions: </strong>This study demonstrated the feasibility and efficacy of combined GMed-ITB PUT as a novel treatment for GTPS in patients who failed CMM. The results showed significant and durable improvement in pain, function, and quality of life at the one-year follow-up. Our study suggests that both ITB and GMed tendons are involved in the pathogenesis of GTPS. The present study compared favorably with previous studies that reported outcomes of either ITB PUT or GMed PUT alone, implying that combining the approaches may offer superior benefits. Furthermore, the study had several strengths, such as the use of a validated outcome measure (VISA-G), the elimination of bias by independent practitioners, and the inclusion of a difficult population with severe pain.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 7","pages":"435-440"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366111","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":"In Response to Comment on \"Effectiveness of Radiofrequency Ablation of the Genicular Nerves of the Knee for the Management of Intractable Pain from Knee Osteoarthritis\".","authors":"Min Cheol Chang","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 7","pages":"E798"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366114","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 Efficacy and Safety of the Rhomboid Intercostal Block for Postoperative Analgesia in Chest Surgery and Breast Surgery: A Systemic Review and Meta-Analysis.","authors":"Qi Hong Shen, Yue-Zhong Lv, Ya-Fen Shi, Lan Lai, Yan-Jun Chen, Qing-He Zhou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Prior research has suggested that the rhomboid intercostal block (RIB) may contribute to postoperative analgesia after surgeries of the chest and breast.</p><p><strong>Objective: </strong>To explore the effectiveness and safety of RIB for postoperative analgesia, as well as whether RIB is superior to other types of nerve blocks.</p><p><strong>Study design: </strong>A systematic review and meta-analysis.</p><p><strong>Setting: </strong>Querying electronic databases, including the Cochrane Library, PubMed, Embase, and Web of Science, was part of the process in searching for eligible clinical trials for this meta-analysis and systematic review.</p><p><strong>Methods: </strong>The Cochrane Collaboration's tool for quality evaluation was utilized in assessing the bias risk in the selected randomized controlled trials (RCTs). meta-analysis was facilitated through the utilization of Review Manager 5.3. The determination of the evidence's quality adhered to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>After the inclusion and exclusion criteria were established, the incorporation of 8 RCTs, encompassing 714 patients, took place. During the first 24 hours after the operation, patients in the RIB group exhibited lower pain scores and less opioid consumption than did those in the no-block group. Furthermore, a decrease in the incidence of postoperative vomiting and nausea was noted in the RIB group. Nevertheless, when comparing outcomes, it was revealed that the RIB group and the other nerve block group did not differ significantly.</p><p><strong>Limitations: </strong>No subgroup analysis to investigate the sources of heterogeneity was performed. The number of studies in this meta-analysis of RIB compared to those that focus on other types of nerve block is relatively small. The optimal concentrations and volumes of local anesthetics were not evaluated.</p><p><strong>Conclusions: </strong>RIB may be a new option for pain relief after chest and breast surgery.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 7","pages":"375-385"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366136","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":"Perioperative Management of Antiplatelet and Anticoagulant Therapy in Patients Undergoing Interventional Techniques: 2024 Updated Guidelines from the American Society of Interventional Pain Physicians (ASIPP).","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Devi Nampiaparampil, Byron J Schneider, Alexander Bautista, Alan D Kaye, Nebojsa Nick Knezevic, Alaa Abd-Elsayed, Annu Navani, Paul J Christo, Standiford Helm Ii, Adam M Kaye, Jay Karri, Vidyasagar Pampati, Sanjeeva Gupta, Vivekanand A Manocha, Amol Soin, Mayank Gupta, Sanjay Bakshi, Christopher G Gharibo, Kenneth D Candido, Anjum Bux, Anilkumar Vinayakan, Vinayak Belamkar, Scott Stayner, Sairam Atluri, Sara E Nashi, Megan K Applewhite, Chelsi Flanagan, Emiliya Rakhamimova, Gerard Limerick, Kunj G Patel, Sierra Willeford, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The frequency of performance of interventional techniques in chronic pain patients receiving anticoagulant and antiplatelet therapy continues to increase. Understanding the importance of continuing chronic anticoagulant therapy, the need for interventional techniques, and determining the duration and discontinuation or temporary suspension of anticoagulation is crucial to avoiding devastating complications, primarily when neuraxial procedures are performed. Anticoagulants and antiplatelets target the clotting system, increasing the bleeding risk. However, discontinuation of anticoagulant or antiplatelet drugs exposes patients to thrombosis risk, which can lead to significant morbidity and mortality, especially in those with coronary artery or cerebrovascular disease. These guidelines summarize the current peer reviewed literature and develop consensus-based guidelines based on the best evidence synthesis for patients receiving anticoagulant and antiplatelet therapy during interventional procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Review of the literature and development of guidelines based on best evidence synthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To provide a current and concise appraisal of the literature regarding the assessment of bleeding and thrombosis risk during interventional techniques for patients taking anticoagulant and/or antiplatelet medications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Development of consensus guidelines based on best evidence synthesis included review of the literature on bleeding risks during interventional pain procedures, practice patterns, and perioperative management of anticoagulant and antiplatelet therapy. A multidisciplinary panel of experts developed methodology, risk stratification based on best evidence synthesis, and management of anticoagulant and antiplatelet therapy. It also included risk of cessation of anticoagulant and antiplatelet therapy based on a multitude of factors. Multiple data sources on bleeding risk, practice patterns, risk of thrombosis, and perioperative management of anticoagulant and antiplatelet therapy were identified. The relevant literature was identified through searches of multiple databases from 1966 through 2023. In the development of consensus statements and guidelines, we used a modified Delphi technique, which has been described to minimize bias related to group interactions. Panelists without a primary conflict of interest voted on approving specific guideline statements. Each panelist could suggest edits to the guideline statement wording and could suggest additional qualifying remarks or comments as to the implementation of the guideline in clinical practice to achieve consensus and for inclusion in the final guidelines, each guideline statement required at least 80% agreement among eligible panel members without primary conflict of interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 34 authors participated in the development of thes","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 S6","pages":"S1-S94"},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971618","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":"Updated Assessment of Practice Patterns of Perioperative Management of Antiplatelet and Anticoagulant Therapy in Interventional Pain Management.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Vidyasagar Pampati, Amol Soin, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The role of antiplatelet/anticoagulant therapy is well known for its primary and secondary prevention of sequela from cardiovascular disease by decreasing the incidence of acute cerebral, cardiovascular, peripheral vascular, and other thrombo-embolicevents. The overwhelming data show that the risk of thrombotic events is significantly higher than that of bleeding during surgery after antiplatelet drug discontinuation. It has been assumed that discontinuing antiplatelet therapy prior to performing interventional pain management techniques is a common practice, even though doing so may potentially increase the risk of acute cerebral and cardiovascular events. A survey of practice patterns was conducted in 2012, since then the risks associated with thromboembolic events and bleeding, has not been systematically evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To conduct an updated assessment of the perioperative antiplatelet and anticoagulant practice patterns of U.S. interventional pain management physicians and compare this with data collected in 2012 with 2021 data regarding practice patterns of continuing or discontinuing anticoagulant therapy. STUDY DESIGNn: Postal survey of interventional pain management physicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study setting: &lt;/strong&gt;Interventional pain management practices in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The survey was conducted based on online responses of the members of the American Society of Interventional Pain Physicians (ASIPP) in 2021. The survey was designed similar to the 2012 survey to assess updated practice patterns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The questionnaire was sent out to 1,700 members in October 2021. Out of these, 185 members completed the survey, while 105 were returned due to invalid addresses. The results showed that 23% changed their practice patterns during the previous year. The results also showed that all physicians discontinued warfarin therapy with the majority of physicians accepting an INR of 1.5 as a safe level. Low dose aspirin (81 mg) was discontinued for 3 to 7 days for low-risk procedures by 8% of the physicians, 34% of the physicians for moderate or intermediate risk procedures, whereas they were discontinued by 76% of the physicians for high-risk procedures. High dose aspirin (325 mg) was discontinued at a higher rate. Antiplatelet agents, including dipyridamole, cilostazol, and Aggrenox (aspirin, extended-release dipyridamole) were discontinued from 3 to 5 days by 18%-23% of the physicians for low-risk procedures, approximately 60% of the physicians for moderate or intermediate-risk procedures, and over 90% of the physicians for high-risk procedures. Platelet aggregation inhibitors clopidogrel, prasugrel, ticlopidine, and ticagrelor were discontinued for 3 to 5 days by approximately 26% to 41% for low-risk procedures, almost 90% for moderate or intermediate-risk procedures, and over 97% for high-risk procedures. Thrombin inhibitor","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 S6","pages":"S95-S114"},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971619","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 Coracohumeral Release for Patients with Adhesive Capsulitis: Two-Year Results from a Randomized Control Crossover Study.","authors":"Ugur Yener, Tahereh Naeimi, Alan D Kaye, Konrad Izumi Gruson, Sandeep Yerra, Jonathan Alerte, David Gonzalez, Pramod Badu Voleti, Eloy Tabeayo Alvarez, Sayed Emal Wahezi","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adhesive capsulitis (AC) causes a variety of symptoms, including but not limited to pain, stiffness, and a gradual restriction of active and passive range of motion (ROM). The coracohumeral ligament (CHL) plays an important role in this disease process, and percutaneous CHL release (PCHLR) has demonstrated efficacy in treating manifestations of this disorder that are refractory to pain medication, physical therapy, and local injections. Our previous study demonstrated one-year efficacy and durability, and this study examines 2-year data from our original randomized control crossover cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To highlight the importance of extended follow-ups evaluating PCHLR's efficacy in AC management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A prospective, randomized, controlled, cross-over trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;An academic medical center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with AC refractory to oral medication, physiotherapy, and at least one local injection were included in our original study. In all, there were initially 40 patients (46 shoulders), including 6 patients who underwent bilateral PCHLR using the Tenex® system. In this prospective study, 2 groups, the experiment group (scheduled to receive PCHLR) and the control group (scheduled to receive a local anesthetic in the coracohumeral ligament [LACHL]) were determined through 2-to-1 block randomization. Of these 46 shoulders initially treated, 39 remained in the study at one year. Twenty-six of the 39 shoulders were assigned to the PCHLR group whereas 13 were assigned to the LACHL group. Nine out of 13 shoulders in the LACHL group crossed over to the PCHLR group. Ultimately, 31 shoulders remained in the PCHLR group for 2-year analysis. The effectiveness of these interventions was assessed using a variety of parameters. Pain scores, ROM, and the Oxford Shoulder Score (OSS) were evaluated before the procedure and at one-year and 2-year follow-up visits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this 2-year follow-up study, a total of 31 shoulders were sampled, comprising 22 women and 5 men, with 4 patients undergoing bilateral procedures. The mean age of the patients was 65 years (± 11.48). Patients' mean body mass index (BMI) was 36.33 (± 6.55), and the mean CHL thickness was 38.5 (± 3.45). Osteoarthritis was present in 11 cases. The mean follow-up period for the study was 29.7 months (± 6.39). The baseline mean external rotation was 30° (± 8), which increased to 62° (± 18) at one year and 53° (± 18) at 2 years. The baseline mean abduction was 60° (± 16), which improved to 77° (± 21) at one year and 68° (± 20) at 2 years. The median NRS decreased from 8 (IQR: 8, 9) at baseline to 3 (IQR: 2, 7) at one year and 5 (IQR: 2, 7) at 2 years. The baseline median OSS was 7 (IQR: 3, 10), which increased to 32 at one year and 22 (IQR: 15, 35) at 2 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The present investigation has a limited sample si","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"303-307"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860537","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":"Evaluation of Online Large Language Models for Patient Education Regarding Chronic Low Back Pain.","authors":"Xiang Liu, Pengfei Li, Xiaohua Fan, Chao Wang","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E645-E647"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860533","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":"A Multimodal Meta-Analysis of Structural and Functional Alterations in the Brain of Knee Osteoarthritis Systematic Review.","authors":"Shirui Cheng, Xiaohui Dong, Peng Lai, Xingyao Chen, Jun Zhou, Zhengjie Li, Xi Wu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Abnormalities of structural and functional brain regions might influence the persistence of knee pain, the progression, and the response to treatments in knee osteoarthritis (KOA). These complex alterations present a challenge to the understanding of its mechanism.</p><p><strong>Objectives: </strong>To meta-analyze the concurrence across structural and functional magnetic resonance imaging studies.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting: </strong>This meta-analysis examined all voxel-based morphometric (VBM) and amplitude of low-frequency fluctuation (ALFF) studies involving the whole-brain alterations of KOA.</p><p><strong>Methods: </strong>VBM and ALFF studies published up to May 7, 2023, were searched in the Web of Science, PubMed, EMBASE, Cochrane Library (CENTRAL), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database, Chongqing VIP, Wanfang Database. Two independent researchers carried out study screening, quality assessment, clinical data extraction, and neuroimaging data extraction. The whole-brain voxel-based gray matter (GM) and brain activity data of KOA were collected from eligible studies and meta-analyzed using the anisotropic effect size-signed differential mapping (AES-SDM).</p><p><strong>Results: </strong>Fourteen studies were included in this study. In VBM meta-analyses, a total of 481 patients were enrolled in this study (252 KOA and 229 healthy patients). In the ALFF meta-analysis, a total of 518 patients were enrolled in this study (265 KOA and 253 healthy patients). According to the meta-analysis, KOA had increased GM volume in the right inferior frontal gyrus and decreased GM volume in the bilateral superior frontal gyrus, as well as increased brain activity in the left inferior frontal gyrus and inferior temporal gyrus, and decreased brain activity in the left middle occipital gyrus, right supramarginal gyrus, right superior frontal gyrus, and right superior parietal gyrus compared with healthy patients.</p><p><strong>Limitations: </strong>Most of the ALFF studies included in this meta-analysis were conducted in China. Our findings are exclusively addressed by the VBM and ALFF studies. The meta-regression between the duration of KOA, pain intensity and abnormal gray matter, and functional activity of brain regions in patients with KOA were unable to be analyzed.</p><p><strong>Conclusion: </strong>The results of this meta-analysis indicate that patients with KOA present significant abnormalities in GM volume and functional activity. These findings contribute to a better understanding of the structural and functional abnormalities seen in patients with KOA.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E557-E566"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860528","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 MuscleSCS Technique (4-8Hz BurstDRTM Octrode™): A Randomized Clinical Study of MuscleSCS Stimulation in the Treatment of Chronic Back Pain.","authors":"Matthias Hubert Morgalla, Laura Olbrisch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>MuscleSCS is a new technique that combines spinal cord stimulation (SCS) with muscle stimulation to relieve pain.</p><p><strong>Objectives: </strong>In this clinical study, we wanted to use rod electrodes to investigate the MuscleSCS method's effectiveness in the treatment of chronic lower back pain. One of our hypotheses was that the combined use of MuscleSCS and BurstDRTM would further improve the treatment.</p><p><strong>Study design: </strong>A prospective, single-center, single-blinded, randomized crossover study.</p><p><strong>Setting: </strong>A university medical center.</p><p><strong>Methods: </strong>Patients with chronic lower back pain had previously (one to 10 years ago) received an SCS system (Octrode™). In this study, they were randomly treated for 2 weeks each with BurstDRTM stimulation alone, MuscleSCS stimulation alone, or a combination of BurstDRTM stimulation and MuscleSCS stimulation. Thereafter, the patients were treated for another 6 weeks with one of the 3 methods (crossover possible). Pain ratings on the visual analog scale (VAS) were recorded and compared. A Pain Disability Index (PDI) questionnaire was used at the baseline and at 3 months.</p><p><strong>Results: </strong>We included 24 patients in this study (11 women, mean age 62.3 yrs.) The values of the second week of the stimulation were the only ones used for the calculations. The first week of the stimulation was used as a wash-out period.The combined application of BurstDRTM and MuscleSCS stimulation was associated with the best results (P = 0.032). PDI scores did not improve during this treatment. No serious adverse events occurred during this study. Seventy-one and a half percent of the patients experienced an improvement in their pain as a result of the additional MuscleSCS stimulation.</p><p><strong>Limitations: </strong>In this study, only one fixed contact setting (3 & 4) was used to ensure uniform conditions for all patients and the ability to compare the different treatment modes.</p><p><strong>Conclusion: </strong>This study showed that the combined application of SCS (BurstDRTM) and additional MuscleSCS stimulation using a rod electrode could significantly improve outcomes for patients suffering from chronic back pain.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"309-316"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860545","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":"Comparing the Effectiveness and Safety of Dexamethasone, Methylprednisolone and Betamethasone in Lumbar Transforaminal Epidural Steroid Injections.","authors":"Alexandra M Moreira, Lorenzo Diaz, Jonathan Presley, Andrea Solorzano, Chris Diaz, Kerstin Yu, Eduard Tiozzo, Alberto Cruz, Chane Price","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Particulate steroids are thought to exert their effects for long durations at injection sites. However, these types of steroids carry higher risks when used in epidural steroid injections. Catastrophic spinal cord complications, including sudden-onset paraplegia, have been reported due to intravascular particulate steroid preparations that cause embolisms and occlusion of blood vessels, resulting in spinal cord infarctions. Clinicians, therefore, recommend nonparticulate steroids to mitigate these adverse events. To our knowledge, this is the first retrospective study that addresses the effectiveness and safety of methylprednisolone, dexamethasone, and betamethasone when used in transforaminal epidural steroid injections (TFESIs) for the treatment of lumbar radiculopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The primary goal of this study was to compare the proportion of patients who received injections of particulate steroids and required zero repeat injections within 12 months of their initial injection to the proportion of patients who received injections of nonparticulate steroids and also required zero repeat injections, as well as to compare the number of patients in the particulate cohort who required one or more repeat injections within 12 months of their initial injection to the number of patients in the nonparticulate cohort who required the same. The secondary goal was to evaluate the proportion of patients ultimately requiring surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This is a single-center, IRB-approved, retrospective study evaluating the safety and effectiveness of nonparticulate as compared to particulate steroid medications when used in TFESIs as minimally invasive treatments for chronic lumbar radiculopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study captured data (n = 1717) over a 4-year time frame (01/15/2018 to 01/15/2022).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The following data were collected from each patient's chart: age, gender, BMI, race, date of initial injection, number of repeat injections at the same lumbosacral level and on the same side within 12 months of the initial injection, and lumbar surgery date (if applicable). Inclusion criteria included: 1) having chronic low back pain of radicular etiology; 2) being at least 18 years old; 3) having experienced the failure of conservative therapy after 12 weeks (including physical therapy and/or medications); 4) having positive physical exam findings supporting nerve impingement (straight leg raise, slump test); and 5) showing lumbar MRI evidence of nerve impingement from disc herniation. Exclusion criteria included: 1) having received prior lumbar surgery at any level (L1-S1); 2) having been given prior TFESIs fewer than 6 months prior to initial injection; 3) having contracted a systemic infection at the proposed injection site; 4) undergoing active cancer treatment; and 5) having gotten any other spine injections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/s","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"341-348"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860530","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}