Pain Practice最新文献

{"title":"Occipital nerve stimulation: A detailed description of a surgical approach and a discussion on implantation techniques.","authors":"Kaare Meier, Ida Stisen Fogh-Andersen, Jens Christian Hedemann Sørensen","doi":"10.1111/papr.13444","DOIUrl":"10.1111/papr.13444","url":null,"abstract":"<p><strong>Objective: </strong>Occipital Nerve Stimulation (ONS) is increasingly used to treat a range of chronic, refractory headache conditions, most notably chronic cluster headache (CCH). Despite this, there is still no consensus on the optimal implantation technique. Clinical reports and reviews in the field have reported remarkably high complication rates of which several can be directly related to the surgical approach. We here describe a comprehensive and detailed surgical approach used at Aarhus University Hospital, Denmark, aiming to improve paresthesia coverage and minimize complications.</p><p><strong>Methods: </strong>The implantation procedure described here is performed with a sleep-awake anesthetic regimen in a lateral position using anatomical landmarks and perioperative testing based on patient feedback. A single lead is subcutaneously implanted from behind the ear and across the back of the head, and the implantable pulse generator (IPG) is placed below the right clavicle.</p><p><strong>Results: </strong>From March 2018 to June 2024, 45 CCH patients were implanted using this approach and followed up for a total of 86.3 patient years. A total of 22 adverse events (AEs) occurred in 17 patients, with nine AEs requiring revision surgery. Notably, no instances of lead migration, lead breakage, or muscle/neck stiffness were observed. Temporary occipital dysesthesia was the most frequent non-surgical AE, resolving spontaneously within weeks. The rate of serious adverse events (SAEs) was one per 9.6 patient years. Six patients had the ONS system explanted due to lack of efficacy.</p><p><strong>Conclusions: </strong>The surgical approach described here in detail offers several advantages, with a favorable complication profile, satisfactory paresthesia coverage, and good perioperative patient comfort. Advances in the surgical technique are vital to both patients and healthcare providers, and we believe this approach is a valuable contribution toward improved patient outcomes and procedural efficiency.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13444"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribers' preferences for triptans in migraine: Insights from the French National Social Security System Open Data.","authors":"Sylvain Redon, Anne Donnet","doi":"10.1111/papr.13432","DOIUrl":"10.1111/papr.13432","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13432"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in removing an aged spinal cord stimulator: A case study of complete fracture in a 9-year-old S-series paddle lead.","authors":"Dong-Chun Kim, Eunsu Kang, Hyun-Seong Lee, Yei Heum Park, Byeongcheol Lee, Ji Yeon Kwon, Junseong Moon, Sang Eun Lee","doi":"10.1111/papr.13429","DOIUrl":"10.1111/papr.13429","url":null,"abstract":"<p><strong>Introduction: </strong>This case report presents an instance of an S-Series™ slim paddle lead fracturing during extraction, highlighting potential risks associated with the removal of this lead.</p><p><strong>Case report: </strong>A 47-year-old male with complex regional pain syndrome type 2, unresponsive to pharmacotherapy, had undergone the implantation of two spinal cord stimulator (SCS) leads, an Octrode™ cylindrical and an S-series™ slim paddle, using the Epiducer™ system (St Jude Medical) 9 years earlier, with a subsequent intrathecal baclofen pump installed 1 year after SCS. Initially, these interventions stabilized the patient's pain symptoms. However, the diminishing effectiveness of SCS, coupled with a decrease in battery life and increased opioid consumption, necessitated recent surgical procedures. These included the removal and replacement of the implantable pulse generator (IPG) and leads to improve pain management and ensure MRI compatibility. During the removal of the S-series™ slim paddle type lead, complications arose, leading to the retention of an electrode fragment, which necessitated abandoning the replacement of both the IPG and lead. Post-surgical assessments revealed no new neurological impairments, and imaging studies confirmed the stable position of the retained fragment. The patient was discharged with a continued comprehensive pain management plan.</p><p><strong>Conclusion: </strong>This case highlights the challenges and risks of percutaneous removal of slim paddle type leads, emphasizing the need for careful procedural planning and consideration of surgical options to avoid complications. Further research is needed to evaluate the long-term durability and removal risks of various SCS lead types.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13429"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid deprescribing in chronic pain management: Insights from Taiwan on the French experience.","authors":"Lien-Chung Wei, Chun-Hung Lee","doi":"10.1111/papr.13442","DOIUrl":"10.1111/papr.13442","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13442"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"9. Chronic knee pain.","authors":"Thibaut Vanneste, Amy Belba, Gezina T M L Oei, Pieter Emans, Loic Fonkoue, Jan Willem Kallewaard, Leonardo Kapural, Philip Peng, Michael Sommer, Bert Vanneste, Steven P Cohen, Jan Van Zundert","doi":"10.1111/papr.13408","DOIUrl":"10.1111/papr.13408","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee.</p><p><strong>Methods: </strong>The literature on the diagnosis and treatment of chronic knee pain was retrieved and summarized. A modified Delphi approach was used to formulate recommendations on interventional treatments.</p><p><strong>Results: </strong>Patients with knee OA commonly present with insidious, chronic knee pain that gradually worsens. Pain caused by knee OA is predominantly nociceptive pain, with occasional nociplastic and infrequent neuropathic characteristics occurring in a diseased knee. A standard musculoskeletal and neurological examination is required for the diagnosis of knee OA. Although typical clinical OA findings are sufficient for diagnosis, medical imaging may be performed to improve specificity. The differential diagnosis should exclude other causes of knee pain including bone and joint disorders such as rheumatoid arthritis, spondylo- and other arthropathies, and infections. When conservative treatment fails, intra-articular injections of corticosteroids and radiofrequency (conventional and cooled) of the genicular nerves have been shown to be effective. Hyaluronic acid infiltrations are conditionally recommended. Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have, at the moment, not enough evidence and can be considered in a study setting. The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary.</p><p><strong>Conclusions: </strong>When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13408"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11680467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing technique-related complications in spinal cord stimulation trials: The Dural Substitute Confetti technique. A retrospective monocentric analysis.","authors":"Alessandro Dario, Luca Ferlendis, Bianca Bossi, Davide Locatelli","doi":"10.1111/papr.13426","DOIUrl":"10.1111/papr.13426","url":null,"abstract":"<p><strong>Background: </strong>Spinal Cord Stimulation (SCS) is an established therapy for chronic pain, employing screening trials to identify suitable candidates before implantation. However, complications arising from both technique and medical factors present challenges to this practice. This study introduces the Dural Substitute Confetti technique, which addresses technique-related complications during SCS implantation by preventing scar-induced lead migration or breakage and reducing operating times.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on 174 patients treated with SCS trials from 2017 to 2022 at our institution. Of these, 85.1% proceeded to permanent implantation. During trial surgery, synthetic dural substitutes (DS) were used to protect leads, which remained connected to an external pulse generator (EPG) for 20-28 days (mean 21.4 days). Utilizing the DS Confetti technique, leads were easily dissected from the DS during the second surgery and connected to an internal pulse generator (IPG). We compared complications and surgical times before and after the introduction of this technique in 2017.</p><p><strong>Results: </strong>Following the complete SCS trial, patients experienced over 50% pain relief, with an implant-to-trial ratio of 85.1% and a mean follow-up of 52 months. No technique-related complications occurred during the trial period post-2017, while the pre-2017 group had a 3.9% lead migration rate due to scarring, necessitating re-implantation. The average surgery duration decreased from 54 min pre-2017 to 32 min post-2017. Medical-related complications included infections (2.1%) and wound dehiscence (1.3%).</p><p><strong>Conclusions: </strong>The DS Confetti technique prevents scar adhesion formation during screening trials, thereby facilitating and expediting the definitive SCS implantation. Additionally, it may also reduce the risk of lead migration and iatrogenic damage, potentially lowering technique-related complications.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13426"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of long-term use of a buprenorphine transdermal patch system in patients with osteoarthritis and low back pain refractory to non-opioid analgesics: Post-marketing surveillance of 3000 cases.","authors":"Takahiro Ushida, Rumiko Kanzaki, Keishi Katayama, Akito Ishikawa","doi":"10.1111/papr.13430","DOIUrl":"10.1111/papr.13430","url":null,"abstract":"<p><strong>Objectives: </strong>A post-marketing surveillance was conducted to evaluate the safety and efficacy of the buprenorphine transdermal patch under actual clinical practice.</p><p><strong>Results: </strong>Of the 3017 patients included in the safety analysis, adverse drug reactions (ADRs) were observed in 1524 (50.5%), the most common being nausea, skin symptoms at the site of application, constipation, and vomiting. The incidences of respiratory depression and withdrawal symptoms were low, and no drug dependence was observed. Among the 2573 patients included in the efficacy analysis, the efficacy (≥2-point improvement in the numerical rating scale) rate was 74.4%, which was significantly higher in older adults (≥65 y.o) than in younger adults. Discontinuation was mostly caused by ADRs during the early initiation phase.</p><p><strong>Conclusion: </strong>This study demonstrated the safety and efficacy of long-term administration of buprenorphine transdermal patches, suggesting that pain control is possible over the long term if attention is paid to ADRs in the early stages of administration.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13430"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of steroid dose with or without local anesthetic in lumbar interlaminar epidural steroid injections.","authors":"Robert Chow, Jessica Ng, Melanie Wood, David Yanez, Zili He, Kanishka Rajput","doi":"10.1111/papr.13410","DOIUrl":"10.1111/papr.13410","url":null,"abstract":"<p><strong>Introduction: </strong>Epidural steroid injections (ESIs) are commonly used as a treatment for lumbar radiculopathy. Currently, most research on comparative efficacy of various steroids in epidural steroid injections is focused on transforaminal ESIs (TFESIs). Through this study, we aimed to compare various steroid doses with or without local anesthetic in interlaminar ESIs (ILESIs).</p><p><strong>Methods: </strong>We reviewed charts for all adult patients who received ILESIs identified by CPT code 62323 between January 2017 to April 2021. Baseline demographic data including age, sex, BMI, and smoking status were recorded. NRS pain scores before the injection and percentage of pain relief at 1-month follow-up were recorded. We compared percentage of patients reporting pain relief at 1 month follow-up of low-dose dexamethasone alone (5 mg), to low-dose dexamethasone mixed with local anesthetic, and to high-dose dexamethasone (10 mg) mixed with local anesthetic, specifically for ILESIs.</p><p><strong>Results: </strong>Data were available for 311 patients. There was no significant difference in pain relief between the 3 groups at 1 month follow-up. The majority of patients had moderate to significant improvement in pain, supporting the use of ILESIs. Moreover, low-dose steroid with local anesthetic was found to be as efficacious as high-dose steroid alone. Although not statistically significant, the addition of local anesthetic to low-dose or high-dose steroid increased the percentage of patients reporting moderate to significant pain relief.</p><p><strong>Conclusion: </strong>ILESIs with non-particulate steroids provide moderate to significant pain improvement in the short term, with low-dose steroid mixed with local anesthetic being as efficacious as a high-dose steroid.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13410"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142293110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative review: Managing buprenorphine and opioid use disorder in the perioperative setting.","authors":"Lynn Kohan, Antje Barreveld, Sudheer Potru, Alaa Abd-Elsayed, Eugene R Viscusi","doi":"10.1111/papr.13427","DOIUrl":"10.1111/papr.13427","url":null,"abstract":"<p><p>The opioid epidemic continues to have a staggering impact on millions of individuals and families across all socioeconomic levels and communities. Recent studies suggest high numbers of patients presenting for surgery with reported opioid misuse and/or opioid use disorder (OUD). Anesthesiologists often lack basic education to treat patients suffering with OUD or patients in recovery from this treatable disease. This manuscript will provide a review of the American Society of Anesthesiology and Pain Medicine Multisociety Working Group Practice Advisory recommendations on existing OUD treatment barriers and perioperative management best practices; it will also demonstrate the benefits that greater involvement of the anesthesiologist can have in managing patients with OUD perioperatively.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13427"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Declining pain medicine fellowship applications from 2019 to 2024: A concerning trend among anesthesia residents and a growing gender disparity.","authors":"Scott G Pritzlaff, Naileshni Singh, Chinar Sanghvi, Michael J Jung, Paul K Cheng, David Copenhaver","doi":"10.1111/papr.13441","DOIUrl":"10.1111/papr.13441","url":null,"abstract":"<p><strong>Introduction: </strong>The fields of anesthesiology and pain medicine are experiencing significant changes driven by market forces and professional preferences. While demand for anesthesiologists is rising, pain medicine is facing a decline in fellowship applications.</p><p><strong>Methods: </strong>This study analyzed data from the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP) from 2019 to 2023, focusing on trends in fellowship applications to pain medicine programs. Additionally, preliminary data from the 2024 match cycle were examined.</p><p><strong>Results: </strong>There has been a notable decrease in anesthesiology residents applying to pain medicine fellowships, with applications dropping from 351 in 2019 to 193 in 2023. The overall decline in anesthesia-based applicants to pain medicine fellowships was 45%, signaling the highest detriment among anesthesiology applicants compared to other specialties. Gender disparities have been prevalent, with the absolute number of female applicants decreasing every year since 2019. Additionally, the 2023 match saw a significant number of unfilled programs, with 35 out of 115 programs failing to fill all positions. Preliminary data from the 2024 match cycle suggest this downward trend is continuing.</p><p><strong>Conclusion: </strong>The decline in pain medicine fellowship applications, particularly among anesthesiology residents, signals potential future workforce shortages and challenges in patient care. Recruitment strategies should include early exposure to pain medicine during residency, enhanced mentorship programs, and robust recruitment efforts (including virtual options). Addressing these issues is essential to ensure enough trained specialists to meet the growing need for pain specialists nationally.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13441"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}