Techniques in regional anesthesia & pain management最新文献

{"title":"Treatment of annular disc tears and “leaky disc syndrome” with fibrin sealant","authors":"Kevin Pauza MD ,&nbsp;Carrie Wright BS ,&nbsp;Adam Fairbourn BS","doi":"10.1053/j.trap.2016.09.008","DOIUrl":"10.1053/j.trap.2016.09.008","url":null,"abstract":"<div><p><span><span>The surfaces of annulus fibrosus tears are known harbingers of inflammatory constituents within </span>intervertebral discs<span><span>, stimulating sensitized nocioceptors within those tears. Other current treatment options of internal disc disruption neglect to specifically address the surface of these tears. Therefore, this investigation answers the question: does nonautologous </span>fibrin sealant<span> applied to the surface of annulus fibrosus tears mechanically glue and seal annular tears? Regarding this query, results suggest nonautologous concentrated fibrin successfully seals annulus fibrosus tears with a “suture-like mechanical sealant,” serving as a safe option for treating symptomatic or nonsymptomatic intervertebral disc tears. Sealing tears prevents pain-generating chemicals of the nucleus pulposus from leaking through annular tears. More specifically, fibrin sealant minimizes or eliminates extravasation of nucleus pulposus through tears and voids within the annulus fibrosus. Moreover, an investigation subjecting discs to an “internal pressure challenge” objectively affirms fibrin׳s ability to seal torn and degenerated discs against a pressure challenge. (1</span></span></span> <!-->psi = 6.89476<!--> <!-->kPs (disc mean pressure pretreatment = 75.84<!--> <!-->kPs; post-treatment = 179.3<!--> <!-->kPs: (<em>n</em> = 347, <em>P</em><span> &lt; 0.001). Therefore, sealing annular tears serves to minimize extravasation of nucleus pulposus through annular tears, thus potentially treating symptoms caused by internal disc disruption, “Leaky Disc Syndrome,” and chemical radiculopathy<span>. Additionally, sealing annular tears potentially allows adjunctive regenerative biologics such as mesenchymal precursor cells, platelet rich plasma, and growth factors to remain within discs, thus, potentially optimizing their efficacy. A prior in vivo investigation demonstrated the vast majority of mesenchymal stem cells<span> leaked from animal intravertebral discs, and another demonstrated radiolabeled mesenchymal stem cells leaked from degenerated discs and were subsequently found within new exuberant osteophytes adjacent to the degenerated disc. Intra-annular nonautologous concentrated fibrin shares a benefit of other intradiscal biologics in that fibrin does not cause aberrant detrimental mechanical forces on adjacent discs, compared with surgical fusion and disc arthrodesis, which both cause aberrant, potentially damaging mechanical forces on adjacent segments. The mean number of morphologically abnormal lumbar intervertebral discs in this population with chronic low back pain was 3.21 discs.</span></span></span></p></div>","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 45-49"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58060718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional orthopedics in pain medicine practice","authors":"Christopher J. Centeno MD,&nbsp;Christopher J. Williams MD,&nbsp;Matthew Hyzy DO","doi":"10.1053/j.trap.2016.09.005","DOIUrl":"10.1053/j.trap.2016.09.005","url":null,"abstract":"<div><p><span><span><span>Interventional pain physicians are in a unique place to take advantage of regenerative medicine technology to improve patient outcomes and decrease the invasiveness of </span>orthopedic procedural care. However, that sea of change would take significant changes to the educational system similar to those established when interventional spine was first introduced as a subspecialty. The tenets of interventional orthopedics are as follows: injectates that can facilitate healing of musculoskeletal tissues, precise placement of those injectates into damaged structures using imaging guidance, and the eventual development of new tools to facilitate percutaneous tissue manipulation. Stem cells are an early injectate being used in this developing field. The research supporting the use of stem cells to treat orthopedic conditions is more robust than many realize. Early clinical work to treat </span>osteonecrosis and </span>fracture nonunion<span> began in the 1990s. Today, early clinical evidence to support the use of bone marrow concentrate to treat knee osteoarthritis and other orthopedic conditions exists and continues to develop. Although more research needs to be completed, the increased availability of biologic agents that can prompt healing in musculoskeletal tissues would usher in a new field of medicine—interventional orthopedics.</span></p></div>","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 26-31"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58060521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FMi: Editorial Board","authors":"","doi":"10.1053/S1084-208X(16)30029-5","DOIUrl":"https://doi.org/10.1053/S1084-208X(16)30029-5","url":null,"abstract":"","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Page A1"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/S1084-208X(16)30029-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138320131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of stromal vascular fraction cells applications in chronic pain","authors":"Elliot B. Lander MD,&nbsp;Mark H. Berman MD,&nbsp;Jackie R. See MD","doi":"10.1053/j.trap.2016.09.002","DOIUrl":"10.1053/j.trap.2016.09.002","url":null,"abstract":"Abstract Autologous stromal vascular fraction (SVF) can be enzymatically released from lipoaspirate obtained under local anesthesia. SVF is known to have regenerative, anti-inflammatory, pain mitigating, and immune-modulatory properties. Our translational research network has been studying the safety and efficacy of SVF since 2012. Almost 100 related physician teams around the world are applying the same institutional review board–approved methods of SVF production, which use a surgically closed SVF isolation system. During the same outpatient surgical procedure, procured SVF is administered according to strict investigative protocols to mitigate diseases associated with chronic pain including arthritis, autoimmune disease, neurodegenerative disease, and various inflammatory conditions. The shared research collaborative online database contains safety and efficacy data on more than 3500 patients. Our processed SVF contains valuable anti-inflammatory cytokine growth factors in addition to both adult mesenchymal and hematopoietic stem cells targeting damaged, or inflamed tissue. SVF administration may potentially play a large role in the outpatient treatment of pain. In this article, we describe our protocol for the production and administration of SVF, and its safety and efficacy in the treatment of pain associated with chronic conditions.","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 10-13"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58060198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-rich plasma injections for knee osteoarthritis: Systematic review of duration of clinical benefit","authors":"Dmitri Souzdalnitski MD, PhD ,&nbsp;Samer N. Narouze MD, PhD, FIPP ,&nbsp;Imanuel R. Lerman MD, MS ,&nbsp;Aaron Calodney MD","doi":"10.1053/j.trap.2016.09.012","DOIUrl":"10.1053/j.trap.2016.09.012","url":null,"abstract":"<div><p><span><span>Both researchers and clinicians have exhibited growing interest in the use of platelet-rich plasma (PRP) and other autologous products for a variety of clinical conditions. Newly published data suggest that PRP injections can be an effective complement to conventional management strategies for knee osteoarthritis<span> (OA) and chondropathy. Using a </span></span>systematic review<span> approach, we sought to synthesize the published data on the duration of clinical effect of PRP on knee OA and chondropathy. We systematically searched PubMed for all reports published in any language between the earliest available date and July (fourth week) of 2015 using the following key words: platelet, rich, plasma, knee, and osteoarthritis. If double-blind randomized, controlled trials were not available, we included other </span></span>clinical trials<span><span> and observational studies. We further searched for the association of the same keywords (platelet, rich, plasma, knee) and chondropathy. After reviewing abstracts, we acquired full-text papers where appropriate. We categorized the level of evidence for the duration of treatment efficacy according to Guyatt and coauthors. Twenty-four relevant studies encompassing 2,385 patients were included in the review. Studies reported clinical outcomes from intra-articular injection of PRP or recounted autologous products. The results showed a consistent improvement </span>in patient pain scores and functional indexes for 6 months after initiation of injections. The residual clinical effect was typically observed beyond 6 months of follow-up in most of the studies. Pain and functional scores decreased after 12 months of follow-up but remained higher than the base scores in the majority of studies. Some suggested that annual injections improved treatment outcomes after 18 months of follow-up. Data from available clinical reports suggest that the PRP administration results in decreased pain and enhanced functional status. The duration of beneficial clinical effects after administration of PRP or recounted autologous products for patients with knee OA and chondropathy was stable up to 6 months following completion of regenerative therapy. The pain and functional scores worsened after 12 months of follow-up but were still better than pre-injection scores according to the majority of publications. The analysis is limited by the wide variability of available studies.</span></p></div>","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 67-72"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58060619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regenerative medicine for muscle and ligament problems: Technical aspects and evidence","authors":"Sean Colio MD ,&nbsp;Matthew McAuliffe MD ,&nbsp;Yvette Uribe BA ,&nbsp;Marko Bodor MD","doi":"10.1053/j.trap.2016.09.014","DOIUrl":"10.1053/j.trap.2016.09.014","url":null,"abstract":"<div><p><span>Interest in regenerative medicine for treating musculoskeletal pathology has grown tremendously over the past decade. Part of its appeal lies in the ability to use a patient׳s own cells to potentially heal acute and chronic injuries. While evidence grows supporting its use in certain injuries, a perception exists that regenerative medicine may be a panacea. In this article, we review the evidence for platelet-rich plasma and bone marrow aspirate concentrate in treating muscle, ligament, and </span>fibrocartilage injuries. We also offer our own practice experiences and technical considerations in the uses of these techniques.</p></div>","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 80-84"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58061014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral nerve entrapment, hydrodissection, and neural regenerative strategies","authors":"Andrea Trescot MD, DABIPP, FIPP ,&nbsp;Michael Brown DC, MD","doi":"10.1053/j.trap.2016.09.015","DOIUrl":"10.1053/j.trap.2016.09.015","url":null,"abstract":"<div><p><span>Peripheral nerve entrapments are an underrecognized cause of pain and disability. Hydrodissection (perineural deep injections) is one of the techniques that can release the entrapped nerve. Futhermore, discussed are the techniques of </span>neural therapy<span>, neural prolotherapy (perineural injection therapy), and autologous platelet lysate, as well as the use of adipose-derived stem cells.</span></p></div>","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 85-93"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58061101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current understanding of safety and efficacy of stem cell therapy for discogenic pain—A systematic review of human studies","authors":"Christine L. Hunt DO, MS ,&nbsp;Stephanie Shen MD ,&nbsp;Ahmad Nassr MD ,&nbsp;Andre J. van Wijnen PhD ,&nbsp;A. Noelle Larson MD ,&nbsp;Jason S. Eldrige MD ,&nbsp;William D. Mauck MD ,&nbsp;Mathew J. Pingree MD ,&nbsp;Patricia J. Erwin MLS ,&nbsp;Mohamad Bydon MD ,&nbsp;Wenchun Qu MD, MS, PhD","doi":"10.1053/j.trap.2016.09.006","DOIUrl":"10.1053/j.trap.2016.09.006","url":null,"abstract":"<div><p><span>This study is a systematic review<span><span> of human clinical studies of stem cell therapy for </span>discogenic pain<span>. To summarize the current human trials and feasibility studies involving mesenchymal stem cell (MSC) therapy for treatment of discogenic pain. A search of Ovid databases and Clinicaltrials.gov was conducted from inception through July 2016. We included human </span></span></span>clinical trials<span> and case reports that evaluated treatment with injected MSCs<span><span><span> for patients with discogenic back pain. The outcomes of interest for published studies included pain score, </span>Oswestry Disability Index<span>, and T2-weighted magnetic resonance imaging signal intensity indicative of water content of the nucleus pulposus. The initial search in Ovid databases using the selected search terms identified 408 results, of which 11 were included in this review based on selection criteria. This includes 6 completed studies and 5 ongoing clinical trials, 4 of which were confirmed active at the time of retrieval. In the 6 completed studies involving intradiscal stem cell injections, improvement in pain score, Oswestry Disability Index, and T2-weighted magnetic resonance imaging signal intensity of nucleus pulposus were reported. Currently active clinical trials focus on establishing safety, tolerability, and efficacy with respect to injected MSCs for discogenic pain. Although pain and functional benefit have been reported in association with stem cell therapy, longer-term safety studies and more </span></span>randomized controlled trials are needed to examine the safety and efficacy of stem cell therapy for discogenic pain.</span></span></p></div>","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 32-37"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58060591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regenerative medicine injection techniques for the hip pathology","authors":"Neil Mandalaywala MD ,&nbsp;George C. Chang Chien DO ,&nbsp;Enrique Galang MD ,&nbsp;Prin X. Amorapanth MD, PhD ,&nbsp;Kenneth D. Candido MD","doi":"10.1053/j.trap.2016.09.011","DOIUrl":"10.1053/j.trap.2016.09.011","url":null,"abstract":"<div><p><span>Hip pain is a common complaint that can have both intra-articular and extra-articular origins. Three common causes of hip pain are hip osteoarthritis<span><span><span>, iliopsoas tendinopathy<span>, and gluteus medius tendinopathy. Current treatment plans range from conservative measures to surgical replacement. Traditionally, minimally invasive approaches with the use of corticosteroid and </span></span>local anesthetic<span> injections have served to manage symptoms of pain without altering disease progression<span>. In addition, these agents have been associated with deleterious effects on bone, tendon, and cartilage health. Emerging regenerative medicine techniques are becoming increasingly popular for the management of hip pain, as they have been shown to improve clinical outcomes and potentially alter disease progression. Some of these techniques, such as injection of platelet-rich plasma, </span></span></span>mesenchymal stem cells<span>, and percutaneous needle fenestration, have been shown to promote healing of damaged tissue. These techniques are often augmented by the use of </span></span></span>ultrasound imaging<span><span>, which greatly increases ease and accuracy. This article reviews ultrasound-guided regenerative orthopedic injections specifically for hip joint </span>osteoarthritis, gluteus medius tendinopathy, and iliopsoas tendinopathy.</span></p></div>","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 60-66"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58060488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-rich plasma injections for lumbar discogenic pain: A preliminary assessment of structural and functional changes","authors":"Annu Navani MD ,&nbsp;Alexandra Hames","doi":"10.1053/j.trap.2016.09.007","DOIUrl":"10.1053/j.trap.2016.09.007","url":null,"abstract":"<div><p><span><span><span>The goal of this case review is to evaluate functional and structural changes with the use of intradiscal PRP </span>in patients with lumbar </span>discogenic pain<span><span>. The secondary outcomes include improvement in pain, medication use, hospitalization, and surgery. Low back pain affects a large portion of the population causing a major social and economic effect. Current interventional treatments remain inadequate and transient targeting the symptoms without addressing the underlying cause. Platelet-rich plasma (PRP) has been used clinically in various settings for its healing properties attributed to growth factors. A total of 6 patients with chronic discogenic low back and leg pain who tried and failed conservative treatments were administered a single injection of 2-mm autologous PRP into the </span>nucleus pulposus after careful study of the disk </span></span>anatomy<span><span> via discography<span> and computed tomography scan. The patients were followed up at 2, 4, 8, 12, 16, 20, and 24 weeks; postinjection and primary and secondary outcomes were recorded. Verbal pain scale score for pain of all patients decreased more than 50% and their function increased for the period of 6 months and beyond. Postprocedure magnetic resonance imaging documented positive structural changes in small percentage of patients. None of the patients presented to the hospital or received surgery after this treatment. Although our preliminary results have been promising, well-designed </span></span>randomized controlled trials are warranted to understand the full breath of the efficacy, risks, and complications from the use of PRP in the disk.</span></p></div>","PeriodicalId":93817,"journal":{"name":"Techniques in regional anesthesia & pain management","volume":"19 1","pages":"Pages 38-44"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.trap.2016.09.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58060657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}