bluuebunny/crossref_metadata_2025 huggingface dataset:
Opioid Tolerance – A Predictor of Increased
Length of Stay and Higher Readmission Rates
Authors: Gulur Padma
Published: February 2021

The increasing use of opioids to manage pain in the United States over the last decade
has resulted in a subset of our population developing opioid tolerance. While the
management of opioid tolerant patients during acute episodes of care is well known
to be a challenge amongst health care providers, there is little in the literature that has
studied opioid tolerance as a predictor of outcomes. We conducted a review on all
admissions to Massachusetts General Hospital over a period of 6 months, from January
2013 to June 2013, and identified opioid tolerant patients at admission using the
FDA definition of opioid tolerance. To compare risk adjusted groups, we placed opioid
tolerant patients and control patients into groups determined by expected length of
stay of less than 2 days, 2 to 5 days, 5 to 10 days, and greater than 10 days. Opioid
tolerant patients were then compared to the control for outcomes measures including
observed length of stay and readmission rates. Our results show that all opioid tolerant
patients have a significantly longer length of stay and a greater 30 day all cause
readmission rate than the control group (P < 0.01). This trend was found in the first
3 risk adjusted groups, but not in the fourth group where expected length of stay
was greater than 10 days. The opioid tolerant population is at risk given the poorer
outcomes and higher health care costs associated with their care. It is imperative that
we identify opportunities for improvement and delineate specific pathways for the
care of these patients.
Key words: Opioid tolerance, opioid tolerant patient population, opioid tolerant
patients, readmission rates, length of stay
Early Adjunct Treatment with Topical Lidocaine
Results in Improved Pain and Function in a
Patient with Complex Regional Pain Syndrome
Authors: Hanlan Dr. Amy
Published: February 2021

Complex regional pain syndrome (CRPS) is a pain disorder characterized by sensory,
motor, trophic and autonomic dysfunction. The hallmark of the disorder is pain out of
proportion of the inciting event. CRPS is difficult for clinicians to manage as there is no
gold standard for diagnosis or treatment. Patients with CRPS are at risk of developing
contractures, tissue atrophy, joint dislocation and severe chronic pain. While CRPS
is thought to be due to peripheral and central nervous system dysfunction, there is
limited understanding of the pathophysiology of CRPS. The proposed mechanisms are
multifactorial and consequently, so are the proposed treatments. These treatments
can be invasive, such as intrathecal drug delivery or sympathectomy, which have
poor evidence for efficacy. Thus, highlighting the need for a safe, effective, and early
intervention. We present a case of topical 5% lidocaine ointment as a non-invasive,
inexpensive and effective adjunct treatment in the management of pain in a spinal cord
injured patient presenting with early CRPS. The clinically important effect of topical
lidocaine for reducing severe allodynia allowed the patient to participate in rehabilitation
strategies to further manage the debilitating consequences of her CRPS, including
decreased range of motion (ROM) and function. The immediate pain relief from topical
lidocaine allowed the patient to tolerate physical therapy sessions directed at her
CRPS. A successful outcome was measured subjectively and objectively by our patient’s
reduction in symptoms and improvement in ROM and function, respectively. This case
study provides preliminary support for improved pain and functional outcome with early
adjunct treatment of CRPS with topical lidocaine.
Key words: Complex Regional Pain Syndrome, topical lidocaine, central cord syndrome,
spinal cord injury
Pulsed Radiofrequency for Occipital Neuralgia
Authors: Manolitsis Nicholas
Published: February 2021

Background: The clinical application of pulsed radiofrequency (PRF) by interventional pain
physicians for a variety of chronic pain syndromes, including occipital neuralgia, is growing. As a
minimally invasive percutaneous technique with none to minimal neurodestruction and a favorable
side effect profile, use of PRF as an interventional neuromodulatory chronic pain treatment is
appealing.
Occipital neuralgia, also known as Arnold’s neuralgia, is defined by the International Headache
Society as a paroxysmal, shooting or stabbing pain in the greater, lesser, and/or third occipital
nerve distributions. Pain intensity is often severe and debilitating, with an associated negative
impact upon quality of life and function. Most cases of occipital neuralgia are idiopathic, with no
clearly identifiable structural etiology. Treatment of occipital neuralgia poses inherent challenges
as no criterion standard exists. Initially, conservative treatment options such as physical therapy
and pharmacotherapy are routinely trialed. When occipital neuralgia is refractory to conservative
measures, a number of interventional treatment options exist, including: local occipital nerve
anesthetic and corticosteroid infiltration, botulinum toxin A injection, occipital nerve subcutaneous
neurostimulation, and occipital nerve PRF. Of these, PRF has garnered significant interest as a
potentially superior, safe, non-invasive treatment with long-term efficacy.
Objective: The objective of this article is to provide a concise review of occipital neuralgia; and a
concise, yet thorough, evidence-based review of the current literature concerning the use of PRF
for occipital neuralgia.
Study Design: Review of published medical literature up through April 2013.
Setting: The Center for Pain Medicine and Regional Anesthesia, the University of Iowa Hospitals
and Clinics.
Results: A total of 3 clinical studies and one case report investigating the use of PRF for knee
occipital neuralgia have been published worldwide. Statistically significant improvements in pain,
quality of life, and adjuvant pain medication usage have been demonstrated.
Limitations: Lack of randomized control trials, small study sample sizes, an absence of diagnostic
block imaging guidance, and the use of outcome measures that are inherently subjective, limiting
objectivity and introducing an unquantifiable degree of bias.
Conclusion: Clinical studies to date examining the efficacy of PRF as a treatment for occipital
neuralgia have yielded promising results, demonstrating sustained improvement in pain, quality
of life, and adjuvant pain medication usage. Despite these encouraging clinical studies, conclusive
evidence in support of PRF as an interventional treatment option for occipital neuralgia awaits to
be seen.
Key words: Occipital neuralgia, pulsed radiofrequency, PRF, greater occipital nerve, lesser
occipital nerve, chronic pain, interventional pain management
Combined Ultrasound and Fluoroscopic
Guidance for Radiofrequency Ablation of
the Obturator Nerve for Intractable CancerAssociated Hip Pain
Authors: Matchett Gerald
Published: February 2021

Management of pain from skeletal metastases is notoriously difficult. Case reports and
case series have described radiofrequency ablation of the obturator nerve branches to the
femoral head for treatment of intractable hip pain. Ablation of the obturator branches to
the femoral head is technically difficult because of bony and vascular anatomy, including
close proximity of the femoral vessels. Here we present the case of a 79-year-old woman
with intractable right hip pain and inability to ambulate secondary to metastatic non-small
cell lung cancer in the femoral head and acetabulum, treated with thermal radiofrequency
ablation of the obturator and femoral nerve branches to the femoral head. Ablation of
the obturator nerve was done via anterior placement of the radiofrequency needle under
combined ultrasound and fluoroscopic guidance, passing the radiofrequency needle
between the femoral artery and femoral vein. Real-time ultrasound guidance was used to
avoid vascular puncture. Thermal radiofrequency ablation resulted in sustained pain relief,
and resumption in the ability of the patient to ambulate. From this case we suggest that an
anterior approach to the obturator nerve branches to the femoral head may be technically
feasible using combined ultrasound and fluoroscopic guidance to avoid vascular puncture.
Key words: Obturator nerve, radiofrequency ablation, cancer associated pain
Deactivation of Distant Pain-Related Regions
Induced by 20-day rTMS: A Case Study of Oneweek Pain Relief for Long-Term Intractable
Deafferentation Pain
Authors: Xu Wen-Dong
Published: February 2021

Background: Deafferentation pain secondary to brachial plexus avulsion, spinal cord injury,
and other peripheral nerve injuries is often refractory to conventional treatments. Stimulation
of the primary motor cortex (M1) has been proven to be an effective treatment for intractable
deafferentation pain. The mechanisms underlying the attenuation of deafferentation pain by
motor cortex stimulation remain hypothetical.
Objectives: The purpose of this case report is to: (1) summarize a case in which a patient
suffering chronic intractable deafferentation pain for 25 years underwent rTMS treatment over
M1, (2) describe the evidence from PET imaging, and (3) reveal a possible relief mechanism with
cortical plasticity.
Study design: Case report.
Setting: University hospital.
Results: This patient had successful pain control with no transient or lasting side effects. The
pain relief remained stable for at least one week. At the end of the 20-day procedure, pain
relief was obtained according to the Visual Analog Scale (VAS) (-34.6%) and the McGill Pain
Questionnaire (MPQ) (-31.6%). In the PET/CT scans, the glucose metabolism was significantly
reduced contralaterally to the pain side in the anterior cingulate cortex (ACC), insula, and caudate
nucleus. There was no statistically significant difference in any other cortical area.
Limitations: Single case of a patient with long-term intractable deafferentation pain having a
PET study.
Conclusion: This study implies that a single session of 20 Hz rTMS over the motor cortex could
reduce the pain level in patients suffering from long-term, intractable deafferentation pain. The
stimulation of the M1 induces deactivation in the ACC, insula, and caudate nucleus. The changes in
these pain-related regions may mirror an adaptive mechanism to pain relief after rTMS treatment.
Key words: Neuropathic pain management, deafferentation pain, transcranial magnetic
stimulation, motor cortex stimulation, cortical plasticity, positron emission tomography
Effects of Systemic Magnesium on Postoperative Analgesia: Is the Current Evidence
Strong Enough?
Authors: Yan Prof. Qu
Published: February 2021

Background: Clinical studies have been previously carried out on the efficacy of systemic
magnesium to minimize postoperative pain, however, with controversial results. A quantitative
meta-analysis was performed to evaluate the analgesic efficacy and safety of systemic
magnesium on post-operative pain.
Study Design: Comprehensive systematic review of all relevant, publsished randomized
controlled trials.
Methods: A search was conducted of published literature in MEDLINE, PsycINFO, Scopus,
EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from
inception to September 2014. Randomized controlled trials (RCTs) that compared magnesium
with placebo were identified. Effects were summarized using standardized mean differences
(SMDs), weighed mean differences (WMD), or odds ratio (OR) with suitable effect model.
Results: Twenty-seven RCTs involving 1,504 patients were included. In total, peri-operative
magnesium significantly reduced the pain score at rest (SMD, -1.43, 95% CI, -2.74 to -0.12, <
0.01). Magnesium significantly reduced analgesic consumption (SMD, -1.72, 95% CI, -3.21 to
-0.23) in patients undergoing urogenital, orthopaedic, and cardiovascular surgeries, but was
inconclusive for patients receiving gastrointestinal surgeries. The obvious analgesia of systemic
magnesium was observed on reducing the pain score during movement at 24 hours after
operation (SMD, -0.05, 95% CI, -0.43 to 0.32). Moreover, magnesium administration showed
a beneficial effect with regard to intra-operative hemodynamics and reduced extubation time
in the cardiovascular surgery patients (WMD, -29.34 min, 95% CI, -35.74 to -22.94, P < 0.01).
Limitations: Focused only on the quality of analgesia on postoperative pain with regards to
surgery type.
Conclusions: Our study suggests that systemic magnesium during general anesthesia
significantly decreases post-operative pain scores without increasing adverse events. It should
be noted that since there are 18 ongoing RCTs without published data, it is still premature to
draw conclusions on the long-term analgesic effects of magnesium as well as potential gender
or age difference.
Key words: Magnesium, post-operative pain, meta-analysis
The Association of rs4753426 Polymorphism in
the Melatonin Receptor 1B (MTNR1B) Gene and
Susceptibility to Adolescent Idiopathic Scoliosis:
A Systematic Review and Meta-analysis
Authors: Yang Huilin
Published: February 2021

Background: Adolescent idiopathic scoliosis (AIS) is a tridimensional structural deformity of
the spine that may deteriorate progressively, leading to significant functional limitations and pain
problems. Several previous studies have implicated the rs4753426 single nucleotide polymorphism
in the melatonin receptor 1B (MTNR1B) gene in the etiology of AIS. However the sample sizes were
limited and the findings of those studies were inconsistent. An overall assessment of the evidence
supporting this association has not been previously conducted.
Objectives: To provide a comprehensive assessment and synthesis of the currently available
evidence on the association between rs4753426 and AIS.
Study Design: A systematic review and meta-analysis.
Setting: University hospital, China.
Methods: This review followed the Preferred Reporting Items for Systematic Review and MetaAnalyses guidelines. PubMed (MEDLINE), EMBASE, Scopus databases, and WANFANG databases
were systematically searched through December 2014 to identify relevant studies following a
sensitive strategy. Statistical analysis was performed using the Review Manager 5.2 software.
Summary odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated
using the fixed-effect inverse variance model for allelic (C vs. T) and genotypic comparisons.
Results: Four papers including 5 studies which involved 2,552 AIS cases and 2,738 controls
were identified for this meta-analysis. The results showed that C allele of the rs4753426 was
significantly associated with AIS (OR = 1.12, 95% CI: 1.03 – 1.21, P = 0.01). CT and CC genotypes
were 26% (OR = 1.26, 95% CI: 1.04 – 1.53, P = 0.01) and 28% (OR = 1.28, 95% CI: 1.05 – 1.56,
P = 0.01), respectively, more likely to have AIS compared with CC genotype. As for the dominant
model (CC+TT vs. TT), summary ORs showed statistically significant association with AIS (OR =
1.28, 95% CI: 1.06 – 1.53, P = 0.009). Compared with the CT+TT genotype, the summary ORs
of the CC genotype showed marginally statistically significant association with AIS (OR = 1.11, 95
% CI: 0.99 – 1.24, P = 0.07). The subgroup meta-analysis results showed the C allele and each
genotype were significantly associated with AIS in the Asian group but not in the Caucasian group.
Limitations: Paucity of available literature.
Conclusions: To our knowledge, there has been no meta-analysis to analyze the association
between rs4753426 polymorphism in the MTNR1B gene and AIS. This systematic review was
a comprehensive analysis of the currently available evidence, and found an overall significant
association of rs4753426 polymorphism with the risk of AIS, especially in the Asian population.
Further investigation of this association is necessary in other populations.
Key words: Adolescent idiopathic scoliosis, MTNR1B, Rs4753426, single nucleotide
polymorphism, occurrence, curve severity, meta-analysis
Predictors of Persistent Neuropathic Pain – A
Systematic Review
Authors: Boogaard Sabine
Published: February 2021

Background: Characterization of the prognostic variables for persistent neuropathic pain (PNP)
remains incomplete despite multiple articles addressing this topic. To provide more insight into the
recovery and prognosis of neuropathic pain, high-quality data are required that provide information
about the predictors that contribute to the development of PNP.
Objective: To determine the methodological quality of studies about predictors for PNP and to
summarize findings of predictors found in high-quality studies.
Study Design: A systematic review.
Setting: VU University Medical Center, Amsterdam, The Netherlands.
Methods: Studies were identified by searching the electronic databases PubMed, Embase, and
Cochrane Library. Methodological quality of each article was independently assessed by 2 reviewers.
Results: Forty-six relevant studies were identified, classified into 4 different neuropathic pain (NP)-
syndromes: postherpetic neuralgia (n = 35), radicular pain and sciatica (n = 3), postsurgical pain (n
= 6), and other types of NP (n = 2). Seven studies were of high quality. The 3 high-quality studies
found for PHN reported male gender, older age, smoking, trauma at the site of lesion, missed antiviral
prescriptions, higher acute pain severity, higher rash severity, more neuropathic characteristics, shorter
rash duration, and a lower health status as predictors for PNP. For persistence of radicular pain one
high-quality study reported negative outcome expectancies, pain-related fear of movement, and
passive pain coping as predictors for PNP. Psychological distress, acute pain, breast cancer surgery,
higher body mass index, area of secondary hyperalgesia, neuropathic characteristics, hypoesthesia,
and hyperesthesia were found to be predictive for postsurgical pain in 3 high-quality studies.
Limitations: Some publications may have been missed during literature search. The low-quality
of the studies could be the result of an incomplete description of their methods.
Conclusions: High-quality studies mainly assessed factors related to disease functions and
structures. Due to shortcomings in methodological quality and limited areas of predictor selection,
there is a need for high-quality studies focusing on predictor measurement, statistical analysis and
the use of a standardized set of predictors.
Key words: Neuropathic pain, persistent pain, systematic review, literature search, predictors,
quality assessment, ICF-model
Peripheral Nerve Stimulation for the Treatment
of Chronic Intractable Headaches: Long-term
Efficacy and Safety Study
Authors: Huh Billy K.
Published: February 2021

Background: Despite the various modalities available for treating headaches, typical therapy
does not provide adequate pain relief for some patients.
Objectives: This study explored the efficacy and safety of long-term peripheral nerve stimulation
(PNS) for intractable chronic headaches.
Study Design: Retrospective study of refractory headache patients at academic pain center.
Methods: The medical records of all patients (N = 46) permanently implanted with PNS
between January 2005 and January 2012 were reviewed retrospectively. Patient records and
phone interviews were used to quantify the levels of pain intensity, headache days per month,
and overall patient satisfaction with treatment. The correlation between headache duration and
effectiveness of PNS was also assessed.
Results: Pain intensity on the 11-point Numeric Rating Scale decreased from 7.60 ± 1.73 before
implantation to 3.78 ± 2.41, 3.32 ± 2.67, 3.42 ± 2.74, and 2.04 ± 2.27 at one, 6, 12, and >
12 (19 – 98) months after implantation, respectively (P < .001). The mean number of headache
days per month decreased by about 14 days from the base line. No correlation (r = -.33) was
found between the number of years the patients had suffered from headaches and the efficacy
of treatment.
Limitations: Due to the limitation of a retrospective study, the data collected via chart reviews
and phone interviews are susceptible to selection and information biases.
Conclusions: PNS is an effective modality in the long-term management of intractable chronic
headaches. Despite long histories of chronic headaches, the majority of patients had significant
reductions in pain scores and the number of headache days per month. The outcomes were
not dependent on the number of years the patients had suffered from headaches before PNS
treatment.
Key Words: Migraine headache, refractory headache, chronic daily headache, occipital
neuralgia, cluster headache, hemicranias continua, refractory headache, occipital nerve
stimulation, peripheral nerve stimulation
Predictive Factors Associated with Success and
Failure for Radiofrequency Thermocoagulation
in Patients with Trigeminal Neuralgia
Authors: Moon Jee Youn
Published: February 2021

Background: Radiofrequency thermocoagulation (RFT) has been widely used to manage
trigeminal neuralgia (TN) refractory to oral medication. Careful selection of patients for
managing TN with RFT can decrease morbidity and improve treatment efficacy.
Objectives: The goal of this study was to determine clinical variables related to the treatment
outcome in patients with TN undergoing RFT.
Study Design: Retrospective analysis.
Setting: University hospital in Korea.
Methods: Demographic and clinical data were garnered by billing records for patients with
TN who received RFT by one pain physician between January 2005 and August 2014. A
successful outcome was pre-defined as at least 50% pain relief on a 0 – 10 NRS pain score
for longer than 6 months after RFT. Variables evaluated for their association with outcome
included age, gender, baseline pain score, etiology, type of pain, co-existing psychopathology,
and history of previous intervention.
Results: Among 90 patients who underwent RFT for managing TN, 75 patients (83.3%)
reported a successful outcome (> 50% pain relief at 6 months after RFT procedure). Pain
characteristics was the most significant predictor associated with successful outcomes of RFT
in both univariate and multivariate logistic analysis; odds ratio of provoked paroxysmal pain
was 131.516 and mixed type of pain was 20.602 in multivariate analysis.
Limitations: Prospective studies are recommended to confirm our findings and ascertain
which additional variables can be taken into account to improve the likelihood of a successful
outcome for RFT in patients with TN.
Conclusion: A provoked paroxysmal pain or mixed pain condition was associated with a
positive outcome for RFT in patients with TN. In addition, bilateral TN, high baseline NRS pain
score, or co-morbid psychiatric condition was related with negative outcomes in univariate
analysis. Pain clinicians should consider these findings when selecting patients for managing
TN to increase the efficacy of RFT.
Key words: Facial pain, outcome assessment, predictive value, radiofrequency
thermocoagulation, trigeminal neuralgia
Hypodermis Tension Loop: A New Preventative
Measure for Lead Migration in the Morbidly
Obese
Authors: Wahezi Sayed E
Published: February 2021

Electrode migration/displacement is reported to be the most common complication of
spinal cord stimulator (SCS) implantation, with the literature reporting incidences from
13.2% to 22.6%. There have been numerous publications describing techniques preventing
lead migration, with most involving tying leads to skin and fascia for trial and permanent
leads, respectively. However, few have addressed how to prevent migration in the case of
hypermobile tissue seen in the morbidly obese. We describe the creation of subcutaneous
tension loops to prevent lead migration.
Key words: Spinal cord stimulator, trial, lead migration, subcutaneous tissue, hypodermis,
tension loop, morbidly obese
Effect of High-Volume Injectate in Lumbar
Transforaminal Epidural Steroid Injections: A
Randomized, Active Control Trial
Authors: Park Hahck Soo
Published: February 2021

Background: There have been many studies proving the effectiveness of lumbar transforaminal
epidural steroid injections (TFESIs) for the treatment of radicular pain. Dexamethasone has been
suggested as an alternative to particulate steroids. However, no controlled trials have investigated
the effect of different injected volumes for a same dose of dexamethasone.
Objective: To compare the effects of a high-volume injectate with those of a low-volume injectate
using the same dose of dexamethasone for 2 groups in lumbar TFESI.
Study Design: A prospective, randomized, active control trial.
Setting: The outpatient clinic of a single academic medical center.
Methods: A total of 66 patients were randomized to receive lumbar transforaminal epidural
dexamethasone injections with either a low-volume injectate (3mL, N = 30) or a high-volume
injectate (8mL, N = 32). The primary outcome measures for this study were the incidence of the
patients achieving meaningful pain relief and a reduction on the Visual Analogue Scale (VAS,
range 0 – 100) at 4 weeks after the procedure. The definition of “meaningful pain relief” was ≥
50% from baseline. The secondary outcomes included the Roland-Morris Disability Questionnaire
(RMDQ, range 0 – 24) score and adverse effects. The outcomes were assessed 4 weeks after the
procedure.
Results: Four weeks after the procedure, in the DL8 group, the incidence of achieving meaningful
pain relief was higher compared with DL3 group (19, 59.4% vs. 9, 30%, P = 0.024). Both groups
demonstrated a significant improvement in their VAS and RMDQ scores (P < 0.05). The VAS of the
high-volume injectate group (DL8) was significantly lower than that of the low-volume injectate
group (DL3) (33.3 ± 25 vs. 46.3 ± 25, P = 0.036). There was no significant difference in the RMDQ
score between the 2 groups.
Limitations: We enrolled a small number of patients and did not assess the long-term outcomes.
Conclusions: Injectate at a volume of 8 mL was more effective than injectate at a volume of 3
mL for radicular pain in a lumbar transforaminal steroid injection, although both of the injectates
contained the same dose of dexamethasone.
Key words: Dexamethasone, disc herniation, epidural injection, lumbar, radiculopathy
Catheter-tip Granulomas Associated with
Intrathecal Drug Delivery – A Two-Center
Experience Identifying 13 Cases
Authors: Kratzsch Tobias
Published: February 2021

Background: Intrathecal (IT) drug therapy with implanted pumps is an effective treatment
modality for chronic pain and/or spasticity, especially after non-invasive treatment has failed.
Long-term use of intrathecal opioids may cause formation of inflammatory masses at the tip of
intrathecal catheters, possibly leading to neurological deficits and/or catheter revision.
Objective: We aimed to identify risk factors for catheter-tip granuloma (CG) formation.
Study Design: Retrospective study.
Setting: Tertiary Spine Centers in Germany and Switzerland
Methods: We retrospectively reviewed data at 2 Swiss centers (Kantonsspital St. Gallen, Swiss
Paraplegic Centre Nottwil) between 01/1994 and 10/2013. Collected data were age at operation,
gender, smoking status, previous spinal operations, spinal level of catheter-tip, clinical symptoms,
catheter testing with contrast agent, applied drugs, drug concentration, as well as cumulative daily
drug dosages.
Results: Thirteen patients with a mean age of 52.6 years and CG formation after a mean of
6.9 years of follow-up were identified and compared to 54 patients of similar age and length of
follow-up (48.6 years, P = 0.535; follow-up 5.3 years, P = 0.236) without CG. In the analysis of risk
factors, catheter ending in the middle thoracic spine (Th4-8; 38.5 vs. 6.5%; P = 0.010), previous
spinal surgery (75 vs. 41%; P = 0.051), and chronic pain as an underlying primary symptom for IT
drug therapy (100 vs. 56%, P = 0.003) were associated with CG formation. IT drug therapy for
spasticity appeared to be much less associated with CG formation (0 vs. 44%, P = .0003). As the
symptomatology is closely related to the medical treatment applied, patients with CG were more
likely to be treated with IT morphine (77 vs. 20%; P < 0.001), and as tendency with IT clonidine
(54 vs. 26%; P = 0.092) and IT bupivacaine (46 vs. 20%; P = 0.077). Average in-pump morphine
concentration (30.3 vs. 19.5 mg/mL; P = 0.05) as well as average daily dose of morphine (12.5 vs.
6.2 mg/d; P = 0.037) were significantly higher in the CG group. Smoking could not be identified
as risk factor for CG formation.
Limitations: Limitations include the retrospective approach, the limited group size of granuloma
patients, as well as missing data in the investigated patient groups.
Conclusion: Our patient cohort with CG differed in some features, of which some like catheter
localization, choice, dosage, and the concentration of drugs are potentially modifiable. These
results could contribute to the prevention of CG in the future.
Key words: Intrathecal drug delivery, intrathecal cathether-tip granuloma, intrathecal cathethertip inflammatory masses, intrathecal morphine, drug pump complications
Can the Novel Lumbo-Iliac Triangle Technique
Based on Biplane Oblique Fluoroscopy Facilitate
Transforaminal Percutaneous Endoscopic Lumbar
Discectomy for Patients with L5-S1 Disc Herniation
Combined with High Iliac Crest? A Case-Control
Study of 100 Patients
Authors: Hao Ding-Jun
Published: February 2021

Background: Percutaneous endoscopic lumbar discectomy (PELD) via the transforaminal
approach is difficult at L5-S1 in patients presenting with high iliac crests (HIC). The conventional
wisdom is that measurement using lumbar radiography, computed tomography (CT), or magnetic
resonance imaging (MRI) is necessary.
Objectives: The objective of this study was to introduce a lumbo-iliac triangular (LI-Tri) technique
based on biplane oblique fluoroscopy and verify whether it facilitated transforaminal PELD for
patients with L5-S1 lumbar disc herniation (LDH) combined with HIC.
Study Design: A retrospective analysis.
Setting: All data were from Honghui Hospital in Xi’an.
Methods: One hundred patients with L5-S1 LDH combined with HIC were treated with PELD.
The LI-Tri technique was used in the first 50 patients (applied group). The other 50 patients were
classified as the nonapplied group, in which the conventional technique was performed. Clinical
outcome evaluation included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores.
The intervals of follow-up were scheduled at 1 day and 1, 3, 6, 12, and 24 months postoperatively.
Results: No significant difference was observed with respect to demographic information (P <
.05, respectively). There were 8 patients in the nonapplied group with difficult punctures. Together
with the remaining 50 patients, the puncture was successful with the LI-Tri technique. The mean
operative duration was shorter in the applied group (55 vs 70 min, P < .01). Compared to the
preoperative data, only the back pain VAS and ODI in the nonapplied group were nonsignificantly
lower at one day postoperatively (P > .05, respectively). With the exception of the back pain VAS
and ODI at one day postoperatively, no significant differences were observed in the 3 parameters
at other time points postoperatively between 2 groups (P > .05, respectively).
Limitations: The study is limited by its retrospective, nonrandomized controlled design.
Conclusions: For patients with L5-S1 LDH combined with HIC treated by transforaminal PELD,
the LI-Tri technique is simple and effective in preoperative evaluations, locating the skin entry
point and guiding the puncture trajectory. Compared to the conventional technique, it shows
advantages in terms of reducing intraoperative surgical duration and promoting fast postoperative
recovery.
Key words: Endoscopic discectomy, iliac crest, L5-S1 disc, PELD, percutaneous, transforaminal.
Effectiveness of Ultrasound-Guided Pulsed
Radiofrequency Treatment in Patients with
Refractory Chronic Cervical Radicular Pain
Authors: Chang Min Cheol
Published: February 2021

Background: The effect of pulsed radiofrequency (PRF) stimulation for alleviating
cervical radicular pain has been demonstrated in several previous studies.
Objectives: We aimed to evaluate the effectiveness of PRF with ultrasound (US)
guidance in patients with chronic cervical radicular pain that was refractory to repeated
transforaminal epidural steroid injections (TFESIs).
Study Design: A prospective outcome study.
Setting: The outpatient clinic of a single academic medical center.
Methods: This study included 49 patients with chronic cervical radicular pain,
unresponsive to repeated TFESIs, and who underwent PRF stimulation under US
guidance. Using US, a cannula was inserted toward the cervical spinal nerve. The pain
intensity was evaluated using the Numeric Rating Scale (NRS-11) for cervical radicular
pain at pretreatment and 1, 3, and 6 months posttreatment; and the Neck Disability
Index (NDI) was used for evaluating functional disability before treatment and 6 months
posttreatment. Successful pain relief was defined as ≥ 50% reduction in the NRS-11 score
as compared with the score before treatment.
Results: Cervical radicular pain was significantly reduced at 1, 3, and 6 months postPRF (P < 0.001). At 6 months post-PRF, functional disability (NDI score) had significantly
reduced, and 63.3% of the patients achieved successful pain relief.
Limitations: The small number of included patients and no long-term follow-up.
Conclusions: PRF stimulation under the guidance of US is a potentially effective
treatment method for managing refractory chronic cervical radicular pain.
Key words: Ultrasound, pulsed radiofrequency, cervical radicular pain, chronic pain
The Effect of Pre-Treatment Depression, Anxiety
and Somatization Levels on Transforaminal
Epidural Steroid Injection: A Prospective
Observational Study
Authors: Şencan Savaş
Published: February 2021

Background: Results of the lumbar transforaminal epidural steroid injection (L-TFESI) used in
the treatment of lumbar radiculopathy may be affected by the current psychiatric condition of
the patient.
Objectives: The study aimed to assess the effects of pretreatment comorbid psychiatric
conditions on patient outcomes in patients with lumbar disc herniation and radiculopathy.
Study Design: The study used a prospective-observational study design.
Setting: Research was conducted at a university hospital international pain management
center.
Methods: In this observational study, 103 patients were included. All patients were evaluated
with the Hospital Anxiety and Depression scale (HADS) for depression and anxiety levels and
the Somatosensory Amplification Scale (SSAS) for somatization levels before the L-TFESI.
The treatment results were evaluated with the Numeric Rating Scale (NRS) and the Oswestry
Disability Index (ODI) at baseline, the third week, and the third month. Relative to baseline, a
50% reduction in the NRS was accepted as a successful treatment.
Results: HADS-depression, HADS-anxiety, and SSAS levels were similar between the patients
with successful treatment outcome and the patients in whom treatment failed. However, there
were negative correlations between percent reduction in the NRS and the HADS-depression
levels at 3 weeks (r = -0.182, P = .022) and 3 months (r = -0.204, P = .037). Also, there were
positive correlations between patients’ pre-injection ODI scores and both the HADS-anxiety (r =
0.271, P = .001) and SSAS (r = 0.201, P = .013) scores.
Limitations: The study was limited by a relatively short-term follow-up period.
Conclusions: Although psychiatric conditions affected the pain and disability of patients
before and after the L-TFESI, and may have an impact on patient-related outcomes, they should
not be a reason to not treat patients or expect a lower chance of success.
Key words: Anxiety, depression, disc herniation, low-back pain, lumbar radiculopathy, patientrelated outcomes, somatization, transforaminal epidural steroid injection
COVID-19 Pandemic - A Narrative Review
of the Potential Roles of Chloroquine and
Hydroxychloroquine
Authors: Boralli Vanessa B.
Published: February 2021

Background: Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used against
malaria, rheumatism, inflammation in the joints, lupus, among others. These drugs showed
positive results in preliminary scientific research for treatment of the severe acute respiratory
syndrome coronavirus (SARS-CoV-2). Since the studies with CQ and HCQ are initial with small
patient populations, it is not yet known whether there are adverse effects from the use of CQ and
HCQ for patients infected with the coronavirus.
Objectives: The aim of this study was to evaluate the evidence regarding the efficacy and safety
of CQ and HCQ used against viral infection caused by SARS-CoV-2.
Study Design: This is a narrative review of the traditional prescriptions of CQ and HCQ efficacy
and adverse effects as well as their employment for coronavirus disease 2019 (COVID-19).
Setting: In vitro and clinical studies comparing the antiviral efficacy and adverse effect profile of
CQ and HCQ against COVID-19 in adult patients were evaluated.
Methods: A systemic search of reviews, including in vitro and clinical trial studies in English focusing
on CQ and HCQ effects and adverse effects against COVID-19 in the adult patient population from
PubMed was performed. It included studies reporting chloroquine and hydroxychloroquine effects
and adverse effects against COVID-19.
Results: A total of 42 articles published between 2004 and April 2020 were reviewed for
therapeutic use of CQ and HCQ. Both these drugs showed a significant in vitro potential against
coronavirus. Many studies for clinical use of CQ and HCQ showed that patients presented adverse
reactions on high doses.
Limitations: Clinical studies have some methodology shortcomings, such as lack of information
about the treatment and small number of experimental patients, leading to a misinterpretation of
the data. Besides, there are few clinical studies with a limited sample size. Moreover, most of them
did not present control groups, and some patients had died during these protocols.
Discussion: Despite both CQ and HCQ in vitro antiviral evidence, clinically, both drugs, either
alone or combined with other medications, may increase the risk of cardiac arrhythmias, leading
to cardiac arrest and sudden death. Besides, a lot of uncertainty still remains, such as starting
administration period, dose prescribed, length of treatment, patients’ condition, concomitant drug
use, among others.
Conclusion: From the studies reviewed, it is not possible to state the precise efficacy and safety
of CQ and HCQ use in the treatment of COVID-19 at any time in the course of the disease. Future
studies are warranted.
Key words: SARS-CoV-2; COVID-19; chloroquine; hydroxychloroquine; pandemic; coronavirus;
adverse effects; side effects; cardiac arrhythmias; ocular toxicity, retinopathy; pharmacokinetic.
Impact of COVID-19 on an Academic Pain
Fellowship Program
Authors: Prem Anand
Published: February 2021

Background: While the COVID-19 pandemic still rages on in the United States, leaving in
its wake hundreds of thousands of infected patients, families shattered by the untimely death
of their loved ones, an economy in free fall that hit all-time highs barely a few months ago,
and a fearful citizenry unsure of what the future holds, the effect it has had on residency
and fellowship training programs across the country may appear inconsequential to the
general populace. However, if you are a graduating trainee confronted with this unusual set of
circumstances, fear of the virus is not the only thing that is foremost in your mind.
Methods: Literature review.
Results: We discuss the unique challenges our pain fellowship program continues to deal
with during this pandemic and particularly its impact on our fellows. It is entirely likely these
concerns are mirrored in academic programs all over the United States.
Limitations: A narrative review with paucity of literature.
Key words: COVID-19, pain fellowship, interventional pain, graduating trainees, pain clinic,
medical education during a pandemic
FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF FRACTURES
OF DISTAL END RADIUS WITH BUTTRESS PLATE
Authors: Nagaraju Nagaraju , Jose Midhun
Published: February 2021

Fundamental goal treatment of distal radial fractures is restoration of normal or near normal alignment and articular
congruity. Twenty patients with fractures of distal radius were selected who were admitted in Government Medical
College,Kurnool between September 2018 and September 2020. Patients were treated with open reduction and internal xation with volar plate
through a volar approach and followed up till functional recovery and assessed clinico radiologically. The study comprised of 14 male and 6
female patients aged from 23 to 62 years with mean age of 39.80 years The follow up ranged from 9 to 18 months. Using the demerit scoring system
of Gartland and Werley, we had 50% excellent, 40% good, 10% fair and none poor results. In carefully selected patients even in the face of
osteoporosis, xation of fractures of distal end of radius with a volar plate has satisfactory outcome
An ecologically valid examination of event-based and time-based prospective memory using immersive virtual reality: the influence of attention, memory, and executive function processes on real-world prospective memory.
Authors: Kourtesis Panagiotis , E. MacPherson Sarah
Published: February 2021

Studies on prospective memory (PM) predominantly assess either event- or time-based PM by implementing non-ecological laboratory-based tasks. The results deriving from these paradigms have provided findings that are discrepant with ecologically valid research paradigms that converge on the complexity and cognitive demands of everyday tasks. The Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive virtual reality (VR) neuropsychological battery with enhanced ecological validity, was implemented to assess everyday event- and time-based PM, as well as the influence of other cognitive functions on everyday PM functioning. The results demonstrated the importance of delayed recognition, planning, and visuospatial attention on everyday PM. Delayed recognition and planning ability were found to be central in event- and time-based PM respectively. In order of importance, delayed recognition, visuospatial attention speed, and planning ability were found to be involved in event-based PM functioning. Comparably, planning, visuospatial attention accuracy, delayed recognition, and multitasking/task-shifting ability were found to be involved in time-based PM functioning. These findings further suggest the importance of ecological validity in the study of PM, which may be achieved using immersive VR paradigms.
Analisis Miskonsepsi Siswa Kelas V dalam Meyelesaikan Masalah Bangun Ruang Berdasarkan Gender di SD IT Mutiara Insan Sorong
Authors: Ramadany Lisa Dewi
Published: February 2021

Miskonsepsi terjadi ketika seseorang meyakini benar konsep yang salah. Miskonsepsi dalam kata lain merupakan perbedaan konsepsi seseorang tentang suatu materi yang berbeda dengan konsepsi para ahli di bidangnya. Struktur kognitif yang ada pada diri siswa tidak sesuai dengan konsepsi yang dikemukakan para ahli di bidangnya juga dapat dikategorikan sebagai miskonsepsi, sehingga antara miskonsepsi dengan gaya kognitif siswa saling berkaitan. Setiap siswa memiliki gaya kognitif yang berbeda termasuk gender. Penelitian yang dilakukan bertujuan untuk menggambarkan miskonsepsi siswa dalam menyelesaikan permasalahan bangun ruang berdasarkan gender serta faktor penyebab miskonsepsi. Jenis penelitian ini adalah penelitian deskriptif dengan pendekatan penelitian kulitatif. Sampel dalam penelitian ini merupakan siswa kelas V SD IT Mutiara Insan Sorong tahun ajaran 2019/2020 sebanyak 6 orang. Subjek dalam penelitian ini sebanyak 4 orang yang dipilih berdasarkan tes diagnostik. Instrumen yang digunakan dalam penelitian ini adalah tes diagnostik dan wawancara untuk mengetahui penyebab miskonsepsi. Hasil penelitian menunjukkan bahwa siswa laki-laki tidak teridentifikasi miskonsepsi, sedangkan siswa perempuan teridentifikasi sebanyak 3 orang. Siswa mengalami miskonsepsi bukan pada materi bangun ruang, akan tetapi pada proses perhitungan perkalian dan pembagian. Penyebab miskonsepsi yang dialami oleh siswa adalah prakonsepsi, pemikiran asosiatif siswa sendiri, pengalaman belajar, dan kurangnya penekanan pada materi yang dibutuhkan siswa.
Pengaruh Guided Inquiry Learning terhadap Hasil Belajar Matematika Siswa di SD Inpres 103 HBM Kota Sorong
Authors: Aynufa Cindi Nuryanti , Alman Alman , Astutik Heny Sri
Published: February 2021

Penelitian ini bertujuan untuk mengetahui pengaruh penggunaan guided inquiry learning terhadap hasil belajar matematika siswa pada materi operasi pecahan. Metode yang digunakan dalam penelitian ini adalah metode pra eksperimen dengan desain penelitian One Shot Case Study Design. Data menunjukkan rata-rata skor observasi guru (peneliti) dan siswa sebesar 100%  dengan kriteria sangat baik. Hasil analisis ketuntasan belajar pada nilai rata – rata posttest 76,78. uji normalitas hasil belajar posttest  memiliki taraf signifikansi 0,121 > 0,05 . Uji -t test one sample t test hasil posttest berdasarkan hasil perhitungan maka diperoleh thitung sebesar 8.953 dengan dk = n – 1 (28-1=27) dipe roleh ttabel  sebesar 1.915. Berdasarkan hasil analisis data yaitu nilai thitung > ttabel (8.953 >1.703), dengan besarnya taraf signifikansi 0.05, yakni (0.000 < 0.05) maka Hipotesis diterima , Dengan demikian dapat disimpulkan bahwa terdapat pengaruh guided inquiry learning terhadap hasil belajar matematika siswa pada materi operasi pecahan di kelas III SD Inpres 103 HBM Kota Sorong
Implementasi Pendidikan Karakter Tanggung Jawab dan Kerja Sama Dalam Pembelajaran Tematik Kurikulum 2013 Di SD Negeri 2 Berkoh
Authors: Pramasanti Rifa , Bramasta Dhi , Anggoro Subuh
Published: February 2021

Pendidikan tidak hanya mengajarkan pengetahuan saja tetapi juga memiliki peranan penting dalam pembentukan karakter bangsa. Pembentukan karakter pada peserta didik dapat dilakukan sejak dini kepada anak. Karakter yang terdapat di dalammnya adalah karakter tanggung jawab dan kerja sama, di SD Negeri 2  Berkoh karakter tanggung jawab dan  kerja sama diimplementasikan dalam kurikulum 2013 melalui beberapa kegiatan seperti kegiatan pembelajaran, spontan, keteladanan, pembiasaan yang dilakukan oleh peserta didik untuk membentuk  tanggung  jawab  dan  kerja  sama  di  dalam  pembelajaran  tematik seperti mengerjakan tugas dan membuat kelompok. Penelitian ini menggunakan metode  kualitatif  deskriptif  untuk  mengetahui  bagaimana  implementasi pendidikan karakter tanggung jawab dan kerja sama di dalam pembelaran dan faktor yang mempengaruhinya, supaya guru dapat membimbing peserta didik supaya peserta didik dapat melakukan kegiatan diskusi, praktikum dan lainnya sebagai bentuk tanggung jawab dan kerja sama di dalam pembelajaran tematik kurikulum 2013.
Pengaruh Metode Pembelajaran Debate terhadap Kecerdasan Emosional pada Mata Pelajaran PPKn Kelas V SD Inpres 133 Bumi Ajo Distrik Moswaren
Authors: Winingsih Sari Yuyuk Sri Rahayu , Mursalim Mursalim , Ihsan Ihsan
Published: February 2021

Penelitian ini bertujuan untuk mengetahui pengaruh metode pembelajaran debate terhadap kecerdasan emosional pada mata pelajaran PPKn kelas V SD Inpres 133 Bumi Ajo Distrik Moswaren. Penelitian ini menggunakan jenis penelitian kuantitatif dengan one group pretest-postest designs. Sampel Penelitian ini yaitu siswa kelas V berjumlah 21. Instrument yang digunakan adalaha angket dan lembar observasi. Hasil uji Reabilitas diperoleh Cronbach’s untuk instrument angket  debate sebesar 0,589 dan angket kecerdasan emosional 0,688. Hasil uji normalitas diperoleh nilai sig untuk instrument angket debate sebesar 0,063 dan instrument angket kecerdasan emosional sebesar 0,492, dengan hasil uji one-sample test sebesar 45,910.  Hasil penelitian menunjukkan bahwa hasil analisis uji one sample t-test diperoleh sebesar 2,086%., dengan  nilai thitung 45,910 > ttabel = 1,725 besar taraf signifikan 0,000 < 0,05 maka keputusan hipotesis yakni H0 ditolak dan H1 diterim. Berdasarkan hasil analisis data dan pengujian hipotesis, maka kesimpulan penelitian ini yaitu terdapat pengaruh signifikan metode pembelajaran debat terhadap kecerdasan emosional siswa kelas V SD Inpres 133 Bumi Ajo Distrik Moswaren.