bluuebunny/crossref_metadata_2025 huggingface dataset:
Iatrogenic Posttraumatic Neuralgia Following Neuromuscular Electrical Stimulation: A Case Report
Authors: Copeland Royce
Published: October 2024

BACKGROUND: Posttraumatic neuralgia (PTN) is a complex and debilitating condition that can arise from physical injury to a peripheral nerve, resulting in chronic neuropathic pain that significantly affects the individual’s quality of life. CASE REPORT: A 52-year-old woman with a recent history of incomplete spinal cord injury developed a common peroneal nerve injury from neuromuscular electrical stimulation during her acute inpatient rehabilitation. The patient was initially managed with oral corticosteroids and neuropathic medications without resolving neuropathic pain symptoms. Ultimately, the patient continued to have chronic neuropathic pain symptoms along the common peroneal nerve pathway leading to the diagnosis of PTN. CONCLUSIONS: We hypothesize this unusual complication resulted from a prior neurological injury, making this patient more susceptible to nerve injury when intense electrical forces were transmitted to the common peroneal nerve, ultimately leading to PTN of the common peroneal nerve. KEY WORDS: Posttraumatic neuralgia, common peroneal nerve injury, neuromuscular electrical stimulation, neuralgia
Dual Peripheral Stimulation of Musculocutaneous and Radial Nerves for Refractory Upper Extremity Pain: Case Report
Authors: Howard Gabriel
Published: October 2024

BACKGROUND: Peripheral nerve stimulation has been available for many years, yet there is relatively little information available regarding stimulation of many of the large sensory and mixed nerves. CASE REPORT: A 42-year-old woman presented to the clinic for a 10-year history of intractable left upper extremity and forearm pain following a motor vehicle accident requiring skin grafting. Based on the patient’s failure of more conservative therapy, a shared decision was made to pursue opioid sparing interventional modalities. Implantable radial and musculocutaneous nerve stimulators were chosen for this patient for ease of use and high likelihood of favorable outcomes. CONCLUSIONS: Sequential radial and musculocutaneous stimulation provided a 45% and 50% reduction in pain respectively, with the summative reduction of pain from original presentation being greater than 72% relief in total. KEY WORDS: Peripheral nerve stimulation, neuromodulation, musculocutaneous nerve, radial nerve, regional anesthesia, upper extremity pain, pain medicine, implantable stimulation
Modified Epidural Adhesiolysis Protocol for the Treatment of Refractory Low Back Pain - A Case Series
Authors: Connolly Brian
Published: October 2024

BACKGROUND: Scar tissue can form within the epidural space following surgical trauma, infection, annular tearing, hematoma formation, and disc herniation. When epidural fibrosis (EF) is present, it can render nerve roots more susceptible to entrapment, compression, and tension—each of which can potentially contribute to low back and radicular pain in the lower extremities. In the past, several different epidural adhesiolysis protocols have been described to treat such pain. CASE REPORT: Three patients with chronic low back and radicular pain, and evidence of EF underwent a modified epidural adhesiolysis protocol over a single visit. All 3 patients reported greater than 50% pain relief for at least 3 months following treatment with the modified epidural adhesiolysis protocol. CONCLUSION: These case results suggest that the proposed modified epidural adhesiolysis can provide significant relief of axial and radicular pain in a cost effective and accessible manner for this patient population. KEY WORDS: Back pain, adhesiolysis protocol, vertebrogenic pain, epidural fibrosis, failed back surgery syndrome, post laminectomy syndrome
Aortoesophageal Fistula Following a Cervical Epidural Steroid Injection: Case Report
Authors: Chen Fangyu
Published: October 2024

BACKGROUND: Immunosuppression after cervical epidural steroid injection (CESI) is a potential complication. This report discusses the development of an aortoesophageal fistula following a CESI. CASE REPORT: Patient is a man in his early 60s with a history of central spinal cord syndrome status post (s/p) anterior cervical discectomy and fusion of C3-C6 and thoracic aortic aneurysm s/p thoracic endovascular aortic repair (TEVAR) who presented with cervical radiculopathy. He underwent a CESI without immediate complications. Twelve days postop, the patient presented with shortness of breath, fatigue, and change in mental status. He was found to have a pleural abscess and an aortoesophageal fistula from his previous TEVAR stent. He subsequently was admitted to the surgical intensive care unit and received mechanical ventilation, antibiotics, and high-dose vasopressors. Patient was eventually transitioned to comfort care and expired one day after admission. CONCLUSIONS: Systemic steroid absorption from ESIs can lead to complications, such as infection, due to immunosuppression. KEY WORDS: Epidural steroid injection, corticosteroids, spinal stenosis
Recurrent Pain From Chemotherapy-Induced Peripheral Neuropathy After COVID-19 Infection – A Case Report
Authors: Lam Loc
Published: October 2024

BACKGROUND: Studies show that COVID-19 can cause neurological complications in both central and peripheral nervous systems. Plausible theories include virus-induced hyperinflammation and hypercoagulability, direct infection, and postinfectious immune processes. Our case report appears to be one of the first case reports highlighting COVID-19 infection, as a possible trigger for recurrent chemotherapy-induced peripheral neuropathy (rCIPN). CASE REPORT: We present a case report of a 59-year-old man with rectal adenocarcinoma and a history of CIPN who experienced rCIPN after contracting COVID-19. Prior to infection, he experienced burning pain and dysesthesias in a stocking-glove distribution due to chemotherapy, with resolution of symptoms shortly after discontinuation. Unfortunately, within one week of his COVID-19 diagnosis, he experienced a return in his previous CIPN pain in a similar distribution and quality. CONCLUSION: This case report suggests a potential role of COVID-19 infection in triggering the recurrence of CIPN, emphasizing the need for further research. KEY WORDS: COVID-19, recurrent chemotherapy-induced peripheral neuropathy, neuropathic pain, cancer pain, chemotherapy-induced peripheral neuropathy
Difficult Single-Lead Spinal Cord Stimulator Trial for Failed Back Surgery Syndrome Salvages Treatment
Authors: Yazdi Cyrus
Published: October 2024

BACKGROUND: Spinal cord stimulation (SCS) is a minimally invasive neuromodulation treatment modality primarily used for failed back surgery syndrome (FBSS), complex regional pain syndrome, and diabetic neuropathy. Specifically, when utilized for the treatment of FBSS, placement can be complicated by the excessive scarring, adhesions, and altered anatomy limiting the access to the epidural space and advancement of the leads. CASE REPORT: Our patient is a 58-year-old woman with a history of scoliosis and severe lumbar spinal stenosis who presented for trial of an SCS for FBSS. Given the refractory nature to medical and minimally invasive management, an SCS trial was performed. Unfortunately, due to the extensive fibrosis and adhesions in her epidural space, only a single lead could be placed but experienced pain relief. During the permanent SCS, 2 leads were successfully placed with the patient ultimately receiving > 50% pain relief. CONCLUSIONS: Here, we present a case of FBSS refractory to medical and minimally invasive management where a single SCS lead was placed during the trial, due to scarring and adhesions, and 2 leads during the permanent SCS procedure. Our case report suggests considering even the trial of a single-lead placement during an SCS trial in patients with an otherwise difficult anatomy, as the placement of the permanent lead offers greater access to the epidural space potentially allowing for the placement of a second lead and potentially salvaging the entire therapy. KEY WORDS: Spinal cord stimulator, spinal stenosis, single lead, failed back surgery syndrome
A Unique Cause of Sacral Radiculopathy After Minimally Invasive Sacroiliac Joint Fusion: A Case Report
Authors: Norris Jordan
Published: October 2024

BACKGROUND: New technologies for sacroiliac joint fusion (SIJF) have demonstrated improvements in pain and function. Sacral radiculopathy is a reported complication. We present a unique case of S1 radiculopathy after lateral transiliac minimally invasive SIJF. The patient provided Health Insurance Portability and Accountability Act (HIPAA)-compliant consent for the inclusion of their clinical information in this report. CASE REPORT: A 40-year-old woman with SI joint dysfunction underwent right-sided SIJF. She reported resolution of her preoperative symptoms but developed new pain radiating to the leg. A revision procedure provided initial relief, but her pain returned. Further imaging demonstrated displaced bone, rather than a misplaced implant, causing a narrowed S1 foramen. An open S1 foraminotomy was performed to further decompress the foramen, improving symptoms, allowing her to return to her previous activity level. CONCLUSION: This case describes a previously unrecognized cause of S1 radiculopathy after minimally invasive SI fusion and supports open foraminotomy with neuronavigation as a potential method for treatment. KEY WORDS: Case report, chronic pain, complications, sacroiliac joint dysfunction, sacroiliac joint fusion
Stellate Ganglion Block for Refractory Post-COVID Headache: Case Report
Authors: Kim Steven
Published: October 2024

BACKGROUND: Long coronavirus disease (COVID) is a multitude of symptoms weeks to months after recovering from COVID 2019 (COVID-19) and involves a variety of symptoms, ranging from brain fog and fatigue to refractory headaches that may result in ongoing disability. CASE REPORT: A 49-year-old man presents for persistent headaches following COVID-19 infection months prior. The pain was frontal and bilateral but more prominent on the right, without sensitivity to light nor sound, and without identifiable triggers. He trialed numerous medications without relief. He rated his pain on average 8-10 on the Visual Analog Scale (VAS). After discussion of options, the patient elected to proceed with a stellate ganglion block (SGB). The patient underwent a right-sided SGB with 5 mL of 0.25% bupivacaine. Following the injection, the patient noted ~50% benefit immediately. On 6-week follow-up, he noted improvement of his headaches to 1-2 on the VAS. At 4 months, the headaches continued to be controlled (1-2 on the VAS). CONCLUSIONS: Reports suggest that symptoms from long COVID are caused by dysregulation of the sympathetic nervous system. We report the use of the SGB for treating refractory headaches related to long COVID, suggesting that the SGB may relieve the dysautonomia. KEY WORDS: Long COVID, stellate ganglion block, dysautonomia, refractory headache, case report
Pain Relief With Peripheral Nerve Stimulation of Superficial Cervical Plexus: A Case Report and Literature Review
Authors: Bastian Luisa
Published: October 2024

BACKGROUND: Neuropathic head and facial pain are relatively common and difficult to treat pain syndromes encountered in pain clinics throughout the world. Atypical syndromes with overlapping nerve distributions can be particularly frustrating for patients and providers. In recent years, as providers search for alternatives to medications, advances in neuromodulation technology, including spinal cord stimulation and peripheral nerve stimulation (PNS), have shown promise in treating neuropathic pain confined to specific nerve distributions, such as the greater and lesser occipital nerves. However, there is limited literature describing the use of PNS for atypical facial pain. We report the first known case of PNS to the superficial cervical plexus in a 45-year-old woman with bilateral ear and postauricular pain. CASE REPORT: A 45-year-old woman presented with over 6 years of bilateral ear and periauricular pain in the auriculotemporal and lesser occipital nerve distribution. Conservative management, including neuropathic pain agents, ketamine infusions, nasal sprays, opioids, nonsteroidal anti-inflammatory medications, ice, heat, and transcutaneous neurostimulation, provided limited relief. She had excellent pain control with a series of nerve blocks to the superficial cervical plexus; however, relief was short term. In an attempt for a more long-term solution, she underwent implantation of the SPRINT PNS (MicroLead, SPR Therapeutics, Cleveland, OH), which resulted in 100% pain relief, improved function at work, and improved sleep tolerance throughout the 60-day treatment. Unfortunately, her symptoms returned shortly after treatment course completion. CONCLUSIONS: To our knowledge, this is the first case utilizing PNS of the superficial cervical plexus to treat atypical facial pain. The 60-day trial resulted in 100% pain relief of previously debilitating and functionally limiting pain symptoms during the treatment phase suggesting that the superficial cervical plexus may be a reasonable target for permanent PNS implants. KEY WORDS: Peripheral nerve stimulator, peripheral nerve stimulation, superficial cervical plexus, atypical facial pain, anesthetic blockade, pain relief, neuropathic pain, neuromodulation, SPRINT
Comparison of Magnetic Resonance Imaging and Intraprocedural Cervical Epidural Depth: A Case Series
Authors: Kim Steven
Published: October 2024

BACKGROUND: Cervical epidural depth is assessed intraprocedurally using loss-of-resistance technique and fluoroscopy. It would be helpful if this depth could be predicted using magnetic resonance imaging (MRI) images. METHODS: This is a case series of 10 patients undergoing cervical epidural steroid injections (CESIs). The following measurements were made: intraprocedural depth, measured on Tuohy needles intraprocedurally, and MRI depth, measured from the MRI cervical spine. Linear regression models were used to compare the 2 depths. RESULTS: For intraprocedural depth vs sagittal MRI depth, R (Version 4.2.0, R Foundation for Statistical Computing, Vienna, Austria, 2021) was 0.8744, P value < 0.0001. For intraprocedural depth vs axial MRI depth, R was 0.8582, P value < 0.001. CONCLUSIONS: Knowledge of the cervical epidural depth prior to CESIs may improve the safety and efficacy of these procedures. KEY WORDS: Cervical epidural depth, cervical radiculopathy, cervical epidural steroid injections, MRI depth, case series
Peripheral Nerve Stimulation Uses High-Frequency Electromagnetic Coupling Technology to Power an Implanted Neurostimulator With a Separate Receiver at the Ilioinguinal Nerve for the Treatment of Chronic Groin and Abdominal Pain: Case Report
Authors: Badawy Amr
Published: October 2024

BACKGROUND: Chronic groin pain can be debilitating to patients, reducing their overall quality of life. Peripheral nerve stimulation (PNS) is an emerging neuromodulation therapy that may be used for groin pain refractory to other treatment modalities. CASE REPORT: An 86-year-old Hispanic man with a history of left inguinal hernia repair with mesh presenting chronic groin and abdominal pain was successfully treated with subthreshold PNS at the ilioinguinal nerve. CONCLUSION: This case study demonstrated that subthreshold PNS can safely and effectively manage chronic groin and abdominal pain. KEY WORDS: Peripheral nerve stimulation, chronic pain, ilioinguinal, groin pain
Phantom Limb Pain Improvement Post Right Lower Extremity Amputation With a Liner-type Prosthesis and Pharmacotherapy Combination: A Case Report
Authors: Tsubaki Takayoshi
Published: October 2024

BACKGROUND: Phantom limb pain is pain in a missing limb postamputation. There is no sufficient evidence for an effective drug therapy, even though various treatment methods have been tried. Apart from drug therapy, mirror therapy, proprioceptive training, and virtual reality, as well as rehabilitation with appropriate orthotics have been tried. Liner-type prostheses use a silicone liner to reduce shear forces between the skin and the orthosis and to maintain suspension function, thereby relieving pain and improving comfort and functionality for the user. CASE REPORT: A 65-year-old man underwent amputation of his right thigh. On the 10th postoperative day, he complained of phantom limb pain centered on the amputation site. Pregabalin was started but did not alleviate his symptoms. After consultation with a physical therapist, the patient began using a liner prosthesis on the 33rd postoperative day. Symptoms gradually lessened, and positive comments were heard from the patient. Pregabalin and duloxetine were administered for a time but were soon reduced. Due to good pain control, the patient was discharged on the 46th postoperative day. After discharge from the hospital, the patient was able to continue treatment as an outpatient without his symptoms worsening, using a liner prosthesis as needed. CONCLUSION: Right thigh amputation is a very physically and emotionally taxing operation for the patient. Phantom limb pain is a difficult symptom to manage, but it must be adequately controlled for the patient. We have achieved phantom limb pain improvement with a combination of pharmacotherapy and a liner prosthesis. We feel a great need for close collaboration with other professions and for a nonpharmacologic approach in addition to pharmacotherapy. KEY WORDS: Phantom limb pain, amputation, pregabalin, duloxetine, liner type prosthesis
Severe Bilateral Glossopharyngeal Neuralgia Managed With Nerve Blocks Following Plasmodium falciparum Malaria Infection Treated With Mefloquine
Authors: Music Stephen
Published: October 2024

BACKGROUND: The Internal Classification of Headache Disorders diagnosis for glossopharyngeal neuralgia (GN) includes recurrent paroxysmal severely painful attacks in the glossopharyngeal nerve distribution. Precipitating factors may be swallowing or talking, and diagnosis is made by exclusion. Conservative management includes medications, such as carbamazepine. For refractory cases, interventional nerve blocks may be required. CASE REPORT: A 38-year-old woman experienced severe bilateral GN and occipital neuralgia with atypical migraines after treatment with mefloquine for severe Plasmodium falciparum malaria. Symptoms included the inability to perform activities of daily living (ADLs) due to severe “electric sharp stabbing pain.” Following ineffective conservative management, she was successfully treated with a series of nerve blocks every 3 months. Over time, with repeated interventions, she acquired a significantly lower baseline of pain enabling her to participate in ADLs. CONCLUSIONS: This case report highlights nerve blocks as a viable treatment option for refractory bilateral GN following treatment with mefloquine. KEY WORDS: Glossopharyngeal neuralgia, malaria, plasmodium, falciparum, mefloquine, regional nerve blocks, stellate ganglion nerve block,glossopharyngeal nerve block
Unveiling the Uncommon: Intradural Extramedullary Cord Lipoma Inducing Chest Wall Pain in a Middle-Aged Female Patient-A Case Report
Authors: Martinez-Lozano Edith
Published: October 2024

BACKGROUND: Intradural extramedullary lipomas are rare spinal cord tumors that remain asymptomatic until compression of the spinal cord results in neurological symptoms. Anterior chest wall pain as the initial presentation is uncommon and can contribute to the delayed diagnosis, as it prompts clinicians to rule out other pathologies. CASE REPORT: The patient is a 44-year-old woman who presented with chronic anterior chest wall pain, instability, imbalance, and upper motor neuron signs. Imaging was obtained, and magnetic resonance revealed an intradural extramedullary mass composed of adipose tissue from T2 to T5, indicative of a spinal lipoma. Subsequently, the patient underwent complete excision and laminoplasty successfully, immediately improving all symptoms. CONCLUSIONS: Diagnosing intradural extramedullary lipomas is intricate and often incidental, with varied presentations depending on tumor localization and size. While uncommon, it is crucial to maintain a heightened level of suspicion when evaluating persistent, unexplained pain resistant to conservative treatments and accompanied by neurological symptoms. KEY WORDS: Chest wall pain, spinal cord lipomas, case report
Herpes Simplex Virus-1 Complicated by Postherpetic Neuralgia: A Case Report
Authors: Jain Esha
Published: October 2024

BACKGROUND: The following case describes management of severe persistent vulvar pain from postherpetic neuralgia through a ganglion impar block. CASE REPORT: A 21-year-old female patient initially presented with genital lesions consistent with herpes simplex virus-1 (HSV-1) and antibody testing suggestive of primary HSV-1 infection. After her genital lesions resolved, she continued to have severe persistent vulvar pain and was diagnosed with postherpetic neuralgia, approximately one year after initial presentation. After unsuccessful medical management with her gynecologist and primary care physician, she was referred to a specialty pain management clinic, where a ganglion impar block was performed and provided significant pain relief. CONCLUSIONS: Genital HSV-1 is a rare cause of postherpetic neuralgia which can cause debilitating pain. Its management requires a multidisciplinary approach, including gynecology, pain management, physiatry, and if appropriate, behavioral health. KEY WORDS: Vulvar pain, postherpetic neuralgia, ganglion impar block, genital pain, case report
Case Report on Chronic Shoulder Pain and Response to Peripheral Nerve Stimulation Twenty-Four Months After Placement
Authors: Adams Lucendia
Published: October 2024

BACKGROUND: Effects of chronic shoulder pain are suffered by millions each year. What options are there for patients who were nonresponsive to conservative treatments and are deemed nonsurgical candidates? CASE REPORT: We present an 82-year-old woman with chronic left shoulder pain secondary to rotator cuff injury. She was nonresponsive to attempts at conservative treatment and pharmacotherapy and was not deemed a surgical candidate. The patient underwent peripheral nerve stimulator (PNS) placement targeting suprascapular and axillary nerves. She participated in a survey 24 months post-PNS placement that evaluated her chronic pain and response to PNS and reported an 80% reduction in pain. CONCLUSIONS: This case illustrates positive short-term reduction in overall chronic shoulder pain after PNS placement, but also highlights the effects of the PNS device 24 months after stimulator placement. As this is just one case highlighted, continued validated research is needed to further support use of PNS devices in this patient population. KEY WORDS: Peripheral, nerve, stimulator, shoulder, pain, chronic, relief
Use of Peripheral Nerve Stimulation and Perineural Catheter to Treat Phantom Limb Pain in a Multiple Limb Amputee: Case Report
Authors: Ahn Daniel
Published: October 2024

BACKGROUND: Limb loss is a debilitating condition affecting many Americans and approximately 80% go on to suffer phantom limb pain (PLP). Peripheral nerve stimulation (PNS) and perineural catheter (PC) placement are promising treatment options for PLP. CASE REPORT: We present a 36-year-old man, who underwent right transhumeral and right transtibial amputations following a work-related accident. He developed significant PLP of both limbs. The right upper extremity PLP was treated first during the inpatient hospital course with a 5-day infusion of 0.5% ropivacaine via a PC. The right lower extremity PLP was later addressed in the outpatient setting with a diagnostic right sciatic/saphenous nerve block followed by a 60-day PNS lead placement, which provided > 50% pain relief from baseline. The patient continues to have > 50% pain relief in his RLE nearly 9 months after the initial procedure. CONCLUSIONS: Our case adds to a growing body of evidence that supports the utility of PNS and PC. Future studies should explore whether early intervention with PNS could improve long-term outcomes. In addition, clinicians could consider the use of a PC for intractable PLP as an opioid-sparing strategy in the inpatient setting where close monitoring is feasible. KEY WORDS: Phantom limb pain, traumatic amputation, peripheral nerve stimulation, perineural catheter
Peripheral Nerve Stimulation Uses High-Frequency Electromagnetic Coupling Technology to Power an Implanted Neurostimulator With a Separate Receiver for the Treatment of Chronic Knee Pain: A Retrospective Study
Authors: Kilbride Earl
Published: October 2024

BACKGROUND: Chronic knee pain is highly prevalent in the United States, especially within the older population. The condition negatively impacts overall quality of life and can be a substantial financial burden. Current conservative and surgical interventions are not always effective in managing chronic knee pain. Peripheral nerve stimulation (PNS) can be an alternative to current management strategies. CASE REPORT: Data was retrospectively extracted from the electronic medical records of patients who received a permanent Freedom® PNS System for treating chronic knee pain. Systems were implanted for at least one month. Outcomes of interest included pain levels and occurrences of adverse events. Seven patients were included in this analysis. Pain scores decreased from 9.8 ± 0.3 to 1.6 ± 1.5 after the trial. The average pain score was 1.3 ± 0.8 at one month, with no adverse events reported. CONCLUSIONS: Chronic knee pain can be safely managed with the Freedom PNS System. KEY WORDS: Peripheral nerve stimulation, chronic pain, CRPS, infrapatellar saphenous neuralgia
Anticoagulation Management During a Spinal Cord Stimulator Trial on a Patient With ST-Elevation Myocardial Infarction
Authors: Yadav Abhishek
Published: October 2024

BACKGROUND: Spinal cord stimulators (SCSs) are indicated for the treatment of many pain syndromes. They are often trialed prior to placement of a permanent implant. Patients on anticoagulation therapy are instructed to follow the American Society of Regional Anesthesia and Pain Medicine guidelines during this process. CASE REPORT: Here we describe a unique case of a patient who had an SCS trial, followed by an ST-elevation myocardial infarction (STEMI) on day 4 postimplantation. After coronary revascularization, the patient started dual antiplatelet therapy, which posed significant for epidural hematoma with recent stimulator implantation. CONCLUSIONS: The patient was bridged with intravenous antiplatelet agents prior to SCS trial removal and monitored closely. Our discussion will focus on all anticoagulation management of patients with a recent STEMI who had undergone a trial SCS implantation. KEY WORDS: Spinal cord stimulation, neuromodulation, chronic pain, anticoagulation
Erector Spinae Plane Blocks with Dexmedetomidine and Dexamethasone for the Treatment of Pain Associated with Rib Fractures: Case Report
Authors: Patel Sagar
Published: October 2024

BACKGROUND: The erector spinae plane block (ESPB) is an ultrasound-guided approach for acute pain management in patients with single or multiple rib fractures. The addition of a dexmedetomidine and dexamethasone (Dex-Dex) solution to an ESPB injection has been shown to provide longer-lasting pain control in rib-fracture patients. Adding a Dex-Dex adjunct to an ESPB injection diminishes the need for more invasive techniques used in longer-lasting pain management, such as ESPB catheter placements. CASE REPORT: We present 2 cases of rib fractures, one in a 79-year-old woman and the other in an 82-year-old-man. Both patients received a single ESPB injection with Dex-Dex to provide longer-lasting pain control. After the procedure, both patients reported a significant reduction in pain and no complications to the intervention. CONCLUSION: The successful analgesic management of both patients’ conditions suggests that a single ESPB injection with Dex-Dex can be used as an alternative to traditional management techniques such as catheter placements. KEY WORDS: Erector spinae plane block, dexmedetomidine and dexamethasone, rib fractures, respiratory distress
Spinal Interferon Regulatory Factor 8 and Brain-derived Neurotrophic Factor in the Prefrontal Cortex are Involved in Pain-induced Depression Relief via Ultrasound-guided Pulsed Radiofrequency in a Rat Spared Nerve Injury Model
Authors: Fang Xiangyu
Published: October 2024

BACKGROUND: Pain-depression comorbidity has become a great burden to individuals and society. Nevertheless, the mechanisms underlying comorbid diseases have still not been fully revealed. Ultrasound-guided pulsed radiofrequency (PRF) on peripheral nerves, which produces remarkable analgesia via high-frequency electromagnetic energy, has become a main, minimally invasive treatment for chronic neuropathic pain. OBJECTIVES: The aim of this study was to explore the effect of ultrasound-guided PRF on the sciatic nerve of spared nerve injury (SNI) rats to relieve pain-induced depression. STUDY DESIGN: Experimental trial in rats. SETTING: The research took place in the Laboratory of The First Affiliated Hospital of Wenzhou Medical University. METHODS: Sixty male Wistar rats were randomly divided into a sham group, an SNI group, an SNI + free-PRF group, and an SNI + PRF group. Ultrasound-guided PRF was applied to the sciatic nerve on day 7 after SNI. The basal paw mechanical withdrawal threshold (PMWT) was evaluated as a measure for pain-related behavior, and a sucrose preference test was performed as a measure for depression-related behavior. The expression levels of spinal interferon regulatory factor 8 (IRF8) and of brain-derived neurotrophic factor (BDNF) in the prefrontal cortex (PFC) were also studied on days 21 and 42. RESULTS: The results showed that the PMWT was significantly decreased in rats following SNI operation; the decreased levels of PMWT were reversed in the SNI + PRF group after the application of PRF on the sciatic nerve on day 7. There were no statistically significant differences among the groups in the sucrose preference rate on day 21 after SNI operation. The sucrose preference rate on day 42 was higher in the SNI + PRF group than in the SNI + free-PRF group. Western blot and reverse transcription polymerase chain reaction also demonstrated that ultrasound-guided PRF on the sciatic nerve downregulated overexpression of spinal IRF8 and increased the levels of BDNF in the PFC. LIMITATIONS: This study was performed using only an SNI rat model which cannot represent all rodent neuropathic pain models. Only the short-term effectiveness of ultrasound-guided PRF on the sciatic nerve of SNI rats was investigated. The BDNF changes of other important brain areas were not taken into consideration in this study. CONCLUSIONS: These findings suggest that ultrasound-guided PRF on sciatic nerve could alleviate pain-induced depression. The mechanisms of this treatment may be involved in the downregulated spinal IRF8 and the increased BDNF in PFC. KEY WORDS: Neuropathic pain, depression, ultrasound, pulsed radiofrequency, interferon regulatory factor 8, brain-derived neurotrophic factor, spinal cord, prefrontal cortex
Comparison of Intercostal Block and Epidural Analgesia for Post-thoracotomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Liu Shanling
Published: October 2024

BACKGROUND: Thoracotomy is associated with severe postoperative pain. Effective management of acute pain after thoracotomy may reduce complications and chronic pain. Epidural analgesia (EPI) is considered the gold standard for postthoracotomy analgesia; however, it is associated with complications and limitations. Emerging evidence suggests that an intercostal nerve block (ICB) has a low risk of severe complications. Anesthetists will benefit from a review that assesses the advantages and disadvantages associated with ICB and EPI in thoracotomy. OBJECTIVES: This meta-analysis aimed to evaluate the analgesic efficacy and adverse effects of ICB and EPI for pain treatment after thoracotomy. STUDY DESIGN: Systematic review. METHODS: This study was registered in the International Prospective Register of Systematic Reviews (CRD42021255127). Relevant studies were searched for in PubMed, Embase, Cochrane, and Ovid databases. Primary (postoperative pain at rest and during cough) and secondary (nausea and vomiting, morphine consumption, and length of hospital stay) outcomes were analyzed. The standard mean difference for continuous variables and the risk ratio for dichotomous variables were calculated. RESULTS: Nine randomized controlled studies with a total of 498 patients who underwent thoracotomy were included. The results of the meta-analysis demonstrated no statistically significant differences between the 2 methods in terms of the Visual Analog Scale scores for pain at 6-8, 12-15, 24-25, and 48-50 hours at rest and at 24 hours during coughing after surgery. There were no significant differences in nausea and vomiting, morphine consumption, or length of hospital stay between the ICB and EPI groups. LIMITATIONS: The number of included studies was small, and the quality of evidence was low. CONCLUSIONS: ICB may be as effective as EPI for pain relief after thoracotomy. KEY WORDS: Thoracic surgery, intercostal nerve block, epidural analgesia, postthoracotomy pain, postoperative pain, randomized controlled trial, meta-analysis, systematic review
The Efficacy of Pericapsular Nerve Group Block Versus Facia Iliaca Block on Immediate Postoperative Pain and Opioid Consumption After Hip Arthroscopy Randomized Trial
Authors: Noaman Safaa Sayed
Published: October 2024

BACKGROUND: Postoperative pain after hip arthroscopy remains a major cause of patient dissatisfaction in the immediate postoperative period. Adequate postoperative analgesia is associated with increased patient satisfaction, earlier mobilization, and decreased opioid consumption. OBJECTIVES: Therefore, there is a need for safe, reliable, and opioid- and motor-sparing methods of achieving postoperative analgesia following hip arthroscopy. We evaluated the efficacy of pericapsular nerve group (PENG) block vs fascia iliaca block (FIB) in reducing postoperative pain and analgesic consumption in the first 24 hours following hip arthroscopy. STUDY DESIGN: A prospective randomized double-blinded control clinical trial. SETTING: At the arthroscopy unit of the orthopedic department of Assiut University Hospitals, Assiut, Egypt from 2019 to 2022. METHODS: Forty-three patients comprising 18 women and 25 men scheduled for hip arthroscopy were randomized to receive a preoperative block with PENG or FIB from March 2019 to March 2022. The mean age was 27.9 years (standard deviation [SD], 6.2 years; range, 18-42 years) and the mean body mass index was 25.13 kg/m2 (SD, 5.08 kg/m2). Patients were randomized into 2 groups: group A comprising 20 patients that received FIB; and group B comprising 23 patients that received PENG block. The efficacies of FIB and PENG block were evaluated using Visual Analog Scale scores. RESULTS: Statistically significant differences in median pain scores and mean at rest pain scores were observed between the 2 groups at all measured time points following surgery (i.e., 6, 12, 18, and 24 hours). Further, dynamic pain scores (with hip flexion) scores significantly differed between the 2 groups at 24 hours postoperatively (P = 0.001). PENG block significantly decreased postoperative opioid use compared to FIB. Total opioid use in the 24-hour postoperative period was lower in the PENG group compared to the FIB group (16.5 ± 9.9 vs 27.5 ± 9.6; P < 005). LIMITATIONS: Different hip pathologies and different interventions lead to different outcomes. Also, a larger sample size and longer follow-up duration are required. CONCLUSIONS: PENG block may represent the ideal regional anesthesia modality for hip arthroscopy as an alternative to more conventional regional nerve blocks, such as FIB, femoral nerve block, and lumbar plexus block. PENG block is reproducible, easily performed in the preoperative setting, and appears to spare motor function while providing prolonged sensory analgesia. KEY WORDS: Pericapsular, nerve group block, fascia iliaca block, peripheral nerve blocks, hip arthroscopy
Green Light-Based Analgesia – Novel Nonpharmacological Approach to Fibromyalgia Pain: A Pilot Study
Authors: Gulur Padma
Published: October 2024

BACKGROUND: There continues to be significant reliance on pharmacological modalities for the management of chronic pain, with a particular focus on opioid analgesics as a singular option for pain management. Fibromyalgia is a prototypical central pain disorder, which is often used as a model to study chronic pain disorders. It has an estimated prevalence of approximately 1.1% to 5.4% in the general population. The widespread use of opioids in patients with fibromyalgia has been well demonstrated in several health claims database studies, with rates of use ranging from 11.3% to 69%. Minimizing opioid exposures reduces misuse risk, but requires adequate opioid-sparing multimodal analgesic strategies, particularly nonopioid analgesic adjuncts, to ensure effective treatment of pain, particularly high-impact pain. We chose fibromyalgia as our study population. Given that it is a disordered sensory processing condition, it may be particularly amenable to the beneficial effects of green-light therapy. OBJECTIVES: Most studies have evaluated exposure to light-emitting diode lights as a mode of green-light delivery; our study used green-light filtering eyeglasses, which would allow the wearer to move about with minimal interference. STUDY DESIGN: We conducted a randomized controlled trial to test the feasibility of green-light filtering eyeglasses in the treatment of chronic pain. SETTING: This study was conducted at Duke University Health System. METHODS: We recruited and randomized adult patients with a known diagnosis of fibromyalgia patients and excluded patients who were unable to wear eyeglasses for at least 4 hours per day or were colorblind according to the Ishihara Colorblindness Test. Patients were assigned to 1 of 3 arms: clear eyeglasses (control), green eyeglasses, or blue eyeglasses. We initially recruited 45 patients and randomly assigned 15 patients per group. RESULTS: To evaluate clinical significance, we determined the rate of >= 10% decline in oral morphine equivalents and found that 33%, 11%, and 8% of the green, blue, and clear eyeglass groups, respectively, achieved this clinically meaningful outcome. LIMITATIONS: This study was powered to detect feasibility of the intervention, rather than conclusive analgesic effects. CONCLUSIONS: Our study demonstrated the feasibility of this treatment approach and study design and supports a future study to determine the efficacy of green light-based analgesia on opioid use, pain, and anxiety. While the reduction of opioid use was not of statistical significance, we believe it to be of clinical significance as there was no increase of patient-reported pain. This warrants further investigation in a large-scale trial of the use of green-light filtration of ambient light to mitigate opioid use and possible mediation of psychological impacts of pain with the use of green-lensed eyeglasses. KEY WORDS: Chronic pain, fibromyalgia, pain, pain management, green light, green-light filtering eyeglasses, green-light analgesia, chronic pain management
The Effectiveness of Medial Branch Blocks and Radiofrequency Neurotomy in Managing Chronic Thoracic Pain: A Systematic Review and Meta-Analysis
Authors: Laxmaiah Laxmaiah
Published: October 2024

BACKGROUND: Extensive research into potential sources of thoracic pain with or without referred pain into the chest wall has demonstrated that thoracic facet joints can be a potential source of pain confirmed by precise, diagnostic blocks. The objective of this systematic review and meta-analysis is to evaluate the effectiveness of medial branch blocks and radiofrequency neurotomy as a therapeutic thoracic facet joint intervention. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies of medial branch blocks and the radiofrequency neurotomy in managing thoracic pain utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was performed. A comprehensive literature search of multiple databases of RCTs and observational studies of medial branch blocks and radiofrequency neurotomy in managing chronic thoracic pain were identified from 1996 to December 2022 with inclusion of manual searches of the bibliography of known review articles and multiple databases. Methodologic quality and risk of bias assessment was also conducted. Evidence was synthesized utilizing principles of quality assessment and best evidence synthesis, with conventional and single meta-analysis. The primary outcome measure of success was 3 months of pain reduction for medial branch blocks and 6 months for radiofrequency thermoneurolysis for a single treatment. Short-term success was defined as up to 6 months and long-term was more than 6 months. RESULTS: This literature search yielded 11 studies meeting the inclusion criteria, of which 3 were RCTs and 8 were observational studies. Of the 3 RCTs, 2 of them assessed medial branch blocks and one trial assessed radiofrequency for thoracic pain. The evidence for managing thoracic pain with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 2 RCTs and 3 observational studies for medial branch blocks was Level II. For radiofrequency neurotomy, with the inclusion of one RCT of 20 patients in the treatment group and 5 observational studies, the evidence was Level III in managing thoracic pain. LIMITATIONS: There was a paucity of literature with RCTs and real-world pragmatic controlled trials. Even observational studies had small sample sizes providing inadequate clinically applicable results. In addition, there was heterogeneity of the available studies in terms of their inclusion and exclusion criteria, defining their endpoints and the effectiveness of the procedures. CONCLUSION: This systematic review and meta-analysis show Level II evidence of medial branch blocks and Level III evidence for radiofrequency neurotomy on a long-term basis in managing chronic thoracic pain. KEY WORDS: Chronic spinal pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks, diagnostic accuracy, radiofrequency neurotomy
High- versus Low-dose Steroid Injection for Adhesive Capsulitis (Frozen Shoulder): A Systematic Review and Meta-analysis
Authors: Lee Sang Chul
Published: October 2024

BACKGROUND: Intraarticular steroid injections are a commonly used and proven treatment for frozen shoulder; however, there is no scientific basis for a certified dose. OBJECTIVES: This study aimed to identify the difference between high- and low-dose steroid injections treatments and suggest an appropriate dose. STUDY DESIGN: Systematic review and meta-analysis. METHODS: The MEDLINE, EMBASE, and Cochrane electronic databases were searched through February 15, 2023 for eligible randomized controlled trials. The effects of high- and low-dose steroid injections were calculated as standardized mean differences (SMD) in pain, shoulder range of motion (ROM), and functional improvement. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate evidence quality. RESULTS: Four studies with 274 patients were included in the final analysis. The meta-analysis showed that improvement in pain (SMD, 0.10; 95% CI, -0.12 to 0.32), ROM (SMD, 0.07; 95% CI, -0.05 to 0.19), and functional improvement (SMD, 0.08; 95% CI, -0.10 to 0.26) did not differ significantly between the high- and low-dose steroid injections. Subgroup follow-up analyses also showed no clinically significant differences in SMD for pain, ROM, and functional scale measurement in any subgroups (after 3 weeks, 6 weeks, and one year). One article described that, although there was no significant difference in adverse events frequency between the high- and low-dose groups, flushing tended to occur more frequently in the high-dose group. LIMITATIONS: Limitations are the small number of studies included in the meta-analysis, no disease stage considered, and a short follow-up period. CONCLUSIONS: This meta-analysis suggests there are no significant differences between the high- and low-dose steroid groups in pain, ROM, or functional improvement. Therefore, considering the side effects of high-dose steroids, starting with low-dose steroids is recommended. However, further studies are needed to establish exact protocols according to disease severity. KEY WORDS: Frozen shoulder, adhesive capsulitis, steroids, triamcinolone acetonide, injections, intraarticular, optimal dose, meta-analysis, randomized controlled trial
Effect of Topical Nonsteroidal Anti-inflammatory Drugs Around the Incision on Postoperative Pain in Transforaminal Lumbar Interbody Fusion Surgery: A Double-blind Randomized Controlled Trial
Authors: Liu Xinyu
Published: October 2024

BACKGROUND: How to minimize postoperative pain following spinal surgery has been a great challenge. We hypothesized that topical nonsteroidal anti-inflammatory drugs (NSAIDs) around the incision could relieve postoperative pain following transforaminal lumbar interbody fusion (TLIF) surgery. OBJECTIVE: This study tested the effect of topical NSAIDs around the incision for pain management after TLIF surgery. STUDY DESIGN: A double-blind randomized controlled trial. SETTING: Qilu Hospital of Shandong University. METHODS: Eighty patients who underwent single-level TLIF surgery were randomized into 2 groups. The treatment group received postoperative topical NSAIDs around the incision. The control group received a postoperative topical placebo around the incision. All patients in both groups received postoperative patient-controlled analgesia (PCA) via an analgesia pump. The primary outcome measures were the amount of opioid consumption and pain measurement via the visual analog scale (VAS). The secondary outcome measures were the time of first analgesic demand, operation time, postoperative drain output, side effects of opioids, postoperative stay, and Oswestry Disability Index (ODI) score. RESULTS: The consumption of opioids in the treatment group was significantly less than in the control group at postoperative 12 hours, 12 to 24 hours, and 24 to 48 hours (P < 0.005). The VAS in the treatment group was significantly lower than those in the control group at all assessment times within 72 hours postoperative (P < 0.005). The time of first analgesic demand of PCA in the treatment group was significantly longer than that in the control group (P < 0.005). The side effects of opioids were significantly less in the treatment group than in the control group (P < 0.05). There was no significant difference in operation time, postoperative drain output, postoperative stay, and ODI between the 2 groups (P > 0.05). LIMITATIONS: This was a single-center study for single-level TLIF surgery. CONCLUSION: Postoperative topical NSAID around the incision is a highly effective and safe method for postoperative pain management following single-level TLIF surgery. In our study it reduced postoperative opioid requirements and prolonged the time of first analgesic demand with no increased side effects. KEY WORDS: Transforaminal lumbar interbody fusion, postoperative pain, NSAID, topical NSAID, nonsteroidal anti-inflammatory drug, loxoprofen