Reported Pain Relief Research Articles

Passive Recharge Burst Spinal Cord Stimulation Provides Sustainable Improvements in Pain and Psychosocial Function: 2-year Results From the TRIUMPH Study.

Prospective, international, multicenter, single-arm, post-market study. The aim of this study was to assess long-term safety and effectiveness of spinal cord stimulation using a passive recharge burst stimulation design for chronic intractable pain in the trunk and/or limbs. Herein we present 24-month outcomes from the TRIUMPH study (NCT03082261). Passive recharge burst spinal cord stimulation (B-SCS) uniquely mimics neuronal burst firing patterns in the nervous system and has been shown to modulate the affective and attentional components of pain processing. After a successful trial period, subjects received a permanent SCS implant and returned for follow-up at 6, 12, 18, and 24 months. Significant improvements in physical, mental, and emotional functioning observed after 6 months of treatment were maintained at 2 years. Pain catastrophizing scale (PCS) scores dropped below the population norm. Health-related quality of life on EQ-5D improved across all domains and the mean index score was within one standard deviation of norm. Pain reduction (on NRS) was statistically significant (P < 0.001) at all timepoints. Patient reported pain relief, a stated percentage of improvement in pain, was consistent at all timepoints at 60%. Patients reported significant improvements across all measures including activity levels and impact of pain on daily life. At 24 months, 84% of subjects were satisfied and 90% would recommend the procedure. Subjects decreased their chronic pain medication intake for all categories; 38% reduced psychotropic and muscle relaxants, 46% reduced analgesic, anti-convulsant and NSAIDs, and 48% reduced opioid medication. Adverse events occurred at low rates without unanticipated events. Early positive results with B-SCS were maintained long term. Evidence across multiple assessment tools show that B-SCS can alleviate pain intensity, psychological distress, and improve physical function and health-related quality of life.Level of Evidence: 3.

What Is the Numerical Nature of Pain Relief?

Pain relief, or a decrease in self-reported pain intensity, is frequently the primary outcome of pain clinical trials. Investigators commonly report pain relief in one of two ways: using raw units (additive) or using percentage units (multiplicative). However, additive and multiplicative scales have different assumptions and are incompatible with one another. In this work, we describe the assumptions and corollaries of additive and multiplicative models of pain relief to illuminate the issue from statistical and clinical perspectives. First, we explain the math underlying each model and illustrate these points using simulations, for which readers are assumed to have an understanding of linear regression. Next, we connect this math to clinical interpretations, stressing the importance of statistical models that accurately represent the underlying data; for example, how using percent pain relief can mislead clinicians if the data are actually additive. These theoretical discussions are supported by empirical data from four longitudinal studies of patients with subacute and chronic pain. Finally, we discuss self-reported pain intensity as a measurement construct, including its philosophical limitations and how clinical pain differs from acute pain measured during psychophysics experiments. This work has broad implications for clinical pain research, ranging from statistical modeling of trial data to the use of minimal clinically important differences and patient-clinician communication.

IMPORTANCE OF TIMELY INTERVENTION IN PATIENTS WITH PERIPHERAL ARTERIAL THROMBOEMBOLIC DISEASE

A 38-year old male welder by profession ,smoker presented with complaints of pain in right lower limb of four days duration and absent peripheral pulses from femoral artery downwards .Arterial doppler revealed diffuse thrombus causing total occlusion of right common iliac ,right common femoral and right supercial femoral artery with no ow. Emergency right femoro-popliteal thromboembolectomy was done after which femoral pulsations returned and patient reported pain relief and the limb was warm.

Herniated disc of lumbar spine caused by bone cement leakage after kyphoplasty - A case report and literature review.

Introduction and importanceTo describe an unusual case with herniated disc caused by bone cement leaking to disc space after kyphoplasty.Case presentationWe reported a 72-year-old woman with L4 osteoporotic compression fracture. New-onset of left sciatica, numbness and intermittent claudication suffered her immediate after kyphoplasty. Herniated disc caused by bone cement leaking to disc space after kyphoplasty. The patient was post decompressive operation of L34 and the symptoms subsided well then.Clinical discussionPercutaneous vertebroplasty (PVP) was a common procedure today. Especially to back pain caused by osteoporotic fracture, reported pain relief rate was satisfactory. Current studies about bone cement leakage showed kyphoplasty less than vertebroplasty. However, for the mechanism and stress effect of balloon expansion, new weak points and cracks over endplate was created, which may cause bone cement leakage to disc space and related symptoms.ConclusionKyphoplasty was a common, effective and minimal invasive operation for patients with compression fracture of spine. Cement leakage to intervertebral disc space was generally asymptomatic, but it should be avoided as much as possible. The leakage could affect the stability and weight-bearing of spinal column. Accelerated degenerative process of disc would be found and newly herniated disc would be noted. It should be ceased the procedure when relative amount of bone cement leakage to disc space during kyphoplasty.

Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain.

Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain.

Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies.

BackgroundSacroiliac joint (SIJ) pain is a common cause of low back pain, a problem experienced by two-thirds of adults in the United States population. Traditionally, the management of persistent SIJ-related pain has involved conservative therapies (physical therapy, topical medications, oral anti-inflammatory medications), interventional therapies (SIJ steroid injections or ablation), and surgery (SIJ fusion; open and lateral approach). Recent advancements in technology have paved the way for SIJ fusion via a posterior approach, which aims to minimize complications and enhance recovery.ObjectiveThe purpose of this study is to introduce the concept of the posterior approach to SIJ fusion as a feasible adjunct and salvage technique for patients with inadequate pain relief from other minimally invasive surgical procedures, and to validate its efficacy through a retrospective multicenter data analysis.DesignMulticenter retrospective observational study.MethodsPatients with refractory SIJ pain were treated by interventional pain physicians at one of the eight different pain management centers. All patients underwent posterior SIJ fusion via the LinQTM sacroiliac fusion procedure. Demographical data were collected, in addition to patient-reported pain relief.ResultsA total of 111 patients were included in the study and underwent posterior SIJ fusion for refractory SIJ-related pain following the use of spinal cord stimulation (SCS), interspinous spacer (ISS), intrathecal drug delivery (IDDS), and/or minimally invasive lumbar decompression (MILD). Overall, the mean patient reported pain relief following posterior SIJ fusion was 67.6%. In patients with a history of failed back surgery syndrome, the mean patient reported pain relief was 76.5%.ConclusionIn this retrospective case series of patients with continued intolerable pain following SCS, ISS, IDDS, or MILD, a novel posterior SIJ fusion device provided significant pain relief in a salvage manner. These early results suggest that this intervention may be a therapeutic option to consider in these patients.

Pain Reduction after Short Exposure to Virtual Reality Environments in People with Spinal Cord Injury.

Emerging literature suggests that virtual reality (VR) may be a viable therapy for neuropathic pain (NP). This pilot study aimed to investigate the immediate effect of VR in reducing NP in people with spinal cord injury (SCI). Eight individuals with chronic NP after SCI were recruited and underwent consecutive exposure to scenery and somatic virtual environments (VE). The numeric rating scale (NRS) was used to assess pain before and after exposure to each VE. The Immersive Tendencies Questionnaire (ITQ) and Presence Questionnaire (UQO-PQ) were used to investigate the interaction between reported pain relief post-intervention with immersion and presence. There was a significant reduction in pain levels (5.1 ± 0.4, mean ± SEM) after short exposure to the scenery (3.1 ± 0.7, p = 0.04) and somatic VE (3.0 ± 0.7, p = 0.04), with no difference between intervention types (p = 0.56). There was a statistically significant negative correlation between the total ITQ score and the change in NRS after the scenery VR intervention (rs = 0.743, p = 0.035). PQ scores showed no significant correlation with changes in pain following either intervention type. We found that short-term exposure to VR environments results in a reduction in chronic NP intensity in people with SCI.

Burst spinal cord stimulation can attenuate pain and its affective components in chronic pain patients with high psychological distress: results from the prospective, international TRIUMPH study

BACKGROUND CONTEXTPsychological characteristics such as catastrophizing and depression have been shown to negatively impact outcome prognosis after spinal interventions. PURPOSETo evaluate whether high psychological distress, defined as clinically elevated levels of catastrophizing and depression, is associated with poorer outcomes after spinal cord stimulation utilizing a passive recharge burst stimulation design. This proprietary waveform may uniquely attenuate the emotional aspects of chronic pain given its affects on the medial pain pathway projecting to the dorsal anterior cingulate cortex and anterior insula. STUDY DESIGN/SETTINGSData were extracted from the prospective, multi-center, single-arm, international TRIUMPH study. The purpose of TRIUMPH was to assess long-term (2 years) safety and effectiveness of spinal cord stimulation for chronic pain in the trunk and/or limbs using a passive recharge enabled burst spinal cord stimulation (B-SCS) system. PATIENT SAMPLETwo subsets of study patients were identified; those with (n=31) and those without (n=54) high psychological distress. OUTCOME MEASURESPsychological and functional outcomes as well as pain intensity and impact of pain on life were administered at baseline and all follow intervals. Additionally, patient satisfaction and patient global impression of change were assessed at all follow-up intervals. METHODSPsychological distress (PD) was defined as a baseline score of ≥ 30 on the Pain Catastrophizing Scale (PCS) and ≥ 10 on the Patient Health Questionnaire Depression scale (PHQ-9). Nondistressed (ND) patients had scores below these thresholds on both scales. All patients were implanted with a B-SCS system and completed data collection for the 24-month follow-up visit. This study was funded by Abbott. JMH is a consultant for Abbott and has received <$20,000 in lifetime consulting fees from Abbott. SMF is a consultant for Abbott and has received >$50,000 in lifetime consulting fees from Abbott. BB is an Abbott employee. RAC is a former Abbott employee. JJY is a consultant for Abbott and has received <$2,500 in lifetime consulting fees from Abbott. RESULTSOf the 128 participants with 24-month data, 31 (24%) and 54 (35%) met the criteria for PD and ND, respectively. Baseline measures indicated a more severe chronic pain profile and worse quality of life in the PD group. Two years after implant, 71% were no longer clinically catastrophizing and 58% were no longer clinically depressed. Notably, more than half of the PD patients on antidepressants discontinued or decreased their medication. Health-related quality of life was 82% higher in the PD group at 24 months, reaching levels similar to the ND group. Psychological distress did not impact outcomes after SCS therapy; composite multi-responder rates were similar in the 2 groups throughout the follow-up period. Patient reported pain relief (58% PD vs. 61% ND) was equivalent in each group. In both groups, 81% were satisfied or very satisfied with the pain relief provided. CONCLUSIONSOur results showed that B-SCS appears to be as effective in a chronic pain population with high psychological distress as in those without distress. This may be due to the unique mechanism of action with the stimulation design involving the emotional-affective medial pain pathway in the brain.

High Frequency 10 kHz Spinal Cord Stimulation as a First Line Programming Option for Patients With Chronic Pain: A Retrospective Study and Review of the Current Evidence.

IntroductionNeuromodulation is an evolving and increasingly popular therapy for chronic pain management. Recent data suggest that novel waveforms have demonstrated greater benefit over traditional spinal cord stimulation (SCS). The authors conducted a retrospective review of patients undergoing high-frequency 10 kHz SCS at a single tertiary medical center for the purpose of contributing further evidence to this growing body of data. The literature of high-frequency SCS published to date was also reviewed.MethodsA retrospective chart review was performed for patients with chronic pain syndrome, including failed back surgery syndrome and sciatica alone, who underwent high-frequency SCS at 10 kHz. This data was analyzed using R software (R Foundation for Statistical Computing, Vienna, Austria) for statistical analysis. The PubMed database was searched for relevant articles using the search terms “high frequency,” “10 kHz,” and “spinal cord stimulation.” All relevant studies conducted to date were included in this literature review.ResultsTwenty-one patients had complete follow-up data and were included in this study. Of the 21 patients, 85.7% subjectively reported post-operative pain relief while 71.4% of the total patients reported pain relief by ≥ 50%. There was a statistically significant decrease in mean VAS scores from pre-operative to 12-months post-operative (8.52 vs 4.37, p < 0.001). Additionally, 76.5% of patients subjectively reported improvements in sleep and activities of daily living. Recent studies indicate that high-frequency SCS appears to be a viable option for delivering quality pain relief in patients for chronic regional pain syndrome, failed back surgery syndrome, sciatica, and also pain in the upper cervical region of the spine.ConclusionThis article provides evidence both with the authors’ own institutional data and from the currently published literature for the efficacy of using high-frequency SCS at 10 kHz as a first-line programming option for patients undergoing SCS.

Direct Sciatic Nerve Electrical Stimulation for Complex Regional Pain Syndrome Type 1

Foot and leg pain in complex regional pain syndrome (CRPS) presents a challenge even with neuromodulation techniques such as spinal cord stimulation (SCS). We report our experience with a novo technique of direct sciatic nerve electrical stimulation (DISNES) for intractable foot and leg pain in CRPS I. Following Research Ethics Board (REB) approval, data were gathered for 16 patients (10 women and 6 men, age 26-61 years) who had been subjected to ipsilateral DISNES. All 16 patients had failed conventional medical management. As well, seven subjects were previously treated with SCS for CRPS I pain. These subjects reported pain relief in the thigh and leg, however the SCS was unable to alleviate the disabling foot pain despite varied and multiple programming techniques. The remaining nine subjects were treated primarily with DISNES. Evaluation was done using visual analog scale (VAS), Oswestry Disability Index version 2 (ODI), and quality of life (EQ-5D and SF-36) scores done both pre-DISNES and at two follow-ups. VAS scores decreased by 59% at follow-up (F/U) 1 (P=0.00001) and 46% F/U 2. ODI improving by 40% F/U 1 (P=0.0038) and 37% F/U 2. SF-36 scores improved by 69% F/U 1 (P=0.015) and 80% F/U 2. EQ-5D scores improved significantly by F/U 1 (P=0.00030) but insignificantly at F/U 2 (P=0.81). There was also a rapid resolution of autonomic features such as edema, hyperemia, and allodynia (within 7-10 days). Three subjects returned to work post-DISNES. Our study shows that DISNES helps to control the disabling foot pain in CRPS I, thus improving the quality of life, improving ambulation and decreasing disability. DISNES also alleviates autonomic features and dystonia in CRPS I. Further studies are needed to determine long-term efficacy as this study pool is limited in size and follow-up period.

Aplicación de una jalea de caléndula al 1% en pacientes con alveolitis

Objetivo: demostrar los beneficios terapéuticos del uso de una jalea de caléndula al 1% en pacientes con alveolitis. Métodos: se realizó una intervención terapéutica en el Policlínico Julián Grimau, provincia Santiago de Cuba, Cuba, entre enero y junio de 2019. Por muestreo no probabilístico se reclutó una muestra de 24 pacientes con diagnóstico de alveolitis seca o húmeda, distribuyéndose en dos grupos: A (control) y B (estudio), los cuales recibieron tratamiento convencional y jalea de caléndula al 1%, respectivamente. Se analizaron las variables: edad, sexo, tipo de alveolitis, tiempo de remisión del dolor y de cicatrización, respuesta al tratamiento (mejorado y no mejorado) y beneficios terapéuticos. Se empleó el porcentaje como medida de resumen y el test estadístico Ji al cuadrado de Independencia con un nivel de significación (a) de 0,05. Resultados: se evidenció un predominio de la alveolitis en pacientes con 19-59 años de edad (50,0%), del sexo femenino (66,7%) y del tipo húmeda (75,0%). En ambos grupos de tratamiento, el mayor porcentaje de los pacientes (17) refirió alivio del dolor a las 48 horas. En el 83,3% de los pacientes, incluidos en el grupo B, se observó menor tiempo de cicatrización. El 100% de los pacientes se categorizó como mejorado. Conclusiones: la jalea de caléndula al 1% resulta beneficiosa, dada su capacidad analgésica y cicatrizante en el tratamiento de pacientes con alveolitis.

Supraspinal Effects of Dorsal Root Ganglion Stimulation in Chronic Pain Patients

Dorsal root ganglion stimulation (DRGS) has become a popular neuromodulatory treatment for neuropathic pain. We used magnetoencephalography (MEG) to investigate potential biomarkers of pain and pain relief, based on the differences in power spectral density (PSD) during varying degrees of pain and how these oscillations change during DRGS-mediated pain relief. Thirteen chronic pain patients with implanted dorsal root ganglion stimulators were included in the MEG analysis. MEG Recordings were performed at rest while the stimulator was turned ON or OFF. Numerical rating scale (NRS) scores were also recorded before and after DRGS was turned OFF and ON. Power spectral and source localization analyses were then performed on preprocessed MEG recordings. With DRGS-OFF, patients in severe pain had significantly increased cortical theta (4-7 Hz) power and decreased cortical alpha (7-13Hz) power compared to patients reporting less pain. This shift in power toward lower frequencies was contrasted by a shift toward the higher frequency power spectrum (low beta 13-20Hz activity) during DRGS-mediated pain relief. A significant correlation was found between the increase in low beta activity and the degree of reported pain relief. Our results demonstrate increased low-frequency power spectral activity in chronic pain patients in the absence of stimulation which shifts toward higher frequency power spectrum activity in response to therapeutic DRGS. These cortical changes in response to DRGS provide support for the use of neuroimaging in the search for potential biomarkers of pain.

Abstract No. 219 Rethinking median arcuate ligament syndrome: the role of celiac plexus block for diagnosis

To evaluate celiac plexus block (CPB) as a preoperative diagnostic tool for median arcuate ligament syndrome (MALS) A retrospective cohort study of 96 clinically diagnosed MALS patients that underwent 103 CT-guided percutaneous CPB at a single hospital between January 1, 2017, and April 3, 2020. Clinical, imaging, and procedural reports were reviewed. A CPB database was established. Numeric rating scale-11 was used to self-report pain scores. Primary outcomes were technical success, pain score, nausea, and vomiting. A total of 96 patients (75 female) with a mean age of 26.7 years. Computed tomography (CT) imaging was available for review in 81 of 96 patients. CT findings of MALS including low-lying median arcuate ligament, celiac artery stenosis, inferiorly displaced celiac trunk, or celiac trunk hook-shaped configuration was present in 22/81 patients. There were no differences in post-CPB pain relief between patients with normal anatomy findings versus MALS anatomy (P = .7447).Technical success was achieved in 102 of 103 cases. Postprandial pain score decreased from 6.3 to 0.9 points (P< .0001). Postprandial nausea decreased from 37.9% to 11.6% (P< .0001). Postprandial vomiting decreased from 15.5% to 4.9% (P = .0194). No major adverse events and one moderate adverse event were reported. Subsequently, 45.8% of patients elected to undergo MALS surgery: exploratory laparotomy with median arcuate ligament resection and celiac ganglionectomy. Patients electing for MALS surgery had significantly higher pre-CPB pain scores (7.0 versus 5.6 points, P = .023) and lower post-CPB pain scores (0.4 versus 1.3 points, P = .043) when compared to patients that did not pursue surgery. MALS is not an arteriopathy, but rather an autonomic neuropathy responsive to local anesthetic block. In our series of 103 CPB, we reported pain relief in 83.5%, regardless of CT findings of arterial involvement. The degree of response to CPB correlates with the decision to undergo MALS surgery. CPB is safe and central to the preoperative diagnosis of MALS.

A clinical study on lateral pancreaticojejunostomy in a case of chronic pancreatitis

Lateral pancreaticojejunostomy is a seldom performed procedure in a peripheral tertiary health care centre. Very few numbers of cases are reported that undergoes surgical procedures for chronic pancreatitis. We report a such rare case in our institute that undergone pancreatic drainage procedure. A 70 year old poor patient was admitted in our institute with a complaint of chronic abdominal pain, subsequently diagnosed to be having chronic pancreatitis with complications with pancreatic duct calculus. Pancreatic drainage procedure, lateral pancreaticojejunostomy was performed and we analysed for the outcome of the procedure with regards to pain relief, anastomotic leak, quality of life and return to work. Patient recovered well post-operatively, reported pain relief, suffered no anastomotic leak and experienced improved quality of life. Lateral pancreaticojejunostomy provides excellent surgical choice for patients of chronic pancreatitis with pancreatic duct calculus with acceptable rates of pain relief, morbidity and mortality, without worsening pancreatic insufficiency.

Clinical Response to Celiac Plexus Block Confirms the Neurogenic Etiology of Median Arcuate Ligament Syndrome

PurposeTo evaluate the response of median arcuate ligament syndrome (MALS) symptoms, including postprandial pain, nausea, and vomiting, to celiac plexus block (CPB) and correlate the response with arterial anatomy. Materials and MethodsIn a single-institution, retrospective cohort of clinically diagnosed MALS patients, 96 patients (female, 75; male, 21; mean age, 27 years) underwent 103 computed tomography‒guided percutaneous CPB procedures. Imaging, procedural, and clinical reports were reviewed. Primary outcomes evaluated were technical success, change in self-reported pain score, and change in nausea and vomiting. ResultsComputed tomography imaging before the procedure was available for 81 of 96 patients and demonstrated findings of celiac artery compression in 22 of 81 (27%) patients. Technical success was achieved in 102 of 103 cases. No major adverse events and 1 moderate adverse event were reported. The postprandial pain score decreased in 86 (84%) patients, and the mean score decreased from 6.3 to 0.9 points (P < .001). The prevalence of postprandial nausea decreased from 37.9% to 11.6% (P < .001) and that of vomiting decreased from 15.5% to 4.9% (P = .019). No differences were noted in pain relief after CPB between patients with and without celiac artery compression (P = .745). ConclusionsIn patients with a clinical diagnosis of MALS, a large majority reported pain relief and decreased gastrointestinal symptoms after CPB. Pain relief did not correlate with the presence of celiac arterial abnormalities. This supports neuropathy as the primary etiology of MALS and suggests that the absence of celiac stenosis should not be used as an exclusion criterion.

Calcitonin gene-related peptide receptor antagonist ubrogepant for the treatment of acute migraine: A meta-analysis.

Background:The objective of this study is to systematically evaluate the efficacy and safety of the calcitonin gene-related peptide (CGRP) receptor antagonist ubrogepant for the treatment of acute migraine.Methods:Randomized controlled trials (RCTs) of ubrogepant for treatment of acute migraine were identified in PubMed, MEDLINE, EMBASE, and the Cochrane Library from database establishment to June 2020; we also searched ClinicalTrials.gov manually during the same period. Then, RevMan 5.3 software was used to perform a meta-analysis on each outcome measure.Results:A total of 5 RCTs involving 4903 patients were included; there were 3358 cases in the ubrogepant group and 1545 cases in the placebo group. The meta-analysis showed the following results: at 2 hours postdose, the percentages of participants reporting pain relief and the absence of photophobia, nausea, and phonophobia were significantly higher in the ubrogepant group than in the placebo group (odds ratio [OR] = 1.71, 95%CI: 1.48–1.97, P < .00001; OR = 1.33, 95%CI: 1.22–1.45, P < .00001; OR = 1.07, 95%CI: 1.03–1.11, P = .0006; OR = 1.21, 95%CI: 1.14–1.28, P < .00001). The incidence of common adverse events was similar between the 2 groups (P > .05).Conclusion:Ubrogepant is effective and safe for the treatment of acute migraine.Registration number:PROSPERO CRD42019145286.

Cervical Cordotomy for Intractable Pain: Do Postoperative Imaging Features Correlate with Pain Outcomes and Mirror Pain?

Percutaneous cervical cordotomy offers relief of unilateral intractable oncologic pain. We aimed to find anatomic and postoperative imaging features that may correlate with clinical outcomes, including pain relief and postoperative contralateral pain. We prospectively followed 15 patients with cancer who underwent cervical cordotomy for intractable pain during 2018 and 2019 and underwent preoperative and up to 1-month postoperative cervical MR imaging. Lesion volume and diameter were measured on T2-weighted imaging and diffusion tensor imaging (DTI). Lesion mean diffusivity and fractional anisotropy values were extracted. Pain improvement up to 1 month after surgery was assessed by the Numeric Rating Scale and Brief Pain Inventory. All patients reported pain relief from 8 (7-10) to 0 (0-4) immediately after surgery (P = .001), and 5 patients (33%) developed contralateral pain. The minimal percentages of the cord lesion volume required for pain relief were 10.0% on T2-weighted imaging and 6.2% on DTI. Smaller lesions on DWI correlated with pain improvement on the Brief Pain Inventory scale (r = 0.705, P = .023). Mean diffusivity and fractional anisotropy were significantly lower in the ablated tissue than contralateral nonlesioned tissue (P = .003 and P = .001, respectively), compatible with acute-phase tissue changes after injury. Minimal postoperative mean diffusivity values correlated with an improvement of Brief Pain Inventory severity scores (r = -0.821, P = .004). The average lesion mean diffusivity was lower among patients with postoperative contralateral pain (P = .037). Although a minimal ablation size is required during cordotomy, larger lesions do not indicate better outcomes. DWI metrics changes represent tissue damage after ablation and may correlate with pain outcomes.

When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases

PurposeTo analyze the follow-up results of patients suffering from symptomatic early-stage endometriosis after a consistent laparoscopic peritoneal stripping of the altered peritoneum (peritoneal endometriosis and surrounding inflamed tissue) was performed. This type of endometriosis is resistant to medical therapy and/or impairs fertility.MethodsUsing our prospectively maintained database, we were able to identify all symptomatic women with the suspicion of only peritoneal endometriosis who underwent laparoscopy at our endometriosis center over a period of 5 years. All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery, and included a suspended hormonal pretreatment for 2 months. Postoperative outcomes including complications, fertility and recurrence rates were analysed.ResultsLaparoscopic peritonectomy was performed on 94 women. Follow-up data were available in 87% of these cases. At the time of surgery, almost all patients tested showed signs of stage I or II endometriosis (44.7 and 48.9%, respectively). More than three-quarters of the women reported pain relief, inter alia, due to the post-surgical hormonal therapy. About one-third of the patients wanted to have children after the procedure. 62% of them became pregnant and the majority did so without the need for assisted reproductive therapy. In seven women a re-operation was performed.ConclusionAccording to our data, a consistent excision of altered peritoneum followed by adjuvant hormonal therapy and multimodal concepts results in better outcomes for the patient, particularly in regards to pregnancy and recurrence rates.

Is Cooled Radiofrequency Genicular Nerve Block and Ablation a Viable Option for the Treatment of Knee Osteoarthritis?

BackgroundThe purpose of this study was to determine demographic and psychosocial factors that influence the effectiveness of cooled radiofrequency genicular nerve ablation (C-RFA) and block in patients with chronic knee pain secondary to osteoarthritis (OA).MethodsA retrospective review was completed including patients with knee OA who underwent genicular nerve ablation or block or both. Patient information collected included opioid use, psychological comorbidities, smoking history, body mass index, and medical comorbidities. Success was defined using the Osteoarthritis Research Society International criterion of greater than or equal to 50% reported pain relief from the procedure. Patients without a diagnosis of knee OA and patients with ipsilateral total knee arthroplasty were excluded. Patient factors were compared between (1) those that did or did not respond to the initial block and (2) those that did or did not respond to C-RFA.ResultsOf the 176 subjects that underwent genicular nerve block, 31.8% failed to respond to the procedure. Subjects that failed the initial block were significantly more likely to have psychological comorbidities, smoking history, and diabetes. Of the subjects that proceeded to genicular nerve ablation, 53.7% reported less than 50% pain relief, and 46.3% reported pain relief greater than or equal to 50% at the first follow-up visit. While the presence of psychological comorbidities, smoking, and diabetes were associated with first-stage block failures, these patient factors were not associated with second-stage ablation failures.ConclusionsC-RFA may be an effective adjunct therapy as part of a multimodal pain regimen; however, individual patient characteristics must be considered.

Med Check: Rapid Blood Test for Concussion; REMS for Some Fentanyl Products; Phase 3 for Troriluzole for OCD; Remote Neuromodulation Device for Adolescent Migraine

Back to table of contents Previous article Next article Med CheckFull AccessMed Check: Rapid Blood Test for Concussion; REMS for Some Fentanyl Products; Phase 3 for Troriluzole for OCD; Remote Neuromodulation Device for Adolescent MigraineTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:10 Feb 2021https://doi.org/10.1176/appi.pn.2021.2.1FDA Approves Rapid Blood Test for ConcussionsIn January the FDA approved Abbott’s i-STAT Alinity handheld device for detecting mild traumatic brain injury (TBI), the company announced. Test results are available within 15 minutes using plasma that is placed into a test cartridge. The test was developed in collaboration with the U.S. Department of Defense.The test measures glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase L1 in blood plasma—two biomarkers that indicate brain injury when they are elevated. According to a statement by the company, the device provides test results with 95.8% sensitivity and greater than 99% negative predictive value. A negative test can rule out the need for a CT scan, and having a blood test available could reduce the number of unnecessary CT scans, according to the company.FDA Toughens REMS for Some Fentanyl ProductsIn December the Food and Drug Administration (FDA) took steps to strengthen the Risk Evaluation and Mitigation Strategy (REMS) program for transmucosal immediate-release fentanyl (TIRF).“To use the TIRF medicines safely, these patients must be opioid tolerant based on concurrent regular use of another opioid medication,” the FDA wrote in a statement. “Despite the decline in the use of TIRF medicines in recent years, data have suggested that prescribing of TIRF medicines still occurs in patients who are not opioid tolerant. With this in mind, the FDA finalized modifications to the REMS program to address the persistence of these concerning prescribing practices.”The TIRF REMS program now requires the following:Prescribers must document a patient’s opioid tolerance with each prescription of a TIRF medicine for outpatient use.Outpatient pharmacies dispensing TIRF medicines must document and verify a patient’s opioid tolerance before dispensing.Inpatient pharmacies must develop internal policies and procedures to verify opioid tolerance in patients who require TIRF medicines while hospitalized.A new patient registry will monitor for accidental exposure, misuse, abuse, addiction, and overdose.Phase 3 Trial Enrollment Begins for Troriluzole for OCDBiohaven has begun enrollment for a phase 3 trial to assess the efficacy and safety of 280 mg troriluzole once per day in patients with obsessive-compulsive disorder (OCD), the company announced in January. The trial will include two double-blind, placebo-controlled studies with approximately 600 patients in each. Troriluzole normalizes synaptic levels of glutamate, a key neurotransmitter implicated in OCD.Biohaven is pressing forward with the phase 3 trial even though troriluzole did not meet its primary endpoint in a previous trial, wherein scores on the Yale-Brown Obsessive-Compulsive Scale for patients who took troriluzole were not statistically significantly better than those who took placebo after 12 weeks. In the previous trial, scores in patients who took troriluzole dropped an average of 5.9 points from baseline, compared with 4.9 points in those who took placebo. However, after eight weeks, there was a 1.5-point gap in scores between the troriluzole group and the placebo group.Remote Neuromodulation Device Shows Promise For Adolescent MigraineA study in Headache suggests that Nerivio, a wearable device approved for treating migraine in adults, may also be helpful in treating the condition in adolescents, manufacturer Theranica announced in December. The device, which is worn with an arm band and controlled through an app on the patient’s smartphone, uses remote electrical neuromodulation to activate the body’s natural ability to modulate pain.Researchers evaluated 45 patients aged 12 to 17 with a history of episodic and chronic migraines who completed at least one treatment with Nerivio. Over the course of the 12-week study, the device treated 159 migraine headaches, 49% of which were moderate and 33% of which were severe at baseline. Two hours after treatment, 71% of participants reported pain relief and 35% reported being free of pain, results that were sustained for 24 hours in 90% of cases. At two hours, 69% of patients experienced improved functional ability, which was defined as the ability to do schoolwork and perform “usual activities.” There were no device-related serious adverse events. ■“Remote Electrical Neuromodulation for Acute Treatment of Migraine in Adolescents” is posted here. ISSUES NewArchived