Pain physician
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Post-traumatic stress disorder (PTSD) is a prevalent and debilitating condition in the United States. Success rates for evidence-based therapies are inconsistent, and many suffer in silence due to the stigmata associated with seeking traditional mental health care. This has led clinicians to explore new therapeutic options, with cervical sympathetic blockade (CSB), performed at the stellate and/or superior cervical ganglion levels, recently emerging as a promising treatment option. Rapid therapeutic onset, improved compliance, and high clinical efficacy rates have made this an attractive approach for both providers and patients. However, to date, CSB as a treatment of PTSD has primarily been used in male patients with military-related trauma. ⋯ CSB seems to be an effective treatment for PTSD symptoms irrespective of gender, trauma type, PTSD-related drug use, suicide attempt, or age.
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Randomized Controlled Trial Multicenter Study
Safety and Efficacy of Platelet Rich Plasma for Treatment of Lumbar Discogenic Pain: A Prospective, Multicenter, Randomized, Double-blind Study.
Interventions for chronic discogenic spine pain are currently insufficient in lowering individual patient suffering and global disease burden. A 2016 study of platelet rich plasma (PRP) for chronic discogenic pain previously demonstrated clinically significant response among active group patients compared with controls. ⋯ These findings are markedly different than the highly promising results of the 2016 PRP study. This study posits necessary caution for researchers who wish to administer PRP for therapeutic benefit and may ultimately point to necessary redirection of interventional research for discogenic pain populations.
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Multicenter Study Observational Study
Radiation Doses for Different Approaches of Fluoroscopy-Guided Epidural Injections: An Observational Clinical Study.
Although fluoroscopy-guided interventional therapies have declined in recent years, radiation exposure remains a critical issue for both patients and medical staff. Radiation exposure varies according to the physicians' experience, procedure time, patients' body mass index (BMI), imaging techniques, and the type of procedure performed. ⋯ Radiation dose levels and procedure times of 4 approaches of epidural injections were obtained from 3,711 procedures performed in a university hospital pain medicine clinic. BMI of patients was taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels, which will guide pain physicians to self-assess their own levels of radiation exposure.
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Observational Study
Computerized Characterization of Spinal Structures on MRI and Clinical Significance of 3D Reconstruction of Lumbosacral Intervertebral Foramen.
Segmentation of spinal structures is important in medical imaging analysis, which facilitates surgeons to plan a preoperative trajectory for the transforaminal approach. However, manual segmentation of spinal structures is time-consuming, and studies have not explored automatic segmentation of spinal structures at the L5/S1 level. ⋯ The 3D-UNet model developed in this study based on deep learning can effectively and simultaneously segment VBSs and IVDs at L5/S1 level formMR images, thereby enabling rapid and accurate 3D reconstruction of LIVF models. The method can be used to segment VBSs and IVDs of spinal structures on MR images within near-human expert performance; therefore, it is reliable for reconstructing LIVF for L5/S1 LTRFA.
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Pregnant women are among the groups most affected by the United States opioid epidemic. ⋯ Hospitalized pregnant women may be classified based on comorbid conditions into 2 latent classes ("birth complications" and "pre-existing and pregnancy-related morbidities"), with the former exhibiting greater OUD frequency than the latter. These findings can inform health care needs of populations with a high-risk for OUD.