Pain physician
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Randomized Controlled Trial Multicenter Study
Improved Sensation Resulting From Spinal Cord Stimulation for the Treatment of Painful Diabetic Neuropathy: The Possible Role of Stochastic Resonance.
Painful diabetic neuropathy (PDN) is a progressive chronic pain condition that significantly affects the quality of life of patients with long-standing diabetes mellitus. Sensory deficits may result in falls, foot ulceration, and lower limb amputations. Recently, spinal cord stimulation (SCS) was studied for treatment of painful diabetic neuropathy. In addition to pain relief, we were surprised to discover that sensory improvements were also demonstrated. No mechanistic explanation has yet been offered to explain these findings. ⋯ SCS might have unexpected benefits in patients with PDN beyond pain reduction. The Senza-PDN trial is the first to describe improved sensation in association with SCS. While the mechanism of action are still unknown, we hypothesize that noise-enhanced signal processing via stochastic resonance may explain these results. Stochastic resonance, or the benefit of additional randomness, should be further studied in the context of spinal cord stimulation. Further, SCS programming that optimizes for stochastic resonance should also be investigated for restoration of sensory and possibly even motor function.
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Randomized Controlled Trial Observational Study
Comparison of Effect and Contrast Spreading in Transforaminal Epidural Injection Using the Retrodiscal Versus Subpedicular Approach: A Prospective, Randomized Trial.
Lumbar transforaminal epidural injection (TFEI) effectively decreases low back pain and radicular pain in herniated intervertebral disc (HIVD) and spinal stenosis (SS). The precise delivery of drugs to the target is important for pain control and minimizing complications. ⋯ The RD approach for TFEI showed a better contrast spreading pattern than the SP approach, especially in patients with severe central and foraminal spinal stenosis. The RD approach might be more beneficial for patients with severe central and foraminal spinal stenosis in the short-term follow-up.
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Randomized Controlled Trial
Intraoperative Intravenous Infusion of Esmketamine Has Opioid-Sparing Effect and Improves the Quality of Recovery in Patients Undergoing Thoracic Surgery: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.
Postoperative thoracic surgery is often accompanied by severe pain, and opioids are a cornerstone of postoperative pain management, but their use may be limited by many adverse events. Several studies have shown that the perioperative application of esketamine adjuvant therapy can reduce postoperative opioid consumption. However, whether esketamine has an opioid-sparing effect after thoracic surgery is unclear. ⋯ Intraoperative intravenous esketamine at 0.25 mg · kg-1 · h-1 reduced postoperative opioids consumption by 34% in postoperative 24 hours and 30% in postoperative 48 hours in patients undergoing thoracic surgery. It also improved the quality of perioperative recovery.