Pain physician
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Orthobiologics have shown promise in repair, restoration and regeneration of damaged and degenerated spine, joint and musculoskeletal tissues. The role of MSCs is to reduce inflammation, gliosis, and oxidative stress, while encouraging angiogenesis, neuronal proliferation, cell survival, and differentiation. While autologous MSCs have homologous advantages, they present with challenges related to donor predisposition, harvesting skills, and processing times. In this regard, allogenic MSCs show promise, but face ethical challenges, contamination, and survival risks. Ongoing efforts to overcome challenges and enhance performance include bioprinting, tissue engineering, artificial intelligence, nanotechnology, and microenvironmental alteration, among many others. Genetically programmed MSCs are being explored and tissue regeneration is now considered a real possibility. In this article, we discuss some of the leading-edge technologies in the process of being developed and perfected for widespread clinical application. ⋯ The role of MSCs in regenerative medicine is still emerging, but their promise for spinal cord injury and other disorders of the spine is clear. Using allogenic or autologous MSCs can help stimulate healing and neural regeneration remains a tantalizing possibility.
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In the medical setting, clinicians frequently attend to patients with chronic musculoskeletal pain. Recent literature demonstrates diet may play a role in inflammation and musculoskeletal pain. ⋯ Clinicians can play a role in the well-being of patients with chronic musculoskeletal pain through holistic interventions such as a dietary emphasis on plant-based regimes. Further research is necessary to elucidate the relationship between diet, inflammatory markers, and disease states, as well as the safety and contraindications of these dietary changes.
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Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery (PELD) has been used to treat ASD through either a transforaminal or interlaminar approach. However, to our limited knowledge there are no reports comparing the 2 approaches for treating ASD. ⋯ Percutaneous endoscopic lumbar decompression surgery is a feasible option for ASD following lumbar decompression surgery with instruments. Compared with PETD, PEID seems to be a better approach to treat symptomatic ASDs.
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Remimazolam is a novel ultrashort-effect benzodiazepine. In 2020, the US Food and Drug Administration approved it for procedural sedation. Remimazolam is beneficial for consistent sedation and quick recovery in painless gastrointestinal endoscopy. Propofol is one of the most commonly used intravenous anesthetics in clinical practice. Recently, only a few studies have compared propofol with remimazolam for general anesthesia induction. ⋯ Evidence suggests that remimazolam has a lower hemodynamic effect during general anesthesia and fewer perioperative adverse effects after general anesthesia than propofol; however, which agent is superior regarding quality benefit in postoperative recovery based on the studies included here remains inconclusive. Additional RCTs with updated meta-analyses to enlarge the sample size and properly analyze the benefit-to-risk ratio to patients are needed to determine the evidence for such a relatively new medicine.