Pain physician
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Multicenter Study Clinical Trial
Composite Treatment Response from a Prospective, Multi-Center Study (US-nPower) Evaluating a Miniature Spinal Cord Stimulator for the Management of Chronic, Intractable Pain.
Measures of therapeutic efficacy in pain studies have historically focused on pain scores, such as the Visual Analog Scale (VAS) or the Numeric Rating Scale. However, pain scores capture a univariate measure of a multivariate condition present in patients with chronic pain, where the pain condition can affect activities of daily living, sleep, quality of life, and mood. Hence, examining composite endpoints, which incorporate outcomes from multiple facets of pain, may allow investigators to better assess improvements in chronic pain patients with various new treatments. ⋯ In the face of improving spinal cord stimulation pain outcomes, composite PROs are likely to become more common in evaluating therapeutic response. Responder rates, defined by the MCID, may help to establish composite endpoints. Since MCID was achieved across a variety of endpoints indicates that treatment with the Nalu Neurostimulation System provided a robust treatment response.
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Fibromyalgia is a complex condition that has long puzzled the medical community. Hypotheses to explain the chronic widespread pain associated with the disease have evolved significantly over the years. However, research efforts to identify disease-specific biomarkers and develop effective treatments have been largely unsuccessful. ⋯ Fibromyalgia is likely the result of multiple causative factors, genetic and environmental. To date, no clear, reliable etiological biomarker for fibromyalgia has been identified. The considerable variability among patients suggests the presence of multiple disease subtypes with different pathophysiological mechanisms. Effective treatment therefore requires a multimodal, multidisciplinary approach that targets each individual patient's pathophysiological features. The proposed treatment paradigm attempts to address multiple factors that have been implicated more recently in the development and maintenance of fibromyalgia, such as micro-inflammation, metabolic syndrome, and gut dysbiosis.
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Acute postoperative pain is one of the most common challenges faced by patients who undergo surgery. Multimodal analgesia has been recommended in recent years to effectively control this condition. Nerve blocks are an important part of multimodal analgesia; a single peripheral nerve block is widely used in clinical practice. To prolong the analgesic duration of a single nerve block, adjuvants with different mechanisms, dosages, or administration routes are added to local anesthetics; however, it is not clear which adjuvant or combination is better. ⋯ Adjuvants with diverse mechanisms of action can variably extend the duration of local anesthetic effects. When utilizing adjuvants in conjunction with local anesthetics, perineural dexmedetomidine (1 mu-g/kg) or intravenous dexamethasone (10 mg) may be preferable, considering their efficacy and side effects. Current research suggests that the combination of perineural dexmedetomidine (1 mu-g/kg) and intravenous dexamethasone (10 mg) is more effective than either dexmedetomidine or dexamethasone alone.
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Comparative Study
L5-S3 Compared to L5-S2 Full-Endoscopic Rhizotomy and Ablation Under a Navigation System for Sacroiliac Joint Pain: A Comparative Study.
Chronic low back pain (CLBP) with sacroiliac joint (SIJ) involvement is a prevalent issue in health care. Surgical intervention, employing an endoscopic technique with a navigation system, targets and ablates nociceptive nerve fibers associated with SIJ pain, although the clinical effect of omitting rhizotomy of the lateral sacral branch of S3 remains uncertain. ⋯ L5-S2 FERA demonstrated clinical outcomes similar to those of L5-S3 FERA for pain relief, functional improvement, and satisfaction. Omitting S3 lateral branch rhizotomy did not adversely affect the outcomes. Surgeons may consider omitting S3 lateral branch rhizotomy for SIJ pain treatment, thereby reducing operative time while maintaining patient benefits.
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The Hartel anterior approach is a commonly used puncture method in percutaneous balloon compression (PBC) surgery. However, anatomical variations along the puncture path, and visual errors on x-ray 2-dimensional imaging, may increase the difficulty of a successful first attempt. Our clinical practice has shown that employing the quadrant localization technique to plan puncture points and angles can enhance the puncture success rate. ⋯ In PBC surgery, the quadrant localization technique improves efficiency and reduces hospital stay compared with the conventional Hartel anterior approach, without increasing the risk of complications.