Pain Management

As spinal cord stimulation (SCS) becomes a staple of chronic pain management, the SCS industry must constantly evolve to ensure safety, convenience and enhanced efficacy. Beyond waveforms and size, MR-conditionality is a key differentiator sought out by physicians and patients when choosing SCS devices. Many common SCS complications, including lead migration, can affect the MR-conditionality. The authors reviewed literature published between 2015 and 2024 using PubMed and Google Scholar databases, as well as US FDA labels for magnetic resonance imaging and technical manuals with further confirmation from local representatives...

Aim: Chronic shoulder pain due to iatrogenic spinal accessory nerve (SAN) injury continues to be under-recognized, resulting in delayed time-to-diagnosis and poorer outcomes. Solutions are needed to improve the management of this condition, which can be challenging as care needs to be coordinated across pain management, neurophysiology, rehabilitation and reconstructive surgery. Cases: We present a series of six patients with shoulder pain refractory to conservative pain treatments to highlight how SAN injuries continued to be missed and treatment delayed, even at advanced care centers...

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Nonopioid analgesics serve to improve analgesia and limit side effects and risks of perioperative opioids. N-acetylcysteine (NAC), the primary treatment of acetaminophen toxicity, may have perioperative indications, including analgesia. NAC impacts glutathione synthesis, oxidant scavenging, glutamate receptor modulation and neuroinflammation. Potential perioperative benefits include arrhythmia prevention after cardiac surgery, decreased contrast-induced nephropathy, improved post-transplant liver function and superior pulmonary outcomes with general anesthesia...

Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals...

Aim: Traditional radiofrequency ablation (TRFA) effectively treats facet joint-related pain, while water-cooled radiofrequency ablation (CRFA) may offer benefits like larger lesions and easier nerve access. Our goal is to assess the effectiveness of TRFA and CRFA for facet joint-related pain. Materials & methods: This retrospective study included an evaluation of 346 RFA interventions performed on 190 patients suffering from long-term low-back pain. The primary outcome was defined as a decrease of ≥50% of the mean numeric rating scale...

Aim: To describe the successful treatment of atypical occipital neuralgia (ON) using a unilateral dual-lead occipital nerve stimulator. Setting: Outpatient clinic/operating room. Patient: A 53-year-old male with atypical ON. Case description: Patient was previously diagnosed with treatment-refractory left-sided trigeminal neuralgia with atypical occipital distribution. On presentation, his symptoms were consistent with ON with distribution to the left fronto-orbital area. He received a left-sided nerve stimulator implant targeting both the greater and lesser occipital nerves...

Aim: Despite the growing evidence supporting the use of peripheral nerve stimulation (PNS) for cancer pain in adults, it is underutilized in the pediatric oncology population. Method: We describe the use of temporary, percutaneous PNS for pain management in pediatric patients suffering from cancer related pain. Results: Two adolescent patients underwent an ultrasound-guided suprascapular nerve PNS placement utilizing the percutaneous 60-day therapy system. Both patients reported approximately 60% pain relief during the therapy, as well as up to 90 days post lead removal...

Aim: This real-world analysis aims to quantify improvements in multiple health domains in patients who received 60-day peripheral nerve stimulation (PNS) for shoulder pain. Materials & methods: Patients reported percent pain relief and Patient Global Impression of Change in quality of life, physical function and sleep at the end of treatment (EOT), 3 months, and 6 months. Results: Of 768 patients, 80.7% were responders in at least one domain at EOT. In a subset who were followed up, a cumulative 75% continued to respond in at least one domain through 6 months (85% [n = 140/165] at 3 months and 88% [n = 53/60] at 6 months)...

Aim: Different nonpharmacological strategies are adopted to decrease primary dysmenorrhea (PD)-related pain. The present study aimed to verify women's use of nonpharmacological methods for pain and compare them with evidence from the literature. Materials & methods: A two-step study was conducted, comprising an online survey with 9144 women to assess nonpharmacological strategies for relieving PD-related pain, and a literature review on PubMed of verify the evidence of nonpharmacological methods. Results: Many women reported using heat therapy (61...

Aim: To identify the characteristics and predictors of post cesarean section (CS) pain among women. Materials & methods: This quantitative study was conducted at Labasa hospital in Fiji over a 6-month period. A total of 312 mothers who received spinal, epidural and general anesthesia were included. Their pain score was assessed using the visual analogue scale 24 h postoperatively. Results: 70.8% women had either moderate or severe pain on the visual analogue scale. About 41.3% women expressed dissatisfaction with their pain management and 70...

We present a case of deep surgical site infection (SSI) at a spinal cord stimulator (SCS) trial implantation site, resulting from an allergic reaction to an unknown agent. A 38-year-old female with complex regional pain syndrome began an SCS trial, noting 100% pain relief for 5 days. Fluid drainage from the surgical site was reported on POD6 and trial leads were removed the following day. The patient was hospitalized with sepsis. Blood cultures revealed Staphylococcus aureus . MRIs showed skin breakdown and cellulitis of the paraspinal musculature extending into the epidural space...

Aim: Diabetic peripheral neuropathy (DPN) induces chronic neuropathic pain in diabetic patients. Current treatments like pregabalin and duloxetine offer limited efficacy. This study evaluates combining pregabalin and duloxetine versus pregabalin alone for DPN pain relief, and explores gene modulation ( PPARγ and Akt ) to understand neuropathic pain's molecular basis. Materials & methods: Diabetic patients with DPN were randomized into groups receiving combination therapy or pregabalin alone for 4 weeks...

Background: This systematic review and meta-analysis assessed the benefits of an automatic lancing device compared with a manual lancet or a hypodermic needle in neonates. Materials & methods: We followed the Cochrane Handbook methodology, used the RoB-2 tool for risk of bias assessment, RevMan 4.1 for meta-analysis and GRADE framework for certainty assessment. We searched the databases and gray literature on 15 November 2023. Results: Six eligible studies enrolling 539 neonates were included. An automatic lancing device reduced pain scores during and after heel prick, sampling time and the need for repeat puncture...

Aim: We aimed to investigate the association between social determinants of health and chronic opioid therapy. Materials & methods: We conducted a retrospective analysis of electronic health records from five family medicine and internal medicine clinics in Oregon in 2020 and 2021. Our outcome variable was whether a patient was receiving chronic opioid therapy for chronic non-cancer pain. Our variables of interest included financial difficulty, insurance types, transportation barriers, currently married or living with a partner and organizations participation...

The treatment of pain remains a critical, unmet public health challenge. According to the CDC, in 2021, an estimated 20.9% of US adults (51.6 million people) endured chronic pain, and 6.9% (17.1 million people) endured high-impact chronic pain. Additionally, the impact of the social determinants of health on pain treatment are beginning to emerge. Treating pain addresses its control and relief, enhancing patient outcomes and quality of life. However, current treatment options have limitations, creating a significant need for innovative solutions...

Background: Complex regional pain syndrome (CRPS) is classified into two subtypes based on clinical presentation: warm or cold. Methods: We examined the distribution of warm and cold subtypes in CRPS patients before they received lumbar sympathetic block. We retrospectively analyzed 81 prelumbar sympathetic block Forward Looking InfraRed images obtained from 30 patients to study temperature asymmetry between affected and unaffected limbs. Results: In 23 of the 30 patients (77%), the temperature difference between the affected and affected limbs was within the normal range (<0...

Aim: Hip fracture management is challenging when surgical risks outweigh benefits. Inadequate analgesia from conservative treatments prompted new procedures targeting hip capsule denervation. This study evaluates the efficacy and safety of single injection chemical hip neurolysis in the pericapsular nerve group plane. Materials & methods: In eligible patients, an ultrasound-guided diagnostic block was performed using 5 ml of 2% lidocaine in the pericapsular nerve group plane. If positive, 6 ml of 99...

Background: Chronic neck and low back pain are very common and have detrimental effects for people and society. In this study, we explore the experiences of individuals with neck and/or back pain using a written narrative methodology. Materials & methods: A total of 92 individuals explained their pain experience using written narratives. Narratives were analyzed through thematic analysis and text data mining. Results: Participants wrote about their experience in terms of pain characteristics, diagnosis process, pain consequences, coping strategies, pain triggers, well-being and future expectations...

Aim: This pilot study evaluated an electronic patient-reported outcomes collection system in pain management to understand providers' experiences using the data, and how it affects their patient interaction and guides their clinical decision-making. Materials & methods: Using stratified convenience sampling, nine semi-structured interviews were conducted with consented pain physicians. The transcribed, de-identified interviews were coded and analyzed. Results: Although most physicians utilized patient reported outcomes (PROs), one-third reported no significant change in their practice since implementation and 56% stated it does not influence their treatment recommendations...