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All high-level evidence studies that explored the various facets for IDDS practice management were included for review.
Despite existing evidence basis for practice considerations, current practice patterns are highly practitioner dependent. More and continued high-level evidence is necessary to support, affirm, and dictate principles in practice considerations.
Incorporation of the principles found in this evidence-based narrative, which is comprised of the highest level of evidence supportive of various facets of IDDS practice management, is essential to optimize outcomes, treatment efficacy, and safety profiles.
Incorporation of the principles found in this evidence-based narrative, which is comprised of the highest level of evidence supportive of various facets of IDDS practice management, is essential to optimize outcomes, treatment efficacy, and safety profiles.
Chronic pain syndromes are clinically challenging to treat, and management with opioid medications is increasingly shown to be inappropriate and ineffective. Spinal cord stimulation (SCS) has been demonstrated across numerous high-quality and well-designed studies to be effective in treating various refractory chronic pain. The efficacy and overall success of SCS is highly dependent on compliance to and consideration of various practice patterns.
This manuscript is intended to compile and present comprehensive recommendations for key SCS management principles including a) patient selection criteria, b) efficacy of SCS for various conditions, c) discussion of SCS waveforms, d) trial and permanent implantation considerations, e) periprocedural management, and f) complications and adverse events.
An evidence-based narrative review.
PubMed, Medline, Cochrane Library, prior systematic reviews, and reference lists were screened by 2 separate authors for all randomized trials, meta-analyses, and observational studies relevant to each of the aforementioned management principles and considered for study inclusion.
All high-level evidence studies that explored the various facets of SCS practice management were included for review.
Both continued investigation into, and practice implementation of, the various facets of SCS management are necessary to optimize patient outcomes.
Implementation of and adherence to the evidenced-based recommendations delineated in this publication may help optimize efficacy outcomes and maintain safety profiles for persons treated with SCS interventions.
Implementation of and adherence to the evidenced-based recommendations delineated in this publication may help optimize efficacy outcomes and maintain safety profiles for persons treated with SCS interventions.
Anticonvulsants are often prescribed as coanalgesics for pathologies presenting chronic pain, such as chronic neuropathic pain and fibromyalgia. These pathologies are associated with a wide range of comorbidities chronic fatigue, cognitive impairment, sleep disturbances, and mood disorders. Pregabalin, an anticonvulsant used to treat fibromyalgia syndrome, has been proven to improve pain and fatigue symptoms. However, most studies have not considered the analytic effect of this drug on comorbid depressive-like symptoms in this syndrome.
The main study objective was to examine the role of pregabalin in depressive symptomatology comorbid to chronic widespread pain using a reserpine-induced myalgia model.
A randomized, controlled, animal study.
Research and data analyses were performed at the GESADA laboratory, Department of Human Anatomy and Embryology, University of Valencia, Spain.
Forty-six Sprague-Dawley male rats were used. Acute chronic pregabalin administration was tested for depressive-like behaviors (Forced Swimming and Novelty-Suppressed Feeding Tests) and for alteration of pain thresholds (tactile allodynia, Electronic Von Frey test; and mechanical hyperalgesia, Randall and Selitto test). The same procedures were followed with duloxetine as a positive control.
Pregabalin significantly improved depressive-like behaviors in acute, but not chronic treatment, and significantly ameliorated pain thresholds.
Lack of histological and electrophysiological tests.
Pregabalin is not effective in depressive-like symptoms associated with chronic pain but might play an acute antidepressive-like role given its antinociceptive effect.
Pregabalin is not effective in depressive-like symptoms associated with chronic pain but might play an acute antidepressive-like role given its antinociceptive effect.
Changes in local anesthetics temperature may influence the characters of the peripheral nerve block. The effect of warmed bupivacaine on supraclavicular brachial plexus block has not yet been evaluated.
This study was designed to evaluate the influence of warming bupivacaine 0.5% on the characteristics of supraclavicular plexus block in adult patients undergoing orthopedic surgery below the mid-arm. The primary objective was the time to onset of sensory block. The secondary objectives were the time to onset of motor block, the duration of sensory and motor blocks, and the time to the first analgesic requirement.
Randomized, double-blind, controlled trial.
University hospital setting.
Ninety patients who underwent elective or emergency orthopedic surgery below the mid-arm were included in this study. Patients were randomly allocated into 2 groups and received ultrasound-guided supraclavicular brachial plexus block. Group I received 30 mL 0.5% bupivacaine at 23°C. Group II received 30 mL bupivacaine 0block and provided better quality of postoperative analgesia.
Suprascapular nerve block (SSNB) is an effective therapeutic approach for shoulder pain and has been increasingly used by professionals in clinical practice. In the landmark-guided nerve block technique, it could be difficult to determine the exact localization of the suprascapular nerve.
To evaluate and compare the clinical and functional outcomes of ultrasound (US)-guided versus landmark-guided SSNB for the treatment of chronic shoulder pain.
Randomized, prospective analysis.
Outpatient physical therapy and rehabilitation clinic.
Seventy-two patients with chronic shoulder pain were enrolled into this study. The patients were randomly allocated to 2 groups. Thirty-six patients received US-guided SSNB and 36 underwent landmark-guided SSNB. Initial examinations before injection and for the first week and first and third months postinjection were recorded. Visual Analog Scale (VAS) pain intensity levels, shoulder functions based on the Shoulder Pain and Disability Index (SPADI), and quality of life levels based on the Health Assessment Questionnaire (HAQ) were evaluated at each control.
Statistically significant recovery was observed in terms of VAS pain levels, SPADI, and HAQ from the first week after injection in both groups, but no significant difference was observed between the groups.
The absence of a control group.
Our results indicate that US-guided SSNB does not potentially offer a significantly greater clinical improvement over landmark-guided SSNB in patients with chronic shoulder pain. Further research is required to establish whether this hypothesis is consistently supported in practice.
Our results indicate that US-guided SSNB does not potentially offer a significantly greater clinical improvement over landmark-guided SSNB in patients with chronic shoulder pain. Further research is required to establish whether this hypothesis is consistently supported in practice.
Thoracolumbar or caudal epidural anesthesia affects intracranial pressure (ICP) in both animals and humans. Epidural injection increases ICP at least transiently. Measurement of the optic nerve sheath diameter (ONSD) using ultrasonography is one of the noninvasive methods for ICP assessment.
The purpose of this study was to investigate the effect of the different posture during epidural saline injection to the ONSD under awake conditions.
Prospective, randomized trial.
An interventional pain management practice in South Korea.
This study included 44 patients receiving thoracic epidural catheterization for pain management after upper abdominal or thoracic surgery. Following successful epidural space confirmation, patients were randomized to receive epidural saline while supine (A group) or in sitting position (B group), respectively. Transorbital sonography was performed for the measurement of the ONSD, and the ONSD was measured at 3 mm posterior to the optic nerve head.
Both A and B groups showed significant increases of ONSD according to time. Mean ONSD values measured at T10, T20, and T40 significantly increased from the baseline value (T0) (*P < 0.05 vs. T0, †P < 0.001 vs. T0, ‡P < 0.005 vs. T0). The mean ONSD values measured at any of the time points and degrees of changes (T10-T0, T20-T0, and T40-T0) between groups A and B did not show any significant changes.
Epidural pressure and ONSD measurement can make this study more reliable. Further study showing changes of epidural pressure with ONSD measurement is required.
Thoracic epidural injection of 10 mL of normal saline resulted in a significant increase of ONSD compared with the baseline. However, the different posture did not affect the increase of ONSD.
Thoracic epidural injection of 10 mL of normal saline resulted in a significant increase of ONSD compared with the baseline. check details However, the different posture did not affect the increase of ONSD.
The usefulness of early sympathetic blockade in the prevention of postherpetic neuralgia (PHN) has been reported. However, the optimal duration and frequency of paravertebral blocks that prevent or maximally reduce the incidence of PHN need to be clarified.
To assess the impact of weekly separated 2 versus 3 paravertebral injections using local anesthetic and steroids, early in the course of acute thoracic herpes zoster, on the incidence of postherpetic neuralgia.
Randomized single-blind study.
University hospitals.
Eighty patients suffering from acute thoracic herpes zoster eruption were randomly allocated into 2 groups. Group I received paravertebral block using 25 mg bupivacaine plus 8 mg dexamethasone in a total volume of 10 mL twice one week apart. Group II received paravertebral block using 25 mg bupivacaine plus 8 mg dexamethasone in a total volume of 10 mL 3 times one week apart. All patients received daily 300 mg pregabalin in divided doses (150 mg/12 hours). Pain scores were evaluated duri in both groups with no significant difference between groups.
Small size, lack of complete blindness, and the use of fluoroscopy in block performance in the era of performing this block under ultrasound.
Repeated paravertebral blocks using local anesthetic and steroids weekly over 2 or 3 weeks in the management of acute thoracic herpes zoster can provide safe and effective pain relief and minimize the incidence of PHN. However, no added benefit was detected from repeated blocks more than twice.
Repeated paravertebral blocks using local anesthetic and steroids weekly over 2 or 3 weeks in the management of acute thoracic herpes zoster can provide safe and effective pain relief and minimize the incidence of PHN. However, no added benefit was detected from repeated blocks more than twice.
