Transcutaneous Electrical Nerve Stimulation for Prevention and Treatment of Post-Herpetic Neuralgia: A Narrative Review.

The present investigation evaluated transcutaneous electrical nerve stimulation (TENS) for the non-pharmacological treatment of post-herpetic neuralgia (PHN). PHN is the most common complication of the Herpes Zoster virus, affecting one in every five patients with shingles, and presents as intense neuropathic pain that can persist for 90 days or longer after the initial onset of symptoms. Current pharmacological treatment options are mainly limited to symptom management, including oral medications such as tricyclic antidepressants and gabapentinoid preparations, as well as topical options such as lidocaine or capsaicin.

Necrotizing Fasciitis and Streptococcal Toxic Shock Syndrome: A Case Report.

Group A (GAS), particularly (), is a significant human pathogen responsible for infections often ranging from mild superficial conditions to severe, life-threatening diseases like necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS). This case report details the rapid deterioration of a previously healthy 49-year-old woman who presented with localized symptoms in her left thigh, later escalating to septic shock and multi-organ failure related to GAS infection. Initial evaluations indicated significant inflammation and acute kidney injury, prompting broad-spectrum antibiotic treatment.

Effectiveness of Intradiscal Regenerative Medicine Therapies for Long-Term Relief of Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

Background: Recent research underscores the potential of intradiscal biologics, such as mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), and alpha-2-macroglobulin, in promoting chondrogenesis within lumbar intervertebral discs as a treatment for discogenic low back pain. Studies indicate significant improvements in pain relief, physical function, and overall quality of life following these interventions.

Objective: This study aims to evaluate the effectiveness of intradiscal injections of MSCs and PRP in managing low back and lower extremity pain.

A 24% Decline in the Utilization of Epidural Procedure Visits for Chronic Spinal Pain Management in the Medicare Population from 2019 to 2022: Updated Analysis of the Effect of Multiple Factors.

Background: The analysis of epidural procedure utilization has revealed several notable trends over recent years. Utilization increased significantly until 2004, then rose minimally until 2011, followed by gradual declines up to 2019 in the Medicare population. The COVID-19 pandemic led to a marked 19% decline in usage from 2019 to 2020.

Escalating Growth to Rapid Decline of Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain in the Medicare Population: Updated Analysis of the Effect of Multiple Factors from 2000 To 2022.

Background: The use of facet joint interventions for spinal pain management experienced rapid growth between 2000 and 2010, with an annual increase of 14.2%. However, this trend slowed significantly from 2010 to 2019, with a reduced growth rate of just 2.

The Efficacy of Botulinum Toxin Use in Service Members and Veterans with Migraine and Post-Traumatic Headache Disorders: A Scoping Review.

Objective: To delineate the trend of use of botulinum toxin, including onabotulinum toxinA (OTA), in active military personnel and veterans with the diagnoses of migraine and post-traumatic headache (PTH) and describe the efficacy of botulinum toxin administration.

Background: Service members and veterans represent a unique population in the medical management of headache disorders, particularly migraine. They exhibit higher susceptibility to pain of greater intensity and longer durations, possibly due to their history of exposure to combat, trauma, and the associated psychological stresses.

Bacillus Calmette-Guérin (BCG) Vaccine in America and Overseas: A Narrative Review.

This narrative review examines the role of the Bacillus Calmette-Guérin (BCG) vaccine in global tuberculosis (TB) control efforts, with particular emphasis on the differences in vaccination policies between countries, such as the US, where routine BCG administration is not practiced. A significant complication of the BCG vaccine is false positive results in the tuberculin skin test (TST), often leading to misdiagnoses and unnecessary treatments. To address these issues, interferon-gamma release assays (IGRAs) have emerged as a more specific diagnostic tool that reduces false positives associated with prior BCG vaccination.

Intrathecal Fentanyl Pump Placement in a Patient With Chronic Pain Caused by Hereditary Multiple Exostoses: A Case Report.

Hereditary multiple exostoses (HME) is a genetic disorder defined by the formation of benign bone tumors known as exostoses, which can lead to chronic pain and functional impairment. This case report details a 57-year-old man with a long-standing history of severe diffuse bone pain attributed to HME. Despite various treatments, his pain remained poorly controlled until an intrathecal pump with fentanyl was implanted.

Cervical Epidural Steroid Injection for Cervical Radicular Pain in a Patient with Fractured Cervical Hardware.

Cervical radicular pain following anterior cervical discectomy and fusion (ACDF) is a challenging condition, particularly in the presence of hardware complications. This case report discusses the successful use of a cervical interlaminar steroid injection to alleviate radicular pain in a patient who presented with a fractured screw following C6/7 ACDF. The patient's symptoms, treatment plan, and outcome are reviewed, highlighting the success of an interlaminar steroid injection in managing radicular pain until the patient could receive corrective surgery.

Kratom: A Narrative Review of the Possible Clinical Uses and Dangers of This Opioid-Like Plant.

The term "kratom" refers to a plant species formally known as  Kratom is composed of over 40 alkaloids, a type of organic compound that contains nitrogen. These compounds work primarily via binding to opioid receptors expressed on neurons, where they stimulate signal transduction mechanisms involving the activation of G proteins. Kratom has been shown to cause both a stimulant-like effect and a sedative effect in humans.

Spinal Cord Stimulator Complication Rates: A Single-Institution, 22-Year Study (1999-2021).

Background: Since the initial introduction in 1967 of spinal cord stimulation (SCS) in the field of neuromodulation, SCS has been utilized to treat a multitude of chronic pain disorders refractory to both conservative and surgical management. Although efficacious when indicated, SCS has associated risks.

Objectives: The goals of this study are to explore the trend of rates of SCS complications in 2 approximately equally sized cohorts (1999-2015 and 2016-2021) within a single institution over a 22-year period.

Exponential Decline of 28.9% in Utilization of Interventional Pain Management Techniques Among Medicare Beneficiaries From 2019 to 2022: Updated Analysis on the Ongoing Effects of COVID-19, Economic Decline, the Affordable Care Act (ACA), and Medical Policies.

Background: Numerous studies have highlighted the escalating costs associated with managing low back and neck pain, as well as other musculoskeletal disorders. In the past, there was a notable increase in the use of interventional techniques to address these disorders. However, the COVID-19 pandemic disrupted various chronic pain treatment approaches, including interventional procedures and opioid use, following a broader trend of reduced healthcare services.

Parkinson's Disease: A Narrative of the Evolving Understanding of the Role of α-Synuclein in Screening.

The present investigation aims to examine the role of α-synuclein seed amplification assays for screening Parkinson's disease. Parkinson's disease (PD) is a debilitating neurodegenerative disorder caused by the loss of dopaminergic neurons in the midbrain, leading to symptoms such as tremors, bradykinesia, postural instability, dementia, and depression. It is classified as an α-synucleinopathy related to the role of α-synuclein aggregates in neuron degeneration.

Cutaneous Dermatologic Manifestations of Cardiovascular Diseases: A Narrative Review.

Cardiovascular diseases represent the largest worldwide cause of morbidity and mortality. Common signs and symptoms of cardiovascular disease are well characterized and taught in medical curricula, allowing clinicians to quickly recognize and diagnose the more acute and emergent cardiovascular diseases. Dermatological features associated with cardiovascular diseases are less understood but very valuable to appreciate in clinical practice.

Comprehensive Evidence-Based Guidelines for Implantable Peripheral Nerve Stimulation (PNS) in the Management of Chronic Pain: From the American Society Of Interventional Pain Physicians (ASIPP).

Background: Peripheral nerve stimulation (PNS) has been used for over 50 years to treat chronic pain by delivering electrical pulses through small electrodes placed near targeted peripheral nerves those outside the brain and spinal cord. Early PNS systems often required invasive neurosurgical procedures. However, since 2015, the Food and Drug Administration (FDA) approved percutaneously implanted PNS leads and neurostimulators  offering a much less invasive, non-opioid option for managing recalcitrant chronic pain.

Repetitive transcranial magnetic stimulation in the treatment of opioid use disorder: A narrative review.

It is estimated that over 16 million people are living with opioid use disorder (OUD) worldwide, with 2.1 million people in the United States. Opioid addiction is theorized to be associated with strong dopaminergic response to opioid receptor stimulations that contributes to reward-seeking behaviors and individuals' experiences with opioids.

Apple Vision Pro and Its Implications in Mohs Micrographic Surgery: A Narrative Review.

Mohs micrographic surgery (MMS) is a precise and effective technique for treating skin cancers, necessitating high accuracy and real-time decision-making to ensure complete tumor removal while preserving healthy tissue. The introduction of the Apple Vision Pro (AVP), an advanced mixed-reality headset, presents a potential technological advancement in surgical practice. The present investigation explores the integration of AVP into Mohs surgery, focusing on its potential to enhance preoperative planning, intraoperative guidance, and postoperative analysis.

The impact of health maintenance organizations on improving cardiac surgery outcomes.

Background And Objectives: California is one of a few states with mandatory reporting of mortality after coronary artery bypass graft (CABG) surgery. The Affordable Care Act restructured Medicaid, preferentially penalizing patients experiencing poverty because payments to hospitals for isolated surgical events overshadow payments to primary care clinicians. We propose outcomes are superior when hospital networks organize surgical episodes within the context of primary care inside that same network.

Managing Menopause: The Evolving Role of Estrogens, Selective Serotonin Reuptake Inhibitors, and Phytoestrogens in Balancing Hormonal Fluctuations.

Menopause is characterized by the cessation of menstruation for 12 consecutive months. In this narrative review, we describe the transitional stages of menopause, clinical presentation, pharmacological management of symptoms, and effects on fluctuating hormone levels. To standardize the stages of menopause, the Stages of Reproductive Aging Workshop + 10 (STRAW+10) system was designed with five distinct categories corresponding to symptom presentation and numerical years.

Virtual Reality for Postoperative Pain Management: A Review of Current Evidence.

Purpose Of Review: With the ongoing opioid crisis, there is a continued need to develop multimodal pain management strategies inclusive of non-pharmacological treatments. Virtual reality (VR) offers a non-invasive treatment approach for the management of acute and chronic pain including postoperative pain. The aim of this review is to describe the use of VR and its effect on pain-related outcome measures compared to routine care in various types of surgical procedures.

Thoracic Radiofrequency Ablation in a Patient With Von Willebrand's Disease: A Case Report.

Congenital bleeding disorders involve specific deficiencies in factors that can alter hemostasis, increasing the risk of bleeding. This case report describes a patient with Von Willebrand's disease who was diagnosed with severe thoracic facet arthritis with pain scores of 9/10. An antihemophilic factor (vWF, Humate-P) injection was administered by a hematologist just before thoracic medial branch blocks.

Robotic Pediatric Urologic Surgery-Clinical Anesthetic Considerations: A Comprehensive Review.

Minimally invasive robotic approaches have become standard in many institutions over the last decade for various pediatric urological procedures. The anesthetic considerations for common laparoscopic and robotic-assisted surgeries are similar since both require the insufflation of CO to adequately visualize the operative area. However, few studies exist regarding anesthesia for robotic procedures in children.