Publications by authors named "Doshi T"

Background: To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.

Methods: Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members.

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Objective: To determine variables associated with difficult clinical encounters.

Patients And Methods: This was a cross-sectional study of 428 new patients evaluated from 2022 to 2023. Demographic, clinical, social (eg, missed appointments, prior felony conviction, prior pain physicians, medical assistance) and visit-related (eg, visit took longer than expected, difficulty communicating) information was recorded, supplemented by in-person history gathered by the trainee and attending whose demographic data were also recorded.

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Central sensitization, or increased responsiveness of the central nervous system to sensory input, is present in many chronic pain patients. Clinically, it is detected through subjective, patient-reported measures. There is a need for reliable, direct measurements of neural response to controlled stimuli to quantify neuronal dysfunction in pain.

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Background: The use of sedation during interventional procedures has continued to rise resulting in increased costs, complications and reduced validity during diagnostic injections, prompting a search for alternatives. Virtual reality (VR) has been shown to reduce pain and anxiety during painful procedures, but no studies have compared it to a control and active comparator for a pain-alleviating procedure. The main objective of this study was to determine whether VR reduces procedure-related pain and other outcomes for epidural steroid injections (ESI).

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Article Synopsis
  • Corticosteroid injections can cause negative side effects like increased blood sugar and decreased bone density, yet lower doses may provide similar benefits as higher ones.
  • The American Society of Regional Anesthesia and Pain Medicine, along with other societies, created practice guidelines focusing on injection safety, efficacy, and adverse events from corticosteroid use in chronic pain management.
  • The final guidelines, which were developed through expert reviews and strong consensus, cover specific areas such as nerve blocks and joint injections to ensure safe and effective treatment protocols.
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Although transforaminal epidural injections have long been used for radicular pain, there is no universal standard injection approach to the neural foramen. The intervertebral foramen and its surrounding structures comprise an anatomically sensitive area that includes bone and joint structures, the intervertebral disk, blood vessels (in particular, the radicular arteries), the epidural sheath, and the spinal nerve root. Given the relatively high risk of inadvertent injury or injection to these nearby structures, image guidance for transforaminal epidural steroid injections (TFESIs) is standard of care.

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Background: Previous research has demonstrated that patients have difficulty with the decision to undergo non-urgent egg freezing (EF). This study aimed to investigate the decisional difficulties and possible decisional support mechanisms for patients considering EF, and for their providers.

Methods: This qualitative study involved a needs assessment via individual interviews.

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Chronic knee pain following total knee arthroplasty (TKA) affects a subset of patients that is refractory to pharmacological and non-pharmacological modalities. Peripheral nerve stimulation (PNS) has been used in patients with chronic knee pain following TKA and has shown some efficacy. Comprehensive search of Ovid Medline, Elsevier Embase, Cochrane Central Register of Controlled Trials, CINAHL Plus with Full Text, Scopus, SPORTDiscus with Full Text and the Web of Science platform.

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Trigeminal neuralgia (TN) is a severe neuropathic facial pain disorder, often caused by vascular or neuronal compression of the trigeminal nerve. In such cases, microvascular decompression (MVD) surgery can be used to treat TN, but pain relief is not guaranteed. The molecular mechanisms that affect treatment response to MVD are not well understood.

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Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned.

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Article Synopsis
  • Infections have historically been the leading cause of illness and death, with pain serving as a key symptom, yet pain may persist even after infections resolve.
  • Chronic pain following infections can take various forms, including neuropathic, nociplastic, and nociceptive pain, influenced by mechanisms like immune responses and direct microbe effects.
  • Certain bacteria and viruses are linked to chronic pain, but while antimicrobial treatments can sometimes help, they may be more harmful than beneficial in cases where pain is tied to autoimmune issues or central sensitization.
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Objective: To determine the association between cervical nonorganic pain signs and epidural corticosteroid injection outcomes and coexisting pain and psychiatric conditions.

Patients And Methods: Seventy-eight patients with cervical radiculopathy who received epidural corticosteroid injection were observed to determine the effects that nonorganic signs have on treatment outcome. A positive outcome was a decrease of 2 or more points in average arm pain, coupled with a score of 5 on a 7-point Patient Global Impression of Change scale 4 weeks after treatment.

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Background: The decision to undergo non-urgent egg freezing (EF) is complex for patients and providers supporting them. Though prior studies have explored patient perspectives, no study has also included the separate perspectives of providers.

Methods: This qualitative study involved semi-structured individual interviews exploring the decision to undergo EF.

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Background: Reproductive decision-making is difficult for BRCA-positive women. Our objective was to assess the complexities of decision-making and identify decisional supports for patients and providers when discussing reproductive options prior to risk-reducing salpingo-oophorectomy (RRSO).

Methods: This study was of qualitive design, using data collection via semi-structured interviews conducted from November 2018 to October 2020.

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Article Synopsis
  • The study examines how various demographic, clinical, and technical factors affect treatment outcomes for three types of interventional procedures aimed at alleviating low back pain (LBP) in a diverse patient group.
  • Data from 346 patients showed significant overall pain reduction post-treatment, but specific factors like baseline pain levels, depression, and obesity were linked to smaller reductions in pain.
  • Identifying patients who respond favorably to treatment is essential, as those with higher disease severity and poorer mental health are more likely to experience less effective outcomes.
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Article Synopsis
  • Acute neuropathic pain presents a diagnostic challenge that requires a clear framework for understanding and researching treatment options.
  • The ACTTION-APS-AAPM collaboration developed the AAAPT Pain Taxonomy to create diagnostic criteria for acute neuropathic pain, informed by expert analysis and literature review.
  • The criteria highlight unique features of specific cases like herpes zoster, chemotherapy-related pain, and limb amputation, potentially guiding future research and management strategies.
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Devices that perform cardiac mapping and ablation to treat atrial fibrillation provide an effective means of treatment. Current devices, however, have limitations that either require tedious point-by-point mapping of a cardiac chamber or have limited ability to conform to the complex anatomy of a patient's cardiac chamber. In this work, a detailed, scalable, and manufacturable technique is reported for fabrication of a multielectrode, soft robotic sensor array.

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Objective: To determine whether women have been equitably represented among plenary speakers at the American Academy of Neurology (AAN) Annual Meeting by counting and categorizing speakers and comparing outcomes to AAN membership and US neurology workforce data.

Methods: Lists of plenary speakers between 1958 and 2019 (62 years) were obtained from the AAN. The primary outcome measures were numbers and proportions of men and women in aggregate and among physicians.

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In this review, we will explore the use of biomarkers in chronic pain, using the examples of two prototypical facial pain conditions: trigeminal neuralgia and temporomandibular disorder. We will discuss the main categories of biomarkers and identify various genetic/genomic, molecular, neuroradiological, and psychophysical biomarkers in both facial pain conditions, using them to compare and contrast features of neuropathic, non-neuropathic, and mixed pain. By using two distinct model facial pain conditions to explore pain biomarkers, we aim to familiarize readers with different types of biomarkers currently being studied in chronic pain, and explore how these biomarkers may be used to develop new precision medicine approaches to pain diagnosis, prognosis, and management.

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Background: The rising use of injections to treat low back pain (LBP) has led to efforts to improve selection. Nonorganic (Waddell) signs have been shown to portend treatment failure for surgery and other therapies but have not been studied for minimally invasive interventions.

Methods: We prospectively evaluated the association between Waddell signs and treatment outcome in 3 cohorts: epidural steroid injections (ESI) for leg pain and sacroiliac joint (SIJ) injections and facet interventions for LBP.

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