Publications by authors named "Mehul Desai"
Article Synopsis
- Traditional pain studies have focused on single pain scores, which don't fully capture the complex effects of chronic pain on a person's daily life, mood, and overall quality of life.
- The study evaluated the Nalu™ Neurostimulation System for treating low-back and leg pain through a 90-day follow-up of patients implanted with this device at 15 pain centers in the US.
- Results showed that 94% of participants achieved meaningful improvements in at least two patient-reported outcomes, indicating the system's effectiveness in managing chronic pain.
Background: There is paucity of data from randomized controlled trials supporting the use of peripheral nerve stimulation, a well-established therapy for the treatment of chronic pain. This study was undertaken, in part, to provide randomized controlled trial data in support of patient access to appropriate peripheral nerve stimulation therapy. The COMFORT study is the first large, postmarket, multicenter randomized controlled trials investigating the use of a Food and Drug Administration-cleared micro-implantable pulse generator (IPG) for treating chronic pain via peripheral nerve stimulation therapy.
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- The American Society of Pain and Neuroscience (ASPN) recognizes a need for guidelines to help healthcare providers effectively use social media for best practices.
- A panel of experts conducted research and analyzed literature to develop these best practices for healthcare professionals engaging online.
- It's essential for providers to understand the impact of social media on patient perceptions and to navigate legal and ethical issues while maintaining a clear and educational online presence.
Article Synopsis
- The COMFORT Study aims to assess the safety and effectiveness of Nalu Neurostimulation for treating chronic neuropathic pain compared to standard medical treatment.
- This randomized controlled trial (RCT) will involve multiple centers, focusing on pain in specific areas like the low back, shoulder, knee, or foot/ankle and following participants for 36 months.
- The findings could provide crucial evidence supporting the use of Peripheral Nerve Stimulation (PNS) for chronic pain, as it would be the largest and first Level-I evidence study on this therapy.
Managing intracranial hemorrhage in patients supported by extracorporeal oxygenation (ECMO) presents significant clinical challenges. We report a case of a postpartum patient with severe acute respiratory distress syndrome (ARDS) necessitating venovenous ECMO support, complicated by multicompartmental intracranial hemorrhage resulting in brain herniation and necessitating emergent medical and surgical management of refractory intracranial hypertension. Care was guided by multimodal neuromonitoring, including intracranial pressure monitoring and electroencephalography.
View Article and Find Full Text PDFIntroduction: Pain is a very common complaint among patients with hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSDs). Often challenging to treat, insights into the underpinnings of pain in this population have been fleeting. Central sensitization (CS) has been postulated as a potential etiological factor.
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- * A majority (70.6%) recognized simplicity and convenience as the main benefits of OBDS, while 88.2% believed it could address unmet needs like reducing IV costs and improving patient compliance.
- * Most payers (88.2%) indicated willingness to cover drugs using OBDS, and 82.4% noted the potential for a price premium compared to standard subcutaneous (SC) drugs, with half estimating a 5-20% increase in price.
Background: Low back pain (LBP) is a highly prevalent, disabling condition affecting millions of people. Patients with an identifiable anatomic pain generator and resulting neuropathic lower extremity symptoms often undergo spine surgery, but many patients lack identifiable and/or surgically corrective pathology. Nonoperative treatment options often fail to provide sustained relief.
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- The study aimed to assess how effective outpatient celiac plexus blocks are in reducing acute pain for patients suspected of having median arcuate ligament syndrome (MALS).
- This retrospective review analyzed data from 31 patients who received these blocks between November 2021 and April 2023, with a focus on changes in pain levels before and after the procedure.
- Results showed a median pain reduction of -4 on the numerical pain rating scale, indicating significant immediate pain relief, and the procedure may help determine the need for subsequent surgery in cases of MALS.
Article Synopsis
- * A thorough review of literature from 2017 to October 2023 was conducted to form evidence-based recommendations, with specific criteria used to evaluate the studies.
- * The resulting guidelines provide best practices for safely improving neurostimulation outcomes, intended to aid healthcare professionals in making informed decisions.
Background: We report the results from the first large, postmarket, multicentre, randomised controlled trial (RCT) evaluating peripheral nerve stimulation (PNS) for the treatment of chronic peripheral pain with a micro-implantable pulse generator (micro-IPG).
Methods: Subjects meeting eligibility were randomised (2:1) to either the active arm receiving PNS and conventional medical management (CMM) or the control arm receiving CMM alone. Treatments were limited to the following areas: lower back, shoulder, knee and foot/ankle.
Scapulalgia or shoulder pain accounts for 16% of all musculoskeletal complaints in the healthy adult population and becomes more common as we age. When this pain exceeds 3 months in duration, it is deemed to be chronic, and typically treated in an escalating manner. Spanning a continuum of conservative and non-conservative measures, chronic shoulder pain treatments range from rest and physical therapy to surgery.
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- Existing healthcare systems struggle with limited resources, prompting the development of a user-friendly on-body delivery system (OBDS) for administering large-volume subcutaneous drugs at home or in clinical settings.
- Research evaluated the economic impact of this system through literature reviews and interviews with US payers, revealing that OBDS offers potential cost savings due to reduced healthcare resource use and improved patient compliance.
- Payers noted that features like the hidden needle and ease-of-use enhance patient experience, making OBDS a viable option that could justify a higher price than traditional administration methods.
Article Synopsis
- Cardiogenic shock (CS) is a serious condition with various causes and can lead to high rates of illness and death (35-50%), even with modern treatments.
- Recent research has focused on better recognition and management of CS through standardized protocols and tailored use of temporary mechanical support, which have shown promising results.
- This review covers the underlying mechanisms of CS, emerging definitions and treatment strategies, and highlights the need for more studies to fill knowledge gaps and improve patient outcomes.
Article Synopsis
- Spinal cord stimulation (SCS) is a common treatment for chronic pain, but pocket pain at the implant site is a poorly understood complication that can affect treatment effectiveness and quality of life.
- A literature review of 305 articles identified only 50 studies that met specific criteria, revealing that most examined pocket pain as a secondary issue rather than the primary focus.
- The review highlights a significant gap in research regarding the incidence and impact of pocket pain, emphasizing the need for thorough investigations through well-designed trials to improve outcomes for patients undergoing SCS.
Article Synopsis
- Radiofrequency ablation (RFA) is a technique that's been used for nearly 100 years to relieve chronic pain by heating tissues with RF energy, leading to injury of pain-signaling nerves.
- This study compares the lesion sizes created by three different gauge probes (18-g, 20-g, 22-g) at various distances to determine the most effective probe for clinical use.
- By analyzing RFA lesions in chicken breast samples, the researchers aim to establish best practices for using bipolar RFA in pain management, with statistical comparisons of lesion sizes across different temperatures and probe gauges.
Background: Chronic, intractable, neuropathic pain is readily treatable with spinal cord stimulation (SCS). Technological advancements, including device miniaturization, are advancing the field of neuromodulation.
Objectives: We report here the results of an SCS clinical trial to treat chronic, low back and leg pain, with a micro-implantable pulse generator (micro-IPG).
Objective: Spinal cord stimulation (SCS) is effective for relieving chronic intractable pain conditions. The Dorsal spInal cord STImulatioN vs mediCal management for the Treatment of low back pain study evaluates the effectiveness of SCS compared with conventional medical management (CMM) in the treatment of chronic low back pain in patients who had not undergone and were not candidates for lumbar spine surgery.
Methods And Materials: Patients were randomized to passive recharge burst therapy (n = 162) or CMM (n = 107).
Introduction: Low back pain is the leading cause of disability worldwide, with sacroiliac joint pain comprising up to 30% of cases of axial lower back pain. Conservative therapies provide only modest relief. Although placebo-controlled trials show efficacy for sacral lateral branch cooled radiofrequency ablation, there are no comparative effectiveness studies.
View Article and Find Full Text PDFBackground: Chronic low back pain (CLBP) is often associated with clinical evidence of central nervous system sensitization and finding a clear source of nociceptive input can be challenging. Conventional therapies targeting peripheral spinal pain structures can fail to address centrally-mediated, underlying causes of pain. Sixty-day percutaneous peripheral nerve stimulation (PNS) applied to the lumbar medial branch nerves is a non-surgical, non-opioid treatment that may restore the balance of peripheral inputs to the central nervous system and reverse maladaptive changes in central pain processing.
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- A study was conducted to examine the link between noninvasive oxygen support methods, the timing of invasive mechanical ventilation (IMV), and patient mortality rates among those hospitalized with COVID-19.
- The retrospective analysis included 709 patients from March 2020 to October 2021, revealing a high crude mortality rate of 56%, with factors such as age and comorbidities like obesity and diabetes being significant predictors.
- Findings suggested that longer use of noninvasive oxygen support before IMV was associated with a higher risk of inpatient mortality, particularly in older patients, indicating the potential need for timely intervention strategies in COVID-19 treatment.
Article Synopsis
- Cluneal neuropathy consists of three types—superior, middle, and inferior cluneal neuralgia—each with distinct symptoms and anatomical considerations.
- A narrative review was conducted, gathering literature from various databases to examine the condition and its treatments.
- There is a wide range of incidence rates (1.6%-11.7%), but diagnosing cluneal neuropathy is difficult due to variability and lack of standardized criteria, while treatment options include nerve blocks, neuromodulation, and surgical methods, with mixed outcomes reported in studies.
Objectives: The aim of this article is to discuss the possible mechanisms of action (MOAs) and results of a pilot study of a novel, anatomically placed, and paresthesia-independent, neurostimulation waveform for the management of chronic intractable pain.
Materials And Methods: A novel, multilayered pulsed stimulation pattern (PSP) that comprises three temporal layers, a Pulse Pattern layer, Train layer, and Dosage layer, was developed for the treatment of chronic intractable pain. During preliminary development, the utility was evaluated of anatomical PSP (aPSP) in human subjects with chronic intractable pain of the leg(s) and/or low back, compared with that of traditional spinal cord stimulation (T-SCS) and physiological PSP.
Background: The benefits of standardized care for cardiogenic shock (CS) across regional care networks are poorly understood.
Objectives: The authors compared the management and outcomes of CS patients initially presenting to hub versus spoke hospitals within a regional care network.
Methods: The authors stratified consecutive patients enrolled in their CS registry (January 2017 to December 2019) by presentation to a spoke versus the hub hospital.