Preoperative Magnetic Resonance Imaging Modifies Percutaneous Spinal Cord Stimulator Trial Progression and Planning.

Objective: Spinal cord stimulator (SCS) percutaneous lead placement has been effective in treating chronic limb, neck, and back pain. However, SCS lead placement poses a risk of neurologic injury, which may be attenuated with preprocedural magnetic resonance imaging (MRI) to identify potential spinal anatomical abnormalities (eg, central canal stenosis) that would either modify or prevent lead placement. However, a large-scale study of the clinical value of preoperative MRIs in percutaneous SCS lead placement is lacking.

A Statement on Abortion by 170 Obstetricians/Gynecologists after the Reversal of Roe v Wade.

In a recent American Journal of Obstetrics and Gynecology, 900 professors submitted a Special Report calling for reinstating federal protection for abortion. Here, we provide an alternative consensus statement. Induced abortion is not a constitutional right.

Low-energy differential target multiplexed SCS derivative reduces pain and improves quality of life through 12 months in patients with chronic back and/or leg pain.

Introduction: Energy-reducing spinal cord stimulation (SCS) approaches have the potential to impact patient experience with rechargeable and non-rechargeable SCS devices through reducing device recharge time or enhancing device longevity. This prospective, multi-center study evaluated the safety, effectiveness, and actual energy usage of differential target multiplexed (DTM) endurance therapy, a reduced energy DTM SCS derivative.

Methods: Subjects who reported an overall pain visual analog score (VAS) of ≥6/10 cm and an Oswestry Disability Index score of 21-80 out of 100 at baseline with moderate to severe chronic, intractable back and/or leg pain were eligible.

Current opinion: optimize radiofrequency ablation through electrophysiological principles, modeling, and clinical recommendations.

Purpose Of Review: This article aims to empower the interventional pain physician to utilize RFA effectively by explaining the technical and electrophysiological features of monopolar, bipolar, and internally cooled RFA. Scientific data are used to provide advice on the effective, well tolerated, and rational application of these techniques. Moreover, physicians need to know how to analyze and generalize ex-vivo and in-vivo models to the clinical setting to optimize clinical outcomes.

Bacterial Biofilm on Tissue Expander and Acellular Dermal Graft After Breast Reconstruction.

A 27-year-old female underwent bilateral mastectomy with left axillary dissection and had immediate breast reconstruction with textured silicone implants and acellular dermal graft (ADG) reinforcement of the inferior quadrants. The patient was maintained on oral antibiotics postoperatively and initially did well. However, she subsequently presented with fever, erythema, and tenderness in the left chest and was admitted for intravenous antibiotic therapy.

Differential Target Multiplexed Spinal Cord Stimulation: A UK Cost-Effectiveness Analysis.

Objectives: The aim of this economic analysis was to evaluate the cost-effectiveness of differential target multiplexed spinal cord stimulation (DTM-SCS) for treating chronic intractable low back pain, compared with conventional spinal cord stimulation (C-SCS) and conservative medical management (CMM), by updating and expanding the inputs for a previously published cross-industry model.

Materials And Methods: This model comprised a 12-month decision-tree phase followed by a long-term Markov model. Costs and outcomes were calculated from a UK National Health Service perspective, over a base-case horizon of 15 years and up to a maximum of 40 years.

Defining Short- and Long-Term Programming Requirements in Patients Treated With 10-kHz Spinal Cord Stimulation.

Objectives: High-frequency spinal cord stimulation (10-kHz SCS) has been shown to be an effective treatment for refractory low back pain and neck pain with and without limb pain in clinical trial and real-world studies. However, limited information is available in the literature on the type and frequency of programming parameters required to optimize pain relief.

Materials And Methods: Retrospective trial and postimplant clinical and system device data were analyzed from consecutive patients with neck pain and low back pain, with and without limb pain, from a single clinical site, including both thoracic and cervical lead placement.

Delayed development of spinal stenosis at the spinal cord stimulator percutaneous lead entry point: case report and literature review.

Background: Spinal cord stimulation (SCS) is an efficacious treatment for various refractory chronic pain syndromes. Serious complications including spinal cord compression (SCC) are rare with 19 previous reports which are mainly attributed to fibrotic scar tissue formation at the distal end of the leads at the location of the contacts. We report a case of SCC following SCS implantation at the lead entry location secondary to a delayed progression of spinal canal stenosis.

Use of Adjunctive Corticosteroid With Antivascular Endothelial Growth Factor Agents in the Treatment of Choroidal Neovascular Membrane Associated With Presumed Ocular Histoplasmosis.

To evaluate the impact of combination treatment of antivascular endothelial growth factor (anti-VEGF) intravitreal injections and corticosteroids in patients with choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS). A retrospective multicenter study was conducted in a cohort from Illinois and Missouri. Patients were identified over an 8-year period, and data were evaluated over a 1-year study window commencing with treatment initiation.

Hidden risk of gadolinium-based contrast agents during interventional pain medicine procedures: a retrospective chart review.

Introduction: Epidural steroid injections and epidural blood patches commonly involve the injection of a small amount of radiocontrast media under fluoroscopy to properly identify the target tissue or anatomic space and prevent off-target or intravascular delivery of therapeutic or diagnostic drugs. Iodinated low osmolar non-ionic contrast media is the standard preparation used as it is considered safe and cost-effective, but gadolinium-based preparations have been used as an alternative for patients with an 'iodine'-related or radiocontrast media allergy label to prevent hypersensitivity reactions. The risk of neurotoxic events when gadolinium is inadvertently injected into the intrathecal space has been reported in recent years, raising concerns when gadolinium-based contrast media is used in lieu of iodinated low osmolar non-ionic contrast media.

Methemoglobinemia in the Setting of G6PD Deficiency and SARS-CoV-2 Infection.

catalyzes the pentose phosphate shunt. It is required to maintain the level of nicotinamide adenine dinucleotide We report a case of a 58 year old African American male patient with Coronavirus Disease-2019 (COVID-19) in the setting of multiple concomitant hematologic disorders, including Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) and sickle cell trait. Typically, G6PD deficiency remains clinically silent, and only a minority of patients will show signs of chronic hemolytic anemia.

Investigation of Needle Characteristics Using an Animal Model for Improved Outcomes in Anterior Chamber Paracentesis.

The current standard of care to perform an anterior chamber paracentesis involves the use of a multipurpose market needle and syringe. The use of standard needles for this purpose may result in injury to the patient due to increased force with insertion and increased globe displacement during the procedure. This research investigates the current market needle characteristics and the impact of each needle characteristic on force.

Water-circulating probes significantly modify lesion length and axon damage in cooled radiofrequency ablations when compared with similar-sized standard radiofrequency probes in rats.

Introduction: Preclinical research demonstrated water-cooled radiofrequency (CRF) ablations have a significant impact on structural and functional changes compared to standard radiofrequency (SRF) ablations. Clinical procedures utilizing RF to treat chronic pain conditions also show sustained functional outcomes. We hypothesize that the design of the RF probes plays an important role in interventional procedure success, but it remains unclear which specific design features.

Multiphase Spinal Cord Stimulation in Participants With Chronic Back or Leg Pain: Results of the BENEFIT-02 Randomized Clinical Trial.

Objective: This study aimed to assess the safety and effectiveness of a new charge-distributed multiphase stimulation paradigm during an extended spinal cord stimulation (SCS) trial.

Materials And Methods: This prospective, multicenter, randomized, single-blind, feasibility study included participants with chronic low back and/or leg pain and baseline numerical rating scale (NRS) for overall pain intensity ≥6. After a successful commercial SCS trial, participants were randomized to multiphase SCS therapy A (approximately 600-1500 Hz) or B (approximately 300-600 Hz), delivered via an investigational external pulse generator and existing leads during an 11-to-12-day testing period.

Acrometastasis as a mimic of complex regional pain syndrome.

Introduction: Complex regional pain syndrome (CRPS) is characterized by chronic pain disproportional to any inciting event, and is associated with poor quality of life, and large clinical, healthcare, and societal costs. A CRPS diagnosis is challenging due to the lack of biomarkers and objective laboratory and radiographic tests. CRPS is currently diagnosed according to the IASP clinical diagnostic criteria, and it is not a radiological diagnosis.

Daring discourse: economics of neuromodulation for the treatment of persistent spinal pain syndrome and complex regional pain syndrome.

The treatment options for patients with chronic pain conditions are impacted by recent research, patient needs, and insurance coverage. Although various factors affect the cost of healthcare, the economic burden on the patient and the healthcare system must be considered when choosing the appropriate treatments for each patient. This Daring Discourse aims to review and further clarify existing economic evaluations and thus examine cost-effectiveness with regards to neuromodulation for the treatment of persistent spinal pain syndrome and complex regional pain syndrome.

Evidence-based consensus guidelines on patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain.

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.

Role of patient selection and trial stimulation for spinal cord stimulation therapy for chronic non-cancer pain: a comprehensive narrative review.

Background/importance: Patient selection for spinal cord stimulation (SCS) therapy is crucial and is traditionally performed with clinical selection followed by a screening trial. The factors influencing patient selection and the importance of trialing have not been systematically evaluated.

Objective: We report a narrative review conducted to synthesize evidence regarding patient selection and the role of SCS trials.

Characterization of a new polymeric food contact coating with emphasis on the chemical analysis and safety assessment of non-intentionally added substances (NIAS).

Regulators have established safety requirements for food packaging raw materials and finished products, including by-products of polymer synthesis known as non-intentionally added substances (NIAS). However, there are no official guidance or regulations for best practices to evaluate the safety of NIAS. Here we described the process we followed to identify, characterize, and prioritize for safety assessment low molecular weight NIAS from an epoxy coating (V70) made with tetramethyl bisphenol F-based diglycidyl ether resin (TMBPF-DGE).