Innovations In Clinical Neuroscience

Pain Management August 2016

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Hot Topics in Pain Management [August 2016] 25 SPINAL CORD STIMULATION Spinal cord stimulation for treatment of neuropathic pain associated with erythromelalgia. Matzke LL, Lamer TJ, Gazelka HM. Reg Anesth Pain Med. 2016 Aug 9. [Epub ahead of print] Summary: Here the authors present a case of successful treatment of pain secondary to erythromelalgia with a spinal cord stimulator in an 80-year-old woman with treatment-resistant severe pain and debility secondary to erythromelalgia. After dual-lead percutaneous spinal cord stimulation implantation, the authors reported excellent pain control at 18 months follow-up in their patient. * PMID: 27512936 BMI as a predictor of spinal cord stimulation success in chronic pain patients. Marola O, Cherala R, Prusik J, et al. Neuromodulation. 2016 Aug 5. doi: 10.1111/ner.12482. [Epub ahead of print] Summary: Investigators examined the effect of body mass index (BMI) on spinal cord stimulation (SCS) success in 77 thoracic and cervical SCS patients at baseline, six months, and one year postoperatively—19 with BMIs ≥36.5 and 58 with BMIs <36.5. While both groups e xperienced successful surgical outcomes, the high BMI patients showed less improvement in depression as measured by Beck Depression Inventory (BDI) at six months and one year and less improvement in pain as measured by Pain Catastrophizing Scale (PCS) at one year compared to the lower BMI group. * PMID: 27491832 A review of spinal cord stimulation systems for chronic pain. Verrills P, Sinclair C, Barnard A. J Pain Res. 2016 Jul 1;9:481-92. doi: 10.2147/JPR.S108884. eCollection 2016. Summary: Here, the authors review recent advances in spinal cord stimulation (SCS) applications and technologies for the treatment of chronic pain. The authors review the existing high-level evidence for the safety, efficacy, and cost- effectiveness (Level I–II) of traditional SCS therapies in the treatment of chronic refractory low back with predominant limb pain. The authors also discuss the recent Level I evidence for both dorsal root ganglion SCS and high- frequency SCS for treatment of chronic pain. In addition, the authors describe the identified variables that can affect SCS efficacy. * PMID: 27445503 KETAMINE Low-dose ketamine infusion for emergency department patients with severe pain. Ahern TL, Herring AA, Miller S, Frazee BW. Pain Med. 2015 Jul;16(7):1402-9. doi: 10.1111/pme.12705. Epub 2015 F eb 3. Summary: Authors investigated whether low-dose ketamine bolus followed by continuous infusion would provide clinically significant and sustained pain relief, be well tolerated, and be feasible in the emergency setting by administering 15mg of intravenous ketamine followed immediately by continuous ketamine infusion at 20 mg/h for 1 hour to 38 patients admitted to the emergency department with numerical rating scale (NRS) pain score of 9. Optional morphine (4 mg) was also offered at 20, 40, and 60 minutes. The authors reported a median reduction in pain score of 4 in their patients, with seven patients reporting a score of 0. At 60 and 120 minutes, 25 and 26 patients, respectively, reported clinically significant pain reduction (decrease NRS score > 3) and high satisfaction with pain control. * PMID: 25643741 Role of ketamine in acute postoperative pain management: a narrative review. Radvansky BM, Shah K, Parikh A, et al. Biomed Res Int. 2015;2015:749837. doi: 10.1155/2015/749837. Epub 2015 Oct 1. Summary: Here, researchers examined the literature regarding the usage of ketamine as a postoperative analgesic agent across a wide variety of surgeries. The authors assessed effectiveness of ketamine through various outcomes such as the amount of opiate consumption, visual analog scale (VAS) pain scores, and persistent postoperative pain at Journal Watch Highlights of Noteworthy Published Studies, Reviews, and Case Reports Click * at the end of each synopsis to access the abstract on Pubmed.

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