American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Apr 2021
Case ReportsDorsal Root Ganglion Stimulation for Treatment of Chemotherapy-Induced Neuropathy: A Case Report.
Chemotherapy-induced neuropathy has limited treatment options, and conventional medications used to treat neuropathic pain often do not provide adequate pain relief for patients with a history of cancer. Neuromodulation such as dorsal root ganglion stimulation remains a treatment that has been studied for chronic painful conditions such as low back pain, pelvic pain, complex regional pain syndrome, and phantom limb pain. Dorsal root ganglion stimulation has been presented for treatment of chemotherapy-induced neuropathy, but with limited duration of follow-up. ⋯ After failure of conservative pharmacotherapies, a 7-day dorsal root ganglion stimulation trial was implanted, resulting in 100% pain relief. A dorsal root ganglion stimulation was then implanted permanently, and our patient reported continued resolution of symptoms at evaluation 3 yrs after placement. To the author's knowledge, this is the first case of sustained relief with dorsal root ganglion stimulation placement for chemotherapy-induced neuropathy and presents a treatment option that warrants further investigation.
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Am J Phys Med Rehabil · Apr 2021
Factors Influencing Fellowship Decision Making During Physical Medicine & Rehabilitation Residency.
Previous surveys have demonstrated an increasing trend among graduating physiatry residents who desired to pursue a subspecialty fellowship. There has been sparse information on whether residents start their training with a subspecialty interest in mind and what factors influenced them to choose a fellowship. This article describes a prospective survey in the 2019-2020 academic year in which 175 responses were collected representing 65 (78.3%) of the 83 physical medicine and rehabilitation programs with graduating residents. ⋯ Forty-six percent agreed that their anticipated subspecialty influenced their choice of residency program. The results of this survey demonstrate that most graduating residents are matriculating into fellowship training with pain, spine, and/or sports medicine being among the top choices. These results underscore the importance of subspecialty interests of trainees at the start of their residency and how training may influence their subspecialty interest.
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Sacroiliac joint pain commonly occurs because of anatomic disruption within the joint. Sacroiliac joint pain and sacroiliac joint mimics create a broad differential, adding difficulty to diagnosis. Clinically, this disruption presents with a mobility limitation relative to baseline and sharp pain inferolateral to the posterior superior iliac spine. ⋯ Pain reduction after the injection indicates the pain originating from the sacroiliac joint. Once confirmed, it is recommended to use a patient-centered approach that focuses on pain control, followed by restoration of function through noninvasive measures such as therapeutic exercise, manual medicine, sacroiliac joint belts, and orthotics. If these noninvasive procedures have not provided adequate treatment, then more invasive procedures should be considered.