Curēus
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Spinal cord stimulation (SCS) is an effective treatment for chronic back and limb pain. The criteria for use of SCS for specific problems such as failed back surgery syndrome (FBSS), peripheral neuropathic pain and residual pain after joint replacement is well established. With an aging population, there are more patients presenting with a combination of various multi-factorial chronic pain problems rather than from a single clear cause. It is not uncommon to see patients with chronic back pain years after spine surgery with new additional pain in the area of joint replacement or due to peripheral neuropathy. ⋯ The patients were evaluated initially with an epidural stimulator trial and if they obtained 50% or greater pain relief to the primary pain generating area, permanent implantation of one or more arrays of spinal cord electrodes was performed but planned to cover also the secondary pain areas. Post-implant follow-up evaluation at one, three and six months included measurement of visual analog scale (VAS), use of pain medication and degree of functional activity and behavior. This report looks at the effectiveness of using multiple overlapping electrodes for SCS in patients with multi-factorial chronic pain.
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Meralgia paresthetica is a neuropathic pain disorder resulting from an entrapment neuropathy of the lateral femoral cutaneous nerve. This condition results in pain, paresthesias and numbness over the anterolateral aspect of the thigh. We present a case of meralgia paresthetica and discuss both the clinical and histopathological findings as they relate to one another. ⋯ These findings corresponded well to the patient's preoperative symptoms of paresthesias and pain. This case serves to shed light on the pathophysiology of meralgia paresthetica and its clinical presentation. It also shows the role of surgical treatment in cases refractory to conservative management in order to alleviate painful symptoms.
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Immune checkpoint inhibitors targeting cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and programmable cell death protein 1 (PD-1)/PD-L1 have shown antitumor activity in cancers such as melanoma, non-small cell lung cancer, renal cell carcinoma, and urothelial cancer. Certain checkpoint inhibitors have been approved for use in Canada, and are becoming a mainstay in the treatment of melanoma and other malignancies. These drugs have a unique side effect profile and are known to cause immune-related adverse events (irAEs). ⋯ IrAEs can occur in any organ system, but adverse events in the skin, gastrointestinal, endocrine, and pulmonary systems are among the most common. As an emergency physician, one must be familiar with these drugs and their adverse events in order to identify patients presenting with irAE and treat them accordingly. This paper provides a brief introduction to immune checkpoint inhibitors, discusses the most common irAEs relevant to emergency physicians, and gives suggestions on how to manage patients presenting to the emergency department (ED) suffering from irAEs.
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Background Many specialty societies have found that neuroimaging in headache is a low-value intervention for benign presentations. This study describes factors that influence Emergency Room (ER) physicians' adherence to Choosing Wisely (CW) recommendations for low-risk headache patients presenting to Calgary's Emergency Departments (EDs). Emergency medicine has yet to address imaging in headache as a CW topic; however, this study may inform that decision. ⋯ Time to assessment, the day of the week, physician gender, years of experience, and training program did not influence CT ordering practices. Conclusion To our knowledge, this is the first study to assess how patient, physician, and environmental factors relate to the use of CT scans in low-risk headaches presenting to the ED. CW guidelines are not optimally adhered to, and the findings in this study findings may inspire new ideas for maximizing the judicious use of healthcare resources.
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Background Psychiatric comorbidities in epilepsy impose significant burdens on patients and their families. It affects their quality of life and medical care and results in cost increases. This study reports the impact of various psychiatric comorbidities in epilepsy patients regarding hospital outcomes and in-hospital mortality. ⋯ Epilepsy with comorbid depression (aOR 1.242; 95% CI 1.172 - 1.317; p-value <0.001) was associated with a higher risk of inpatient total charge of more than $21,000 (median), followed by comorbid psychosis (aOR 1.071; 95% CI 1.045 - 1.098; p-value <0.001). Conclusion Psychiatric comorbidities are influential factors that must be considered in models of Health-Related Quality of Life (HRQOL) in epilepsy. Further, efforts to improve HRQOL and reduce the burden of epilepsy require greater emphasis on the early diagnosis and treatment of comorbid psychopathology.