Pain physician
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Randomized Controlled Trial Multicenter Study
Improved Sensation Resulting From Spinal Cord Stimulation for the Treatment of Painful Diabetic Neuropathy: The Possible Role of Stochastic Resonance.
Painful diabetic neuropathy (PDN) is a progressive chronic pain condition that significantly affects the quality of life of patients with long-standing diabetes mellitus. Sensory deficits may result in falls, foot ulceration, and lower limb amputations. Recently, spinal cord stimulation (SCS) was studied for treatment of painful diabetic neuropathy. In addition to pain relief, we were surprised to discover that sensory improvements were also demonstrated. No mechanistic explanation has yet been offered to explain these findings. ⋯ SCS might have unexpected benefits in patients with PDN beyond pain reduction. The Senza-PDN trial is the first to describe improved sensation in association with SCS. While the mechanism of action are still unknown, we hypothesize that noise-enhanced signal processing via stochastic resonance may explain these results. Stochastic resonance, or the benefit of additional randomness, should be further studied in the context of spinal cord stimulation. Further, SCS programming that optimizes for stochastic resonance should also be investigated for restoration of sensory and possibly even motor function.
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Meta Analysis
Radiofrequency Therapies for Trigeminal Neuralgia: A Systematic Review and Updated Meta-analysis.
Conventional radiofrequency (CRF), pulsed radiofrequency (PRF), and pulsed com-bined conventional radiofrequency (PCRF) are widely used in the clinical treatment of trigeminal neuralgia (TN), collective evidence comparing the efficacy and safety of these radiofrequency therapies is still controversial. ⋯ PCRF provides better long-term efficacy and fewer adverse effects for treating TN. Yet, it is hard to draw definitive conclusions about excellent pain relief comparisons due to the moderate quality of evidence, high heterogeneity, and scarcity of available data.
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Meta Analysis
Efficacy of Nalbuphine as a Local Anesthetic Adjuvant for Brachial Plexus Block: A Systematic Review and Meta-analysis.
Nalbuphine has been increasingly used as a local anesthetic adjuvant to extend the duration of analgesia in brachial plexus block (BPB). ⋯ Perineural use of nalbuphine in BPB is an effective strategy for analgesia in adult patients undergoing upper extremity surgery.
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Randomized Controlled Trial
The Effect of Tramadol Versus Sufentanil on Controlling Postoperative Pain for Men Who Smoke and Do Not Smoke: A Randomized Clinical Trial.
Smoking behavior alters the analgesic threshold, which challenges postoperative pain management for patients who smoke. ⋯ Our data suggest that tramadol has a better analgesic effect than sufentanil in relieving postoperative pain in patients who smoke.
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With increased hospitalizations and deaths related to opioid use disorder, there is an impetus for federal and private insurance companies to provide coverage for integrative treatments that address pain. The Centers for Disease Control and Prevention (CDC) and the current literature recommend that nonpharmacological and nonopioid treatments must be considered for chronic pain management. The continued examination of potential coverage and cost-effectiveness for opioid-sparing alternatives with proven efficacy is critical for physicians who treat chronic pain. ⋯ Integrative treatments for chronic back pain are currently available, yet coverage varies widely depending on the patient's Medicare or Medicaid status. Different states cover different therapies, which may lead to unequal healthcare outcomes for patients with chronic pain.