Pain physician
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Comparative Study
Evaluation of interaction between a spinal cord stimulator and implanted cardioverter-defibrillator in a swine model.
Spinal cord stimulators (SCS) have been used for many years to treat a myriad of chronic pain conditions using electrical signals to diminish the perception of a painful stimulus. Because of the electrical nature of the devices, there is a concern about the potential for electromagnetic interaction between the device and lifesaving cardiac implantable cardioverters-defibrillators (ICVD). ⋯ This study clearly demonstrated the feasibility of the 2 devices coexisting and functioning appropriately in an animal model using an ICVD and SCS donated by Boston Scientific. Further studies are needed to elucidate restrictions, optimal settings and parameters in a human setting.
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Neuropathic pain induction by nerve injury has been shown by in vitro studies to be accompanied by synaptic strengthening in the anterior cingulate cortex (ACC) and has been shown by pharmacological studies in vivo to be prevented by blocking N-methyl-D-aspartate (NMDA) receptor-dependent ACC plasticity. These findings indicate that ACC neurons undergo nerve injury-induced synaptic modifications and further raise a new question about neuropathic pain-associated changes in neuronal activity in the ACC in vivo, particularly spontaneous neuronal oscillations - a process believed to be fundamental for many forms of brain function. ⋯ Neuropathic pain is accompanied by the increase in rates of spontaneous oscillations of ACC neurons. This change may be critical for neuropathic pain development, as well as pain hypersensitivity and spontaneous pain in neuropathic pain animals.
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Letter Case Reports
Serotonin syndrome with perioperative oxycodone and pregabalin.
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Review
Vertebral augmentation: update on safety, efficacy, cost effectiveness and increased survival?
Although over 300 articles have been published annually on vertebral augmentation in the last 5 years, there remains much debate about a fundamental question - is vertebral augmentation a safe and effective treatment to achieve analgesia, reduce disability, and improve quality of life in patients with a vertebral fracture? In this modern era of evidence-based clinical practice and public health care policy and funding, an evidentiary basis is needed to continue to perform vertebral augmentation. The aim of this narrative review is to summarize the latest and highest quality evidence for efficacy, safety, cost effectiveness, and potential survival benefit after vertebroplasty and kyphoplasty. The design, major inclusion criteria, primary outcome measures, relevant primary baseline characteristics, primary outcomes, relevant secondary outcomes, and limitations of prospective multicenter randomized sham-controlled and conservative management-controlled trials are summarized. ⋯ Finally, emerging literature assessing the potential cost-effectiveness of vertebral augmentation is considered. This narrative review will provide interventional pain physicians a summary of the latest and highest quality data published on vertebral augmentation. This will allow integration of the best available evidence with clinical expertise and patient wishes to make the most appropriate evidence-based clinical decisions for patients with symptomatic vertebral fracture.