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Campos-Fajardo S, Sierra-Peña JA, Suárez-Monsalve S, Acevedo-González JC. Effectiveness of Dorsal Root Ganglion Stimulation in Chronic Pain Management: A Systematic Review. World Neurosurg 2024; 190:157-171. [PMID: 38945208 DOI: 10.1016/j.wneu.2024.06.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE This systematic review aims to determine the effectiveness of dorsal root ganglion stimulation (DRGS) in chronic pain management. METHODS In 2023, a comprehensive systematic review was undertaken utilizing various electronic databases, employing MeSH terms and free search terms tailored to the study's aims. This review included primary research such as cohorts, case-control studies, and clinical trials, all focusing on the efficacy of DRGS in treating various chronic pain conditions. Nonhuman or animal studies were omitted from the selection process. A review of study quality was conducted, followed by a meticulous analysis of the findings to synthesize the evidence. This review represents the most current research, with updates extending to 2024. A total of 400 articles were reviewed. Twenty-nine articles were included in our review after meticulous screening. RESULTS Twenty-nine articles published in the last five years meeting selection criteria were identified, encompassing patients with various diagnoses warranting the use of DRGS beyond complex regional pain syndrome. Additionally, the analysis includes different outcome measurement tools, emphasizing improvements in pain management, functionality, and quality of life. Finally, common complications such as surgical site infections and issues with electrodes are highlighted. CONCLUSIONS This systematic review affirms the effectiveness of DRGS therapy in managing diverse chronic pain conditions, highlighting improvements in quality of life, functionality, and mood states, making it a viable alternative for patients unresponsive to traditional treatments.
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Affiliation(s)
- Santiago Campos-Fajardo
- Neurosurgery Research Group, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Julián Alfonso Sierra-Peña
- Neurosurgery Research Group, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Silvia Suárez-Monsalve
- Neurosurgery Research Group, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia; Clinical Epidemiology Master's Degree, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juan Carlos Acevedo-González
- Neurosurgery Research Group, Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia; Neurosurgeon Specialized in Functional Neurosurgery and Management of Pain and Spasticity. Professor, Department of Neurosciences, Hospital Universitario San Ignacio, Bogotá, Colombia
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Tong L, Solla C, Staack JB, May K, Tran B. Perioperative Pain Management for Thoracic Surgery: A Multi-Layered Approach. Semin Cardiothorac Vasc Anesth 2024:10892532241235750. [PMID: 38506340 DOI: 10.1177/10892532241235750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Cardiothoracic surgeries frequently pose unique challenges in the management of perioperative acute pain that require a multifaceted and personalized approach in order to optimize patient outcomes. This article discusses various analgesic strategies including regional anesthesia techniques such as thoracic epidurals, erector spinae plane blocks, and serratus anterior plane blocks and underscores the significance of perioperative multimodal medications, while providing nuanced recommendations for their use. This article further attempts to provide evidence for the efficacy of the different modalities and compares the effectiveness of the choice of analgesia. The roles of Acute Pain Services (APS) and Transitional Pain Services (TPS) in mitigating opioid dependence and chronic postsurgical pain are also discussed. Precision medicine is also presented as a potential way to offer a patient tailored analgesic strategy. Supported by various randomized controlled trials and meta-analyses, the article concludes that an integrated, patient-specific approach encompassing regional anesthesia and multimodal medications, while also utilizing the services of the Acute Pain Service can help to enhance pain management outcomes in cardiothoracic surgery.
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Affiliation(s)
- Larry Tong
- Virginia Commonwealth University, Richmond, VA, USA
| | - Che Solla
- University of Tennessee, Knoxville, TN, USA
| | | | - Keith May
- University of Tennessee, Knoxville, TN, USA
| | - Bryant Tran
- Virginia Commonwealth University, Richmond, VA, USA
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3
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Lo Bianco G, Tinnirello A, Papa A, Torrano V, Russo G, Stogicza A, Mercadante S, Cortegiani A, Mazzoleni S, Schatman ME. Interventional Pain Procedures: A Narrative Review Focusing on Safety and Complications. Part 1 Injections for Spinal Pain. J Pain Res 2023; 16:1637-1646. [PMID: 37223436 PMCID: PMC10202209 DOI: 10.2147/jpr.s402798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic- or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.
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Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Department of Anesthesiology and Pain, Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Andrea Tinnirello
- Department of Anesthesiology and Pain Medicine, ASST Franciacorta, Ospedale di Iseo, Iseo, Italy
| | - Alfonso Papa
- Department of Pain Management– AO “Ospedali dei Colli” – Monaldi Hospital, Naples, Italy
| | - Vito Torrano
- Department of Anesthesia, Critical Care and Pain Medicine, Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gianluca Russo
- Department of Anesthesia, Postoperative Intensive Care and Pain Therapy, Lodi Hospital, Lodi, Italy
| | - Agnes Stogicza
- Department of Anesthesiology Saint Magdolna Hospital, Budapest, Hungary
| | - Sebastiano Mercadante
- Department of Pain Relief and Supportive Care, Private Hospital La Maddalena, Palermo, Sicilia, Italy
| | - Andrea Cortegiani
- Department of Anesthesiology and Intensive Care, Università degli Studi di Palermo, Palermo, Italy
| | - Silvia Mazzoleni
- Department of Anesthesiology and Pain Medicine, ASST Franciacorta, Ospedale di Iseo, Iseo, Italy
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU School of Medicine, New York, NY, USA
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Lo Bianco G, Tinnirello A, Papa A, Marchesini M, Day M, Palumbo GJ, Terranova G, Di Dato MT, Thomson SJ, Schatman ME. Interventional Pain Procedures: A Narrative Review Focusing On Safety and Complications. PART 2 Interventional Procedures For Back Pain. J Pain Res 2023; 16:761-772. [PMID: 36925622 PMCID: PMC10010974 DOI: 10.2147/jpr.s396215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasound-guided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.
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Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Andrea Tinnirello
- Anesthesiology and Pain Medicine Department, ASST Franciacorta, Ospedale di Iseo, Iseo, 25049, Italy
| | - Alfonso Papa
- Pain Department, AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy
| | - Maurizio Marchesini
- Mininvasive Surgery Department, Unit of Pain Medicine IRCCS Maugeri Pavia, Pavia, 27100, Italy
| | - Miles Day
- Pain Research, The Pain Center at Grace Clinic, Texas Tech University HSC, Lubbock, TX, USA
| | - Gaetano Joseph Palumbo
- Azienda Ospedale - Università Padova, Department of Anesthesia and Intensive Care, Padova, Italy
| | - Gaetano Terranova
- Anaesthesia and Intensive Care Department, Asst Gaetano Pini, Milano, Italy
| | | | - Simon J Thomson
- Pain Management, Mid and South Essex University Hospitals NHSFT, Basildon, SS16 5NL, UK
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU School of Medicine, New York, NY, USA
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Chapman KB, Sayed D, Lamer T, Hunter C, Weisbein J, Patel KV, Dickerson D, Hagedorn JM, Lee DW, Amirdelfan K, Deer T, Chakravarthy K. Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience. J Pain Res 2023; 16:839-879. [PMID: 36942306 PMCID: PMC10024474 DOI: 10.2147/jpr.s364370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/17/2023] [Indexed: 03/14/2023] Open
Abstract
With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain.
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Affiliation(s)
- Kenneth B Chapman
- The Spine & Pain Institute of New York, New York, NY, USA
- Department of Anesthesiology, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
- Department of Anesthesiology, NYU Langone Medical Center, New York, NY, USA
- Correspondence: Kenneth B Chapman, NYU Langone Medical Center, Zucker School of Medicine at Hofstra/Northwell, Pain Medicine at Staten Island University Hospital, 1360 Hylan Boulevard, Staten Island, NY, 10305, USA, Email
| | - Dawood Sayed
- Department of Anesthesiology, The University of Kansas Medical Center (KUMC), Kansas City, KS, USA
| | - Tim Lamer
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Corey Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | - Kiran V Patel
- The Spine & Pain Institute of New York, New York, NY, USA
- Department of Anesthesiology, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
- Department of Anesthesiology, NYU Langone Medical Center, New York, NY, USA
| | - David Dickerson
- Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University Health System, Evanston, IL, USA
- Department of Anesthesia & Critical Care, University of Chicago, Chicago, IL, USA
| | | | - David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | | | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Krishnan Chakravarthy
- Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
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Lo Bianco G, Misseri G, Stogicza AR, Cesare G, Li S, Day M, Kennedy DJ, Schatman ME. Radiofrequency Ablation for Chronic Lumbar Zygapophyseal Joint Pain Using a V-Shaped Active Tip Needle: An Observational Retrospective Study. J Pain Res 2023; 16:1243-1255. [PMID: 37069943 PMCID: PMC10105587 DOI: 10.2147/jpr.s406714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
Background Lumbar zygapophyseal joint dysfunction represents one of the major sources of chronic low back pain. Radiofrequency ablation (RFA) using a V-shaped active tip needle may offer a larger lesion of the medial branch nerves, improving clinical outcome. The aim of our study is to evaluate the efficacy and the feasibility of RFA using V-shaped active tip needles. Methods This is a single-center observational retrospective study. Clinical records were screened and analyzed if they met the following inclusion criteria: adult patients (>18 years), diagnosis of chronic lumbar zygapophyseal joint pain, failure of conservative treatments, ability to provide informed consent for data analysis and publication. Exclusion criteria: lumbar pain not related to zygapophyseal joints, previous spinal/lumbar surgery, incomplete data, absence or withdrawal of informed consent. The primary outcome of the study was a change in pain intensity at follow-up. The secondary outcomes were the evaluation of quality-of-life improvement, the occurrence of adverse events and the impact on post-procedural analgesic consumption. For these purposes, pre- and post-treatment numeric rating scale (NRS), neuropathic pain 4 questions (DN4), EuroQoL - EQ-5D-3L, EQ-VAS, EQ-index and North American Spine Society (NASS) index were retrieved and analysed. Results Sixty-four patients were included. 7.8% of patients at 1-month (CI95% 0.026, 0.173), 37.5% at 3-month (CI95% 0.257, 0.505), 40.6% at 6-month (CI95% 0.285, 0.536) and 35.9% at 9-month (CI95% 0.243, 0.489) follow-up reported a reduction of more than 80% in NRS Statistical analysis indicated a significant change in NRS, DN4, EQ-index and EQ-5D-VAS (p-value <0.001) at the different time-points. Conclusion RFA using a V-shaped active tip needle might be a feasible and effective treatment for chronic lumbar zygapophyseal joint pain.
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Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Anesthesiology and Pain Department, Fondazione Istituto “G. Giglio”, Cefalù, Palermo, Italy
- Correspondence: Giuliano Lo Bianco, Anesthesia and Pain Medicine Department, Fondazione Giglio Cefalù, Contrada Pietrapollastra, Via Pisciotto, Cefalù, Palermo, 90015, Italy, Tel +393289682219, Email
| | - Giovanni Misseri
- Anesthesiology and Pain Department, Fondazione Istituto “G. Giglio”, Cefalù, Palermo, Italy
| | - Agnes R Stogicza
- Anesthesia and Pain, Saint Magdolna Private Hospital, Budapest, Hungary
| | - Gregoretti Cesare
- Anesthesiology and Pain Department, Fondazione Istituto “G. Giglio”, Cefalù, Palermo, Italy
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Sean Li
- National Spine and Pain Centers, Shrewsbury, NJ, USA
| | - Miles Day
- Pain Research, The Pain Center at Grace Clinic, Texas Tech University HSC, Lubbock, TX, USA
| | - David J Kennedy
- Department of PM&R, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
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Muacevic A, Adler JR, Gabriel RA. Ultrasound-Guided Percutaneous Cryoneurolysis for Post-Thoracotomy Pain Syndrome: A Case Report. Cureus 2022; 14:e32888. [PMID: 36699749 PMCID: PMC9867988 DOI: 10.7759/cureus.32888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
Post-thoracotomy pain syndrome (PTPS) is a post-operative thoracotomy complication that is difficult to treat. We describe the first-time use of ultrasound-guided percutaneous cryoneurolysis of the intercostal nerves to successfully treat PTPS refractory to conventional medications and interventions. We report a case of a 40-year-old male with two years of severe PTPS sustained after undergoing a thoracotomy. Treatment with intercostal cryoneurolysis resulted in an immediate 75% improvement in pain for six weeks followed by sustained 50% pain relief for eight weeks. This highlights the potential of this intervention as a radiation-free, safe, and efficacious therapy for chronic PTPS.
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8
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Liu Y, Zhang L, Xu ZH, Zhu J, Ma JL, Gao YP, Xu GY. Increased ten-eleven translocation methylcytosine dioxygenase one in dorsal root ganglion contributes to inflammatory pain in CFA rats. Mol Pain 2022; 18:17448069221143671. [PMID: 36411533 PMCID: PMC9720829 DOI: 10.1177/17448069221143671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
DNA hydroxylation catalyzed by Tet dioxygenases occurs abundantly in neurons in mammals. However, effects of ten-eleven translocation methylcytosine dioxygenase 1 (TET1) expression and hydroxymethylation status on neuron injury remain unclear. This study was designed to explore the effects of TET1 and TET2 expression in the inflammatory pain of rats induced by complete Freund's adjuvant (CFA). Mechanical paw withdrawal threshold (PWT) and thermal withdrawal latency (TWL) were detected to assess pain behavior. The expression of TET1 and TET2 were measured in the dorsal root ganglion (DRG) with western blotting analysis. Immunofluorescence staining is employed to detect the expression and co-location of TRPV1 with TET1. Intrathecal administration of Bobcat339 was used to inhibit TET1 function in dorsal root ganglion. The paw withdrawal threshold and thermal withdrawal latency of rats were significantly reduced after CFA Injection. Western blot results showed that the expression of TET1 was significantly increased at 3 days after CFA injection, but TET2 had no statistical difference. Immunofluorescence results showed that TET1 was co-localized with TRPV1. Intrathecal administration of Bobcat339 improved mechanical and thermal pain threshold in CFA rats. Our findings highlight the role of TET1 in chronic inflammatory pain model. The expression of TET1 was increased in CFA rats, and suppression of TET1 will ameliorate inflammatory pain.
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Affiliation(s)
- Yun Liu
- Department of Anesthesiology,
The
Affiliated Zhangjiagang Hospital of Soochow
University, Suzhou, China
| | - Ling Zhang
- Center for Translational Medicine,
The
Affiliated Zhangjiagang Hospital of Soochow
University, Suzhou, China
| | - Zhen-hua Xu
- Department of Anesthesiology,
The
Affiliated Zhangjiagang Hospital of Soochow
University, Suzhou, China
| | - Jie Zhu
- Department of Anesthesiology,
The
Affiliated Zhangjiagang Hospital of Soochow
University, Suzhou, China
| | - Jia-ling Ma
- Department of Anesthesiology,
The
Affiliated Zhangjiagang Hospital of Soochow
University, Suzhou, China
| | - Yan-ping Gao
- Department of Anesthesiology,
The
Affiliated Zhangjiagang Hospital of Soochow
University, Suzhou, China,Yan-ping Gao, Department of Anesthesiology,
The Affiliated Zhangjiagang Hospital of Soochow University, 68, Jiyang West
Road, Suzhou 215600, China. and Guang-Yin
Xu, Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of
Neuroscience, Soochow University, Suzhou 215123, China.
| | - Guang-Yin Xu
- Center for Translational Medicine,
The
Affiliated Zhangjiagang Hospital of Soochow
University, Suzhou, China,Jiangsu Key Laboratory of
Neuropsychiatric Diseases and Institute of Neuroscience,
Soochow
University, Suzhou, China,Yan-ping Gao, Department of Anesthesiology,
The Affiliated Zhangjiagang Hospital of Soochow University, 68, Jiyang West
Road, Suzhou 215600, China. and Guang-Yin
Xu, Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of
Neuroscience, Soochow University, Suzhou 215123, China.
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Post-thoracotomy Pain Syndrome. Curr Pain Headache Rep 2022; 26:677-681. [PMID: 35816220 DOI: 10.1007/s11916-022-01069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This article reviews PTPS demographics, diagnosis, pathophysiology, surgical and anesthetic techniques, and their role in preventing PTPS along with updated treatment options. RECENT FINDINGS Post-thoracotomy pain syndrome (PTPS) can be incapacitating. The neuropathic type pain of PTPS is along the incision site and persists at least 2 months postoperatively. There is a wide reported range of prevalence of PTPS. There are several risk factors that have been identified including surgical technique and younger age. Several surgical and anesthetic techniques have been trialed to reduce pain after thoracotomy. Multimodal pain control is the suggested long-term treatment plan for patients with PTPS. There are several factors that can be modified to reduce pain and incidence of PTPS during the perioperative period and the use of multimodal analgesia is suggested for the treatment of PTPS.
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10
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Wang H, Li K, Wang Q, Liu X, Zhao X, Zhong Z, Gu C, Li R. Magnetic Resonance Neurography for Evaluation of Dorsal Root Ganglion Morphology. World Neurosurg 2021; 154:e54-e60. [PMID: 34224889 DOI: 10.1016/j.wneu.2021.06.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In this study, the morphologic characteristics and anatomic position of the dorsal root ganglion (DRG) were measured and analyzed in healthy people using magnetic resonance neurography (MRN), which provided an anatomical reference for minimally invasive spinal surgery. METHODS From January 2018 to December 2019, 20 healthy adult volunteers (10 male and 10 female volunteers between 20 and 65 years old) were scanned and imaged by 3.0 T magnetic resonance imaging combined with neuroimaging technology. Here, the position of the DRG was located, and the shape and size of the DRG, as well as its distance to the upper pedicle, were measured. RESULTS All volunteers provided satisfactory MRN scans of the L1-S1 lumbar DRG. According to the spatial position of the DRG, the morphology of the DRG can be divided into the intervertebral foramen type (81.01%), intraspinal type (16.01%), extraforaminal type (0.8%), and mixed type (2.0%). CONCLUSIONS The intervertebral foramen type and Intraspinal type were observed to be the main distribution forms of lumbar DRG. Due to the downward movement of lumbar segments, the position of the DRG was noted to gradually move to the spinal canal while its volume gradually increased. In addition, the distance from the upper pedicle was found to decrease gradually. MRN imaging can clearly show the shape, location, and adjacent relationship of the DRG, providing effective imaging guidance for the minimally invasive lumbar techniques.
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Affiliation(s)
- Hongwei Wang
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China.
| | - Kaixiang Li
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Qingyun Wang
- Department of Radiology, Dongguan Tungwah Hospital, Dongguan, China
| | - Xiaoqiang Liu
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Xiangjun Zhao
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Zhanghua Zhong
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Changwei Gu
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Ruibing Li
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
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11
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Lo Bianco G, Papa A, Schatman ME, Tinnirello A, Terranova G, Leoni MLG, Shapiro H, Mercadante S. Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques. J Clin Med 2021; 10:2303. [PMID: 34070601 PMCID: PMC8198659 DOI: 10.3390/jcm10112303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/24/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients. METHODS Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19 patients. RESULTS Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.
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Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy;
- Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy
| | - Alfonso Papa
- Pain Department, AO “Ospedali dei Colli”, Monaldi Hospital, 80131 Naples, Italy;
| | - Michael E. Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA;
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Andrea Tinnirello
- Anesthesiology and Pain Management Unit, Azienda Socio Sanitaria Territoriale della Franciacorta, 25032 Chiari, Italy
| | - Gaetano Terranova
- Anaesthesia and Intensive Care Department, Asst Gaetano Pini, 20122 Milano, Italy;
| | | | - Hannah Shapiro
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Sebastiano Mercadante
- Pain Relief and Supportive Care, Private Hospital La Maddalena, 90100 Palermo, Italy;
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Stelter B, Karri J, Marathe A, Abd-Elsayed A. Dorsal Root Ganglion Stimulation for the Treatment of Non-Complex Regional Pain Syndrome Related Chronic Pain Syndromes: A Systematic Review. Neuromodulation 2021; 24:622-633. [PMID: 33501749 DOI: 10.1111/ner.13361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND While the majority of indications and approvals for dorsal root ganglion stimulation (DRGS) are for the refractory management of complex regional pain syndrome (CRPS), emerging evidence has suggested that DRGS may be favorably used for a plethora of other chronic pain phenomena. Consequently, we aimed to characterize the use and efficacy of DRGS for these non-CRPS-related chronic pain syndromes. MATERIALS AND METHODS A systematic review of clinical studies demonstrating the use of DRGS for non-CRPS-related chronic pain syndromes. The literature search was performed using PubMed, Cochrane Library, and CINAHL plus across August and September 2020. RESULTS A total of 28 reports comprising 354 total patients were included in the analysis. Of the chronic pain syndromes presented, axial low back pain, chronic pelvic and groin pain, other peripheral neuropathies, and studies with multiple concomitant pain syndromes, a majority demonstrated >50% mean pain reduction at the time of last follow-up following DRGS. Physical function, quality of life (QOL), and lesser pain medication usage also were repeatedly reported to be significantly improved. CONCLUSIONS DRGS continues to lack supportive evidence from well designed, high level studies and recommendations from consensus committee experts. However, we present repeated and consistent evidence from lower level studies showing success with the use of DRGS for various non-CRPS chronic pain syndromes in reducing pain along with increasing function and QOL from one week to three years. Due to such low-level, high bias evidence, we strongly encourage the continuation of high-level studies in order to provide a stronger foundation for the use of DRGS in non-CRPS chronic pain patients. However, it may be reasonable and appropriate to evaluate patients for DRGS candidacy on a case-by-case basis particularly if they manifest focal pain syndromes refractory to noninterventional measures and may not be ideal candidates for other forms of neuromodulation.
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Affiliation(s)
- Bradly Stelter
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Anuj Marathe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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