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Berwal D, Branisteanu DD, Glickman M, Sagar A, Pilitsis JG. The sex-dependent impact of adipose tissue and inflammation on chronic pain - A cross-sectional study from the all of us research program. Cytokine 2024; 179:156614. [PMID: 38621331 DOI: 10.1016/j.cyto.2024.156614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
Emerging evidence suggests an association between chronic pain and elevated body fat. We sought to determine if individuals with higher body fat, measured by hip circumference (HC) and waist circumference (WC), are at risk for chronic pain when they demonstrate higher expression of inflammatory markers. We investigated the incidence and severity of pain in patients with varying WC/HC and inflammatory markers (C-Reactive Protein, IL-6, leptin) using the NIH-sponsored All of Us Database. For each inflammatory marker and sex, participants were divided into four groups based on combinations of normal/high marker levels and small/large WC/HC. We used statistical analysis to compare WC/HC and pain severity (mean NRS pain score) between groups of the same sex. In females, but not males, combinations of elevated CRP with large WC/HC exerted additive effects on the incidence of chronic pain (p < 0.01) and severe pain (p < 0.001), as well as on the severity of pain evaluated by the mean NRS pain score (p < 0.01). This relationship held true for females with high IL-6 or leptin and large WC or HC (p < 0.001 for chronic pain and severe pain incidence, and p < 0.05 for pain severity). Neither IL-6 nor leptin showed any significant impact on pain in males. Obesity status and CRP exert additive prognostic effects for chronic pain in females, but not in males. The concomitant evaluation of other inflammatory factors, such as IL-6 or leptin in females, may further augment the prediction of chronic pain. PERSPECTIVE: This article investigates the relationship between chronic pain, obesity, and inflammatory markers. It could help elucidating sex difference in pain mechanisms, as well as the risk factors for chronic pain, potentially improving patient diagnosis, follow-up and treatment.
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Affiliation(s)
- Deepak Berwal
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Dumitru D Branisteanu
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; Department of Endocrinology, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
| | - Mia Glickman
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Amit Sagar
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA.
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Elliott T, Merlano Gomez M, Morris D, Wilson C, Pilitsis JG. A scoping review of mechanisms of auricular acupuncture for treatment of pain. Postgrad Med 2024:1-11. [PMID: 38501597 DOI: 10.1080/00325481.2024.2333232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES Auricular acupuncture (AA) is becoming increasingly common in primary care clinics, emergency departments and peri-operatively for pain relief. Over the last decade, since the last comprehensive reviews were published, the literature has expanded. In this scoping review, we seek to document the efficacy of AA in treating both acute and chronic pain, describe the mechanism of action of AA in treating pain, and discuss how AA has been integrated into Western medicine to date. METHODS The authors performed a MEDLINE search inclusive of articles from 1966 to June 2023 including articles written in English identifying literature. We included human studies when more than 3 patients were included. Three hundred and fourteen unique articles were identified and 152 were selected by title screen. After abstract review, 117 were chosen for full-text review. Following full-text review, 33 articles were excluded and 21 added from references, totaling 105 articles included in our scoping review. RESULTS AA reduces pain severity in patients with both acute and chronic pain. The best studies in the acute settings have occurred in the peri-operative setting where sham AA is employed, multiple sessions of AA are given, and medication dosing is carefully monitored. In these cases, AA reduced pain and post-operative medications. In patients with chronic pain, multiple sessions of AA resulted not only in pain relief but also in improvements in function and disability. Literature suggests that AA works through multiple mechanisms with the most compelling data coupled to the autonomic nervous system and neuroendocrine system. Curriculums designed to teach AA and aid in implementation have been published. CONCLUSION AA is an accessible, effective means of pain relief. AA is relatively straightforward to learn, and protocols and curriculums exist to teach healthcare professionals this valuable skill. Overcoming implementation barriers, including patient education, are essential next steps.
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Affiliation(s)
- Trish Elliott
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Maria Merlano Gomez
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Deborah Morris
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Candy Wilson
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA
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Bean LL, Goon M, McClure JJ, Aguiar RST, Kato N, DiMarzio M, Pilitsis JG. The Evolution of Surgical Technique in Spinal Cord Stimulation: A Scoping Review. Oper Neurosurg (Hagerstown) 2024; 26:372-380. [PMID: 37976139 DOI: 10.1227/ons.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
Since the advent of spinal cord stimulation (SCS), its operative technique has consistently advanced. We performed a scoping review of the literature regarding SCS operative techniques to highlight key advancements. To review, summarize, and highlight key changes in SCS implantation techniques since their inception. The authors performed a MEDLINE search inclusive of articles from 1967 to June 2023 including human and modeling studies written in English examining the role of trialing, intraoperative neuromonitoring, and surgical adaptations. Using the Rayyan platform, two reviewers performed a blinded title screen. Of the 960 articles, 197 were included in the title screen, 107 were included in the abstract review, and ultimately 69 articles met inclusion criteria. We examined the utility of trialing and found that historical controls showed significant efficacy, whereas recent results are more equivocal. We discuss the significant improvement in outcomes with intraoperative neuromonitoring for asleep SCS placement. We highlight technique improvements that led to significant reductions in infection, lead migration, and inadequate pain relief. Physicians implanting SCS systems for chronic pain management must continually refine their surgical techniques to keep up with this rapidly evolving therapy. In addition, through collaborative efforts of neuromodulators and industry, SCS is safer and more effective for patients suffering from chronic pain.
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Affiliation(s)
- Lindsay L Bean
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Madison Goon
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Jesse J McClure
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Rodrigo S T Aguiar
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Nicholas Kato
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Marisa DiMarzio
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
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Goudman L, Moens M, Pilitsis JG. Incidence and Prevalence of Pain Medication Prescriptions in Pathologies with a Potential for Chronic Pain. Anesthesiology 2024; 140:524-537. [PMID: 38081041 DOI: 10.1097/aln.0000000000004863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Heightened risks of dependence, addiction, anxiolytic effects, or prescription overdose death due to long-term use of pain medication have increased awareness about extended pain medication use in chronic pain populations. The goal of this study was to evaluate the incidence and prevalence of pain medication prescriptions from 2012 to 2022 in common pathologies with a potential for chronic pain. METHODS A retrospective cohort study was conducted using electronic health records from TriNetX (Cambridge, Massachusetts) Global Collaborative Network. For 10 distinct cohorts (total n = 9,357,584 patients), pain medication prescriptions were extracted for five classes, namely nonsteroidal anti-inflammatory drug (NSAIDs) and acetaminophen, opioids, gabapentinoids, neuropathic mood agents, and muscle relaxants. Annual incidence and prevalence of each class of medication were evaluated for the past 11 yr. RESULTS From 2012 to 2022, there was a significant increase in prescriptions of NSAIDs, except for patients with fibromyalgia, and persistent spinal pain syndrome (PSPS) type 2. Interestingly, over time, prescriptions of opioids in patients with complex regional pain syndrome, endometriosis, osteoarthritis, and PSPS type 2 increased, as did prescriptions of muscle relaxants for all cohorts except those with fibromyalgia. Incidence of prescriptions of neuropathic mood agents is high for patients with complex regional pain syndrome (both types) and PSPS type 2. Only for benzodiazepines did there seem to be a decline over the years, with a significantly decreased time trend in patients with complex regional pain syndrome type 1, fibromyalgia, and PSPS type 2. CONCLUSIONS During the last 11 yr, an increase in incidence of NSAIDs and acetaminophen, opioids, neuropathic agents, and muscle relaxants was observed. Only prescriptions of benzodiazepines significantly decreased over time in specific cohorts. Overall, patients with PSPS type 2 and complex regional pain syndrome (both types) consume a broad variety of pain medication classes. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Lisa Goudman
- Faculty of Medicine and Pharmacy for reSearch and TeachIng NeuroModULation Uz BruSsel (STIMULUS) Research Group, Center for Neurosciences (C4N), and Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Research Foundation Flanders, Brussels, Belgium; Florida Atlantic University, Boca Raton, Florida
| | - Maarten Moens
- Faculty of Medicine and Pharmacy for reSearch and TeachIng NeuroModULation Uz BruSsel (STIMULUS) Research Group, Center for Neurosciences (C4N), and Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; and Departments of Neurosurgery and Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
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Paredes Mogica JA, Feigenbaum F, Pilitsis JG, Schrot RJ, Oaklander AL, De EJB. Sacral Tarlov perineurial cysts: a systematic review of treatment options. J Neurosurg Spine 2024; 40:375-388. [PMID: 38100766 DOI: 10.3171/2023.9.spine23559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 12/17/2023]
Abstract
Tarlov perineurial spinal cysts (TCs) are an underrecognized cause of spinal neuropathic symptoms. TCs form within the sensory nerve root sleeves, where CSF extends distally and can accumulate pathologically. Typically, they develop at the sacral dermatomes where the nerve roots are under the highest hydrostatic pressure and lack enclosing vertebral foramina. In total, 90% of patients are women, and genetic disorders that weaken connective tissues, e.g., Ehlers-Danlos syndrome, convey considerable risk. Most small TCs are asymptomatic and do not require treatment, but even incidental visualizations should be documented in case symptoms develop later. Symptomatic TCs most commonly cause sacropelvic dermatomal neuropathic pain, as well as bladder, bowel, and sexual dysfunction. Large cysts routinely cause muscle atrophy and weakness by compressing the ventral motor roots, and multiple cysts or multiroot compression by one large cyst can cause even greater cauda equina syndromes. Rarely, giant cysts erode the sacrum or extend as intrapelvic masses. Disabling TCs require consideration for surgical intervention. The authors' systematic review of treatment analyzed 31 case series of interventional percutaneous procedures and open surgical procedures. The surgical series were smaller and reported somewhat better outcomes with longer term follow-up but slightly higher risks. When data were lacking, authorial expertise and case reports informed details of the specific interventional and surgical techniques, as well as medical, physical, and psychological management. Cyst-wrapping surgery appeared to offer the best long-term outcomes by permanently reducing cyst size and reconstructing the nerve root sleeves. This curtails ongoing injury to the axons and neuronal death, and may also promote axonal regeneration to improve somatic and autonomic sacral nerve function.
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Affiliation(s)
| | - Frank Feigenbaum
- 2Department of Neurosurgery, Feigenbaum Neurosurgery, Dallas, Texas
| | - Julie G Pilitsis
- 3Department of Neurosurgery, Florida Atlantic University, Boca Raton, Florida
| | - Rudolph J Schrot
- 4Department of Neurosurgery, Sutter Medical Center Sacramento, Sacramento, California
| | - Anne Louise Oaklander
- 5Departments of Neurology and Pathology (Neuropathology), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Elise J B De
- 6Department of Urology, Albany Medical College, Albany, New York
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6
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Kolls BJ, Muir KW, Savitz SI, Wechsler LR, Pilitsis JG, Rahimi S, Beckman RL, Holmes V, Chen PR, Albers DS, Laskowitz DT. Experience with a hybrid recruitment approach of patient-facing web portal screening and subsequent phone and medical record review for a neurosurgical intervention trial for chronic ischemic stroke disability (PISCES III). Trials 2024; 25:150. [PMID: 38419030 PMCID: PMC10900735 DOI: 10.1186/s13063-024-07988-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Recruitment of participants is the greatest risk to completion of most clinical trials, with 20-40% of trials failing to reach the targeted enrollment. This is particularly true of trials of central nervous system (CNS) therapies such as intervention for chronic stroke. The PISCES III trial was an invasive trial of stereotactically guided intracerebral injection of CTX0E03, a fetal derived neural stem cell line, in patients with chronic disability due to ischemic stroke. We report on the experience using a novel hybrid recruitment approach of a patient-facing portal to self-identify and perform an initial screen for general trial eligibility (tier 1), followed by phone screening and medical records review (tier 2) prior to a final in-person visit to confirm eligibility and consent. METHODS Two tiers of screening were established: an initial screen of general eligibility using a patient-facing web portal (tier 1), followed by a more detailed screen that included phone survey and medical record review (tier 2). If potential participants passed the tier 2 screen, they were referred directly to visit 1 at a study site, where final in-person screening and consent were performed. Rates of screening were tracked during the period of trial recruitment and sources of referrals were noted. RESULTS The approach to screening and recruitment resulted in 6125 tier 1 screens, leading to 1121 referrals to tier 2. The tier 2 screening resulted in 224 medical record requests and identification of 86 qualifying participants for referral to sites. The study attained a viable recruitment rate of 6 enrolled per month prior to being disrupted by COVID 19. CONCLUSIONS A tiered approach to eligibility screening using a hybrid of web-based portals to self-identify and screen for general eligibility followed by a more detailed phone and medical record review allowed the study to use fewer sites and reduce cost. Despite the difficult and narrow population of patients suffering moderate chronic disability from stroke, this strategy produced a viable recruitment rate for this invasive study of intracranially injected neural stem cells. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03629275.
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Affiliation(s)
- Brad J Kolls
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
- Department of Neurology, Duke University School of Medicine, Duke Box 2900 Bryan Research Building, 311 Research Drive, Durham, NC, 27710, USA.
| | - Keith W Muir
- School of Psychology & Neuroscience, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston, TX, USA
| | - Lawrence R Wechsler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Scott Rahimi
- Department of Neurosurgery, Medical College of Georgia, Augusta, GA, USA
| | | | | | - Peng R Chen
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA
| | | | - Daniel T Laskowitz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Neurology, Duke University School of Medicine, Duke Box 2900 Bryan Research Building, 311 Research Drive, Durham, NC, 27710, USA
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Berwal D, Quintero A, Telkes I, DiMarzio M, Harland T, Paniccioli S, Dalfino J, Iyassu Y, McLaughlin BL, Pilitsis JG. Improved Selectivity in Eliciting Evoked Electromyography Responses With High-Resolution Spinal Cord Stimulation. Neurosurgery 2024:00006123-990000000-01063. [PMID: 38376181 DOI: 10.1227/neu.0000000000002878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/29/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES As spinal cord stimulation (SCS) offers a therapy for increasing numbers of patients with chronic pain and spinal cord injury, it becomes increasingly important to better understand its somatotopy. In this prospective study, we investigate whether high-resolution SCS (HR-SCS) offers improved selectivity assessed through elicitation of evoked electromyography (EMG) responses as compared with commercial paddle leads. METHODS Vertical tripole configurations were used to elicit EMG responses in both types of paddles placed for standard-of-care indications between T6 and T10. In HR-SCS, evoked EMG responses in lower extremity/abdominal muscle groups were monitored at 6 to 8 mediolateral sites. All commercial paddle columns were tested. Percentage change in the maximum root mean square value was calculated at a group level. Heat maps were generated to identify responders for each muscle group. Responders were considered patients who had a >50% change in root mean square over baseline. RESULTS We demonstrated significantly greater motor responses across medial and lateral contacts and greater responder rates consistently at the T6 and T9 levels with HR-SCS as compared with commercial paddles in 18 patients. Distal muscle groups (gastrocnemius and tibialis anterior) and proximal muscle groups (biceps femoris and quadriceps) were selectively activated at both levels. CONCLUSION We demonstrate that HR-SCS has greater selectivity in eliciting evoked EMG responses in an intraoperative setting. HR-SCS offers recruitment of muscle groups at lateral contacts concurrently with medial contacts. We provide data that HR-SCS may provide higher spatial resolution, which has the potential to allow for personalization of care and treatment of pain syndromes/symptoms which to date have not been effectively treated.
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Affiliation(s)
- Deepak Berwal
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - Alejandra Quintero
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - Ilknur Telkes
- Department of Biomedical Sciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - Marisa DiMarzio
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - Tessa Harland
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | | | - John Dalfino
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | | | | | - Julie G Pilitsis
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Neurosurgery, University of Arizona- Tucson, Tucson, Arizona, USA
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8
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Mayer R, Desai K, Aguiar RSDT, McClure JJ, Kato N, Kalman C, Pilitsis JG. Evolution of Deep Brain Stimulation Techniques for Complication Mitigation. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01044. [PMID: 38315020 DOI: 10.1227/ons.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024] Open
Abstract
Complication mitigation in deep brain stimulation has been a topic matter of much discussion in the literature. In this article, we examine how neurosurgeons as individuals and as a field generated and adapted techniques to prevent infection, lead fracture/lead migration, and suboptimal outcomes in both the acute period and longitudinally. The authors performed a MEDLINE search inclusive of articles from 1987 to June 2023 including human studies written in English. Using the Rayyan platform, two reviewers (J.P. and R.M.) performed a title screen. Of the 776 articles, 252 were selected by title screen and 172 from abstract review for full-text evaluation. Ultimately, 124 publications were evaluated. We describe the initial complications and inefficiencies at the advent of deep brain stimulation and detail changes instituted by surgeons that reduced them. Furthermore, we discuss the trend in both undesired short-term and long-term outcomes with emphasis on how surgeons recognized and modified their practice to provide safer and better procedures. This scoping review adds to the literature as a guide to both new neurosurgeons and seasoned neurosurgeons alike to understand better what innovations have been trialed over time as we embark on novel targets and neuromodulatory technologies.
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Affiliation(s)
- Ryan Mayer
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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9
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Goudman L, Pilitsis JG, Billet B, De Vos R, Hanssens K, Billot M, Roulaud M, Rigoard P, Moens M. The level of agreement between the numerical rating scale and visual analogue scale for assessing pain intensity in adults with chronic pain. Anaesthesia 2024; 79:128-138. [PMID: 38058100 DOI: 10.1111/anae.16151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 12/08/2023]
Abstract
The numerical rating scale and visual analogue scale are used to quantify pain intensity. However, it has not yet been explored whether these scores are interchangeable in adults with chronic pain. Data from the prospective multicentre cross-sectional INTERVAL study were used to evaluate the one-dimensionality and agreement between numerical rating scale scores and visual analogue scale scores in adults with chronic pain. Pain intensity scores using the numerical rating scale and visual analogue scale were provided by 366 patients with chronic pain for current, average, minimal and maximal pain. To evaluate whether pain intensity scales are completed in accordance with each other, the proportion of patients who satisfied the following condition was calculated: minimal pain intensity ≤ maximal pain intensity. A factor analysis confirmed the one-dimensionality of the pain measures. A significant difference was found between numerical rating scale and visual analogue scale scores for average, current, minimum and maximum pain. Intra-class correlation coefficient estimates ranged from 0.739 to 0.858 and all measures failed to show sufficient and acceptable agreement at the 95% level. The strength of agreement between pain severity categories was classified as 'moderate' for average and minimal pain and 'substantial' for current and maximal pain. The proportion of patients who scored minimal pain ≤ maximal pain was 97.5% for the numerical rating scale and 89.5% for the visual analogue scale. This study failed to show an acceptable agreement between the numerical rating scale and visual analogue scale when pain intensity was rated by adults with chronic pain, despite showing both scales measure the same information.
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Affiliation(s)
- L Goudman
- STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - J G Pilitsis
- Florida Atlantic University, Boca Raton, FL, USA
| | - B Billet
- STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium
- Pain Clinic, AZ Delta, Roeselare, Belgium
| | - R De Vos
- Pain Clinic, AZ Delta, Roeselare, Belgium
| | - K Hanssens
- Pain Clinic, AZ Delta, Roeselare, Belgium
| | - M Billot
- PRISMATICS Lab, Poitiers University Hospital, Poitiers, France
| | - M Roulaud
- PRISMATICS Lab, Poitiers University Hospital, Poitiers, France
| | - P Rigoard
- PRISMATICS Lab, Poitiers University Hospital, Poitiers, France
- Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France
| | - M Moens
- STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium
- Departments of Neurosurgery and Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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10
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Goudman L, Demuyser T, Pilitsis JG, Billot M, Roulaud M, Rigoard P, Moens M. Gut dysbiosis in patients with chronic pain: a systematic review and meta-analysis. Front Immunol 2024; 15:1342833. [PMID: 38352865 PMCID: PMC10862364 DOI: 10.3389/fimmu.2024.1342833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Recent evidence supports the contribution of gut microbiota dysbiosis to the pathophysiology of rheumatic diseases, neuropathic pain, and neurodegenerative disorders. The bidirectional gut-brain communication network and the occurrence of chronic pain both involve contributions of the autonomic nervous system and the hypothalamic pituitary adrenal axis. Nevertheless, the current understanding of the association between gut microbiota and chronic pain is still not clear. Therefore, the aim of this study is to systematically evaluate the existing knowledge about gut microbiota alterations in chronic pain conditions. Methods Four databases were consulted for this systematic literature review: PubMed, Web of Science, Scopus, and Embase. The Newcastle-Ottawa Scale was used to assess the risk of bias. The study protocol was prospectively registered at the International prospective register of systematic reviews (PROSPERO, CRD42023430115). Alpha-diversity, β-diversity, and relative abundance at different taxonomic levels were summarized qualitatively, and quantitatively if possible. Results The initial database search identified a total of 3544 unique studies, of which 21 studies were eventually included in the systematic review and 11 in the meta-analysis. Decreases in alpha-diversity were revealed in chronic pain patients compared to controls for several metrics: observed species (SMD= -0.201, 95% CI from -0.04 to -0.36, p=0.01), Shannon index (SMD= -0.27, 95% CI from -0.11 to -0.43, p<0.001), and faith phylogenetic diversity (SMD -0.35, 95% CI from -0.08 to -0.61, p=0.01). Inconsistent results were revealed for beta-diversity. A decrease in the relative abundance of the Lachnospiraceae family, genus Faecalibacterium and Roseburia, and species of Faecalibacterium prausnitzii and Odoribacter splanchnicus, as well as an increase in Eggerthella spp., was revealed in chronic pain patients compared to controls. Discussion Indications for gut microbiota dysbiosis were revealed in chronic pain patients, with non-specific disease alterations of microbes. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023430115.
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Affiliation(s)
- Lisa Goudman
- STIMULUS (Research and Teaching Neuromodulation Uz Brussel) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Thomas Demuyser
- Department Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium
- AIMS Lab, Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Julie G. Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
- Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Maarten Moens
- STIMULUS (Research and Teaching Neuromodulation Uz Brussel) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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11
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Harland TA, Staudt MD, Bandlamuri S, Juneja A, Pilitsis JG, Sukul VV. Predictors of Skip Laminotomy for Placement of Paddle Leads for Spinal Cord Stimulation. Neuromodulation 2024; 27:183-187. [PMID: 37632516 DOI: 10.1016/j.neurom.2023.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVES Placement of a standard paddle lead for spinal cord stimulation (SCS) requires a laminotomy for positioning of the lead within the epidural space. During initial placement, an additional laminotomy or laminectomy, termed a "skip" laminotomy, may be necessary at a higher level to pass the lead to the appropriate midline position. Patient and radiographic factors that predict the need for a skip laminotomy have yet to be identified. MATERIALS AND METHODS Participants who underwent SCS paddle placement at Albany Medical Center between 2016 and 2017 were identified. Operative reports were reviewed to identify the paddle type, level of initial laminotomy, target level, and skip laminotomy level. Preoperative thoracic magnetic resonance images (MRIs) were reviewed, and spinal canal diameter, interpedicular distance, and dorsal cerebral spinal fluid thickness were measured for each participant when available. RESULTS A total of 106 participants underwent thoracic SCS placement. Of these, 97 had thoracic MRIs available for review. Thirty-eight participants required a skip laminotomy for placement of the paddle compared with 68 participants who did not. There was no significant difference in demographic features including age, sex, body mass index, and surgical history. Univariate analyses that suggested trends were selected for further analysis using binary logistic regression. Level of initial laminotomy (odds ratio [OR] = 1.51, p = 0.028), spinal canal diameter (OR = 0.71, p = 0.015), and dorsal cerebrospinal fluid thickness (OR = 0.61, p = 0.011) were correlated with skip laminotomy. Target level (OR = 1.27, p = 0.138) and time from trial (1.01, p = 0.117) suggested potential association. The multivariate regression was statistically significant, X2(10) = 28.02, p = 0.002. The model explained 38.3% of the variance (Nagelkerke R2) and predicted skip laminectomy correctly in 73.3% of cases. However, for the multivariate regression, only a decrease in spinal canal diameter (OR = 0.59, p = 0.041) was associated with a greater odds of skip laminotomy. CONCLUSIONS This study aims to characterize the patient and radiographic factors that may predict the need to perform a skip laminotomy during the initial placement of SCS paddles. Here, we show that radiographic and anatomic variables, primarily spinal canal diameter, play an important role in predicting the need for a skip laminotomy. Furthermore, we suggest that target level for placement and level of initial laminotomy also may contribute. Further investigation of the predictive factors for performing a skip laminotomy would help optimize surgical planning and preoperative patient selection and counseling.
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Affiliation(s)
- Tessa A Harland
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Michael D Staudt
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, MI, USA
| | - Sruti Bandlamuri
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Ankit Juneja
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Vishad V Sukul
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
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12
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Hani Abdullah UE, Kelly S, Ricker A, Nabage M, Khazen O, Telkes I, DiMarzio M, Wilson C, Pilitsis JG. Perceptions of pain in aging females undergoing spinal cord stimulation. Pain Manag 2023; 13:701-708. [PMID: 38193309 DOI: 10.2217/pmt-2023-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Aim: Effects of age and sex on chronic pain outcomes following spinal cord stimulation (SCS) have not yet been assessed. Methods: We retrospectively reviewed 1 year outcomes from a database of patients receiving thoracic SCS. Subjects were divided into four cohorts: pre-menopausal and post-menopausal females, and aged-matched males. Improvement using the numerical rating scale, Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), McGill Pain Questionnaire and Pain Catastrophizing Scale (PCS) was assessed. Results: Older females were notably different from males and females under 60 as they had greater improvements in ODI, BDI and PCS. Further, females ≥60 had greater improvement in PCS compared with males ≥60. Conclusion: Our findings suggest greater improvement with 1 year SCS treatment in post-menopausal females, compared with age-matched males.
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Affiliation(s)
- Umm E Hani Abdullah
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr, West Lafayette, IN 47907, USA
| | - Sophie Kelly
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Adam Ricker
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Melisande Nabage
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Olga Khazen
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Ilknur Telkes
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Marisa DiMarzio
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Candy Wilson
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, USA
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
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13
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Harland TA, Pilitsis JG, Selden NR, Benzil DL. An assessment of the long-term impacts of the coronavirus disease 2019 pandemic on academic neurosurgery. J Neurosurg 2023; 139:1741-1747. [PMID: 37148231 DOI: 10.3171/2023.4.jns23368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/07/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The goal of this study was to survey residents, fellows, and residency program leadership to assess the long-term impacts of the coronavirus disease 2019 (COVID-19) on residency training by using a structured survey methodology. METHODS A survey was distributed to US neurosurgical residents and fellows (n = 2085) as well as program directors (PDs) and chairs (n = 216) in early 2022. Bivariate analysis was performed to identify factors associated with a decreased likelihood of pursuing a career in academic neurosurgery because of the pandemic, a perception that surgical skills preparation was negatively impacted, personal financial concerns, and a preference for remote education. Significant differences in the bivariate analysis underwent further multivariate logistic regression analysis to evaluate for predictors of these outcomes. RESULTS An analysis of complete surveys from 264 residents and fellows (12.7%) and 38 PDs and chairs (17.6%) was performed. Over half of the residents and fellows (50.8%) believed that their surgical skills preparation was negatively impacted by the pandemic, and a notable proportion believed that they were less likely to go into academics because of the pandemic's impact on their professional (20.8%) and personal (28.8%) life. Those less likely to pursue academics were more likely to report that work-life balance did not improve (p = 0.049), personal financial concerns increased (p = 0.01), and comradery among residents (p = 0.002) and with faculty (p = 0.001) did not improve. Residents who indicated they were less likely to go into academics were also more likely to have been redeployed (p = 0.038). A large majority of PDs and chairs indicated that the pandemic resulted in financial setbacks for their departments (71.1%) and institutions (84.2%), with 52.6% reporting reduced faculty compensation. Financial setbacks at the institutional level were associated with a worsened opinion of hospital leadership (p = 0.019) and reports of a reduced quality of care for non-COVID-19 patients (p = 0.005) but not from faculty member losses (p = 0.515). A plurality of trainees (45.5%) reported a preference for a remote format for educational conferences compared to 37.1% who disagreed. CONCLUSIONS This study provides a cross-section of the pandemic's impact on academic neurosurgery, highlighting the importance of continued efforts to assess and address the long-term consequences of the COVID-19 pandemic for US academic neurosurgery.
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Affiliation(s)
- Tessa A Harland
- 1Department of Neurological Surgery, Albany Medical College, Albany, New York
| | - Julie G Pilitsis
- 2Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Nathan R Selden
- 3Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Deborah L Benzil
- 4Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
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14
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Pilitsis JG. In Reply: A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder. Neurosurgery 2023; 93:e140. [PMID: 37695040 DOI: 10.1227/neu.0000000000002678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
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15
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Goudman L, Moens M, Kelly S, Young C, Pilitsis JG. Incidence of Infections, Explantations, and Displacements/Mechanical Complications of Spinal Cord Stimulation During the Past Eight Years. Neuromodulation 2023:S1094-7159(23)00744-4. [PMID: 37855766 DOI: 10.1016/j.neurom.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES The overall awareness and potential of real-world data have drastically increased in the medical field, with potential implications for postmarket medical device surveillance. The goal of this study was to evaluate real-world data on incidence of infections, explantations, and displacements/mechanical complications of spinal cord stimulation (SCS) during the past eight years and to forecast point estimates for the upcoming three years on the basis of the identified patterns. MATERIALS AND METHODS Based on electronic health records from 80 healthcare organizations within the TriNetX data base in the USA, data of 11,934 patients who received SCS as treatment for persistent spinal pain syndrome type 2 (PSPS T2) were extracted. Events of interest were explantations and displacements/mechanical complications of both the lead and implanted pulse generator (IPG), in addition to infection rates from 2015 to 2022. Mann-Kendall tests were performed to detect monotonic trends in the time series. Forecasts were conducted for the upcoming three years for every event of interest. RESULTS Statistically significant increasing time trends were revealed for the annual incidence of IPG and lead displacements/mechanical complications in patients with PSPS T2 over the past eight years. These time trends were visible in both male and female patients and in smokers and nonsmokers. For annual incidence of explantations and infections, no significant time effect was observed. In 2025, the incidence of displacements/mechanical complications of the lead (3.07%) is predicted to be the highest, followed by explantations of the IPG (2.67%) and lead (2.02%). CONCLUSIONS Based on real world data, device explantation was the most frequent event of interest, with negative peaks in the time series in 2016 and 2020, presumably due to the introduction of rechargeable pulse generators and to the COVID-19 pandemic, respectively.
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Affiliation(s)
- Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Sophie Kelly
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Christopher Young
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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16
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Olinger C, Vest J, Tarasek M, Yeo D, DiMarzio M, Burdette C, Williams E, Khazen O, Pilitsis JG. MR thermometry imaging for low intensity focused ultrasound modulation of spinal nervous tissue. Magn Reson Imaging 2023; 101:35-39. [PMID: 37004795 PMCID: PMC10804415 DOI: 10.1016/j.mri.2023.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Previously in rodent and swine models, we have shown that external low intensity focused ultrasound (liFUS) can be used to modulate pain responses. To ensure no adverse heating events occur with liFUS modulation in a non-invasive manner, we perform initial work in swine to show that magnetic resonance thermometry imaging (MRTI) is capable of measuring <2.0 °C changes at the L5 DRG. Further, we show that our device can be constructed in an MR-compatible fashion to minimize artifact. METHODS Three MRTI techniques (referenceless, corrected proton resonance frequency shift (PRFS), and PRFS) were applied to assess accuracy of detecting thermal changes at the L5 DRG in unheated euthanized swine. A region of interest (ROI) that includes the L5 DRG was delineated, within which MRTI temperature changes were spatially averaged (ground truth 0 °C). In separate experiments with phantoms, B0 field-inhomogeneity, RF transmit (B1+) and fast gradient echo (fSPGR) magnitude images were acquired to downselect liFUS device materials that produce the least MRI artifacts. RESULTS Referenceless, corrected PRFS, and PRFS MRTI resulted in temperature measurements of 0.8 ± 1.1 °C, 1.1 ± 1.3 °C and 5.2 ± 5 °C, respectively. Both materials caused B0 perturbation but minimal B1+ and MRTI artifacts. The presence of imaging artifacts did not preclude thermal imaging of the region. SIGNIFICANCE We provide preliminary data suggesting that referenceless MRTI can adequately detect small thermal changes at the DRG that may occur with neuromodulation, which is one of the first steps in creating a table of safe parameters for liFUS therapy in humans.
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Affiliation(s)
- Clayton Olinger
- Department of Biomedical Science, Florida Atlantic University, Boca Raton, FL, United States of America
| | - Jonah Vest
- Department of Biomedical Science, Florida Atlantic University, Boca Raton, FL, United States of America
| | | | - Desmond Yeo
- GE Global Research, Niskayuna, NY, United States of America
| | - Marisa DiMarzio
- Department of Biomedical Science, Florida Atlantic University, Boca Raton, FL, United States of America
| | - Clif Burdette
- Acoustic Medsystems, Savoy, IL, United States of America
| | - Emery Williams
- Acoustic Medsystems, Savoy, IL, United States of America
| | - Olga Khazen
- Department of Biomedical Science, Florida Atlantic University, Boca Raton, FL, United States of America
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, FL, United States of America.
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17
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Berwal D, Telkes I, Agarwal S, Paniccioli S, McCarthy K, DiMarzio M, McLaughlin B, Pilitsis JG. Investigation of the intraoperative cortical responses to spinal motor mapping in a patient with chronic pain. J Neurophysiol 2023; 130:768-774. [PMID: 37609700 PMCID: PMC10649839 DOI: 10.1152/jn.00221.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023] Open
Abstract
Intraoperative neurophysiological monitoring (IONM) in spinal cord stimulation (SCS) surgery for chronic pain is shown to provide effective guidance during device placement. Electromyography (EMG) is used to determine the laterality of the paddle. In some SCS cases, laterality cannot be obtained via EMG due to patient physiology. Electroencephalography (EEG) is already used in IONM to monitor cortical responses. Here, we show proof-of-concept of assessing the responses of epidurally evoked EMGs simultaneously with EEGs to determine laterality during IONM using a high-resolution (HR) SCS paddle. An 8-column HR-SCS paddle was acutely placed at T9-T10 interspace in patients with failed back surgery syndrome. EMG signals from 18 muscle groups were recorded simultaneously with 60-channel EEG signals at various stimulation amplitudes (0-10 mA). Particular attention was paid to regions associated with pain including the somatosensory cortex (S1), prefrontal cortex (PFC), and motor cortex (M1). When left and right lateral contacts were stimulated at low amplitudes (1-2 mA), significant changes were seen in θ, α, and β powers in the contralateral PFC but not in M1 or S1. There was a significant correlation between M1 and contralateral contacts in α power. At higher currents (7-8 mA), right-sided contacts resulted in α power change. We found significant differences in α, θ, and β powers in PFC for contralateral stimulation of the lateral SCS contacts at low amplitudes and in α power at higher amplitudes. The changes in PFC suggest the potential of EEG for understanding a cortical mechanism of action of SCS and provide insight into the pathophysiology of chronic pain.NEW & NOTEWORTHY Here, we present proof of concept of assessing the responses of epidurally evoked electromyography simultaneously with scalp electroencephalography to determine whether both laterality and insights into pain mechanisms can be elucidated. With stimulation, significant changes were seen in θ, α, and β band power in the contralateral prefrontal cortex and in α power in the motor cortex. We provide insight into the mechanism of action of SCS in preventing pain in this patient.
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Affiliation(s)
- Deepak Berwal
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States
| | - Ilknur Telkes
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States
| | - Shruti Agarwal
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States
| | | | - Kevin McCarthy
- Nuvasive Clinical Services, San Diego, California, United States
| | - Marisa DiMarzio
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, United States
| | | | - Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States
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18
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Staudt MD, Hayek SM, Rosenow JM, Narouze S, Arle JE, Pilitsis JG, Schwalb JM, Falowski SM, Sweet JA. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Occipital Nerve Stimulation for the Treatment of Patients With Medically Refractory Occipital Neuralgia: Update. Neurosurgery 2023; 93:493-495. [PMID: 37458729 DOI: 10.1227/neu.0000000000002578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/10/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The Guidelines Task Force conducted a systematic review of the relevant literature on occipital nerve stimulation (ONS) for occipital neuralgia (ON) to update the original 2015 guidelines to ensure timeliness and accuracy for clinical practice. OBJECTIVE To conduct a systematic review of the literature and update the evidence-based guidelines on ONS for ON. METHODS The Guidelines Task Force conducted another systematic review of the relevant literature, using the same search terms and strategies used to search PubMed and Embase for relevant literature. The updated search included studies published between 1966 and January 2023. The same inclusion/exclusion criteria as the original guideline were also applied. Abstracts were reviewed, and relevant full text articles were retrieved and graded. Of 307 articles, 18 were retrieved for full-text review and analysis. Recommendations were updated according to new evidence yielded by this update . RESULTS Nine studies were included in the original guideline, reporting the use of ONS as an effective treatment option for patients with medically refractory ON. An additional 6 studies were included in this update. All studies in the original guideline and this current update provide Class III evidence. CONCLUSION Based on the availability of new literature, the current article is a minor update only that does not result in modification of the prior recommendations: Clinicians may use ONS as a treatment option for patients with medically refractory ON.
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Affiliation(s)
- Michael D Staudt
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak , Michigan , USA
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester , Michigan , USA
| | - Salim M Hayek
- Department of Anesthesiology, University Hospitals Cleveland Medical Center, Cleveland , Ohio , USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Medical School, Chicago , Illinois , USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls , Ohio , USA
| | - Jeffrey E Arle
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston , Massachusetts , USA
| | - Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit , Michigan , USA
| | - Steven M Falowski
- Neurosurgical Associates of Lancaster, Lancaster , Pennsylvania , USA
| | - Jennifer A Sweet
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland , Ohio , USA
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19
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Hariharan V, Harland TA, Young C, Sagar A, Gomez MM, Pilitsis JG. Machine Learning in Spinal Cord Stimulation for Chronic Pain. Oper Neurosurg (Hagerstown) 2023; 25:112-116. [PMID: 37219574 PMCID: PMC10586864 DOI: 10.1227/ons.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Spinal cord stimulation (SCS) is an effective treatment for chronic neuropathic pain. The success of SCS is dependent on candidate selection, response to trialing, and programming optimization. Owing to the subjective nature of these variables, machine learning (ML) offers a powerful tool to augment these processes. Here we explore what work has been done using data analytics and applications of ML in SCS. In addition, we discuss aspects of SCS which have narrowly been influenced by ML and propose the need for further exploration. ML has demonstrated a potential to complement SCS to an extent ranging from assistance with candidate selection to replacing invasive and costly aspects of the surgery. The clinical application of ML in SCS shows promise for improving patient outcomes, reducing costs of treatment, limiting invasiveness, and resulting in a better quality of life for the patient.
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Affiliation(s)
- Varun Hariharan
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Tessa A. Harland
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Christopher Young
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Amit Sagar
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Maria Merlano Gomez
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Julie G. Pilitsis
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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20
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Mahoney-Rafferty EC, Tucker HR, Akhtar K, Herlihy R, Audil A, Shah D, Gupta M, Kochman EM, Feustel PJ, Molho ES, Pilitsis JG, Shin DS. Assessing the Location, Relative Expression and Subclass of Dopamine Receptors in the Cerebellum of Hemi-Parkinsonian Rats. Neuroscience 2023; 521:1-19. [PMID: 37116741 DOI: 10.1016/j.neuroscience.2023.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 04/30/2023]
Abstract
Parkinson's Disease (PD) is a neurodegenerative disease with loss of dopaminergic neurons in the nigrostriatal pathway resulting in basal ganglia (BG) dysfunction. This is largely why much of the preclinical and clinical research has focused on pathophysiological changes in these brain areas in PD. The cerebellum is another motor area of the brain. Yet, if and how this brain area responds to PD therapy and contributes to maintaining motor function fidelity in the face of diminished BG function remains largely unanswered. Limited research suggests that dopaminergic signaling exists in the cerebellum with functional dopamine receptors, tyrosine hydroxylase (TH) and dopamine transporters (DATs); however, much of this information is largely derived from healthy animals and humans. Here, we identified the location and relative expression of dopamine 1 receptors (D1R) and dopamine 2 receptors (D2R) in the cerebellum of a hemi-parkinsonian male rat model of PD. D1R expression was higher in PD animals compared to sham animals in both hemispheres in the purkinje cell layer (PCL) and granule cell layer (GCL) of the cerebellar cortex. Interestingly, D2R expression was higher in PD animals than sham animals mostly in the posterior lobe of the PCL, but no discernible pattern of D2R expression was seen in the GCL between PD and sham animals. To our knowledge, we are the first to report these findings, which may lay the foundation for further interrogation of the role of the cerebellum in PD therapy and/or pathophysiology.
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Affiliation(s)
- Emily C Mahoney-Rafferty
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Heidi R Tucker
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Kainat Akhtar
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Rachael Herlihy
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Aliyah Audil
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Dia Shah
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Megan Gupta
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Eliyahu M Kochman
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Eric S Molho
- Department of Neurology, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA; Department of Neurosurgery, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Damian S Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA; Department of Neurology, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
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21
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Goudman L, Pilitsis JG, Russo M, Slavin KV, Hayek SM, Billot M, Roulaud M, Rigoard P, Moens M. From pain intensity to a holistic composite measure for spinal cord stimulation outcomes. Br J Anaesth 2023:S0007-0912(23)00252-0. [PMID: 37328304 DOI: 10.1016/j.bja.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- Lisa Goudman
- STIMULUS Research Group (reSearch and TeachIng NeuroModULation Uz BruSsel), Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (Fonds voor Wetenschappelijk Onderzoek - FWO), Brussels, Belgium; Florida Atlantic University, Boca Raton, USA.
| | | | - Marc Russo
- Hunter Pain Specialists, Broadmeadow, Australia
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois Chicago, Chicago, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, USA
| | - Salim M Hayek
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery Laboratory), Poitiers University Hospital, Poitiers, France
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery Laboratory), Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery Laboratory), Poitiers University Hospital, Poitiers, France; Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, Poitiers, France; Prime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Maarten Moens
- STIMULUS Research Group (reSearch and TeachIng NeuroModULation Uz BruSsel), Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Szewczyk B, Johansen P, Tarasek M, Campwala Z, Trowbridge R, Zhao Z, Olmsted ZT, Bhushan C, Fiveland E, Ghoushal G, Heffter T, Tavakkolmoghaddam F, Bales C, Wang Y, Rajamani DK, Gandomi K, Nycz C, Jeannotte E, Mane S, Nalwalk J, Burdette C, Fischer GS, Yeo D, Qian J, Pilitsis JG. 209 What Happens to Brain Outside the Thermal Ablation Zones? An Assessment of Needle-Based Therapeutic Ultrasound in Survival Swine. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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23
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Patel NP, Kapural L, Jameson J, Johnson C, Calodney AK, Kosek P, Pilitsis JG, Bendel MA, Petersen EA, Wu C, Cherry T, Lad NP, Yu C, Sayed D, Goree J, Lyons MK, Sack A, Bruce D, Rubenstein F, Province-Azalde R, Caraway D. 139 Durable Pain Relief With 10 kHz Spinal Cord Stimulation for Patients With Refractory Back Pain Who are not Surgical Candidates. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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24
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Kandah M, Wilson C, Pilitsis JG. Role of Integrative Health on Neuropathic Pain. Curr Pain Headache Rep 2023; 27:49-55. [PMID: 36862302 DOI: 10.1007/s11916-023-01102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW Patients diagnosed with neuropathic pain experience continuous or intermittent spontaneous pain throughout their lives. Pharmacological treatments often provide limited relief; therefore, a multidisciplinary approach should be utilized to manage neuropathic pain. This review examines the current literature on integrative health modalities (anti-inflammatory diets, functional movement, acupuncture, meditation, and transcutaneous therapy) for treating patients with neuropathic pain. RECENT FINDINGS The use of an anti-inflammatory diet, functional movement, acupuncture, meditation, and transcutaneous therapy in treating neuropathic pain has been investigated in prior literature with positive outcomes. However, there remains a large void in evidence-based knowledge and clinical applicability for these interventions. Overall, integrative health offers a cost-efficient and harmless way of creating a multidisciplinary approach to managing neuropathic pain. There are many complementary approaches to treating neuropathic pain as part of an integrative medicine approach. Research is needed to explore other herbs and spices not yet reported in the peer-review literature. Additionally, follow-on research is needed to understand the clinical applicability of the proposed interventions as well as the dose and timing of the interventions to predict response and duration.
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Affiliation(s)
- Maya Kandah
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC 71, Room 235, Boca Raton, FL, 33431, USA
| | - Candy Wilson
- Christine E. Lynn, College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Florida Atlantic Univeristy, Boca Raton, FL, USA.
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25
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Prabhala T, Figueroa F, Harland T, Nabage MN, Pilitsis JG. The Use of Salvage Procedures for Wound Complications in Neuromodulation. World Neurosurg 2023; 171:e596-e604. [PMID: 36529435 DOI: 10.1016/j.wneu.2022.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Wound complications are a prevalent concern for neuromodulation procedures. While removal of the device was recommended, attempts to salvage expensive hardware have become commonplace. We examine our management in wound issues to aid in providing guidance for these situations. METHODS We identified 40 patients over an 8-year period in a large neuromodulation practice, who underwent washout or partial salvage of hardware. We examined the efficacy of washout and partial explants on the ability to salvage the implants. Covariates including age, sex, body mass index, smoking status, anticoagulation, and device type were considered. RESULTS There were 29 washouts and 10 partial hardware removal cases. Washouts were successful in 15/29 cases (51.7%), partial hardware removal was successful in 2/10 cases (20%), and removal with replacement was not successful (0 of 1). Washouts tended to be more successful than partial removal procedures (P = 0.08). In cases of successful washout, the average duration between infectious symptoms and washout was 7.27 ± 2.19 days. None of the demographic variables were associated with increased likelihood of washout failure. CONCLUSIONS Our results demonstrate a higher rate of washout failure in those who underwent partial device removal and in the presence of purulence at the surgical site. Further investigation must be conducted to determine the instances in which hardware removal is indicated to prevent failure or removal due to infection. Identification of these parameters will optimize therapeutic benefit and long-term financial impact.
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Affiliation(s)
- Tarun Prabhala
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Fernando Figueroa
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Tessa Harland
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Melisande N Nabage
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA; Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA.
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26
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Rauck RL, Loudermilk E, Thomson SJ, Paz-Solis JF, Bojrab L, Noles J, Vesper J, Atallah J, Roth D, Hegarty J, Prud'Homme M, Phillips GM, Smith SG, Ibrahim M, Willoughby CD, Obray JB, Gupta M, Paez J, Berg AP, Harrison NJ, Maino P, Mambalam P, McCarty M, Towlerton G, Love-Jones S, Ahmed S, Lee A, Shah B, Goor-Aryeh I, Russo MA, Varela N, Phelps JB, Cid J, Fernandez T, Pérez-Hernández C, Keehn D, Rosenow JM, Haider N, Parrent AG, Lawrence MM, Georgius P, Demartini L, Mendiola A, Mehta V, Thoma R, Israel AF, Carolis GD, Bhatia S, Green M, Villarreal A, Crooks MT, Gwinn RP, Pilitsis JG, Sato H, Vega SM, Hillegass MG, Carnes P, Scherer C, Brill S, Yu J, Brennan JJ, Gatzinsky K, Navani A, Snook LT, Bujedo BM, Andrés Ares JD, Murillo A, Trobridge AT, Assil K, Shah J, McLeod C, Buwembo J, Coster OD, Miller N, Sanapati M, Mikhael M, Przkora R, Sukenaga N, Raso LJ, Calodney AK, Cáceres Jerez LE, Uchiyama T, Kallewaard JW, Chandler B, Piedimonte F, Candido KD, Weaver TE, Agari T, Holthouse D, Woon R, Patel N, Lechleiter K, Jain R. Long-term safety of spinal cord stimulation systems in a prospective, global registry of patients with chronic pain. Pain Manag 2023; 13:115-127. [PMID: 36691862 DOI: 10.2217/pmt-2022-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: The availability of long-term (>2 years) safety outcomes of spinal cord stimulation (SCS) remains limited. We evaluated safety in a global SCS registry for chronic pain. Methods: Participants were prospectively enrolled globally at 79 implanting centers and followed out to 3 years after device implantation. Results: Of 1881 participants enrolled, 1289 received a permanent SCS implant (1776 completed trial). The annualized rate of device explant was 3.5% (all causes), and 1.1% due to inadequate pain relief. Total incidence of device explantation >3 years was 7.6% (n = 98). Of these, 32 subjects (2.5%) indicated inadequate pain relief as cause for removal. Implant site infection (11 events) was the most common device-related serious adverse event (<1%). Conclusion: This prospective, global, real-world study demonstrates a high-level of safety for SCS with low rate of explant/serious adverse events. Clinical Trial Registration: NCT01719055 (ClinicalTrials.gov).
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Affiliation(s)
- Richard L Rauck
- Carolinas Pain Institute & The Center for Clinical Research LLC, Winston-Salem, NC 27103, USA
| | | | - Simon J Thomson
- Mid & South Essex University Hospitals, Basildon, Essex, SS16 5NL, United Kingdom
| | | | - Louis Bojrab
- Forest Health Medical Center, Ypsilanti, MI 48198, USA
| | - John Noles
- Spine & Pain Specialists, Shreveport, LA 71105, USA
| | - Jan Vesper
- University Hospital Düsseldorf, Düsseldorf, 40225, Germany
| | | | - Daniel Roth
- Summit Pain Management, Fort Wayne, IN 46804, USA
| | - Joseph Hegarty
- Optim Health System - Tattnall Hospital, Reidsville, GA 30453, USA
| | | | | | - Stephen G Smith
- Ramos Center for Interventional & Functional Pain Medicine, Englewood, FL 34205, USA
| | - Mohab Ibrahim
- University of Arizona, Banner Health - University Medical Center, Tucson, AZ 85719, USA
| | | | - Jon B Obray
- Southwest Spine & Pain Center, St George, UT 84790, USA
| | - Mayank Gupta
- Kansas Pain Management & Neuroscience Research Center, LLC, Overland Park, KS 66210, USA
| | - Julio Paez
- Southlake Pain Institute, Clermont, FL 34711, USA
| | | | | | - Paolo Maino
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, 6900, Switzerland
| | | | | | - Glyn Towlerton
- Chelsea & Westminster Hospitals, London, SW10 9NH, United Kingdom
| | | | - Shakil Ahmed
- Weill Cornell Medicine, Center for Comprehensive Spine Care, New York City, NY 10022, USA
| | - Albert Lee
- Tallahassee Neurological Clinic, Tallahassee, FL 32308, USA
| | - Binit Shah
- Carolinas Pain Center, Charlotte, NC 28262, USA
| | - Itay Goor-Aryeh
- Pain Medicine Institute, Sheba Medical Center, Ramat Gan, 52621, Israel
| | - Marc A Russo
- Hunter Pain Specialists, Broadmeadow, New South Wales, 2292, Australia
| | | | | | - José Cid
- Toledo University Hospital Complex, Toledo, 45004, Spain
| | - Tacson Fernandez
- Royal National Orthopaedic Hospital, NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | | | - Douglas Keehn
- Pain Centers of Wisconsin, Fort Atkinson, WI 53220, USA
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nameer Haider
- APMR Spinal & Skeletal Pain Medicine, Utica, NY 13502, USA
| | - Andrew G Parrent
- London Health Sciences Centre, Western University, London, ON, N6A 5W9, Canada
| | | | - Peter Georgius
- Sunshine Coast Clinical Research, Noosa Heads, Queensland, 4567, Australia
| | | | - Agustin Mendiola
- Puerta de Hierro University Hospital, Boadilla del Monte, 28222, Spain
| | - Vivek Mehta
- St. Bartholomew's Hospital, London, EC1A 7BE, United Kingdom
| | | | - Atef F Israel
- Pain Management Associates, Lee's Summit, MO 64086, USA
| | | | - Sanjay Bhatia
- West Virginia University Neurosurgery, Morgantown, WV 26506, USA
| | - Matthew Green
- Pain Medicine of South Australia, Wayville, South Australia, 5034, Australia
| | | | | | - Ryder P Gwinn
- EvergreenHealth Neurosurgery, Kirkland, WA 98034, USA
| | - Julie G Pilitsis
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Hitoaki Sato
- Kobe University Hospital, Kobe City, Hyōgo, 650-0017, Japan
| | | | | | - Paul Carnes
- Raleigh Neurology Associates, Raleigh NC 27607, USA
| | | | - Silviu Brill
- Sourasky Medical Center, Tel Aviv, 6423914, Israel
| | - James Yu
- Sydney Spine & Pain, Hurstville, NSW, 2220, Australia
| | - James J Brennan
- Sentara Neurosurgery Specialists, Virginia Beach, VA 23454, USA
| | | | - Annu Navani
- Comprehensive Spine & Sports Center, Campbell, CA 95008, USA
| | - Lee T Snook
- Metropolitan Pain Management Consultants, Sacramento, CA 95821, USA
| | | | | | - Abel Murillo
- AMPM Research Clinic, Miami Gardens, FL 33169, USA
| | | | - Kamyar Assil
- Conejo Pain Specialists Medical Group, Thousand Oaks, CA 91360, USA
| | - Jawad Shah
- Insight Neurosurgery, Dearborn Heights, MI 48091, USA
| | - Carroll McLeod
- Mississippi Sports Medicine & Orthopaedic Center, Jackson, MS 39110, USA
| | - Joseph Buwembo
- University of Saskatchewan College of Medicine, Saskatoon, SK, S7N 5E5, Canada
| | | | - Nathan Miller
- Coastal Pain & Spinal Diagnostics, Carlsbad, CA 92009, USA
| | | | | | - Rene Przkora
- University of Florida Health, Gainesville, FL 32610, USA
| | - Norihiko Sukenaga
- Hyōgo College of Medicine Hospital, Nishinomiya, Hyōgo, 663-8501, Japan
| | | | | | | | - Takuya Uchiyama
- Kindai University, Faculty of Medicine, Osaka-sayama, Osaka, 577-8502, Japan
| | | | | | | | | | - Tristan E Weaver
- The Ohio State University Medical Center, Columbus, OH 43210, USA
| | - Takashi Agari
- Tokyo Metropolitan Neurological Hospital, Tokyo, 150-0013, Japan
| | - David Holthouse
- Green Lizard Science, Claremont, Western Australia, 6010, Australia
| | - Rex Woon
- Boston Scientific Neuromodulation, Valencia, CA 91355, USA
| | | | | | - Roshini Jain
- Boston Scientific Neuromodulation, Valencia, CA 91355, USA
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27
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Levy RM, Mekhail N, Abd-Elsayed A, Abejón D, Anitescu M, Deer TR, Eldabe S, Goudman L, Kallewaard JW, Moens M, Petersen EA, Pilitsis JG, Pope JE, Poree L, Raslan AM, Russo M, Sayed D, Staats PS, Taylor RS, Thomson S, Verrills P, Duarte RV. Holistic Treatment Response: An International Expert Panel Definition and Criteria for a New Paradigm in the Assessment of Clinical Outcomes of Spinal Cord Stimulation. Neuromodulation 2023:S1094-7159(22)01379-4. [PMID: 36604242 DOI: 10.1016/j.neurom.2022.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment response to spinal cord stimulation (SCS) is focused on the magnitude of effects on pain intensity. However, chronic pain is a multidimensional condition that may affect individuals in different ways and as such it seems reductionist to evaluate treatment response based solely on a unidimensional measure such as pain intensity. AIM The aim of this article is to add to a framework started by IMMPACT for assessing the wider health impact of treatment with SCS for people with chronic pain, a "holistic treatment response". DISCUSSION Several aspects need consideration in the assessment of a holistic treatment response. SCS device data and how it relates to patient outcomes, is essential to improve the understanding of the different types of SCS, improve patient selection, long-term clinical outcomes, and reproducibility of findings. The outcomes to include in the evaluation of a holistic treatment response need to consider clinical relevance for patients and clinicians. Assessment of the holistic response combines two key concepts of patient assessment: (1) patients level of baseline (pre-treatment) unmet need across a range of health domains; (2) demonstration of patient-relevant improvements in these health domains with treatment. The minimal clinical important difference (MCID) is an established approach to reflect changes after a clinical intervention that are meaningful for the patient and can be used to identify treatment response to each individual domain. A holistic treatment response needs to account for MCIDs in all domains of importance for which the patient presents dysfunctional scores pre-treatment. The number of domains included in a holistic treatment response may vary and should be considered on an individual basis. Physiologic confirmation of therapy delivery and utilisation should be included as part of the evaluation of a holistic treatment response and is essential to advance the field of SCS and increase transparency and reproducibility of the findings.
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Affiliation(s)
- Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
| | - Nagy Mekhail
- Department of Pain Management, Cleveland Clinic, Cleveland, OH, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology and Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Abejón
- Multidisciplinary Pain Management Unit, Hospital Universitario Quirónsalud, Madrid, Spain
| | | | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium; STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Jan W Kallewaard
- Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, the Netherlands; Department of Anesthesiology and Pain Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium; STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Lawrence Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Marc Russo
- Hunter Pain Specialists, Broadmeadow, New South Wales, Australia
| | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Rod S Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK; MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Simon Thomson
- Department of Pain Medicine and Neuromodulation, Mid & South Essex University Hospitals, Essex, UK
| | - Paul Verrills
- Metro Pain Group, Melbourne, New South Wales, Australia
| | - Rui V Duarte
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia; Liverpool Reviews and Implementation Group, Department of Health Data Science, University of Liverpool, Liverpool, UK.
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28
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Deer TR, Pope JE, Falowski SM, Pilitsis JG, Hunter CW, Burton AW, Connolly AT, Verrills P. Clinical Longevity of 106,462 Rechargeable and Primary Cell Spinal Cord Stimulators: Real World Study in the Medicare Population. Neuromodulation 2023; 26:131-138. [PMID: 35690511 DOI: 10.1016/j.neurom.2022.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/25/2022] [Accepted: 04/14/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Spinal cord stimulators (SCS) are available with either primary cell (PC) or rechargeable cell (RC) batteries. Although RC systems are proposed to have a battery longevity upward of nine years, in comparison with four years for PC systems, there are few studies of longevity of SCS in the real world. MATERIALS AND METHODS This was an observational, nonrandomized, retrospective study of Medicare beneficiaries who received neurostimulator implants in the outpatient hospital. This study used Medicare fee-for-service claims data from 2013 to 2020. The clinical longevity of the implantable pulse generator (IPG), defined as the duration from implant until removal for any reason, was compared between PC and RC devices. Life distribution analysis was used to approximate device lifespan. The secondary analysis separated removals into explant or replacements. The statistics were adjusted for relevant clinical covariates. RESULTS A total of 25,856 PC and 79,606 RC systems were included in the study. At seven years after implant, 53.8% of PC IPGs and 55.0% of RC IPGs remained in use. The life distribution modeling analysis projected a median lifespan of 8.2 years for PC and 9.0 years for RC devices. The rate of explant was lower for PC devices (19.2%) than for RC devices (22.0%, hazard ratio (HR) = 0.96, p = 0.082), whereas the rate of replacements was higher for PC devices (33.7%) than for RC devices (29.5%, HR = 1.31, p < 0.001). An analysis of the battery type used in device replacements showed an increasing adoption of PC devices over time. CONCLUSIONS This large, retrospective, real-world analysis of Medicare claims data demonstrated that the clinical longevity of neurostimulator devices is similar for PC and RC batteries. In the past, clinicians may have defaulted to RC devices based on the assumption that they provided extended battery life. Considering this longevity data, clinicians should now consider the choice between PC and RC devices based on other individual factors pertinent to the patient experience and not on purported longevity claims.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Centers of the Virginias, Charleston, WV, USA.
| | | | | | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Corey W Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | | | - Paul Verrills
- Metro Pain Group, Melbourne, New South Wales, Australia
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29
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Johansen PM, Trujillo FA, Hagerty V, Harland T, Davis G, Pilitsis JG. Establishing Minimal Clinically Important Difference in Sleep Outcomes after Spinal Cord Stimulation in Patients with Chronic Pain Disorders. Stereotact Funct Neurosurg 2023; 101:41-46. [PMID: 36574755 DOI: 10.1159/000527257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/16/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION As one of the most common medical conditions for which patients seek medical care, chronic pain can be debilitating. The relationship between chronic pain and sleep is thought to be bidirectional, suggesting that treatment of one can be beneficial to the other. There is mounting evidence that spinal cord stimulation (SCS) improves aspects of sleep. How meaningful that is to patients' lives has not been ascertained. OBJECTIVE The aim of the current study was to further elucidate the effect of SCS on sleep by examining the relationship between pain outcome measures with the insomnia severity index (ISI) and to establish the minimally clinical important difference (MCID), which is defined as the smallest noticeable change that an individual perceives as clinically significant. MATERIALS AND METHODS We prospectively collected ISI, Epworth sleepiness scale (ESS), Numerical Rating Scale, McGill Pain Questionnaire-Short Form, Oswestry Disability Index, Beck Depression Inventory, and Pain Catastrophizing Scale data both pre- and postoperatively for chronic pain patients who underwent SCS placement and had long-term outcomes. The ISI is a well-studied questionnaire used to assess an individual's level of insomnia. RESULTS We correlated the ESS and ISI with pain outcome measures in sixty-four patients at a mean follow-up of 9.8 ± 2.9 months. The ISI showed correlations with disability as measured through the Oswestry Disability Index (p = 0.014) and depression as measured through the Beck Depression Inventory (p = 0.024). MCID values for the ISI were calculated using both anchor- and distribution-based methods. The minimal detectable change method resulted in an MCID of 2.4 points, standard error of measurement resulted in an MCID of 2.6 points, and the change difference resulted in an MCID of 2.45. The receiver operating characteristic method yielded an MCID of 0.5-point change with an area under the curve of 0.61. CONCLUSION This study successfully established MCID ranges for the ISI outcome measure to help gauge improvement in insomnia after SCS. The ISI has ample evidence of its validity in assessment of insomnia, and MCID values of 2.4-2.6 correlate with improvement in disability and depression in our patients.
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Affiliation(s)
- Phillip M Johansen
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Frank A Trujillo
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Vivian Hagerty
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Tessa Harland
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Gregory Davis
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Julie G Pilitsis
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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Nuzov NB, Bhusal B, Henry KR, Jiang F, Vu J, Rosenow JM, Pilitsis JG, Elahi B, Golestanirad L. Artifacts Can Be Deceiving: The Actual Location of Deep Brain Stimulation Electrodes Differs from the Artifact Seen on Magnetic Resonance Images. Stereotact Funct Neurosurg 2023; 101:47-59. [PMID: 36529124 PMCID: PMC9932848 DOI: 10.1159/000526877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/04/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a common treatment for a variety of neurological and psychiatric disorders. Recent studies have highlighted the role of neuroimaging in localizing the position of electrode contacts relative to target brain areas in order to optimize DBS programming. Among different imaging methods, postoperative magnetic resonance imaging (MRI) has been widely used for DBS electrode localization; however, the geometrical distortion induced by the lead limits its accuracy. In this work, we investigated to what degree the difference between the actual location of the lead's tip and the location of the tip estimated from the MRI artifact varies depending on the MRI sequence parameters such as acquisition plane and phase encoding direction, as well as the lead's extracranial configuration. Accordingly, an imaging technique to increase the accuracy of lead localization was devised and discussed. METHODS We designed and constructed an anthropomorphic phantom with an implanted DBS system following 18 clinically relevant configurations. The phantom was scanned at a Siemens 1.5 Tesla Aera scanner using a T1MPRAGE sequence optimized for clinical use and a T1TSE sequence optimized for research purposes. We varied slice acquisition plane and phase encoding direction and calculated the distance between the caudal tip of the DBS lead MRI artifact and the actual tip of the lead, as estimated from MRI reference markers. RESULTS Imaging parameters and lead configuration substantially altered the difference in the depth of the lead within its MRI artifact on the scale of several millimeters - with a difference as large as 4.99 mm. The actual tip of the DBS lead was found to be consistently more rostral than the tip estimated from the MR image artifact. The smallest difference between the tip of the DBS lead and the tip of the MRI artifact using the clinically relevant sequence (i.e., T1MPRAGE) was found with the sagittal acquisition plane and anterior-posterior phase encoding direction. DISCUSSION/CONCLUSION The actual tip of an implanted DBS lead is located up to several millimeters rostral to the tip of the lead's artifact on postoperative MR images. This distance depends on the MRI sequence parameters and the DBS system's extracranial trajectory. MRI parameters may be altered to improve this localization.
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Affiliation(s)
- Noa B Nuzov
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA, .,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,
| | - Bhumi Bhusal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kaylee R Henry
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Fuchang Jiang
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Jasmine Vu
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Julie G Pilitsis
- Department of Neurosciences & Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Behzad Elahi
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Laleh Golestanirad
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Harland T, Gillogly M, Khazen O, Gajjar AA, Nabage M, Trujillo F, DiMarzio M, Pilitsis JG. A Pilot Study Comparing Algorithmic Adaptive Conventional Stimulation with High-Dose Stimulation in Chronic Pain Patients. World Neurosurg 2022; 167:e871-e876. [PMID: 36031115 DOI: 10.1016/j.wneu.2022.08.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Spinal cord stimulation is an effective method of treatment for chronic pain. We previously showed that programming using accelerometry was advantageous for paresthesia-based stimulation. However, programming can be labor intensive. OBJECTIVE Here we focus on standardized programming for both accelerometer-based paresthesia-induced programming (termed "shuffle") and high-dose (HD) subthreshold programming with stimulation delivered over the T9-10 interspace. METHODS In this prospective cross-over study, patients received 4 weeks of shuffle programming and 4 weeks of HD programming in a randomized order. In both intervals, contacts overlying T9-10 were programmed. Pain scales with measurements of activity and sleep were collected at the end of each study arm and compared with preoperative baseline scores. RESULTS Twelve patients were enrolled, with 10 patients completing this study. Compared with baseline, during the HD study period, significant improvements were seen in worst pain of week (P = 0.03) and current pain (P = 0.04) as rated on Numeric Rating Scale scores and walking on the Activity Test (P = 0.012). No difference was seen from baseline compared with shuffle stimulation or in shuffle stimulation compared with HD stimulation. CONCLUSION In this pilot study, we demonstrated that HD stimulation at T9-10 is superior to algorithmic programming of paresthesia-based stimulation. These results compared with our previous work with shuffle suggest that paresthesia-based stimulation may necessitate stimulation of additional contact locations and additional programming to optimize. This algorithmic programming of paresthesia-based stimulation continues to warrant exploration.
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Affiliation(s)
- Tessa Harland
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Michael Gillogly
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Avi A Gajjar
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Melisande Nabage
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Frank Trujillo
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA; Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA.
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D’Souza RS, Pilitsis JG, Langford BJ, Orhurhu V, Hussain N, Hoffmann CM, Anitescu M, Vanterpool S, Ali R, Patel K, Moeschler SM. Speaker Gender Representation at the North American Neuromodulation Society Annual Meeting (2017-2021): Have We Made Progress in Closing the Gender Gap? J Pain Res 2022; 15:3423-3432. [PMID: 36320224 PMCID: PMC9618239 DOI: 10.2147/jpr.s380152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Background Speaker gender representation at medical conferences is a significant site of gender disparity. Our primary objective was to quantify the proportion of female speakers and compare plenary session opportunities by gender at the North American Neuromodulation Society (NANS) Annual Conference. Methods Data from the 2017-2021 NANS Annual Conference presentations were abstracted. Primary outcomes included gender composition of speaker slots, gender composition of individual speakers, and comparison of plenary speaker slots by gender. Secondary outcomes included comparisons of session size, age, professional degree, and number of presentations per speaker based on gender. Results Gender composition of annual speaker slots was (% slots presented by women): 2017:14.6%; 2018:20.5%; 2019:23.5%; 2020:21.0%; 2021:41.4%. Annual gender composition of individual speakers was (% women): 2017:18.7%; 2018:20.6%; 2019:24.6%; 2020:24.9%; 2021:33.8%. Of all speaker slots, the percentage of plenary slots did not differ based on gender, with 11.4% presented by female speakers versus 11.2% presented by male speakers (OR 1.0, 95% CI 0.7-1.5, P=0.893). Compared to male speaker slots, there was an association of lower age (43.9±5.6 vs 50.8±8.9, P<0.001), lower odds of holding a single doctorate degree (OR 0.3, 95% CI 0.2-0.5, P<0.001), and lower odds of holding a dual MD/PhD or DO/PhD degree (OR 0.3, 95% CI 0.1-0.5, P<0.001) in female speaker slots. Compared to male speakers, there was an association of higher number of presentations per female speaker at the 2021 NANS Annual Meeting (2.48±1.60 vs 1.79±1.30, P=0.008). Conclusion Although the volume of female speaker slots and individual speakers trailed behind their male counterparts, female speaker representation steadily increased at each subsequent annual NANS meeting. We identified no difference in plenary session slots based on gender.
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Affiliation(s)
- Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA,Correspondence: Ryan S D’Souza, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA, Email
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, FL, USA
| | - Brendan J Langford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Vwaire Orhurhu
- Department of Pain Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nasir Hussain
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Chelsey M Hoffmann
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Magdalena Anitescu
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA
| | | | - Rushna Ali
- Division of Neurosurgery, Spectrum Health, Grand Rapids, MI, USA
| | - Kiran Patel
- Department of Anesthesiology, New York University Langone Medical Center, New York City, NY, USA
| | - Susan M Moeschler
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
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Bao J, Byraju K, Patel VJ, Hellman A, Neubauer P, Burdette C, Rafferty E, Park YL, Trowbridge R, Shin DS, Pilitsis JG. The effects of low intensity focused ultrasound on neuronal activity in pain processing regions in a rodent model of common peroneal nerve injury. Neurosci Lett 2022; 789:136882. [PMID: 36152743 DOI: 10.1016/j.neulet.2022.136882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Non-invasive, external low intensity focused ultrasound (liFUS) offers promise for treating neuropathic pain when applied to the dorsal root ganglion (DRG). OBJECTIVE We examine how external liFUS treatment applied to the L5 DRG affects neuronal changes in single-unit activity from the primary somatosensory cortex (SI) and anterior cingulate cortex (ACC) in a common peroneal nerve injury (CPNI) rodent model. METHODS Male Sprague Dawley rats were divided into two cohorts: CPNI liFUS and CPNI sham liFUS. Baseline single-unit activity (SUA) recordings were taken 20 min prior to treatment and for 4 h post treatment in 20 min intervals, then analyzed for frequency and compared to baseline. Recordings from the SI and ACC were separated into pyramidal and interneurons based on waveform and principal component analysis. RESULTS Following CPNI surgery, all rats (n = 30) displayed a significant increase in mechanical sensitivity. In CPNI liFUS rats, there was a significant increase in pyramidal neuron spike frequency in the SI region compared to the CPNI sham liFUS animals beginning at 120 min following liFUS treatment (p < 0.05). In the ACC, liFUS significantly attenuated interneuron firing beginning at 80 min after liFUS treatment (p < 0.05). CONCLUSION We demonstrate that liFUS changed neuronal spiking in the SI and ACC regions 80 and 120 min after treatment, respectively, which may in part correlate with improved sensory thresholds. This may represent a mechanism of action how liFUS attenuates neuropathic pain. Understanding the impact of liFUS on pain circuits will help advance the use of liFUS as a non-invasive neuromodulation option.
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Affiliation(s)
- Jonathan Bao
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Kanakaharini Byraju
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Vraj J Patel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Abigail Hellman
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | | | | | - Emily Rafferty
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Yunseo Linda Park
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Rachel Trowbridge
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Damian S Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States; Department of Neurosurgery, Albany Medical Center, Albany, NY, United States.
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Topp G, Harland T, Spurgas M, Rock A, Pilitsis JG. Techniques for Safe Removal of Spinal Cord Stimulation Paddle Leads. Oper Neurosurg (Hagerstown) 2022; 23:e348-e352. [DOI: 10.1227/ons.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/12/2022] [Indexed: 11/06/2022] Open
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Telkes I, Hadanny A, DiMarzio M, Chitnis G, Paniccioli S, O'Connor K, Grey R, McCarthy K, Khazen O, McLaughlin B, Pilitsis JG. High-Resolution Spinal Motor Mapping Using Thoracic Spinal Cord Stimulation in Patients With Chronic Pain. Neurosurgery 2022; 91:459-469. [PMID: 35876669 PMCID: PMC10553191 DOI: 10.1227/neu.0000000000002054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High-resolution spinal cord stimulation (HR-SCS) paddle can stimulate medial-dorsal columns and extend stimulation coverage to the laterally positioned spinal targets. OBJECTIVE To investigate the medio-lateral selectivity of an HR-SCS paddle in patients with chronic pain. METHODS During standard-of-care spinal cord stimulation (SCS) placement, epidurally evoked electromyography and antidromic dorsal column-evoked potentials were recorded in 12 subjects using an HR-SCS paddle with 8 medio-lateral sites spanning the full epidural width at thoracic T9-12 and a commercial paddle consecutively. RESULTS Recruitment maps were aligned with respect to physiological midline which was overlapping with anatomic midline in 10 of 11 cases. Overlapping contacts between the HR-SCS and commercial paddles exhibited similar patterns while HR-SCS demonstrated higher precision targeting of certain dermatomes. Spinal motor maps showed that the lateral contacts triggered stronger responses in medial gastrocnemius, adductor magnus, and tibialis anterior while the medial contacts triggered stronger responses in gluteus maximus and adductor hallucis. The time-locked popliteal fossa responses indicated ipsilateral activation by HR-SCS at the lateral contacts and bilateral activation at the medial contacts with stronger ipsilateral responses. CONCLUSION This study is the first to perform high-resolution medio-lateral SCS mapping in patients with chronic pain. These results show promise that HR-SCS may provide additional ipsilateral recruitment within the extremities which improve targeting of focal pain in the lower extremities. Furthermore, this study supports the functional use of intraoperative neuromonitoring as a decision tool to determine physiological midline in thoracic SCS surgeries and provides a full methodological framework.
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Affiliation(s)
- Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | | | | | | | - Rachael Grey
- Nuvasive Clinical Services, San Diego, California, USA
| | | | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | | | - Julie G. Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
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Tangney T, Heydari ES, Sheldon BL, Shetty A, Argoff CE, Khazen O, Pilitsis JG. Botulinum Toxin as an Effective Treatment for Trigeminal Neuralgia in Surgical Practices. Stereotact Funct Neurosurg 2022; 100:314-320. [PMID: 35944492 DOI: 10.1159/000526053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/29/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a common cause of craniofacial pain with many medical and surgical therapies, all of which are imperfect. We examine the use of botulinum toxin type-A (BTX-A) as an intermediary approach in surgical practices. METHODS We retrospectively identified TN patients seen by both pain neurology and neurosurgery at our center. Demographics were collected. Pain intensity was assessed using the numerical rating scale (NRS) and compared from baseline to after BTX-A treatment via paired t test. Responder status was assessed, and success of BTX-A was determined for each cohort. Doses of common medications were compared between baseline visit and the most recent BTX-A administration visit. RESULTS Thirty-one patients underwent BTX-A therapy for TN, 24 (77%) female and 7 (23%) male. Mean age was 62.5 ± 3.1 years and 29 (94%) identified as white. When divided into cohorts according to indication, 11 (35%) failed prior TN surgery, 9 (29%) either declined surgery or were poor surgical candidates, 4 (13%) had multiple sclerosis, 4 (13%) had trigeminal neuropathic pain, and 3 (10%) had atypical TN with pain in additional dermatomes outside the trigeminal distribution. Significant reductions in NRS from baseline to following initial BTX-A treatment were seen in the declined/high risk for surgery (p = 0.004) and those who failed prior TN surgery (p = 0.035) groups. No significant variation in demographics was found between any two groups (p > 0.05 for all). Finally, there was no significant reduction in total daily dose of gabapentin, carbamazepine, oxcarbazepine, baclofen, or lamotrigine in BTX-A responders (p > 0.05 for all). DISCUSSION Indication is an important predictor for BTX-A, with classical TN patients exhibiting the highest response rates. This research highlights the viability of BTX-A as an important tool in the arsenal of providers seeking to treat TN in a minimally invasive manner.
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Affiliation(s)
- Thomas Tangney
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Ehsaun S Heydari
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Breanna L Sheldon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Amit Shetty
- Department of Neurology, Albany Medical College, Comprehensive Pain Center, Albany Medical Center, Albany, New York, USA
| | - Charles E Argoff
- Department of Neurology, Albany Medical College, Comprehensive Pain Center, Albany Medical Center, Albany, New York, USA
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA.,Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
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Hadanny A, Harland TA, Khazen O, DiMarzio M, Telkes I, Pilitsis JG. In Reply: Development of Machine Learning-Based Models to Predict Treatment Response to Spinal Cord Stimulation. Neurosurgery 2022; 91:e68-e70. [PMID: 35603938 PMCID: PMC9514737 DOI: 10.1227/neu.0000000000002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Tessa A Harland
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Olga Khazen
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Marisa DiMarzio
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Ilknur Telkes
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, New York, USA
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Harland TA, Topp G, Shao K, Pilitsis JG. Revision and Replacement of Spinal Cord Stimulator Paddle Leads. Neuromodulation 2022; 25:753-757. [DOI: 10.1016/j.neurom.2022.02.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
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Barrie U, Williams M, Nguyen M, Kenfack YJ, Mason H, Ata A, Aoun SG, Pilitsis JG. Characteristics of graduating medical students interested in neurosurgery with intention to practice in underserved areas: Implications for residency programs. Clin Neurol Neurosurg 2022; 218:107293. [DOI: 10.1016/j.clineuro.2022.107293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
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Harland TA, Giridharan N, Hayek S, Russo MA, Pilitsis JG. What the International and North American Neuromodulation Societies Are Doing for You: The Benefits of Becoming a Member. Neuromodulation 2022; 25:645-647. [DOI: 10.1016/j.neurom.2022.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022]
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Abstract
Chronic pain is a leading cause of disability in the United States. Limited efficacy associated with pharmacologic management and surgical interventions in refractory patients has led to further exploration of cognitive and behavioral interventions as both an adjunctive and primary therapeutic modality. Mindfulness-based meditation has shown to be effective in reducing pain in randomized studies of chronic pain patients as well as models of experimentally induced pain in healthy participants. These studies have revealed specific neural mechanisms which may explain both short-term and sustained pain relief associated with mindfulness-based interventions.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA
| | - Christine Lin
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA
| | - Devon Hennel
- Department of Neurscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Olga Khazen
- Department of Neurscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Biomedical Research, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA.
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Entezami P, Rock AK, Topp GP, Heydari ES, Field NC, Boulos AS, Dalfino JC, Yamamoto J, Pilitsis JG, Cherukupalli D, McCallum SE, Paul AR. Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques. Interv Neuroradiol 2022:15910199221104616. [PMID: 35648585 DOI: 10.1177/15910199221104616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION As we emerge from the current pandemic, hospitals, staff, and resources will need to continue to adjust to meet ongoing healthcare demands. Lessons learned during past shortages can be used to optimize peri-procedural protocols to safely improve the utilization of hospital resources. METHODS Retrospective review of patients who underwent elective endovascular intracranial aneurysm treatment was performed. Multivariable logistic regression was used to identify factors associated with patients who were able to be discharged within 24 h of elective procedures. Rates of complications (particularly readmission) were determined. RESULTS 330 patients underwent elective endovascular aneurysm treatment with 86 (26.1%) discharged within 24 h. Factors associated with earlier discharge included procedure years (2019-2021) and male sex. Patients were more likely to be discharged later (after 24 h) if they underwent stent-coil embolization or flow-diversion. There was no association between discharge timing and likelihood of readmission. DISCUSSION Our review highlights the safety of earlier discharge and allowed us to prepare a fast-track protocol for same-day discharge in these patients. This protocol will be studied prospectively in the next phase of this study. As we gain more comfort with emerging, minimally invasive endovascular therapies, we hope to safely achieve same-day discharge on a protocolized and routine basis, reducing the demand of elective aneurysm treatments on our healthcare system. CONCLUSION We retrospectively demonstrate that early discharge following elective aneurysm treatment is safe in our cohort and provide a fast-track pathway based on these findings for other centers developing similar protocols.
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Affiliation(s)
- Pouya Entezami
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
| | - Andrew K Rock
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
| | - Gregory P Topp
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
| | - Ehsaun S Heydari
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
| | - Nicholas C Field
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
| | - Alan S Boulos
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
| | - John C Dalfino
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
| | - Junichi Yamamoto
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience, 1782Florida Atlantic University, Boca Raton, FL, USA
| | - Divya Cherukupalli
- Department of Anesthesiology, 138207Albany Medical Center, Albany, NY, USA
| | - Sarah E McCallum
- Department of Neuroscience and Experimental Therapeutics, 1092Albany Medical College, Albany, NY, USA
| | - Alexandra R Paul
- Department of Neurosurgery, 138207Albany Medical Center, Albany, NY, USA
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Liss A, Hellman A, Patel VJ, Maietta T, Byraju K, Trowbridge R, Acheta J, Panse D, Srikanthan A, Neubauer P, Burdette C, Ghoshal G, Williams E, Qian J, Pilitsis JG. Low Intensity Focused Ultrasound Increases Duration of Anti-Nociceptive Responses in Female Common Peroneal Nerve Injury Rats. Neuromodulation 2022; 25:504-510. [PMID: 35667768 DOI: 10.1111/ner.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chronic pain affects 7%-10% of Americans, occurs more frequently and severely in females, and available treatments have been shown to have less efficacy in female patients. Preclinical models addressing sex-specific treatment differences in the treatment of chronic pain have been limited. Here we examine the sex-specific effects of low intensity focused ultrasound (liFUS) in a modified sciatic nerve injury (SNI) model. MATERIALS AND METHODS A modified SNI performed by ligating the common peroneal nerve (CPN) was used to measure sensory, behavioral pain responses, and nerve conduction studies in female and male rats, following liFUS of the L5 dorsal root ganglion. RESULTS Using the same dose of liFUS in females and males of the same weight, CPN latency immediately after treatment was increased for 50 min in females compared to 25 min in males (p < 0.001). Improvements in mechanical pain thresholds after liFUS lasted significantly longer in females (seven days; p < 0.05) compared to males (three days; p < 0.05). In females, there was a significant improvement in depression-like behavior as a result of liFUS (N = 5; p < 0.01); however, because males never developed depression-like behavior there was no change after liFUS treatment. CONCLUSIONS Neuromodulation with liFUS has a greater effect in female rats on CPN latency, mechanical allodynia duration, and depression-like behavior. In order to customize neuromodulatory techniques for different patient phenotypes, it is essential to understand how they may alter sex-specific pathophysiologies.
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Affiliation(s)
- Andrea Liss
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Abigail Hellman
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Vraj J Patel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Teresa Maietta
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Kanakaharini Byraju
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Rachel Trowbridge
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Jenica Acheta
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Drishti Panse
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Adithya Srikanthan
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | | | | | | | - Jiang Qian
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA; Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
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Sweeney J, Sheldon BL, Juneja A, Hadanny A, Foley J, Pilitsis JG, Sukul V. Efficacy of 10 kHz spinal cord stimulation in complex regional pain syndrome: A retrospective analysis. Clin Neurol Neurosurg 2022; 216:107220. [PMID: 35366453 DOI: 10.1016/j.clineuro.2022.107220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We examine the clinical efficacy of High Frequency 10 kHz (HF10) spinal cord stimulation (SCS) CRPS patients. MATERIALS AND METHODS This is a retrospective cohort study of SCS-naïve patients with CRPS treated with HF10-SCS after a successful trial. Patients were evaluated at 2 weeks, 6 weeks, 3 months, and 6 months post-operatively. Outcomes included mean numeric pain rating scale (NRS), mean NRS reduction, NRS percentage improvement (PI), patient reported subjective pain PI (Pain PI), and patients reporting > 50% benefit in symptoms. Pre and post-operative NRS were compared by ordinal regression analysis accounting for the patient's response to the SCS trial. RESULTS 20 patients met inclusion criteria. 75% were female. Mean age 51 years. Baseline mean NRS was 6.1 for the cohort (1.7). Post-operatively, mean NRS decreased to 4.5 at 2 weeks (p = 0.077), 3.8 at 6 weeks (p = 0.034), 3.7 at 3 months (p = 0.307), and 4.4 at 6 months (p = 0.832). Mean NRS reduction and NRS PI is reported within. Pain PI was 25% at 2 weeks, 55% at 6 weeks, 54% at 3 months, and 53% at 6 months. Greater than 50% reduction in symptoms was reported in 25% of patients at 2 weeks, 85% at 6 weeks, 87% at 3 months, and 64% at 6 months. CONCLUSIONS HF10 SCS may represent an effective treatment option for reducing objective and subjective symptoms in CRPS that warrants further study.
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Affiliation(s)
- Jared Sweeney
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States.
| | - Breanna L Sheldon
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Ankit Juneja
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States
| | - Jeffery Foley
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States; Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Vishad Sukul
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States; Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States
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Hadanny A, Harland T, Khazen O, DiMarzio M, Marchese A, Telkes I, Sukul V, Pilitsis JG. Development of Machine Learning-Based Models to Predict Treatment Response to Spinal Cord Stimulation. Neurosurgery 2022; 90:523-532. [PMID: 35179133 PMCID: PMC9514733 DOI: 10.1227/neu.0000000000001855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/03/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite spinal cord stimulation's (SCS) proven efficacy, failure rates are high with no clear understanding of which patients benefit long term. Currently, patient selection for SCS is based on the subjective experience of the implanting physician. OBJECTIVE To develop machine learning (ML)-based predictive models of long-term SCS response. METHODS A combined unsupervised (clustering) and supervised (classification) ML technique was applied on a prospectively collected cohort of 151 patients, which included 31 features. Clusters identified using unsupervised K-means clustering were fitted with individualized predictive models of logistic regression, random forest, and XGBoost. RESULTS Two distinct clusters were found, and patients in the cohorts significantly differed in age, duration of chronic pain, preoperative numeric rating scale, and preoperative pain catastrophizing scale scores. Using the 10 most influential features, logistic regression predictive models with a nested cross-validation demonstrated the highest overall performance with the area under the curve of 0.757 and 0.708 for each respective cluster. CONCLUSION This combined unsupervised-supervised learning approach yielded high predictive performance, suggesting that advanced ML-derived approaches have potential to be used as a functional clinical tool to improve long-term SCS outcomes. Further studies are needed for optimization and external validation of these models.
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Affiliation(s)
- Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA;
| | - Tessa Harland
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA;
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Anthony Marchese
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Vishad Sukul
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA;
| | - Julie G. Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA;
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
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Pilitsis JG, Rosenow JM. Advances in Pain Management. Neurosurg Clin N Am 2022; 33:xiii. [DOI: 10.1016/j.nec.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Harland T, Hadanny A, Pilitsis JG. Machine Learning and Pain Outcomes. Neurosurg Clin N Am 2022; 33:351-358. [DOI: 10.1016/j.nec.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Bao J, Tangney T, Pilitsis JG. Focused Ultrasound for Chronic Pain. Neurosurg Clin N Am 2022; 33:331-338. [DOI: 10.1016/j.nec.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Campwala Z, Davis G, Khazen O, Trowbridge R, Nabage M, Bagchi R, Argoff C, Pilitsis JG. The Impact of Multidisciplinary Conferences on Healthcare Utilization in Chronic Pain Patients. Front Pain Res (Lausanne) 2022; 2:775210. [PMID: 35295478 PMCID: PMC8915707 DOI: 10.3389/fpain.2021.775210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Approximately 100 million adults in the United States have chronic pain, though only a subset utilizes the vast majority of healthcare resources. Multidisciplinary care has been shown to improve outcomes in a variety of clinical conditions. There is concern that multidisciplinary care of chronic pain patients may overwhelm existing resources and increase healthcare utilization due to the volume of patients and the complexity of care. We report our findings on the use of multidisciplinary conferences (MDC) to facilitate care for the most complex patients seen at our tertiary center. Thirty-two of nearly 2,000 patients seen per year were discussed at the MDC, making up the top 2% of complex patients in our practice. We evaluated patients' numeric rating score (NRS) of pain, medication use, hospitalizations, emergency department visits, and visits to pain specialists prior to their enrollment in MDC and 1 year later. Matched samples were compared using Wilcoxon's signed rank test. Patients' NRS scores significantly decreased from 7.64 to 5.54 after inclusion in MDC (p < 0.001). A significant decrease in clinic visits (p < 0.001) and healthcare utilization (p < 0.05) was also observed. Opioid and non-opioid prescriptions did not change significantly (p = 0.43). 83% of providers agreed that MDC improved patient care. While previous studies have shown the effect of multi-disciplinary care, we show notable improvements with a team established around a once-a-month MDC.
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Affiliation(s)
- Zahabiya Campwala
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Gregory Davis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Rachel Trowbridge
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Melisande Nabage
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Rohan Bagchi
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Charles Argoff
- Department of Neurology, Albany Medical Center, Albany, NY, United States
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States.,Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
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50
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Sheldon BL, Bao J, Khazen O, Pilitsis JG. Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain. Front Pain Res 2022; 2:699993. [PMID: 35295456 PMCID: PMC8915692 DOI: 10.3389/fpain.2021.699993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023] Open
Abstract
Neuropathic pain is a rampant disease exacting a significant toll on patients, providers, and health care systems around the globe. Neuromodulation has been successfully employed to treat many indications including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), phantom limb pain (PLP), radiculopathies, and intractable pelvic pain, among many others. Recent studies have also demonstrated efficacy for cancer-related pain and chemotherapy induced neuropathy with these techniques. Spinal cord stimulation (SCS) is the most commonly employed technique and involves implantation of percutaneous or paddle leads targeting the dorsal columns of the spinal cord with the goal of disrupting the pain signals traveling to the brain. Tonic, high frequency, and burst waveforms have all been shown to reduce pain and disability in chronic pain patients. Closed-loop SCS systems that automatically adjust stimulation parameters based on feedback (such as evoked compound action potentials) are becoming increasingly used to help ease the burden placed on patients to adjust their programming to their pain and position. Additionally, dorsal root ganglion stimulation (DRGS) is a newer technique that allows for dermatomal coverage especially in patients with pain in up to two dermatomes. Regardless of the technique chosen, neuromodulation has been shown to be cost-effective and efficacious and should be given full consideration in patients with chronic pain conditions.
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Affiliation(s)
- Breanna L Sheldon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Jonathan Bao
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States.,Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
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