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  • 1
    Online Resource
    Online Resource
    Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional Paresthesia Based Waveforms: A Pilot Study
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 1 ( 2021-02-22)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 1 ( 2021-02-22)
    Abstract: Background: Chronic back and neck pain affects 20% of Americans. Spinal cord stimulation (SCS) is an effective therapy for otherwise refractory chronic pain. Traditional SCS relies on low-frequency stimulus in the 40 - 60 Hz range causing robust paresthesia in regions overlapping with painful dermatomes. Objectives: This study aims to determine the effect of superimposing sub-perception stimulation in patients who previously had good long-term relief with paresthesia. Methods: This is a prospective observational trial examining patients who had previously been implanted with paresthesia based SCS for failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS). These patients presented for implantable pulse generator (IPG) replacement based on battery depletion with an IPG capable of combined sub-perception and paresthesia based SCS therapy. Patients were assessed immediately following the exchange and four weeks later using a telephone survey. Their pain was assessed on each follow up using a Numerical Rating scale (NRS); the primary outcome was the change in NRS after four weeks from the exchange day. Secondary outcomes included paresthesia changes, which included the subjective quality of sensation generated, the overall subjective coverage of the painful region, subjective variation of coverage with positional changes, and global perception of the percentage improvement in pain. Results: Based on our clinic registry, 30 patients were eligible for IPG exchange, 16 were consented for follow up and underwent an exchange, and 15 were available for follow up four weeks following. The average NRS decreased from 7.47 with traditional SCS to 4.5 with combination therapy. 80% of patients reported an improvement in the quality of paresthesia over traditional SCS therapy, and in most patients, this translated to significantly improved pain control. Conclusions: Our findings suggest improved pain relief in patients who had previously had good results with paresthesia based therapy and subsequently underwent IPG exchange to a device capable of delivering combined sub-perception stimulation. The mechanism of action is unclear though there may be an additive and/or synergistic effect of the two waveforms delivered. Larger studies with long-term follow-up are needed to elucidate the durability of pain relief and the precise mechanism by which combined subperception and paresthesia based SCS may improve overall patient outcomes.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.113089
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 2
    Online Resource
    Online Resource
    Inferior Hypogastric Block for the Treatment of Chronic Pelvic Pain
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 1 ( 2021-02-16)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 1 ( 2021-02-16)
    Abstract: Context: Pelvic pain is described as pain originating from the visceral or somatic system localizing to the pelvis, the anterior abdominal wall at the level of or below the umbilicus, lumbosacral back in either men or women. Evidence Acquisition: Narrative review. Results: Chronic pelvic pain can be a complex disorder that may involve multiple systems such as urogynecological, gastrointestinal, neuromusculoskeletal, and psychosocial systems. The etiopathogenesis for chronic pain remains unknown for many patients. For achieving optimal patient management, a multimodal and individualized assessment of each patient is the best strategy. Conclusions: There are non-pharmacologic treatments as well as pharmacologic treatments. In addition to these treatment options, inferior hypogastric plexus block is a promising treatment modality.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.112225
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 3
    Online Resource
    Online Resource
    Intraoperative Hypotension Increased Risk in the Oncological Patient
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 1 ( 2021-02-24)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 1 ( 2021-02-24)
    Abstract: : Patient safety advocacy involves avoiding, preventing, and amelioration of adverse outcomes or injuries caused by the process of healthcare rather than a patient's underlying medical illness. Intraoperative hypotension (IOH), a common morbid event, reduces perfusion to critical organs and tissues and has a wide incidence, depending on how it is defined. IOH has adverse intraoperative and postoperative consequences, which make its prevention important to improve patient outcomes. Certain populations have even greater consequences related to IOH, and clinicians must understand these risks. In this narrative review, we examine the risk of intraoperative hypotension in the oncological patient population.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.112830
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 4
    Online Resource
    Online Resource
    Intubating Through Supraglottic Airway Devices: A Narrative Review
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 3 ( 2021-06-29)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 3 ( 2021-06-29)
    Abstract: Implication Statement: Despite the increasing popularity of video laryngoscopes, the supraglottic airway device (SAD) remains a critical airway rescue tool. The SAD provides a conduit for tracheal intubation in failed laryngoscopy. This article aims to help the operator: (1) select an intubating SAD with consistent performance; (2) inform the appropriate SAD-endotracheal tube pairings; and (3) explain various SAD and endotracheal tube maneuvers available to increase chances of successful intubation. Objectives: The first supraglottic airway device (SAD) was introduced more than thirty years ago. Since then, SADs have undergone multiple iterations and improvements. The SAD remains an airway rescue device for ventilation and an intubation conduit on difficult airway algorithms. Data Sources: Several SADs are specifically designed to facilitate tracheal intubation, i.e., “intubating SADs,” while most are “non-intubating SADs.” The two most commonly reported tracheal intubation methods via the SADs are the blind and visualized passage of the endotracheal tube (ETT) preloaded on a fiberoptic scope. Fiberoptic guided tracheal intubation (FOI) via an intubating SAD generally has higher success rates than blind intubations and is thus preferred. However, fiberscopes might not always be readily available, and anesthesiologists should be skilled to successfully intubate blindly through a SAD. Summery: This narrative review describes intubating SAD with consistent performance, appropriate SAD-ETT pairings, and various SAD and ETT maneuvers to increase successful intubation chances.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.113719
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 5
    Online Resource
    Online Resource
    Utilization of Intravenous Lidocaine Infusion for the Treatment of Refractory Chronic Pain
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 10, No. 6 ( 2021-01-02)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 10, No. 6 ( 2021-01-02)
    Abstract: Context: Chronic pain accounts for one of the most common reasons patients seek medical care. The financial burden of chronic pain on health care is seen by direct financial cost and resource utilization. Many risk factors may contribute to chronic pain, but there is no definite risk. Managing chronic pain is a balance between maximally alleviating symptoms by utilizing a therapeutic regimen that is safe for long-term use. Currently, non-opioid analgesics, NSAIDs, and opioids are some of the medical treatment options, but these have numerous adverse effects and may not be the best option for long-term use. However, Lidocaine can achieve both central and peripheral analgesic effects with relatively few side effects, which may be an ideal compound for managing chronic pain. Evidence Acquisition: This is a Narrative Review. Results: Infusion of lidocaine (2-(diethylamino)-N-(2,6-dimethylphenyl)acetamide), an amino-amide compound, is emerging as a promising option to fill the therapeutic void for treatment of chronic pain. Numerous studies have outlined dosing protocols for lidocaine infusion for the management of perioperative pain, outlined below. While there are slight variations in these different protocols, they all center around a similar dosing regimen to administer a bolus to reach a rapid steady state, followed by infusion for up to 72 hours to maintain the therapeutic analgesic effects. Conclusions: Lidocaine may be a promising pharmacologic solution with a low side effect profile that provides central and peripheral analgesia. Even though the multifaceted mechanism is not entirely understood yet, lidocaine may be a promising novel remedy in treating chronic pain in various conditions.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.112290
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
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    Online Resource
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 6
    Online Resource
    Online Resource
    Dorsal Root Ganglion (DRG) and Chronic Pain
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 2 ( 2021-03-28)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 2 ( 2021-03-28)
    Abstract: Context: Chronic neuropathic pain is a common condition, and up to 11.9% of the population have been reported to suffer from uncontrolled neuropathic pain. Chronic pain leads to significant morbidity, lowered quality of life, and loss of workdays, and thus carries a significant price tag in healthcare costs and lost productivity. dorsal root ganglia (DRG) stimulation has been recently increasingly reported and shows promising results in the alleviation of chronic pain. This paper reviews the background of DRG stimulation, anatomical, and clinical consideration and reviews the clinical evidence to support its use. Evidence Acquisition: The DRG span the length of the spinal cord and house the neurons responsible for sensation from the periphery. They may become irritated by direct compression or local inflammation. Glial cells in the DRG respond to nerve injury, producing inflammatory markers and contribute to the development of chronic pain, even after the resolution of the original insult. While the underlying mechanism is still being explored, recent studies explored the efficacy of DRG stimulation and neuromodulation for chronic pain treatment. Results: Several reported cases and a small number of randomized trials were published in recent years, describing different methods of DRG stimulation and neuromodulation with promising results. Though evidence quality is mostly low, these results provide evidence to support the utilization of this technique. Conclusions: Chronic neuropathic pain is a common condition and carries significant morbidity and impact on the quality of life. Recent evidence supports the use of DRG neuromodulation as an effective technique to control chronic pain. Though studies are still emerging, the evidence appears to support this technique. Further studies, including large randomized trials evaluating DRG modulation versus other interventional and non-interventional techniques, are needed to further elucidate the efficacy of this method. These studies are also likely to inform the patient selection and the course of treatment.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.113020
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
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    Online Resource
    Open Access Request
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 7
    Online Resource
    Online Resource
    Etiology Diagnosis and Management of Radial Nerve Entrapment
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 1 ( 2021-02-14)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 1 ( 2021-02-14)
    Abstract: Context: The anatomy of the radial nerve is prone to entrapment, each with different symptomology. Compression of entrapment of the radial nerve can occur near the radiocapitellar joint, the spiral groove, the arcade of Frohse, the tendon of the extensor carpi radialis brevis (ECRB), and at the radial tunnel. Those who require repetitive motions are at increased risk of peripheral neuropathy syndromes, including repetitive pronation and supination, trauma, or systemic disease; however, t the influence of all risk factors is not well understood. Depending on the location of entrapment, radial nerve entrapment syndrome presents different symptoms. It may include both a motor component and a sensory component. The motor component includes a dropped arm, and the sensory component can include pain and paresthesia in the distribution of the radial nerve that resolves with rest and exacerbates by repetitive pronation and supination. Evidence Acquisition: Diagnostic evaluation for radial nerve entrapment, apart from clinical symptoms and physical exam, includes electromyography, nerve conduction studies, ultrasonography, and magnetic resonance imaging. Conservative management for radial nerve entrapment includes oral anti-inflammatory medications, activity modification, and splinting. Some recently performed studies mentioned promising minimally invasive techniques, including corticosteroid injections, peripheral nerve stimulation, and pulsed radiofrequency. Results: When minimally invasive techniques fail, open or endoscopic surgery can be performed to release the nerve Conclusions: Endoscopic surgery has the benefit of decreasing incision size and reducing time to functional recovery.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.112823
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
    Library Location Call Number Volume/Issue/Year Availability
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    Online Resource
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 8
    Online Resource
    Online Resource
    Topical Sevoflurane: A Novel Treatment for Chronic Pain Caused by Venous Stasis Ulcers
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 1 ( 2021-02-24)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 1 ( 2021-02-24)
    Abstract: : In the US, an estimated 1 - 2% of chronic venous insufficiency (CVI) patients (of 6 - 7 million nationwide) develop at least one venous stasis ulcer (VSU) during their illness. Of these, approximately 40% develop subsequent ulcers, making VSU prognostically poor. Current management of VSU is costly, with poor prognosis, high recurrence rate, inadequate pain management, and significantly reduced quality of life (QoL). Topical volatile anesthetic agents, such as sevoflurane, offer improved pain relief and symptom control in patients suffering from chronic VSU. The immediate impact of topical sevoflurane in reducing pain associated with ulcer bed debridement has several implications in improving the quality of life in patients with CVI induced ulcers and in the prognosis and healing of the ulcers. This review summarizes a topical formulation of a volatile anesthetic and its implications for the management of VSUs.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.112832
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
    Library Location Call Number Volume/Issue/Year Availability
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    Online Resource
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    Availability (electronic / print)
    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 9
    Online Resource
    Online Resource
    Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 1 ( 2021-02-02)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 1 ( 2021-02-02)
    Abstract: Context: Piriformis syndrome is a solely clinical diagnosis that often eludes the practitioner and goes underdiagnosed. PS is a pain syndrome and for those it affects, causes persistent pain and limits daily activity and work capacity. It is a form of deep gluteal syndrome that needs to be considered on the differential of low back pain as it comprises between 0.3% - 6% of all low back pain cases and is frequently underdiagnosed. Piriformis syndrome may be primary due anatomic anomalies or secondary, though the majority of cases are secondary to some insult. The objective of this manuscript is to provide a description of the epidemiology and presentation of piriformis as well as both non-operative and operative treatment options. We review all of the recent clinical evidence regarding the aforementioned therapies. Evidence Acquisition: Literature searches were performed using the below MeSH Terms using Mendeley version 1.19.4. Search fields were varied until further searches revealed no new articles. All articles were screened by title and abstract. Decision was made to include an article based on its relevance and the list of final articles was approved three of the authors. This included reading the entirety of the article. Any question regarding the inclusion of an article was discussed by all authors until an agreement was reached. Results: Medical management and physical therapy show some promise; however, when conservative treatment fails minimally invasive methods such as steroid injections, botulinum toxin injections, dry needling are all efficacious and there is substantial clinical evidence regarding these therapies. In those patients in which minimally invasive techniques do not result in an adequate relief of pain and return of function, endoscopic release can be considered. Endoscopic release is far superior to open release of the piriformis syndrome given the higher success and lower rate of complications. Conclusions: Piriformis syndrome is an important differential diagnosis in the work up of lower back pain and should not be ruled out with proper examination and testing. Clinicians should consider medical management and conservative management in the initial treatment plan for piriformis syndrome. There are many options within the conservative management and the literature shows much promise regarding these. Physical therapy, steroid injections, botulinum toxin injections, and dry needling are all potentially effective therapies with few adverse effects. Surgical options remain as gold standard, but only when conservative management has failed and the symptoms are significant to affect daily living activities. Endoscopic decompression of the sciatic nerve with or without release of the piriformis muscle has a reported high likelihood of success and a low complication rate. Current literature supports the preference of the endoscopic approach over the open approach due to improved outcomes and decreased complications. Further research is to well define the metrics for the diagnosis of piriformis syndrome and may include a need to develop diagnostic criteria.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.112825
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
    Library Location Call Number Volume/Issue/Year Availability
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    Online Resource
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
  • 10
    Online Resource
    Online Resource
    Efficacy of Acupuncture in the Treatment of Chronic Abdominal Pain
    Briefland ; 2021
    In:  Anesthesiology and Pain Medicine Vol. 11, No. 2 ( 2021-03-17)
    Details
    In: Anesthesiology and Pain Medicine, Briefland, Vol. 11, No. 2 ( 2021-03-17)
    Abstract: Context: Abdominal pain is a widespread complaint and is one of the common reasons leading patients to seek medical care, either in emergency situations or with their primary providers. While acute abdominal pain is a better defined, usually surgical condition, chronic abdominal pain requires longer, typically lifelong, therapy. Chronic abdominal pain may also present with acute flares and complications. Here we review seminal and novel evidence discussing the use of acupuncture in the treatment of abdominal pain, indications, and conditions that may benefit from this approach. Evidence Acquisition: Chronic abdominal pain is a common complaint causing significant morbidity and disability and has a hefty price tag attached. Recent studies show it may be prevalent in as much as 25% of the adult population. It is defined as three episodes of severe abdominal pain over the course of three months. Chronic abdominal pain could be the result of chronicity of acute pain or of chronic pain syndromes, most commonly IBD syndromes and IBS. While a plethora of treatments exists for both conditions, these treatments usually fall short of complete symptom control, and there is a need for complementary measures to curb disability and increase the quality of life in these patients. Acupuncture is a form of integrative medicine that has long been used in Chinese and traditional medicine, based on the rebalancing of the patient’s Qi, or Ying/Yang balance. It has been shown to be effective in treating several other conditions, and novel evidence may expand its use into other fields as well. Clinical trials studying acupuncture in chronic pain conditions have been promising, and recent evidence supports the use of abdominal pain in chronic abdominal pain conditions as well. Though not curative, acupuncture is a complementary approach that helps reduce symptoms and improved quality of life. Conclusions: Chronic abdominal pain is a widespread condition, mostly affected by the IBS and IBD spectrum. Etiologies are still being studied for these conditions, and while novel treatment approaches are absolute game changers for these patients, many continue to experience some level of symptoms and disability. Acupuncture may provide further alleviation of these symptoms in select patients, thus improving quality of life, reducing disability, and saving healthcare dollars. It is a largely safe and inexpensive method that may significantly contribute to the quality of life of selected patients.
    Type of Medium: Online Resource
    ISSN: 2228-7523 , 2228-7531
    URL: Journal
    URL: Article
    DOI: 10.5812/aapm
    DOI: 10.5812/aapm.113027
    Language: Unknown
    Publisher: Briefland
    Publication Date: 2021
    detail.hit.zdb_id: 3018888-X
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    Online Resource
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    BTU Cottbus
    Wissenschaftspark Albert Einstein
    EUV Frankfurt
    TH Wildau
    FH Potsdam
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