Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Back Pain: HELP
Articles from Lousiana
Based on 165 articles published since 2009
||||

These are the 165 published articles about Back Pain that originated from Lousiana during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Guideline Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. 2019

Navani, Annu / Manchikanti, Laxmaiah / Albers, Sheri L / Latchaw, Richard E / Sanapati, Jaya / Kaye, Alan D / Atluri, Sairam / Jordan, Sheldon / Gupta, Ashim / Cedeno, David / Vallejo, Alejandro / Fellows, Bert / Knezevic, Nebojsa Nick / Pappolla, Miguel / Diwan, Sudhir / Trescot, Andrea M / Soin, Amol / Kaye, Adam M / Aydin, Steve M / Calodney, Aaron K / Candido, Kenneth D / Bakshi, Sanjay / Benyamin, Ramsin M / Vallejo, Ricardo / Watanabe, Art / Beall, Douglas / Stitik, Todd P / Foye, Patrick M / Helander, Erik M / Hirsch, Joshua A. ·Comprehensive Pain Management Center, Campbell, CA. · Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY. · University Pain Medicine and Rehabilitation Center, Newark, NJ. · LSU Health Science Center, New Orleans. · Tri State Spine Care Institute. · Associate Director of Research at Millennium Pain Center, Bloomington, IL; Chief Science Officer at South Texas Orthopaedic Research Institute, Laredo, TX; and Adjunct Researcher at Illinois Wesleyan University, Bloomington, IL. · Millennium Pain Center, Bloomington, IL; Illinois Wesleyan University, Bloomington, Illinois. · Millennium Pain Center, Bloomington, Illinois; University of Illinois at Urbana-Champaign, Champaign, Illinois. · Vice Chair for Research and Education, Department of Anesthesiology and Pain Management, Advocate Illinois Masonic Medical Center, Clinical Associate Professor of Anesthesiology and Surgery at University of Illinois, Chicago, IL. · St. Michael's Pain and Spine Clinics, Houston, TX, and Univeristy of Texas Medical Branch, Galveston, TX. · Pain and Headache Center, Eagle River, Alaska. · Ohio Pain Clinic. · Manhattan Spine and Pain Medicine, New York, NY, and Hofstra-North Shore/LIJ School of Medicine, New York, NY. · Texas Spine and Joint Hospital, Tyler, TX. · SurgiCare of Manhattan and Lenox Hill Hospital. · Millennium Pain Center, Bloomington, IN. · Mt. Baker Pain Center, Bellingham, WA. · Clinical Radiology of Oklahoma, Edmond, OK. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA. · Massachusetts General Hospital and Harvard Medical School, Boston, MA. ·Pain Physician · Pubmed #30717500.

ABSTRACT: BACKGROUND: Regenerative medicine is a medical subspecialty that seeks to recruit and enhance the body's own inherent healing armamentarium in the treatment of patient pathology. This therapy's intention is to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous or allogenic biologics. This field is rising like a Phoenix from the ashes of underperforming conventional therapy midst the hopes and high expectations of patients and medical personnel alike. But, because this is a relatively new area of medicine that has yet to substantiate its outcomes, care must be taken in its public presentation and promises as well as in its use. OBJECTIVE: To provide guidance for the responsible, safe, and effective use of biologic therapy in the lumbar spine. To present a template on which to build standardized therapies using biologics. To ground potential administrators of biologics in the knowledge of the current outcome statistics and to stimulate those interested in providing biologic therapy to participate in high quality research that will ultimately promote and further advance this area of medicine. METHODS: The methodology used has included the development of objectives and key questions. A panel of experts from various medical specialties and subspecialties as well as differing regions collaborated in the formation of these guidelines and submitted (if any) their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these guidelines. The literature pertaining to regenerative medicine, its effectiveness, and adverse consequences was thoroughly reviewed using a best evidence synthesis of the available literature. The grading for recommendation was provided as described by the Agency for Healthcare Research and Quality (AHRQ). SUMMARY OF EVIDENCE: Lumbar Disc Injections: Based on the available evidence regarding the use of platelet-rich plasma (PRP), including one high-quality randomized controlled trial (RCT), multiple moderate-quality observational studies, a single-arm meta-analysis and evidence from a systematic review, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best-evidence synthesis. Based on the available evidence regarding the use of medicinal signaling/ mesenchymal stem cell (MSCs) with a high-quality RCT, multiple moderate-quality observational studies, a single-arm meta-analysis, and 2 systematic reviews, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Epidural Injections Based on one high-quality RCT, multiple relevant moderate-quality observational studies and a single-arm meta-analysis, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Facet Joint Injections Based on one high-quality RCT and 2 moderate-quality observational studies, the qualitative evidence for facet joint injections with PRP has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Sacroiliac Joint Injection Based on one high-quality RCT, one moderate-quality observational study, and one low-quality case report, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. CONCLUSION: Based on the evidence synthesis summarized above, there is Level III evidence for intradiscal injections of PRP and MSCs, whereas the evidence is considered Level IV for lumbar facet joint, lumbar epidural, and sacroiliac joint injections of PRP, (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis.Regenerative therapy should be provided to patients following diagnostic evidence of a need for biologic therapy, following a thorough discussion of the patient's needs and expectations, after properly educating the patient on the use and administration of biologics and in full light of the patient's medical history. Regenerative therapy may be provided independently or in conjunction with other modalities of treatment including a structured exercise program, physical therapy, behavioral therapy, and along with the appropriate conventional medical therapy as necessary. Appropriate precautions should be taken into consideration and followed prior to performing biologic therapy. Multiple guidelines from the Food and Drug Administration (FDA), potential limitations in the use of biologic therapy and the appropriate requirements for compliance with the FDA have been detailed in these guidelines. KEY WORDS: Regenerative medicine, platelet-rich plasma, medicinal signaling cells, mesenchymal stem cells, stromal vascular fraction, bone marrow concentrate, chronic low back pain, discogenic pain, facet joint pain, Food and Drug Administration, minimal manipulation, evidence synthesis.

2 Editorial A critical overview of the current myofascial pain literature - November 2018. 2019

Dommerholt, Jan / Hooks, Todd / Chou, Li-Wei / Finnegan, Michelle. ·Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: jan@bpcemail.com. · New Orleans Pelicans, New Orleans, LA, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: trhooks@hotmail.com. · China Medical University, Taichung, Taiwan. Electronic address: chouliwe@gmail.com. · Myopain Seminars, Bethesda, MD, USA; ProMove PT Pain Specialists, Bethesda, MD, USA. Electronic address: mbfpt77@gmail.com. ·J Bodyw Mov Ther · Pubmed #30691765.

ABSTRACT: This is the first issue of this review column since the passing of Dr. Leon Chaitow. We would like to take a brief moment to acknowledge how much his mentorship, friendship, and confidence have meant to us. Leon was a force in osteopathic and naturopathic medicine and his influence reaches to all corners of the musculoskeletal realm crossing over many disciplines through his lectures, workshops, and of course, his many books, editorials, and articles. In the foreword to one of his books, Jan Dommerholt wrote that "Leon Chaitow […] continued the work of Travell and Simons, but also of many others, whose contributions he has skillfully woven into an intricate tapestry of clinical pearls, practical tips, and solid evidence-informed research." Dr. Chaitow was a synthesizer, who always considered what different clinicians and researchers could possibly contribute to a better understanding of pain and dysfunction and provide real solutions to real problems. Even when he would not necessarily agree with all suggested remedies, he maintained an open mind and was able to take a step back and consider the bigger picture. For example, Leon was not a big fan of dry needling, yet, he valued the importance of this approach and encouraged the inclusion of dry needling papers in this review article and in his journal. The Journal of Bodywork and Movement Therapies became his baby and, considering the growth of the journal, there is no question that Leon's intense focus and efforts are appreciated by many around the globe. We wish to extend our condolences to Leon's wife Alkmini and daughter Sasha. He will surely be missed, but we can find peace in knowing that his legacy will stay with us forever. In this issue, we have included several basic myofascial pain research articles. As usual, dry needling (DN) studies and case reports are the most commonly referenced papers, but we also included neuroscience and electromyography studies, sleep studies, interrater reliability studies, and case reports of adverse events.

3 Editorial A critical overview of the current myofascial pain literature - July 2018. 2018

Dommerholt, Jan / Finnegan, Michelle / Hooks, Todd / Chou, Li-Wei. ·Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: jan@bpcemail.com. · Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: mbfpt77@gmail.com. · New Orleans Pelicans, New Orleans, LA, USA. Electronic address: trhooks@hotmail.com. · China Medical University, Taichung, Taiwan. Electronic address: chouliwe@gmail.com. ·J Bodyw Mov Ther · Pubmed #30100296.

ABSTRACT: In the current issue of this clinical overview, we are pleased to include several basic research studies ranging from the differentiation of radicular and non-radicular low back pain based on the presence of trigger points (TrPs) to the role of TrPs in patients with osteoarthritis, the diagnostic criteria of TrP, the accurate placement of needles in the piriformis muscle with dry needling (DN), and the reliability of TrP identification, among others. As usual, there are many new DN studies, but also several review papers, and manual TrP research. Contributing authors come from as many as 15 different countries!

4 Review Cauda Equina Syndrome Secondary to Diffuse Infiltration of the Cauda Equina by Acute Myeloid Leukemia: A Case Report and Literature Review. 2019

Walton, Alice / Mecklosky, Jessica / Carr, Christopher / Scullen, Tyler / Mathkour, Mansour / Werner, Cassidy / Amenta, Peter S. ·Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA. · Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA. Electronic address: peter.amenta@gmail.com. ·World Neurosurg · Pubmed #31759146.

ABSTRACT: BACKGROUND: Cauda equina syndrome (CES) results from the dysfunction of the lumbar, sacral, and coccygeal rootlets composing the cauda equina. The underlying etiology is most commonly compression secondary to a large herniated lumbosacral disc; however, any pathology affecting the rootlets can result in the syndrome. We present a rare case of CES secondary to neoplastic polyradiculitis in a patient with acute myelogenous leukemia (AML) and review the pertinent literature. CASE PRESENTATION: A 72-year-old male with a past medical history of AML presented with two-weeks of difficulty with ambulation followed by the acute-onset of low back pain radiating to the buttocks bilaterally. Imaging of the lumbar spine demonstrated diffuse enhancement and thickening of the cauda equina rootlets. Lumbar puncture showed numerous blasts with monocytoid features consistent with AML, and the patient was diagnosed with polyradiculopathy of the cauda equina secondary to diffuse metastatic infiltration. CONCLUSION: Central nervous system (CNS) involvement of leukemia is poorly understood, even though such lesions are not uncommon in advanced disease. As treatment has improved, many types of leukemia, such as AML, are believed to be curable, and patients with the disease are living longer. With improved survival, it is reasonable to suspect that such involvement by AML may become more common. Our patient is a classic presentation of CES secondary to diffuse infiltration by AML and serves as an example of this rare manifestation of hematologic malignancy.

5 Review Treatment of Discogenic Low Back Pain: Current Treatment Strategies and Future Options-a Literature Review. 2019

Zhao, Lei / Manchikanti, Laxmaiah / Kaye, Alan David / Abd-Elsayed, Alaa. ·Department of Orthopedics, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250021, China. · Pain Management Centers of America, Paducah, KY, USA. · Departments of Anesthesiology and Pharmacology, Louisiana State University School of Medicine, 1501 Kings Highway, Shreveport, LA, 71103, USA. akaye@lsuhsc.edu. · Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WA, USA. ·Curr Pain Headache Rep · Pubmed #31707499.

ABSTRACT: PURPOSE OF REVIEW: Many studies have demonstrated that discogenic low back pain is the most common type of chronic low back pain (CLBP), one of the major causes of disability, and has a major socioeconomic impact. Our aim is to review present therapeutic interventions for discogenic low back pain. RECENT FINDINGS: There are a multitude of treatments used in clinical practice to treat CLBP, but there is continued debate and lack of consensus among clinicians and the policy makers as to which modality is the best approach. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26 to 39% of patients. Treatment modalities include noninvasive treatments such as drug therapy, multiple physical modalities, and multidisciplinary biopsychosocial rehabilitation; interventional modalities such as intradiscal therapies and epidural injections; and regenerative modalities with disc injections of various solutions; and, finally, surgical approaches such as fusion and artificial disc replacement, all of which are accompanied by significant discussion, limited evidence, and lack of consensus. The results of this evaluation show that the evidence for drug therapy in chronic discogenic low back pain is limited; for multidisciplinary biopsychosocial rehabilitation, it is moderate; and for multiple physical and behavioral therapies, the evidence is limited. For intradiscal therapies, it is poor; for epidural injections, it is moderate; and for regenerative therapies, evidence levels of 3 to 4. The evidence for surgical fusions and disc replacement is similar, without superiority when compared with multidisciplinary biopsychosocial rehabilitation, well-designed physical therapy, or epidural injections.

6 Review Stem Cell Therapies for Treatment of Discogenic Low Back Pain: a Comprehensive Review. 2019

Urits, Ivan / Capuco, Alexander / Sharma, Medha / Kaye, Alan D / Viswanath, Omar / Cornett, Elyse M / Orhurhu, Vwaire. ·Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu. · Georgetown University School of Medicine, Washington, DC, USA. · University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. · Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA. · Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. · Department of Anesthesiology, School of Medicine, Creighton University, Omaha, NE, USA. · Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA. · Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. ·Curr Pain Headache Rep · Pubmed #31359164.

ABSTRACT: PURPOSE OF REVIEW: Discogenic low back pain (DLBP) stems from pathology in one or more intervertebral discs identified as the root cause of the pain. It is the most common type of chronic low back pain (LBP), representing 26-42% of attributable cases. RECENT FINDINGS: The clinical presentation of DLBP includes increased pain when sitting, coughing, or sneezing, and experiencing relief when standing or ambulating. Dermatomal radiation of pain to the lower extremity and neurological symptoms including numbness, motor weakness, and urinary or fecal incontinence are signs of advanced disease with disc prolapse, nerve root compression, or spinal stenosis. Degenerative disc disease is caused by both a decrease in disc nutrient supply causing decreased oxygen, lowered pH, and lessened ability of the intervertebral disc (IVD) to respond to increased load or injury; moreover, changes in the extracellular matrix composition cause weakening of the tissue and skewing the extracellular matrix's (ECM) harmonious balance between catabolic and anabolic factors for cell turnover in favor of catabolism. Thus, the degeneration of the disc causes a shift from type II to type I collagen expression by NP cells and a decrease in aggrecan synthesis leads to dehydrated matrix cells ultimately with loss of swelling pressure needed for mechanical support. Cell-based therapies such as autologous nucleus pulposus cell re-implantation have in animal models and human trials shown improvements in LBP score, retention of hydration in IVD, and increased disc height. Percutaneously delivered multipotent mesenchymal stem cell (MSC) therapy has been proposed as a potential means to uniquely ameliorate discogenic LBP holistically through three mechanisms: mitigation of primary nociceptive disc pain, slow or reversal of the catabolic metabolism, and restoration of disc tissue. Embryonic stem cells (ESCs) can differentiate into cells of all three germ layers in vitro, but their use is hindered related to ethical concerns, potential for immune rejection after transplantation, disease, and teratoma formation. Another similar approach to treating back pain is transplantation of the nucleus pulposus, which, like stem cell therapy, seeks to address the underlying cause of intervertebral disc degeneration by aiming to reverse the destructive inflammatory process and regenerate the proteoglycans and collagen found in healthy disc tissue. Preliminary animal models and clinical studies have shown mesenchymal stem cell implantation as a potential therapy for IVD regeneration and ECM restoration via a shift towards favorable anabolic balance and reduction of pain.

7 Review Advances in the Understanding and Management of Chronic Pain in Multiple Sclerosis: a Comprehensive Review. 2019

Urits, Ivan / Adamian, Leena / Fiocchi, Jacob / Hoyt, Dylan / Ernst, Carly / Kaye, Alan D / Viswanath, Omar. ·Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu. · Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA. · A T Still University, Kirksville College Of Osteopathic Medicine, Kirksville, MO, USA. · Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. · Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA. · Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. · Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA. ·Curr Pain Headache Rep · Pubmed #31342191.

ABSTRACT: PURPOSE OF REVIEW: Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system that can lead to severe physical, cognitive, and neurological deficits that often manifest in young adults. Central neuropathic pain is a common presenting symptom, often prompting patients to seek treatment with opioids, NSAIDS, antiepileptics, and antidepressants despite minimal effectiveness and alarming side-effect profiles. Additionally, spasticity occurs in more than 80% of MS patients and is an important consideration for further study in treatment. RECENT FINDINGS: Related to inconsistencies in pain presentation and clinical reporting, current studies continue to investigate clinical patient presentation to define chronic pain characteristics to optimize treatment plans. Although often neuropathic in origin, the complex nature of such pain necessitates a multimodal approach for adequate treatment. While psychiatric comorbidities typically remain unchanged in their severity over time, physical conditions may lead to worsening chronic pain long-term, often due to decreased quality of life. The prevalence of neuropathic pain is ~ 86% in patients with multiple sclerosis and most commonly presents as extremity pain, trigeminal neuralgia, back pain, or headaches. As MS symptoms are frequently unremitting and poorly responsive to conventional medical management, recent attention has been given to novel interventions for management of pain. Among these, medicinal cannabis therapy, targeted physical therapy, and neuromodulation offer promising results. In this review, we provide a comprehensive update of the current perspective of MS pathophysiology, symptomatology, and treatment.

8 Review An Update on Cognitive Therapy for the Management of Chronic Pain: a Comprehensive Review. 2019

Urits, Ivan / Hubble, Ashley / Peterson, Emily / Orhurhu, Vwaire / Ernst, Carly A / Kaye, Alan D / Viswanath, Omar. ·Department of Anesthesia, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu. · Phoenix Regional Campus, Creighton University School of Medicine, Phoenix, AZ, USA. · Department of Anesthesia, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. · A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO, USA. · Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. · Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA. · Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. · Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA. ·Curr Pain Headache Rep · Pubmed #31292747.

ABSTRACT: PURPOSE OF REVIEW: Psychological approaches to the management of chronic pain have proven to be very effective in allowing patients to better manage their symptoms and with overall functioning. RECENT FINDINGS: Cognitive functional therapy (CFT) is centered on a three-step process, beginning with cognitive training, then progressing to functional movement training and exposure with control, and ending with physical activity and lifestyle changes. Cognitive behavioral therapy (CBT) as a technique focuses on identifying and changing maladaptive behaviors, thought patterns, and situations that contribute to psychiatric dysfunction, which may lead to further progression of pain. The purpose of this review is to provide a comprehensive update of recent advances in the use of both CFT and CBT for the management of chronic pain conditions.

9 Review A Multimodal Approach to Pain Management for Patients with Chronic Back Pain: Outcome Measures at 1 Year. 2019

Eskander, Jonathan P / Beakley, Burton D / Zhang, Si / Paetzold, Jacquelyn / Sharma, Bharat / Kaye, Alan D / Sharma, Sanjay. ·Department of Anesthesiology, Portsmouth Anesthesia Associates, Portsmouth, VA, USA. jeskande@tulane.edu. · Department of Anesthesiology, Ocshner Health System, New Orleans, LA, USA. · Department of Anesthesiology, Stamford Health Medical Group, Stamford, CT, USA. · Department of Anesthesiology, STAR Anesthesia, P.A., San Antonio, TX, USA. · Department of Anesthesiology, Duke University, Durham, NC, USA. · Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. · Department of Anesthesiology, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA. ·Curr Pain Headache Rep · Pubmed #31286279.

ABSTRACT: PURPOSE OF REVIEW: The purpose of this study is to evaluate the effectiveness of a multimodal approach to treating chronic low back pain. RECENT FINDINGS: Chronic non-cancer-related back pain is often a frustrating and poorly managed problem for patients. It poses a significant public health issue worsened by the widespread use of narcotics. In 2016, the CDC released guidelines with noticeably more strict recommendations on prescription of narcotics for pain. Veterans at an interventional pain clinic presenting with chronic back pain refractory to medical and to surgical care were enrolled in an 8-week interdisciplinary pain management program. Pain scores were significantly reduced 1 year after completion of the program. Patients in this study benefitted from lower and sustained pain scores, a reduction in emergency room, and urgent care clinic visits, as well as generally high satisfaction with the interdisciplinary program.

10 Review Platelet-Rich Plasma for the Treatment of Low Back Pain: a Comprehensive Review. 2019

Urits, Ivan / Viswanath, Omar / Galasso, Annemarie C / Sottosani, Emily R / Mahan, Keenan M / Aiudi, Christopher M / Kaye, Alan D / Orhurhu, Vwaire J. ·Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu. · Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA. · Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. · Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA. · Georgetown University School of Medicine, Washington, D.C., USA. · University of Massachusetts Medical School, Worcester, MA, USA. · Harvard Medical School, Boston, MA, USA. · Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. · Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA. ·Curr Pain Headache Rep · Pubmed #31270622.

ABSTRACT: PURPOSE OF REVIEW: Back pain is a growing problem worldwide, incurring enormous economic costs and disability. Current treatment modalities often provide adequate relief but fail to address underlying conditions. Regenerative cellular modalities aim to restore anatomical function in degenerative conditions which may cause low back pain. Platelet-rich plasma (PRP) consists of an increased concentration of autologous platelets suspended in a small amount of plasma. PRP can be administered via injection or topically and is prepared using various techniques. RECENT FINDINGS: While a unifying mechanism of action is not well understood, biochemical and cellular changes involved in inflammation and mechanical structure have been detected in both in vitro and in vivo studies. At a higher level, PRP injection research utilizing animal models and patient data have provided insights into pain relief, chondroprotection, and factors that impact the therapy's efficacy. Recently, a small number of studies have promoted PRP injection as a relatively safe means of treating patients with degenerative disc disease who have failed other means of managing their lower back pain. PRP injections for sacroiliac joint-related pain are not an accepted or common treatment modality; the evidence for their efficacy remains to be seen outside of small RCTs and case reports. A small number of prospective trials have suggested there may be some benefit to using PRP injection in the treatment of pain or functional decline caused by facet joint arthropathy. These commonly used modalities require further study to improve quality of evidence and to investigate the safety and efficacy of PRP injections for various common causes of chronic low back.

11 Review Spinal Cord Stimulation: Comparing Traditional Low-frequency Tonic Waveforms to Novel High Frequency and Burst Stimulation for the Treatment of Chronic Low Back Pain. 2019

Morales, Ariel / Yong, R Jason / Kaye, Alan D / Urman, Richard D. ·Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. · Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. · Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. rurman@bwh.harvard.edu. ·Curr Pain Headache Rep · Pubmed #30868285.

ABSTRACT: PURPOSE OF REVIEW: The purpose of the present investigation is to summarize supporting evidence for novel sub-perception spinal cord stimulation (SCS) therapy over traditional paresthesia inducing low-frequency waveforms for the treatment of chronic pain. The focus of this review is to summarize key studies comparing traditional low-frequency tonic waveforms to modern high frequency and burst stimulation for the treatment of patients with chronic intractable low back pain and/or leg pain. RECENT FINDINGS: Several recent studies have demonstrated the benefit of novel SCS therapies over traditional low-frequency SCS for the treatment of patients with chronic low back and/or leg pain. SENZA-RTC showed that paresthesia-free high-frequency SCS was superior to low-frequency stimulation for treatment of chronic low back pain with leg pain. The SUNBURST crossover trial recently found that high-frequency burst stimulation was preferred over low-frequency tonic SCS with patients citing better pain relief and a preference for paresthesia-free SCS. The new ongoing EVOLVE workflow retrospective multicenter study uses technology that can deliver both low-dose and high-dose SCS. Further, the wavewriter technology addresses patient variability with its ability to layer sub-perception waveforms and paresthesia inducing low-frequency stimulation tailored to patient needs via an interactive feedback feature. Neuromodulation for the treatment of chronic pain is rapidly evolving with technology at its forefront. Modern SCS systems use novel waveforms, frequencies, and stimulation modes to deliver paresthesia-free pain relief to patients suffering from chronic low back pain and/or leg pain with better results than traditional tonic low-frequency SCS. As the field advances, new studies are needed comparing new waveform and delivery systems to optimize patient selection and treatment response.

12 Review Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. 2019

Urits, Ivan / Burshtein, Aaron / Sharma, Medha / Testa, Lauren / Gold, Peter A / Orhurhu, Vwaire / Viswanath, Omar / Jones, Mark R / Sidransky, Moises A / Spektor, Boris / Kaye, Alan D. ·Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu. · Department of Orthopedic Surgery, Hofstra-Northwell Health System, Great Neck, NY, 11021, USA. · Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. · Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA. · Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. · Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA. · Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Tyler, TX, USA. · Department of Anesthesiology, Emory School of Medicine, Atlanta, GA, 30308, USA. · Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA, 70112, USA. ·Curr Pain Headache Rep · Pubmed #30854609.

ABSTRACT: PURPOSE OF REVIEW: Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general US adult population is 10-30%, and the lifetime prevalence of US adults is as high as 65-80%. RECENT FINDINGS: Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is most effective and can include multimodal medical, psychological, physical, and interventional approaches. Low back pain is a difficult condition to effectively treat and continues to affect millions of Americans every year. In the current investigation, we present a comprehensive review of low back pain and discuss associated pathophysiology, diagnosis, and treatment.

13 Review Functional Improvements Utilizing the Short Physical Performance Battery (SPPB) in the Elderly after Epidural Steroid Injections. 2019

Przkora, Rene / Kinsky, Michael P / Fisher, Steve R / Babl, Christopher / Heyde, Christoph E / Vasilopoulos, Terrie / Kaye, Alan D / Volpi, Elena. ·Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA. rprzkora@anest.ufl.edu. · Departments of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA. · Departments of Physical Therapy, University of Texas Medical Branch, Galveston, TX, USA. · Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA. · Department of Orthopaedic Surgery, University Hospital Leipzig, Leipzig, Germany. · Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA. · Internal Medicine-Geriatrics, University of Texas Medical Branch, Galveston, TX, USA. ·Curr Pain Headache Rep · Pubmed #30796532.

ABSTRACT: PURPOSE OF REVIEW: The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Our study was IRB-approved and included 16 patients, 68 to 83 years old, with symptomatic back and radicular leg pain secondary to lumbar stenosis. Patients could elect to undergo a lumbar ESI (n = 11) or be treated via medication management (n = 5). Numeric pain score, SPPB score, and adverse events were measured and compared at baseline and a 1-month follow-up visit. RECENT FINDINGS: Statistically significant improvements were observed from baseline compared to the 1-month follow-up for total SPPB score in the injection group. Similar improvements in the injection group were observed for pain scores and the SPPB subcomponents such as the 4-m walk test, chair stand time, and balance score. Comparatively, no statistically significant improvements were observed in the medication group. Lumbar ESIs improved objective physical capacity parameters and pain scores in elderly patients with symptomatic lumbar stenosis compared to medication management. In addition, the SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic.

14 Review Current Concepts in the Evaluation and Management of Type II Superior Labral Lesions of the Shoulder. 2018

Hester, William A / O'Brien, Michael J / Heard, Wendell M R / Savoie, Felix H. ·Tulane University School of Medicine, Department of Orthpaedic Surgery, New Orleans, LA 70112, USA. ·Open Orthop J · Pubmed #30197715.

ABSTRACT: Background: Superior labrum tears extending from anterior to posterior (SLAP lesion) are a cause of significant shoulder pain and disability. Management for these lesions is not standardized. There are no clear guidelines for surgical versus non-surgical treatment, and if surgery is pursued there are controversies regarding SLAP repair versus biceps tenotomy/tenodesis. Objective: This paper aims to briefly review the anatomy, classification, mechanisms of injury, and diagnosis of SLAP lesions. Additionally, we will describe our treatment protocol for Type II SLAP lesions based on three groups of patients: throwing athletes, non-throwing athletes, and all other Type II SLAP lesions. Conclusion: The management of SLAP lesions can be divided into 4 broad categories: (1) nonoperative management that includes scapular exercise, restoration of balanced musculature, and that would be expected to provide symptom relief in 2/3 of all patients; (2) patients with a clear traumatic episode and symptoms of instability that should undergo SLAP repair without (age < 40) or with (age > 40) biceps tenotomy or tenodesis; (3) patients with etiology of overuse without instability symptoms should be managed by biceps tenotomy or tenodesis; and (4) throwing athletes that should be in their own category and preferentially managed with rigorous physical therapy centered on hip, core, and scapular exercise in addition to restoration of shoulder motion and rotator cuff balance. Peel-back SLAP repair, Posterior Inferior Glenohumeral Ligament (PIGHL) release, and treatment of the partial infraspinatus tear with debridement, PRP, or (rarely) repair should be reserved for those who fail this rehabilitation program.

15 Review Functional Connectivity Alterations: Novel Therapy and Future Implications in Chronic Pain Management. 2018

Thorp, Stephen L / Suchy, Thomas / Vadivelu, Nalini / Helander, Erik M / Urman, Richard D / Kaye, Alan D. ·Crystal Run Healthcare, Department of Pain Medicine, Middletown, NY. · Yale-New Haven Hospital, Department of Anesthesiology, New Haven, CT. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA. · Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard, Boston, MA; Department of Anesthesiology, LSU School of Medicine, New Orleans, LA. ·Pain Physician · Pubmed #29871376.

ABSTRACT: BACKGROUND: Chronic pain is a major public health problem resulting in physical and emotional pain for individuals and families, loss of productivity, and an annual cost of billions of dollars. The lack of objective measures available to aid in diagnosis and evaluation of therapies for chronic pain continues to be a challenge for the clinician. OBJECTIVES: Functional magnetic resonance imaging (fMRI) is an imaging technique that can establish regional areas of interest and examine synchronous neuronal activity in functionally related but anatomically distinct regions of the brain, known as functional connectivity. STUDY DESIGN: The present investigation examines changes in functional connectivity in 4 common pain syndromes: chronic back pain (CBP), fibromyalgia, diabetic neuropathy, and complex regional pain syndrome (CRPS). SETTING: This is a review of the current understanding of functional connectivity. METHODS: Utilizing functional imaging, patients with these conditions have been shown to have significant structural and functional differences when compared to healthy controls. RESULTS: Functional connectivity, therefore, has the potential to assist in diagnostic classification of different pain conditions, predict individual responses to specific therapeutic interventions, and serve as a gateway for personalized medicine. Indirect activation of brain activity can be seen by the blood flow to the brain at specific sites, with chronic pain patients having increased brain activity. LIMITATIONS: The present investigation is limited in that few studies have examined this relatively new modality. CONCLUSIONS: Knowing and observing the brain's activity as related to pain gives pain patients an opportunity to decrease pain-related brain activity and decrease severe chronic pain. This modality can be used along with interventional pain management techniques in order to provide optimum pain relief. KEY WORDS: Functional connectivity, fMRI, chronic pain, chronic back pain, fibromyalgia, diabetic neuropathy, chronic regional pain syndrome.

16 Review Tuberculous Spondylolisthesis: A Reappraisal of the Clinicoradiologic Spectrum and Surgical Treatment Paradigm. 2018

Narayan, Vinayak / Mohammed, Nasser / Savardekar, Amey R / Patra, Devi Prasad / Nanda, Anil. ·Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. · Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu. ·World Neurosurg · Pubmed #29526779.

ABSTRACT: INTRODUCTION: Spinal tuberculosis (TB) is a common infectious disease prevalent in developing countries and an increasing issue in developed countries. The association of tuberculosis with spondylolisthesis is rarely reported in literature. The aim of our review is to analyze the clinical features and radiologic characteristics of TB spondylolisthesis and to provide a concise update on its surgical management, based on the literature. METHODS: A systematic review was performed after conducting a thorough search of the PubMed database. Articles were selected systematically and reviewed completely and relevant data were summarized and discussed. RESULTS: Nineteen articles were selected for the review. The most common clinical manifestation was focal back pain, followed by motor deficit. Most patients had grade 2 listhesis and associated tubercular abscess. The anterior as well as the posterior surgical approach have their own advantages and the choice of approach depends on the location of disease, ease of access, achievement of spinal stability, and avoidance of spread of contiguous infection. Although a posterior approach and fixation using pedicular screws and rods along with debridement of pus or granulation tissue is the favored approach in dorsolumbar TB, an anterior approach, corpectomy, and fusion are preferred in cervical TB. CONCLUSIONS: Treatment of TB spondylolisthesis encompasses a wide spectrum of surgical options. However, the mainstay of treatment is chemotherapy. The indications for which surgical management may have an upper hand over medical management are spinal cord compression, significant instability, large tubercular abscess, painful vertebral lesions, kyphosis, and infection by multidrug-resistant TB or extreme drug-resistant TB, when medical management alone does not help. Surgery is effective in these situations by achieving radical debridement, permanent stability, prevention of further neurologic deterioration, and early recovery. Even although conservative management may help in certain cases, a posterior approach, decompression, and fusion are preferred for unstable dorsolumbar disease, whereas an anterior approach is preferred for cervical disease. Combined approaches can be considered in pediatric spinal TB for the correction of kyphotic deformity and its consequent maintenance.

17 Review Tanezumab: a selective humanized mAb for chronic lower back pain. 2018

Webb, Michael P / Helander, Erik M / Menard, Bethany L / Urman, Richard D / Kaye, Alan D. ·Department of Anesthesiology, North Shore Hospital, Auckland, New Zealand. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA. · Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. ·Ther Clin Risk Manag · Pubmed #29503555.

ABSTRACT: Chronic lower back pain is a significant disease that affects nearly 20% of the worldwide population. Along with hindering patients' quality of life, chronic lower back pain is considered to be the second most common cause of disability among Americans. Treating chronic lower back pain is often a challenge for providers, especially in light of our current opioid epidemic. With this epidemic and an increased aging population, there is an imminent need for development of new pharmacologic therapeutic options, which are not only effective but also pose minimal adverse effects to the patient. With these considerations, a novel therapeutic agent called tanezumab has been developed and studied. Tanezumab is a humanized monoclonal immunoglobulin G2 antibody that works by inhibiting the binding of NGF to its receptors. NGF is involved in the function of sensory neurons and fibers involved in nociceptive transduction. It is commonly seen in excess in inflammatory joint conditions and in chronic pain patients. Nociceptors are dependent on NGF for growth and ongoing function. The inhibition of NGF binding to its receptors is a mechanism by which pain pathways can be interrupted. In this article, a number of recent randomized controlled trials are examined relating to the efficacy and safety of tanezumab in the treatment of chronic lower back pain. Although tanezumab was shown to be an effective pain modulator in major trials, several adverse effects were seen among different doses of the medication, one of which led to a clinical hold placed by the US Food and Drug Administration. In summary, tanezumab is a promising agent that warrants further investigation into its analgesic properties and safety profile.

18 Review Pain States, the Opioid Epidemic, and the Role of Radiologists. 2018

Jones, Mark R / Kaye, Alan D / Manchikanti, Laxmaiah / Hirsch, Joshua A. ·Department of Anesthesiology, Beth Israel Hospital, Harvard Medical School, Boston, MA, USA. · Department of Anesthesia, LSU Health Science Center, New Orleans, LA, USA. · Pain Management Center of Paducah, Paducah, KY, USA. · Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA. · Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA. hirsch@snisonline.org. · Harvard Medical School, Boston, MA, USA. hirsch@snisonline.org. ·Curr Pain Headache Rep · Pubmed #29476355.

ABSTRACT: PURPOSE OF REVIEW: The prevalence of chronic pain and prescription opioid abuse has resulted in epidemic problems for patients and clinicians. The consequences are taking a heavy toll on patients, physicians, and society. Specific to radiology, a significant need exists for best practice assessment and treatment approaches for pain management, as patients with chronic pain often undergo radiological tests of unclear clinical relevance. RECENT FINDINGS: The USA is amid an opioid-prescribing epidemic and resultant overdose public health emergency. A variety of reasons, which are examined in this manuscript, have contributed to the dramatic increase in the use of chronic opioid therapy for chronic non-cancer pain. This increase of opioid prescriptions and related deaths is based on many factors including the perception that there was systemic undertreatment of pain, the philosophical approach of advocacy groups for pain relief, promotion by the pharmaceutical industry, Joint Commission's Fifth Vital Sign, and permissive regulations by boards of medical licensures promoting excessive use of opioids. Overall, opioid treatment has been based on subjective pain relief and radiographic findings, which may not correlate with the source of pain generation. Radiologists, along with interventionalists, frequently interact with patients on chronic opioid therapy and at times take responsibility for patients with chronic pain. Beyond reading studies, diagnostic radiologists provide care to larger percentages of patients taking narcotics than ever before. This manuscript focuses on chronic pain, escalating opioid therapy, and adverse consequences, including the epidemic of overdoses and deaths. Radiologists' expertise can potentially reduce unnecessary radiological tests and inappropriate prescribing of medications.

19 Review An Analysis of New Approaches and Drug Formulations for Treatment of Chronic Low Back Pain. 2017

Bhangare, Karishma Patel / Kaye, Alan D / Knezevic, Nebojsa Nick / Candido, Kenneth D / Urman, Richard D. ·Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. · Department of Anesthesiology and Pain Medicine, Louisiana State University School of Medicine, LSU Health Science Center, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA. · Department of Anesthesiology and Pain Medicine, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA. · Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: urmanr@gmail.com. ·Anesthesiol Clin · Pubmed #28526154.

ABSTRACT: The prevalence of chronic low back pain (CLBP) is increasing. Treatment is effective in less than 50% of patients after 1 year. This review investigates new treatments for CLBP. An extensive literature review focuses on new treatments for CLBP. Their safety and efficacy were evaluated and are described in detail in this review. The investigation identified new treatments for CLBP including chemonucleolysis, platelet-rich plasma injections, artemin, tanezumab, and stem cells. Further research and innovation are needed to implement these methods into practice and assess clinical significance. The current evidence suggests that there are promising new agents for the treatment of CLBP.

20 Review Frontline Temporomandibular Joint/Orofacial Pain Therapy for Every Dental Practice. 2017

Germain, Lisa / Malcmacher, Louis. ·Faculty, American Academy of Facial Esthetics; Private Practice, New Orleans, Louisiana. · President, American Academy of Facial Esthetics; Private Practice, Bay Village, Ohio. ·Compend Contin Educ Dent · Pubmed #28459248.

ABSTRACT: Temporomandibular disorders (TMD) are a group of conditions affecting the temporomandibular joint and/or muscles of mastication. TMD may present along with many comorbid pain syndromes such as myofascial pain, headache, and neck and back stiffness with limited range of motion, as well as fibromyalgia and chronic fatigue syndrome. The diagnosis and management of TMD is complex and, many times, multidisciplinary. However, dentists can provide their patients with frontline temporomandibular/orofacial pain therapy with didactic and hands-on training that provides a better understanding and a conservative approach for treatment of TMDs.

21 Review A critical overview of the current myofascial pain literature - July 2016. 2016

Dommerholt, Jan / Grieve, Rob / Finnegan, Michelle / Hooks, Todd. ·Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: jan@myopain4u.com. · Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol, United Kingdom. Electronic address: Rob.Grieve@uwe.ac.uk. · Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: mbfpt77@gmail.com. · New Orleans Pelicans, New Orleans, LA, USA. Electronic address: trhooks@hotmail.com. ·J Bodyw Mov Ther · Pubmed #27634092.

ABSTRACT: The overview of the myofascial pain literature includes a wide variety of basic and clinical studies, ranging from assessing muscle activation patterns to the impact of platelet-rich plasma injections. Contributions to the literature once again came from all corners of the world, such as Australia, Belgium, Brazil, Germany, Greece, Iran, Italy, Japan, Korea, the Netherlands, Norway, Poland, Spain, Taiwan, Turkey, and the USA. A total of 30 papers are included in this overview.

22 Review Safety and tolerability review of lorcaserin in clinical trials. 2016

Greenway, F L / Shanahan, W / Fain, R / Ma, T / Rubino, D. ·Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA. Frank.Greenway@pbrc.edu. · Formerly of Arena Pharmaceuticals, Inc., San Diego, CA, USA. · Formerly of Eisai Inc., Woodcliff Lake, NJ, USA. · Washington Center for Weight Management and Research, Arlington, VA, USA. ·Clin Obes · Pubmed #27627785.

ABSTRACT: Lorcaserin is a novel selective serotonin 2C receptor agonist indicated by the US Food and Drug Administration for chronic weight management in adults with obesity or overweight with ≥1 comorbidity. The safety and efficacy of lorcaserin were established during two Phase III clinical trials in patients without diabetes (BLOOM and BLOSSOM) and one Phase III clinical trial in patients with type 2 diabetes (BLOOM-DM). Headache was the most common adverse event experienced by patients during all Phase III trials. Additional adverse events occurring in >5% of patients receiving lorcaserin included dizziness, fatigue, nausea, dry mouth and constipation in patients without diabetes, and hypoglycaemia, back pain, cough and fatigue in patients with diabetes. In a pooled analysis of echocardiographic data collected during the three lorcaserin Phase III trials, the incidence of FDA-defined valvulopathy was similar in patients taking lorcaserin and the placebo. Here, the safety profile of lorcaserin at the FDA-approved dose of 10 mg twice daily is reviewed using data from the lorcaserin Phase III programme, with a focus on theoretical adverse events commonly associated with agonists of the serotonin receptor family. Based on the lorcaserin Phase III clinical trial data, lorcaserin is safe and well tolerated in the indicated patient populations.

23 Review Clinical Case Of the Month: A 35 Year Old Woman with Abdominal Pain. 2016

Spera, Melissa / Thelin, Camille / Gandolfi, Abby / Clayton, Nicholas / Nettles, Karl M / Hagensee, Michael E / Hutchings, John J / Lopez, Fred. ·House officer in the Internal Medicine Residency in the Department of Medicine at the Louisiana State University Health Sciences Center in New Orleans, LA. · Gastroenterology fellow at Tulane University Health Sciences Center in New Orleans, LA. · House officer in the Internal Medicine Residency in the Department of Medicine at the Louisiana State University Health Sciences Center in New Orleans. · House Officer in the Radiology residency program at the University of Alabama at Birmingham. · Assistant Professor in the Department of Radiology at Louisiana State University Health Sciences Center in New Orleans, LA. · Vice Chair for Research and Professor in the Department of Medicine at LSUHSC in New Orleans, LA. · Medical Director of Endoscopy at University Medical Center in New Orleans, LA. · Associate Professor in the Departments of Internal Medicine, Psychiatry, and Family Medicine at the Louisiana State University Health Sciences Center in New Orleans. · Richard Vial Professor and Vice Chair for Education in the Department of Medicine at Louisiana State University Health Sciences Center in New Orleans, LA. ·J La State Med Soc · Pubmed #27389384.

ABSTRACT: A 35 year old woman with past medical history of hypertension presented to the emergency department with chief complaint of severe abdominal pain for one week. The abdominal pain was located in the epigastrium and described as "cramping" and "intermittent". The pain intensity was quantified initially as 6 out of 10 on the pain scale. As the week progressed the pain became constant and radiated to the back. The intensity of the abdominal pain increased to 10 out of 10. The patient reported some relief from her pain while lying in the prone position. Initially the pain was associated with loose stools for several days. The loose stools resolved spontaneously and then the patient began to experience nausea and vomiting. Her medications included lisinopril-hydrochlorothiazide which she had been taking for the past five months. She had no history of alcohol, tobacco or illicit drug use.

24 Review A critical overview of the current myofascial pain literature - March 2016. 2016

Dommerholt, Jan / Hooks, Todd / Finnegan, Michelle / Grieve, Rob. ·Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: dommerholt@myopainseminars.com. · New Orleans Pelicans, New Orleans, LA, USA. Electronic address: trhooks@hotmail.com. · Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: mbfpt77@gmail.com. · Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol, United Kingdom. Electronic address: Rob.Grieve@uwe.ac.uk. ·J Bodyw Mov Ther · Pubmed #27210859.

ABSTRACT: The worldwide interest in myofascial pain syndrome (MPS) and trigger points (TrPs) is reflected in the increasing number of publications. In this overview of the literature, we included 26 studies, case reports and review articles by authors from 18 different countries. Several research groups are exploring the characteristic of TrPs such as Chen and colleagues, who continued their work on the quantification of the taut bands. Meng and colleagues studied the relationships between TrPs and central sensitization, while Yu and colleagues examined the electrophysiological characteristics that occur as a result of active TrPs. Several researchers used objective measurements to determine clinical outcomes, such as Koppenhaver and colleagues who measured objective changes in the function and nociceptive sensitivity of lumbar multifidus muscle subjects with low back pain. Turo and colleagues quantified muscle tissue changes after dry needling in chronic myofascial pain using elastography. Multiple studies explored various treatment options for TrPs, such as dry needling, injections with lidocaine or granisetron, traditional Thai massage, self-myofascial release, kinesiotaping, and monochromatic infrared photo energy, among others.

25 Review Pain in the Elderly. 2016

Jones, Mark R / Ehrhardt, Ken P / Ripoll, Juan G / Sharma, Bharat / Padnos, Ira W / Kaye, Rachel J / Kaye, Alan D. ·Medical Student, Tulane University School of Medicine, New Orleans, LA, USA. · Medical Student, Louisiana State University Health Science Center, New Orleans, LA, USA. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA. · Department of Biochemistry, Bowdoin College, Brunswick, ME, USA. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA. alankaye44@hotmail.com. ·Curr Pain Headache Rep · Pubmed #26896947.

ABSTRACT: Pain management in the elderly has increasingly become problematic in the USA as the aged population grows. The proportion of the population over 65 continues to climb and may eclipse 20 % in the next decade. In order to effectively diagnosis and treat these patients, a proper history and physical exam remain essential; pain assessment scales such as the Verbal Descriptor Scales (VDS), the Numerical Rating Scales (NRS), and the Visual Analogue Scales (VAS) often but not always prove beneficial. The conditions most frequently afflicting this population include osteoarthritis, diabetic neuropathy, post-herpetic neuralgia, and lower back pain which include spondylosis and radiculopathies. While the normal aging process does not necessarily guarantee symptoms of chronic pain, elderly individuals are far more likely to develop these painful conditions than their younger counterparts. There are many effective treatment modalities available as potential therapeutic interventions for elderly patients, including but not limited to analgesics such as NSAIDs and opioids, as well as multiple interventional pain techniques. This review will discuss chronic pain in the elderly population, including epidemiology, diagnostic tools, the multitude of co-morbidities, and common treatment modalities currently available to physicians.

Next