Publications by authors named "Alan D Kaye"

682 Publications

Liposomal Bupivacaine Decreases Post-Operative Opioid Use after Anterior Cruciate Ligament Reconstruction: A Review of Level I Evidence.

Orthop Rev (Pavia) 2022 5;14(3):37159. Epub 2022 Aug 5.

Department of Anesthesiology, Louisiana State University Health Shreveport.

Introduction: Anterior Cruciate Ligament tears are common after a non-contact injury and several thousand reconstructions (ACLR) occur yearly in the United States. Multimodal pain management has evolved greatly to include nerve blocks to minimize physical therapy losses post-operatively, pericapsular and wound injections, and other adjunctive measures. However, there is a surprisingly high use of opioid use after ACLR.

Objective: The purpose of present investigation is to summarize the current state of knowledge regarding opioid use after ACLR and to synthesize the literature regarding the use of liposomal bupivacaine and its potential to reduce post-operative opioid use in ACLR patients.

Methods: The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. A full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by three authors until an agreement was reached.

Results: Eighteen articles summarized the literature around the opioid epidemic in ACL surgery and the current context of multimodal pain strategies in ACLR. Five primary articles directly studied the use of liposomal bupivacaine as compared to reasonable control options. There remains to be over prescription of opioids within orthopedic surgery. Patient and prescriber education are effective methods at decreasing opioid prescriptions. Many opioid pills prescribed for ACLR are not used for the correct purpose. Several risk factors have been identified for opioid overuse in ACLR: American Society of Anesthesiologists score, concurrent meniscal/cartilage injury, preoperative opioid use, age < 50, COPD, and substance abuse disorder. Liposomal bupivacaine is effective in decreasing post-operative opioid use and reducing post-operative pain scores as compared to traditional bupivacaine. LB may also be effective as a nerve block, though the data on this is more limited and the effects on post-operative therapy need to be weighed against the potential therapeutic benefit. LB is associated with significantly greater costs than traditional bupivacaine.

Discussion: The role for opioid medications in ACLR should continue to decrease over time. Liposomal bupivacaine is a powerful tool that can reduce post-operative opioid consumption in ACLR.
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http://dx.doi.org/10.52965/001c.37159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353693PMC
August 2022

Back pain in adolescent athletes: a narrative review.

Orthop Rev (Pavia) 2022 5;14(3):37097. Epub 2022 Aug 5.

Department of Anesthesiology, Louisiana State University Health Shreveport.

Background: Back pain in young athletes is common. Adolescents are at an increased risk for back pain related to several factors including rapid growth. Traditionally, the conversation around back pain in the adolescent age group has been centered around diagnosis and treatment; however, there are emerging studies regarding prevention.

Objective: The purpose of the present investigation is to summarize sport-specific risk factors, to describe the growing emphasis on prevention/screening, and report results on minimally invasive and surgical options.

Methods: The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. The full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by at least 3 authors until an agreement was reached.

Results: Adolescent athletes have a higher risk of developing spondylolysis and spondylolisthesis than their non-athletic counterparts. Participation in athletic activity alone, increased body mass index, varsity status, and nationally/internationally competitive status are identified are demographic risk factors. Weightlifters, gymnasts, football players, and combat athletes may be at higher risks. Increased lumbar lordosis, abdominal muscle weakness, hip flexor tightness, hamstring tightness, thoracolumbar fascia tightness, femoral anteversion, genu recurvatum, and thoracic kyphosis also predispose. Recent cadaveric and kinematic studies have furthered our understanding of pathoanatomic. There is some evidence to suggest that isokinetic testing and electromyographic data may be able to identify at-risk individuals. Perturbation-based exercise interventions can reduce the incidence of adolescent athletic back pain. There is a large body of evidence to support the efficacy of physical therapy. There is some data to support minimally invasive treatments including external bone growth simulators, steroid injections, and chemonucleolysis for specific pathologies. Endoscopic surgery results for a limited subset of patients with certain disease processes are good.

Conclusions: Back pain in adolescent athletes is common and may not lead to appropriate alterations in athletes' level of participation. Athletes with a higher body mass index should be counseled regarding the benefits of losing weight. Isokinetic testing and electromyographic data have the potential as diagnostic and screening tools. Strength deficits and postural control could be used to identify patients requiring early intervention and thus reduce the incidence. External bone growth simulators, steroid injections, and chemonucleolysis could potentially become conservative options in the future. When surgery is indicated, the endoscopic intervention has the potential to decrease operative time, decrease cost, and promote healing.
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http://dx.doi.org/10.52965/001c.37097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353696PMC
August 2022

Spinal Cord Stimulation for Post Total Knee Replacement Pain: A Case Series.

Orthop Rev (Pavia) 2022 3;14(3):33835. Epub 2022 Aug 3.

Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center.

It is not uncommon for orthopedic patients to experience pain following a total knee replacement (TKR). Use of oral pain medications, nerve blocks, and periarticular injections are implemented to provide multimodal analgesia and to reduce postoperative chronic pain. Spinal cord stimulation (SCS) can also be used to control pain in patients who are refractory to conservative measures. Few studies have explored this possibility for patients with chronic pain status post TKR. We present three cases that demonstrate the effectiveness of SCS in this challenging patient population.
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http://dx.doi.org/10.52965/001c.33835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353541PMC
August 2022

The role for high volume local infiltration analgesia with liposomal bupivacaine in total hip arthroplasty: A scoping review.

Orthop Rev (Pavia) 2022 5;14(3):37101. Epub 2022 Aug 5.

Department of Anesthesiology, Louisiana State University Health Shreveport.

Introduction: Liposomal bupivacaine has been integrated into clinical practice within many surgical disciplines to reduce post-operative pain and opioid consumption. This novel agent has been utilized in this regard in many subdisciplines of orthopedic surgery. Total hip arthroplasty has significant opioid use post-operatively as compared to many other orthopedic disciplines.

Objectives: The purpose of the present investigation is to summarize the current use of liposomal bupivacaine after total hip arthroplasty and to shed light on the prospect of liposomal bupivacaine to reduce opioid use after total hip arthroplasty. A tertiary purpose is to identify future areas of adjunctive pain measures that can assist in the reduction of opioid use after total hip arthroplasty.

Methods: This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist strictly. The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. The full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by three authors until an agreement was reached.

Results: A total of 21 articles were included for qualitative description of the opioid epidemic, opioid overuse in total hip arthroplasty, and risk factors for opioid overuse in total hip arthroplasty. A total of 9 articles were included regarding the use of liposomal bupivacaine in total hip arthroplasty. Several risk factors have been identified for opioid overuse after total hip arthroplasty. These include younger age, an opioid risk tool score of > 7, a higher body mass index, chronic obstructive pulmonary disease, immunodeficiency syndromes, preexisting pain syndromes, peripheral vascular disease, anxiety and mood disorders, and substance abuse disorders. Liposomal bupivacaine reduces postoperative opioid use, patient-reported outcomes, length of stay, and time to ambulation, yet is more expensive than traditional bupivacaine.

Conclusions: Liposomal bupivacaine represents a useful adjunct for multimodal pain strategies in total hip arthroplasty with sufficient evidence to suggest that it may be useful in decreasing postoperative opioid use. The high costs of LB represent a barrier to institutional acceptance of LB into standardized multimodal pain strategies. Further efforts should be aimed toward better understanding the current state of integration of LB into academic and private practice settings, industry movements to decrease the cost, and the role other adjunctive measures may have in reducing post-operative opioid use.
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http://dx.doi.org/10.52965/001c.37101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353692PMC
August 2022

Review on Nerve Blocks Utilized for Perioperative Total Knee Arthroplasty Analgesia.

Orthop Rev (Pavia) 2022 5;14(3):37405. Epub 2022 Aug 5.

Department of Anesthesia, Louisiana State University Health Shreveport.

Total Knee Arthroplasty (TKA) is an increasingly common procedure performed for advanced osteoarthritis. Optimal perioperative pain management strategies are critical for early mobilization and shorter hospital stays in TKA. Peripheral nerve blocks commonly used in TKA perioperative analgesia including individual and combined femoral, obturator, sciatic, lumbar plexus, and adductor canal nerve blocks. Overall, the safety profile varies depending on which block is utilized, but the current evidence suggests when optimally chosen and delivered, peripheral nerve blocks may provide a safe, effective option for perioperative analgesia. Determining optimal analgesic regimens for total knee arthroplasty is critical to improve postoperative pain, patient satisfaction, decreasing opioid usage, recovery times and functional outcomes, and as such, peripheral nerve blocks may represent a viable option to supplement analgesic requirements in the perioperative period.
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http://dx.doi.org/10.52965/001c.37405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9353705PMC
August 2022

Aducanumab, a Novel Anti-Amyloid Monoclonal Antibody, for the Treatment of Alzheimer's Disease: A Comprehensive Review.

Health Psychol Res 2022 30;10(1):31925. Epub 2022 Jan 30.

Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA.

Alzheimer's disease (AD) is the most common form of dementia affecting millions of individuals, including family members who often take on the role as caregiver. This debilitating disease reportedly consumes 8% of the total United States healthcare expenditure, with medical and nursing outlays accounting for an estimated $290 billion. Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists have historically been the most widely used pharmacologic therapies for patients with AD, however, these drugs are not curative. This review discusses the epidemiology, pathophysiology, risk factors, presentation, and current treatment of AD followed by the role of the novel monoclonal antibody, aducanumab, in treatment of AD. Currently aducanumab is the only Food and Drug Administration (FDA) approved drug that acts to slow progression of this disease. Aducanumab is an anti-amyloid drug which functions by selectively binding amyloid aggregates in both the oligomeric and fibrillar states. Studies show aducanumab may help to restore neurological function in patients with AD by reducing beta-amyloid plaques and reestablishing neuronal calcium permeability. However, there is concern the magnitude of this drug's benefit may only be statistically significant and not clinically significant. Despite this skepticism, aducanumab has proven to significantly decrease amyloid in all cortical brain regions examined. In summary, aducanumab has provided hope for those working toward the goal of providing patients a safe and viable treatment option in the management of AD.
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http://dx.doi.org/10.52965/001c.31925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9346954PMC
January 2022

Aduhelm, a novel anti-amyloid monoclonal antibody, for the treatment of Alzheimer's Disease: A comprehensive review.

Health Psychol Res 2022 28;10(3):37023. Epub 2022 Jul 28.

Department of Anesthesiology,, Louisiana State University Health Shreveport, Shreveport, LA.

Alzheimer's disease (AD) is the most common form of dementia affecting millions of individuals, including family members who often take on the role of caregivers. This debilitating disease reportedly consumes 8% of the total United States healthcare expenditure, with medical and nursing outlays accounting for an estimated $290 billion. Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists have historically been the most widely used pharmacologic therapies for patients with AD; however, these drugs are not curative. The present investigation describes the epidemiology, pathophysiology, risk factors, presentation, and current treatment of AD followed by the role of the novel monoclonal antibody, Adulhelm, in the treatment of AD. Currently, Adulhelm is the only Food and Drug Administration (FDA) approved drug that acts to slow the progression of this disease. Adulhelm is an anti-amyloid drug that functions by selectively binding amyloid aggregates in both the oligomeric and fibrillar states. Studies show Adulhelm may help to restore neurological function in patients with AD by reducing beta-amyloid plaques and reestablishing neuronal calcium permeability. At present, there is concern the magnitude of this drug's benefit may only be statistically significant, although not clinically significant. Despite skepticism, Adulhelm has proven to significantly decrease amyloid in all cortical brain regions examined. With such high stakes and potential, further research into Adulhelm's clinical efficacy is warranted in the treatment of AD.
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http://dx.doi.org/10.52965/001c.37023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9334157PMC
July 2022

Viloxazine, a Non-stimulant Norepinephrine Reuptake Inhibitor, for the Treatment of Attention Deficit Hyperactivity Disorder: A 3 Year Update.

Health Psychol Res 2022 28;10(3):37018. Epub 2022 Jul 28.

Anesthesiology, Louisiana State University Health Science Center Shreveport.

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Current treatment options for ADHD include pharmacological treatment (stimulants, non-stimulants, anti-depressants, anti-psychotics), psychological treatment (behavioral therapy with or without parent training, cognitive training, neurofeedback), and complementary and alternative therapies (vitamin supplementation, exercise). Central nervous system (CNS) stimulants are the primary pharmacological therapy used in treatment; however, these stimulant drugs carry a high potential for abuse and severe psychological/physical dependence. Viloxazine, a non-stimulant medication without evidence of drug dependence, is a selective norepinephrine reuptake inhibitor that has historically been prescribed as an anti-depressant medication. The extended-release (ER) form was approved by the US Food and Drug Administration (FDA) in April 2021 for the treatment of ADHD in pediatric patients aged 6-17 years. Phase 2 and 3 randomized control trials have demonstrated significant efficacy of viloxazine in improving ADHD symptoms versus placebo. Related to its long-standing use as an antidepressant, the safety profile and pharmacokinetics of viloxazine are well understood. Viloxazine appears to be a suitable alternative to current standard-of-care pharmacotherapy for ADHD, but the further investigation remains to be done in comparing its efficacy to that of current treatments.
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http://dx.doi.org/10.52965/001c.37018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9334155PMC
July 2022

Efficacy of Botulinum Toxin, Local Anesthetics, and Corticosteroids in Patients With Piriformis Syndrome: A Systematic Review and Meta-analysis.

Pain Physician 2022 Aug;25(5):325-337

Paolo Procacci Fdn, Roma, Italy.

Background: Piriformis syndrome (PS) is a painful condition caused by entrapment of the sciatic nerve within the piriformis muscle. PS is typically unilateral and mainly occurs related to entrapment of the sciatic nerve. Treatments include physiotherapy, analgesics, anti-inflammatory drugs, behavioral modifications, injection therapy with local anesthetics (LAs) and steroids, epidural injection, botulinum toxin (BT) injection, and surgery.

Objectives: To investigate the efficacy of BT, LA, and corticosteroid (CS) injections in relieving pain in patients affected by PS.

Study Design: This systematic review and meta-analysis was conducted according to the "Cochrane Handbook for Systematic Reviews of Interventions" and the "Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA)" guidelines.

Methods: A systematic search was conducted through PubMed, Cochrane, Web of Science, and Scopus through April 2021 for studies investigating the efficacy of BT, LA, or CS injection in improving pain in patients with PS. After screening retrieved studies, data were extracted from included studies and pooled. Overall results were reported as standardized mean difference (SMD) and 95% confidence interval (CI). Analysis was performed using RevMan software version 5.4.

Results: Sixteen studies were included in this systematic review, and 12 of them were included in the quantitative synthesis. The pain scores decreased significantly after treatment with BT (SMD = -2.00; 95% CI [-2.84, -1.16], P < 0.001), LA and CS (SMD = -4.34; 95% CI [-5.77, 2.90], P < 0.001), LA (SMD = -3.73; 95% CI [-6.47, -0.99], P = 0.008), CS (SMD = -2.78; 95% CI [-3.56, -2.00], P < 0.001), and placebo injection (SMD = -0.04; 95% CI [-0.07, -0.01], P = 0.002). BT injection was less effective than LA and CS together (P = 0.006), more effective than placebo (P = 0.001), and similar to LA (P = 0.24) and CS (P = 0.18), when injected alone.

Limitations: A wide variety of study designs were utilized to obtain the largest sample size available. Many of the included studies lack randomization, and some are retrospective in nature. These limitations may introduce bias into the analyzed data and affect the results. Many studies had a low sample size and are of moderate quality, limiting the generalizability of the results. Also, we could not conduct a direct meta-analysis due to the lack of sufficient double-arm studies comparing different types of injection therapies.

Conclusions: In patients with PS, satisfactory pain improvement can be obtained by BT, LA plus CS, LA, or CS injection therapy. Injection of LA plus CS showed the best efficacy.
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August 2022

Physiologic and pharmacologic considerations in morbid obesity and bariatric anesthesia.

Saudi J Anaesth 2022 Jul-Sep;16(3):306-313. Epub 2022 Jun 20.

Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

Obesity is a growing worldwide health hazard that is characterized by excess malnutrition. Excess food intake leads to dysregulated energy homeostasis and increased adiposity, activating pro-inflammatory physiologic pathways that can contribute to the chronic inflammatory state associated with many chronic illnesses. Obesity is a preventable illness, but its multifaceted etiology, including genetic, behavioral, and environmental variables, is critical to understanding its epidemiology and pathophysiology. Obesity is a critical predisposing factor for illnesses including type II diabetes, cardiovascular disease, and cancer, with higher morbidity and death. Obesity rates are rising, and so will the need for perioperative anesthesia for subjects with obesity. Obesity epidemiology, biochemistry, and pathophysiology are significant concepts in perioperative anesthesia management for subjects with obesity. To provide optimal intraoperative care for subjects with obesity, preoperative cardiovascular assessment for coronary artery disease and drug monitoring is required. Individuals suffering from obesity have significantly higher oxygen consumption rates and a higher risk of desaturation and surgical complications. Individuals suffering from obesity require specialized perioperative treatment related to higher prevalence of perioperative complications.
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http://dx.doi.org/10.4103/sja.sja_185_22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9311176PMC
June 2022

The patient with obesity and super-super obesity: Perioperative anesthetic considerations.

Saudi J Anaesth 2022 Jul-Sep;16(3):332-338. Epub 2022 Jun 20.

Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.

Obesity is associated with increased morbidity and mortality related to many complex physiologic changes and the rise worldwide has had far ranging implications in healthcare. According to the World Health Organization, over 2.8 million people die each year from being overweight or obese. Patients who are obese often need surgical procedures or interventional pain procedures and are at higher risk of complications. Patients with super-super obesity are those with body mass index greater than 60 kg/m and are at even greater risk for complications. The present investigation reviews epidemiology, pathophysiology, and anesthesia considerations for best practice strategies in managing these higher risk patients. Clinical anesthesiologists must utilize careful assessment and consultation in developing safe anesthesia plans. Improvements in technology have advanced safety with regard to airway management with advanced airway devices and in regional anesthesia with ultrasound-guided nerve blocks that can provide increased flexibility in formulating a safe anesthetic plan. As well, newer drugs and monitors have been developed for perioperative use to enhance safety in patients with obesity.
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http://dx.doi.org/10.4103/sja.sja_235_22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9311171PMC
June 2022

Sudden Unexpected Death in Epilepsy.

Neurol Int 2022 Jul 18;14(3):600-613. Epub 2022 Jul 18.

Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA.

Epilepsy is a complex neurological condition with numerous etiologies and treatment options. In a subset of these patients, sudden unexpected death can occur, and to date, there are numerous explanations as to the pathophysiological mechanisms and how to mitigate these catastrophic outcomes. Approximately 2.3 million Americans have epilepsy, and nearly 150,000 people develop the condition each year. Sudden unexpected death in epilepsy (SUDEP) accounts for 2-18% of all epilepsy-related deaths and this is equivalent to one death in 1000 person-years of diagnosed epilepsy. It is more common in young adults aged 20-45. Seizures in the past year; the absence of terminal remission in the last five years; increased seizure frequency, particularly GTCS; and nocturnal seizures are the most potent modifiable risk factors for SUDEP. Patients not receiving any antiepileptic drug therapy are at higher risk of SUDEP. Patient education on medication compliance; care plans for seizure clusters (rescue medicines); epilepsy self-management programs; and lifestyle changes to avoid seizure-triggering factors, including avoiding excessive alcohol use and sleep deprivation, should be provided by health care providers. Continued research into SUDEP will hopefully lead to effective interventions to minimize occurrences. At present, aggressive control of epilepsy and enhanced education for individuals and the public are the most effective weapons for combating SUDEP. This narrative review focuses on updated information related to SUDEP epidemiology; pathophysiology; risk factor treatment options; and finally, a discussion of important clinical studies. We seek to encourage clinicians who care for patients with epilepsy to be aggressive in controlling seizure activity and diligent in their review of risk factors and education of patients and their families about SUDEP.
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http://dx.doi.org/10.3390/neurolint14030048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9326725PMC
July 2022

Factors Associated With Prescription Opioid Abuse and Dependence Among Those Reporting Prescription Opioid Misuse: A Retrospective Cross-Sectional Study.

Pain Physician 2022 07;25(4):E669-E679

Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston MA.

Background: Prescription opioid misuse is an ongoing epidemic in the United States. Though the number of people misusing prescription opioids is declining, the prevalence of abuse and dependence remains stable. This highlights the need to identify and intervene in factors leading to the escalation of prescription opioid misuse.

Objectives: The aim of this study was to explore the association of prescription opioid-specific misuse factors such as pill source, misuse motivation, and misuse habits with abuse and dependence.

Study Design: A retrospective cross-sectional study.

Setting: Participants in the 2015 to 2018 National Survey on Drug Use and Health (NSDUH) reporting prescription opioid misuse in the past 12 months.

Methods: Simple and multivariable logistic regression were used to estimate the association of prescription opioid-specific misuse factors with prescription opioid abuse and dependence, which were determined by participant responses to screening questions according to DSM-IV criteria.

Results: After multivariable adjustment, prescription opioid abuse was associated with use in greater amounts than prescribed and misuse for 3-19 days in the past month, whereas dependence was associated with use in greater amounts and more often than prescribed, and misuse for 6 or more days in the past month. Initiating misuse in the past year and misuse without one's own prescription in the past year were associated with lower odds of opioid dependence.

Limitations: Only associations and not causal relationships can be claimed between the factors and outcomes. Second, the survey relies on self-reported data, and there is likely both underreporting and overreporting, leading to bias towards the null. The survey target population was civilian, so it excluded individuals living in institutional group quarters such as hospitals, treatment facilities, nursing homes, and prisons. This study does not differentiate between prescription opioids used for acute versus chronic pain.

Conclusions: Study results suggest the importance of the frequency of prescription opioid misuse as a possible risk factor for dependence and emphasize the need to monitor for misuse even in instances of acute pain.
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July 2022

A Comprehensive Review of Celecoxib Oral Solution for the Acute Treatment of Migraine.

Health Psychol Res 2022 26;10(2):34265. Epub 2022 Apr 26.

Department of Anesthesiology, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA.

A migraine is a clinical diagnosis with a presentation of one or more severe unilateral or bilateral headache(s) often preceded by an aura and typically accompanied by nausea, vomiting, photophobia, and/or phonophobia. This neurological disease is often debilitating and greatly affects the quality of life of those it inflicts. In fact, a recent study conducted by the Global Burden of Disease and published in The Lancet Neurology revealed that migraines ranked second to only back pain as the most disabling disease. Triggers for migraines have ranged from female sex, low socioeconomic status, and diet to loud noises, sleep hygiene, and stress. Along with its clinical presentation, laboratory tests and imaging help rule out other potential causes of the headache and lead to a diagnosis of migraine. Migraines are typically divided into three phases: prodromal, headache, and postdrome. The pathophysiology of each phase remains under investigation, with differing theories regarding their pathways. Existing therapies are abortive therapies for acute migraines or preventative therapies. Abortive therapy consists of NSAIDs and triptans. Preventative therapies include tricyclic antidepressants, calcium channel blockers, beta-blockers, and anticonvulsants. In this review, we focus on the role of NSAIDs and the COX-2 inhibitor, celecoxib oral solution, for the abortive treatment of acute migraines.
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http://dx.doi.org/10.52965/001c.34265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242839PMC
April 2022

Superior Block Length and Reduced Opioid Use with Dexmedetomidine and Dexamethasone regional block versus plain Ropivacaine: a retrospective trial.

Orthop Rev (Pavia) 2022 25;14(3):31921. Epub 2022 Apr 25.

Anesthesiology and Pain Medicine, Portsmouth Anesthesia Associates, Portsmouth, VA.

Purpose: The purpose of this study is to determine if using a combination of dexamethasone and dexmedetomidine (Dex-Dex) in a single-shot perineural local anesthestic provides an increased duration of pain relief and reduced consumption of opioids for patients undergoing shoulder surgery.

Patients And Methods: This is a retrospective trial of adult patients without major comorbidities undergoing elective, upper arm orthopedic procedures with regional nerve block for post-operative analgesia. Patients underwent nerve block with either 0.5% ropivacaine or 0.2% ropivacaine with 5mg dexamethasone and 25mg dexmedetomidine ("dex-dex"). Patients were assessed in 1-week intervals for two weeks for duration of block analgesia, pain scores, and opioid use.

Results: 31 patients were included, 12 controls and 19 in the dex-dex group. These patients underwent one of arthroscopic rotator cuff repair, reverse total shoulder repair or repair of humerus fractures. Dex-dex blocks provided significantly longer analgesia (median block time 3.5 versus 1.5 days, p<0.0001), significantly better analgesia (mean NRS 2.32 versus 8.58 on post-operative day 1, p<0.0001), and significantly reduced opioid requirements (108.16mg vs 275.63mg in MME, p<0.0001). One patient experienced transient hypotension and prolonged paresthesia in the dex-dex group.

Conclusion: Preoperative single-shot interscalene nerve blocks with preservative-free dexamethasone and dexmedetomidine added as adjuvants to ropivicaine provide approximately two additional days of benefit versus ropivicaine alone. Additionally, postoperative opioid consumption is reduced.
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http://dx.doi.org/10.52965/001c.31921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239360PMC
April 2022

Schmorl's Node: An Uncommon Case of Back Pain and Radiculopathy.

Orthop Rev (Pavia) 2022 25;14(3):33641. Epub 2022 Apr 25.

Department of Radiology, University of Nebraska Medical Center.

Background: Schmorl's nodes are herniations of nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebra. Schmorl's nodes are extremely common and are typically seen as incidental findings on radiographic imaging. In postmortem studies, it has been estimated that greater than 70% of the population has Schmorl's nodes. Rarely, however, Schmorl's nodes can be a cause of acute back pain and, even less often, radiculopathy.

Case Presentation: In the present case, an elderly male presented with an acute onset of lower back pain and radiculopathy. MRI demonstrated a large L3 vertebral body inferior endplate Schmorl's node with posterior extension through the vertebral body cortex and into the ventral epidural space superiorly. This resulted in severe effacement of the right L2-L3 subarticular recess, as well as the right L3-L4 neural foramen, impinging on the right L3 nerve root. Surrounding cortical edema and enhancement on MRI further suggested an acute Schmorl's node.

Conclusion: Although rare, Schmorl's nodes can be a cause of acute back pain and, even less commonly, radiculopathy. The imaging modality of choice for the diagnosis of a Schmorl's node is MRI as it has a greater capability to detect edema, neovascularization, and in this case, extruded disc material. In both asymptomatic and symptomatic cases, the mainstay of treatment for Schmorl's nodes is conservative therapy. Surgical removal of disc material has been successful in cases of persistent radiculopathy from compression by a tunneling Schmorl's node.
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http://dx.doi.org/10.52965/001c.33641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239389PMC
April 2022

A Look at Commonly Utilized Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) in Chronic Pain.

Health Psychol Res 2022 30;10(3):32309. Epub 2022 May 30.

Department of Anesthesiology and Pain Medicine, University of Texas Medical Branch.

Purpose Of Review: Chronic pain continues to be one of the leading healthcare cost burdens in the United States and is typically defined as ongoing pain, lasting longer than six months. Various treatment options exist for chronic pain, including physical therapy, medical management, pain psychology, and interventional therapies. Pain medications have been the mainstay of treatment for chronic pain conditions with an increasing use of membrane stabilizers and antidepressants to treat neuropathic pain conditions. Specifically, serotonin noradrenaline reuptake inhibitors (SNRIs) have been used to treat a range of pain conditions expanding from everyday use for depressive disorders.

Recent Findings: SNRIs, including duloxetine, venlafaxine, and milnacipran, have demonstrated efficacy in reducing pain in musculoskeletal pain (chronic low back pain and osteoarthritis), fibromyalgia, and neuropathic pain conditions (peripheral diabetic neuropathy).

Summary: The article describes the function, role, and use of SNRIs to treat chronic and neuropathic pain by altering the noradrenergic descending inhibitory pathways.
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http://dx.doi.org/10.52965/001c.32309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239373PMC
May 2022

Combination Olanzapine and Samidorphan for the Management of Schizophrenia and Bipolar 1 Disorder in Adults: A Narrative Review.

Health Psychol Res 2022 25;10(3):34224. Epub 2022 Apr 25.

Department of Anesthesiology, Louisiana State University Health Shreveport.

Schizophrenia is a debilitating psychotic disorder characterized by positive symptoms such as delusions, hallucinations, and disorganized thoughts, and negative symptoms like lack of effect or motivation. Bipolar 1 disorder (B1D) is a psychiatric illness characterized by recurrent manic episodes in alternation with depressive episodes and interspersed periods of euthymia, ultimately resulting in psychological distress and impairment of daily functioning. Effective treatments are needed for both schizophrenia and B1D to reach the treatment goals of reducing the debilitating symptomology, improving social functioning and quality of life, and increasing the chances of recovery and more favorable long-term outcomes. To date, olanzapine is one of the most efficacious atypical antipsychotics (AAPs) for the treatment of both schizophrenia and B1D and is associated with fewer extrapyramidal effects compared to other treatments. However, compared to other AAPs, olanzapine is associated with a greater chance of metabolic syndrome, limiting its clinical use and affecting treatment compliance. Samidorphan mitigates the weight gain side effects of olanzapine by antagonizing μ-, κ-, and δ-opioid receptors. The use of combination drugs to treat psychiatric conditions is an emerging field with the goal of increasing therapeutic efficacy and decreasing undesirable side effects. Clinical trials have demonstrated combination on olanzapine and samidorphan (OLZ/SAM) treatment resulted in significantly less weight gain than olanzapine monotherapy. Clinical trial patients reported improvements in symptoms of psychosis, reduced weight gain, and overall satisfaction with their treatment. OLZ/SAM has been as shown to be a safe and effective pharmaceutical option for the clinical management of schizophrenia and B1D.
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http://dx.doi.org/10.52965/001c.34224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239397PMC
April 2022

A Comprehensive Review of Zavegepant as Abortive Treatment for Migraine.

Health Psychol Res 2022 28;10(3):35506. Epub 2022 Jun 28.

Department of Anesthesiology, Louisiana State University Health Sciences Center - Shreveport.

Migraine headache is a widespread and complex neurobiological disorder that is characterized by unilateral headaches that are often accompanied by photophobia and phonophobia. Migraine is one of the leading chief complaints in the emergency department with negative impacts on quality of life and activities of daily living. The high number of emergency presentations also results in a significant economic burden. Its risk factors include family history, genetics, sex, race, socioeconomics, the existence of comorbid conditions, and level of education. Triggers include stress, light, noise, menstruation, weather, changes in sleep pattern, hunger, dehydration, dietary factors, odors, and alcohol. The International Headache Society has defined criteria for the diagnosis of migraine with and without aura. The pathophysiology of migraine headaches is multifactorial so there are a variety of treatment approaches. The current treatment approach includes abortive medications and prophylactic medications. Abortive medications include the first-line treatment of triptans, followed by ergot alkaloids, and calcitonin gene-related peptide (CGRP) receptor antagonists along with supplemental caffeine and antiemetics. Trigeminal afferents from the trigeminal ganglion innervate most cranial tissues and many areas of the head and face. These trigeminal afferents express certain biomarkers such as calcitonin gene-related peptide (CGRP), substance P, neurokinin A, and pituitary adenylate cyclase-activating polypeptide that are important to the pain and sensory aspect of migraines. In this comprehensive review, we discuss Zavegepant, a calcitonin gene-related peptide receptor antagonist, as a new abortive medication for migraine headaches.
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http://dx.doi.org/10.52965/001c.35506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239361PMC
June 2022

pitolisant, a novel histamine-3 receptor competitive antagonist, and inverse agonist, in the treatment of excessive daytime sleepiness in adult patients with narcolepsy.

Health Psychol Res 2022 30;10(3):34222. Epub 2022 May 30.

Department of Anesthesiology, Louisiana State University Health Shreveport.

Narcolepsy is a debilitating sleep disorder that presents with excessive daytime sleepiness (EDS) and cataplexy, which is a sudden paralysis of muscle tone triggered by strong emotions such as laughing. It is also associated with many other disorders, including psychiatric disorders, neurologic illnesses, and medication side effects. Common causes of delayed and incorrect diagnoses of these conditions include lack of physician familiarity with narcolepsy symptoms and comorbidities which mask narcolepsy signs and symptoms. Current pharmacologic therapies include Modafinil and Armodafinil for EDS and sodium oxybate for cataplexy. This review discusses the epidemiology, pathophysiology, risk factors, presentation, treatment of narcolepsy, and the role of a novel drug, Pitolisant, in the treatment of EDS in adults with narcolepsy. Pitolisant is a histamine-3 receptor (H3R), competitive antagonist, and inverse agonist, acting through the histamine system to regulate wakefulness. It is a novel drug approved in August 2019 by the FDA, is not classified as a controlled substance, and is approved for use in Europe and the United States to treat EDS and cataplexy in narcolepsy. Recent phase II and III trials have shown that Pitolisant helps reduce the ESS score and cataplexy. In summary, based on comparative studies, recent evidence has shown that Pitolisant is non-inferior to Modafinil in the treatment of EDS but superior to Modafinil in reducing cataplexy.
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http://dx.doi.org/10.52965/001c.34222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239364PMC
May 2022

Opicapone, a Novel Catechol-O-methyl Transferase Inhibitor, for Treatment of Parkinson's Disease "Off" Episodes.

Health Psychol Res 2022 28;10(3):36074. Epub 2022 Jun 28.

Department of Anesthesiology, Louisiana State University Health Sciences Center.

Parkinson's Disease (PD) is a common neurodegenerative disorder and the leading cause of disability. It causes significant morbidity and disability through a plethora of symptoms, including movement disorders, sleep disturbances, and cognitive and psychiatric symptoms. The traditional pathogenesis theory of PD involves the loss of dopaminergic neurons in the substantia nigra (SN). Classically, treatment is pursued with an assortment of medications that are directed at overcoming this deficiency with levodopa being central to most treatment plans. Patients taking levodopa tend to experience "off episodes" with decreasing medication levels, causing large fluctuations in their symptoms. These off episodes are disturbing and a source of morbidity for these patients. Opicapone is a novel, peripherally acting Catechol-O-methyl transferase (COMT) inhibitor that is used as adjunctive therapy to carbidopa/levodopa for treatment and prevention of "off episodes." It has been approved for use as an adjunct to levodopa since 2016 in Europe and has recently (April 2020) gained FDA approval for use in the USA. By inhibiting COMT, opicapone slows levodopa metabolism and increases its availability. Several clinical studies demonstrated significant improvement in treatment efficacy and reduction in duration of "off episodes." The main side effect demonstrated was dyskinesia, mostly with the 100mg dose, which is higher than the approved, effective dose of 50mg. Post-marketing surveillance and analysis are required to further elucidate its safety profile and contribute to patient selection. This paper reviews the seminal and latest evidence in the treatment of PD "off episodes" with the novel drug Opicapone, including efficacy, safety, and clinical indications.
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http://dx.doi.org/10.52965/001c.36074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239372PMC
June 2022

A minimally invasive lumbar decompression procedure after an interspinous spacer device implantation: an uncommon order of treatment with a successful outcome.

Orthop Rev (Pavia) 2022 27;14(4):35844. Epub 2022 Jun 27.

Department of Anesthesiology, Louisiana State University Health Sciences Center.

A patient with lumbar spinal stenosis (LSS) was referred to our clinic due to refractory low back pain, radicular pain, and neurogenic claudication despite conservative treatment with medical management. Imaging of the lumbar spine revealed spinal canal and foraminal stenosis. Multiple epidural steroid injections (ESI) were performed which did not resolve her condition. We offered her an Implantation of an Interspinous Spacer Device (ISD) since her primary symptoms were predominantly characteristic of radicular pain. Her radicular symptoms improved but experienced worsening of her lower back pain and neurogenic claudication. For these reasons, we then offered her a Minimally Invasive Lumbar Decompression (MILD) procedure. Though both procedures share the same incisional approach, the first one deploys an implant in the interspinous process, as opposed to the MILD procedure which does not. We therefore describe the intricacies of performing a MILD procedure after an ISD implant and share the patient's outcome.
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http://dx.doi.org/10.52965/001c.35844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235438PMC
June 2022

Descriptive epidemiology of orthopedic injury and illness during the Special Olympics of Pennsylvania Summer Games from 2008 to 2017.

Orthop Rev (Pavia) 2022 27;14(4):35276. Epub 2022 Jun 27.

Department of Family Medicine, Louisiana State University Health Sciences Center, School of Medicine.

Background: The Special Olympics Pennsylvania Summer Games attract over 2000 athletes each year. Volunteer medical staff ensures their safety throughout this period. However, few studies have examined the incidence of orthopedic injury and sickness in this group, especially with a large sample.

Objective: Identify the incidence of orthopedic injury and Illness at the Special Olympics Pennsylvania Summer Games based on demographic criteria and identify the incidence of transports required for advanced care.

Methods: Data was collected from logs provided by Special Olympics Pennsylvania. The data were analyzed and stratified by gender, age, sport, and type of encounter. We summarized the data and compared it to data from other years and the average.

Results: An average of 1971 athletes competed annually. On average, 10% (N=144) of competitors required medical care. Males comprised 58.2% (N = 837) of encounters, females 33.6% (N = 483), and in 8.1% (N = 117) of encounters gender was not identified/recorded. The mean age of participants was 29 years of age (range from 10 to 83). 56.6% (N= 813) of encounters required first aid management only. Injuries made up 31.7% (N = 455) of total encounters, and 11.8% (N=169) of encounters were classified as illnesses. Basketball was the sport with the most injuries, 49.5% (N = 711). An average of 9.8 transports was required annually.

Conclusions: Special Olympics athletes suffer the same injuries as regular athletes, but they are also prone to various medical disorders that regular athletes are not.
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http://dx.doi.org/10.52965/001c.35276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235415PMC
June 2022

Restoring Successful Spinal Cord Stimulation Therapy for a Patient with Severe Pocket Pain Utilizing Nalu Micro-Implantable Pulse Generator.

Orthop Rev (Pavia) 2022 31;14(4):35326. Epub 2022 May 31.

Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport.

Spinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The primary indications for SCS therapy are post-laminectomy syndrome as well as complex regional pain syndrome. SCS therapy is minimally invasive and reversible. It involves the implantation of percutaneous or paddle leads along with a surgically implanted pulse generator (IPG). Severe pocket pain from the IPG is a well-known complication following SCS implants that can be challenging to treat and can lead to an explant of the SCS system. We present the case of a patient with post-laminectomy syndrome who underwent an explant of her SCS system due to severe pocket pain complaints. The patient was successfully reimplanted with a Nalu micro-implantable pulse generator for SCS therapy with 75% improvement in her post-laminectomy pain complaints with no complaints of pocket pain.
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http://dx.doi.org/10.52965/001c.35326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235421PMC
May 2022

An Update on Posterior Tarsal Tunnel Syndrome.

Orthop Rev (Pavia) 2022 31;14(4):35444. Epub 2022 May 31.

Department of Anesthesiology, Louisiana State University New Orleans.

Posterior tarsal tunnel syndrome (PTTS) is an entrapment neuropathy due to compression of the tibial nerve or one of its terminal branches within the tarsal tunnel in the medial ankle. The tarsal tunnel is formed by the flexor retinaculum, while the floor is composed of the distal tibia, talus, and calcaneal bones. The tarsal tunnel contains a number of significant structures, including the tendons of 3 muscles as well as the posterior tibial artery, vein, and nerve. Focal compressive neuropathy of PTTS can originate from anything that physically restricts the volume of the tarsal tunnel. The variety of etiologies includes distinct movements of the foot, trauma, vascular disorders, soft tissue inflammation, diabetes mellitus, compression lesions, bony lesions, masses, lower extremity edema, and postoperative injury. Generally, compression of the posterior tibial nerve results in clinical findings consisting of numbness, burning, and painful paresthesia in the heel, medial ankle, and plantar surface of the foot. Diagnosis of PTTS can be made with the presence of a positive Tinel sign in combination with the physical symptoms of pain and numbness along the plantar and medial surfaces of the foot. Initially, patients are treated conservatively unless there are signs of muscle atrophy or motor nerve involvement. Conservative treatment includes activity modification, heat, cryotherapy, non-steroidal anti-inflammatory drugs, corticosteroid injections, opioids, GABA analog medications, tricyclic antidepressants, vitamin B-complex supplements, physical therapy, and custom orthotics. If PTTS is recalcitrant to conservative treatment, standard open surgical decompression of the flexor retinaculum is indicated. In recent years, a number of alternative minimally invasive treatment options have been investigated, but these studies have small sample sizes or were conducted on cadaveric models.
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http://dx.doi.org/10.52965/001c.35444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235437PMC
May 2022

Opioid Use Consequences, Governmental Strategies, and Alternative Pain Control Techniques Following Total Hip Arthroplasties.

Orthop Rev (Pavia) 2022 31;14(4):35318. Epub 2022 May 31.

Department of Anesthesiology, Louisiana State University Shreveport.

Over the last several decades, rates of opioid use and associated problems have dramatically increased in the United States leading to laws limiting prescription duration for acute pain management. As a result, orthopedic surgeons who perform total hip arthroplasty (THA), a procedure that often leads to significant postoperative pain, have been faced with substantial challenges to adequately mitigate patient pain while also reducing opioid intake. Current strategies include identifying and correcting modifiable risk factors associated with postoperative opioid use such as preoperative opioid use, alcohol and tobacco abuse, and untreated psychiatric illness. Additionally, recent evidence has emerged in the form of Enhanced Recovery After Surgery (ERAS) protocols suggesting that a multidisciplinary focus on patient factors perioperatively can lead to reduced postoperative opioid administration and decreased hospital stays. A cornerstone of ERAS protocols includes multimodal pain regimens with opioid rescue only as needed, which often includes multiple systemic pain therapies such as acetaminophen, gabapentin, non-steroidal anti-inflammatory drugs, as well as targeted pain therapies that include epidural catheters and ultrasound-guided nerve blocks. Many hospital systems and states have also implemented opioid prescribing limitations with mixed success. As the opioid epidemic continues in the United States, while contributing to poor outcomes following elective surgeries, further research is warranted to identify multidisciplinary strategies that mitigate opioid use while also allowing for adequate pain control and rehabilitation.
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http://dx.doi.org/10.52965/001c.35318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235447PMC
May 2022

A Comprehensive Review of Cluneal Neuralgia as a Cause of Lower Back Pain.

Orthop Rev (Pavia) 2022 31;14(4):35505. Epub 2022 May 31.

School of Medicine, Louisiana State University Health Sciences Center.

Lower back pain (LBP) is one of the most common presenting complaints in clinical adult medical patients. While most often diagnosed as "nonspecific mechanical" in etiology, several lesser known, rarer causes of LBP exist, some of which can even cause neuropathic pain. One of these infrequent causes, cluneal neuralgia (CN), is associated most often with damage or entrapment of the cluneal nerves, particularly the superior cluneal nerve (SCN) and/or the middle cluneal nerve (MCN). These nerves supply sensation to the posterior lumbar and buttock area. However, the LBP caused by CN is often difficult to recognize because it can mimic radiculopathy or sacroiliac joint (SIJ) pain or lead to symptoms in the legs. This makes CN significantly important for clinicians and surgeons to include in their differential. A thorough history proves beneficial in the diagnostic workup, as many risk factors for CN have been reported in the literature. If a CN diagnosis is made, several effective conservative measures can alleviate patients' pain, such as nerve blocks, peripheral nerve stimulation, or high frequency thermal coagulation. Additionally, surgical treatments, such as CN release or endoscopic decompression, have resulted in fantastic patient outcomes. The purpose of the present investigation is to investigate the existing literature about CN as a cause for LBP, consider its epidemiology, discuss its pathophysiology and risk factors, elucidate its clinical presentation and diagnosis, and examine the various treatment modalities that have been reported across the world.
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http://dx.doi.org/10.52965/001c.35505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235435PMC
May 2022

A Comprehensive Update of Prolotherapy in the Management of Osteoarthritis of the Knee.

Orthop Rev (Pavia) 2022 31;14(4):33921. Epub 2022 May 31.

Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA.

This is a comprehensive review of the literature focusing on the use of prolotherapy in the treatment of osteoarthritis of the knee. It covers the background, efficacy, and advantages of prolotherapy in the management of osteoarthritis symptoms and then covers the existing evidence of the use of prolotherapy for this purpose. Current treatments for osteoarthritis of the knee are numerous, yet patients continue to endorse chronic pain and poor quality of life. Prolotherapy is a treatment that has been inadequately studied with poor sample sizes and lack of standardization between trials. However, in recent years the literature on prolotherapy in the treatment of knee osteoarthritis has grown. Although there is still a lack of homogeneity, trials have shown that dextrose prolotherapy, autologous conditioned serum, hyaluronic injections, and normal saline administered either intra- or peri-articularly are comparable in reducing pain scores to other primary treatment options. The mechanism of action for prolotherapy is still unclear, but researchers have found that prolotherapy plays some role in cartilage growth or chondrogenesis and has been shown to have improved radiographic outcomes. Prolotherapy appears to be a safe treatment alternative that has been shown to improve stiffness, pain, function, and quality of life in osteoarthritis of the knee. Knee osteoarthritis is remarkably prevalent in the United States and is one of the most common causes of disability in the elderly population. Although there are many treatment options, patients continue to live with chronic pain which can incur high costs for patients. A safe, long-term, and effective solution has not yet been identified. Prolotherapy has been shown to be a safe option for improving pain, function, and quality of life as effectively as other treatment options.
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http://dx.doi.org/10.52965/001c.33921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235417PMC
May 2022

An Evidence-Based Approach to Multi-Ligamentous Knee Injuries.

Orthop Rev (Pavia) 2022 31;14(4):35825. Epub 2022 May 31.

Department of Anesthesiology, Louisiana State University Health Shreveport.

Multi ligament knee injuries (MLKIs) are highly complex injuries with associated complications and often present with difficult management strategies. MLKIs may affect the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (or posteromedial corner (PMC)), and lateral collateral ligament (or posterolateral corner (PLC)) in addition to other structures including the menisci, common peroneal nerve, and popliteal artery. MLKIs are highly associated with the male sex and are commonly seen in high-velocity motor vehicle accidents and low-velocity sports injuries. Given the multiple planes of movement in the knee and various primary and secondary stabilizers throughout those planes, there is great heterogeneity in an injury pattern and most involve the ACL and PCL. Initial evaluation of this injury includes assessment of lower extremity sensation, distal pulses, and ankle-brachial index (ABI). If vascular compromise is suspected, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are indicated to evaluate the vasculature. As opposed to CTA, MRA offers visualization of the soft-tissue structures that are commonly damaged in MLKIs. Initial management typically includes closed reduction of the knee with subsequent external fixation. Classification systems guide initial assessments; however, further management is unclear and leads the surgical team to decide the best, individualized management option for each patient. As a result, optimal surgical and postoperative treatment options remain complicated, and clinical outcomes remain difficult to predict. The purpose of this review is to consolidate the most up-to-date practices of the diagnostic workup, management, and treatment of MLKIs.
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http://dx.doi.org/10.52965/001c.35825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235428PMC
May 2022

Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature.

Orthop Rev (Pavia) 2022 31;14(4):34098. Epub 2022 May 31.

Department of Anesthesiology, Louisiana State University Shreveport.

Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.
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http://dx.doi.org/10.52965/001c.34098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235436PMC
May 2022
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