Publications by authors named "Brandon J Goff"

9 Publications

  • Page 1 of 1

Intradiscal quantitative chemical exchange saturation transfer MRI signal correlates with discogenic pain in human patients.

Sci Rep 2021 Sep 28;11(1):19195. Epub 2021 Sep 28.

Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.

Low back pain (LBP) is often a result of a degenerative process in the intervertebral disc. The precise origin of discogenic pain is diagnosed by the invasive procedure of provocative discography (PD). Previously, we developed quantitative chemical exchange saturation transfer (qCEST) magnetic resonance imaging (MRI) to detect pH as a biomarker for discogenic pain. Based on these findings we initiated a clinical study with the goal to evaluate the correlation between qCEST values and PD results in LBP patients. Twenty five volunteers with chronic low back pain were subjected to T2-weighted (T2w) and qCEST MRI scans followed by PD. A total of 72 discs were analyzed. The average qCEST signal value of painful discs was significantly higher than non-painful discs (p = 0.012). The ratio between qCEST and normalized T2w was found to be significantly higher in painful discs compared to non-painful discs (p = 0.0022). A receiver operating characteristics (ROC) analysis indicated that qCEST/T2w ratio could be used to differentiate between painful and non-painful discs with 78% sensitivity and 81% specificity. The results of the study suggest that qCEST could be used for the diagnosis of discogenic pain, in conjunction with the commonly used T2w scan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-97672-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478892PMC
September 2021

Characteristics of phantom limb pain in U.S. civilians and service members.

Scand J Pain 2021 Sep 17. Epub 2021 Sep 17.

Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

Objectives: The population of Americans with limb loss is on the rise, with a different profile than in previous generations (e.g., greater incidence of amputation due to diabetes). This study aimed to identify the key characteristics of phantom limb sensation (PLS) and pain (PLP) in a current sample of Americans with limb loss.

Methods: This cross-sectional study is the first large-scale (n=649) study on PLP in the current population of Americans with limb loss. A convenience sample of military and civilian persons missing one or more major limbs was surveyed regarding their health history and experience with phantom limb phenomena.

Results: Of the participants surveyed, 87% experienced PLS and 82% experienced PLP. PLS and PLP typically first occurred immediately after amputation (47% of cases), but for a small percentage (3-4%) onset did not occur until over a year after amputation. Recent PLP severity decreased over time (β=0.028, 95% CI: -0.05-0.11), but most participants reported PLP even 10 years after amputation. Higher levels of recent PLP were associated with telescoping (β=0.123, 95% CI: 0.04-0.21) and higher levels of pre-amputation pain (β=0.104, 95% CI: 0.03-0.18). Those with congenitally missing limbs experienced lower levels of recent PLP (t (37.93)=3.93, p<0.01) but there were no consistent differences in PLP between other amputation etiologies.

Conclusions: Phantom limb phenomena are common and enduring. Telescoping and pre-amputation pain are associated with higher PLP. Persons with congenitally missing limbs experience lower levels of PLP than those with amputation(s), yet PLP is common even in this subpopulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/sjpain-2021-0139DOI Listing
September 2021

Prospective cohort study examining the use of regional anesthesia for early pain management after combat-related extremity injury.

Reg Anesth Pain Med 2019 Sep 27. Epub 2019 Sep 27.

Department of Military and Emergency Medicine, Uniformed Services University, Rockville, Maryland, USA

Background: No studies have examined the long-term benefits of regional anesthesia (RA) for pain management after combat-related injury. The objective of this prospective cohort study was to examine the relationship between RA administration and patient-reported pain-related outcomes among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) service members sustaining a combat-related extremity injury.

Methods: Between 2007 and 2013, n=358 American military personnel injured in OEF/OIF were enrolled at two military treatment facilities. Individuals were followed for up to 2 years after injury. Cohorts were defined based on whether participants were administered RA within 7 days after sustaining a combat-related injury, or not. Linear mixed effects models examined the association between RA and average pain intensity. Secondary outcomes included pain relief, pain interference, neuropathic pain symptoms, treatment outcomes related to pain management, and mental health symptoms.

Results: Receiving early RA was associated with improved average pain over the first 6 months after injury (β=-0.57; p=0.012) adjusting for injury severity and length of stay at the primary treatment facility. This difference was observed up to 24 months after injury (β=-0.36; p=0.046). Individuals receiving early RA reported greater pain relief, improved neuropathic pain intensity, and higher satisfaction with pain outcomes; however, by 24 months, mean scores did not significantly differ between cohorts.

Conclusion: Findings indicate that when administered soon after traumatic injury, RA is a valuable pain management intervention. Future longitudinal studies investigating the timely delivery of RA for optimal pain management in civilian trauma settings are needed.

Trial Registration Number: NCT00431847.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/rapm-2019-100773DOI Listing
September 2019

Upper Extremity Amputation and Prosthetics Care Across the Active Duty Military and Veteran Populations.

Phys Med Rehabil Clin N Am 2019 02 31;30(1):73-87. Epub 2018 Oct 31.

Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonioa, TX 78234, USA. Electronic address:

The hand and arm are exceptionally dexterous, exquisitely sensitive, and proficient in performing tasks and functions. Given the invaluable functions of the upper extremity in daily life, replacement of a missing limb through prosthetic substitution is challenging. Prosthetic and rehabilitation needs of injured Service members from recent military conflicts have brought upper extremity amputation to the forefront, which has led to an increase in attention and resource allocation. This article provides an overview of the care of the upper extremity amputee including surgical considerations, prosthetic design and fitting, and preprosthetic and post-prosthetic rehabilitation considerations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pmr.2018.08.011DOI Listing
February 2019

The effect of pulsed electromagnetic frequency therapy on health-related quality of life in military service members with chronic low back pain.

Nurs Outlook 2017 Sep - Oct;65(5S):S26-S33. Epub 2017 Jul 20.

Brooke Army Medical Center, Center for Nursing Science & Clinical Inquiry, San Antonio, TX.

Background: In the U.S. military, chronic low back pain is among the most frequent complaints for medical visits, lost work time, and attrition from active duty and the deployed setting by service members.

Purpose: The aim of this pilot study was to determine whether adjunctive treatment with pulsed electromagnetic frequency (PEMF) produced significant variability in chronic low back pain symptoms and secondary health-related quality of life, mental health and disability outcomes.

Methods: Prospective, randomized pilot study with repeated measures at baseline, post-treatment, and 1 month follow-up for two groups: usual care (UC) vs. UC + PEMF.

Findings: In a convenience sample of 75 service members, health-related quality of life mental and physical component scores were significant: F(2, 104) = 4.20, p = .018 (η = .075) and F(2, 104) = 4.75, p = .011 (η = .084), respectively; as was anxiety symptom severity: F(2, 104) = 5.28, p = .007 (η = .092).

Discussion And Recommendations: Adjunctive treatment with PEMF demonstrated improvements in service members' overall physical health-related quality of life with expected, yet statistically nonsignificant improvements in reported pain and LBP-related disability. There were significant between group differences in anxiety symptom severity with higher symptoms reported by the UC + PEMF group, surprising findings that warrant further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.outlook.2017.07.012DOI Listing
November 2017

Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study).

J Orthop Trauma 2017 04;31 Suppl 1:S71-S77

*Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine; ‡Department of Orthopaedics, The MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; §Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA; ‖Department of Orthopaedic Surgery, Louisiana State University Health Shreveport, Shreveport, LA; ¶Department of Pain Management, Brooke Army Medical Center, San Antonio, TX; **Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and ††R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.

Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BOT.0000000000000793DOI Listing
April 2017

Economic Impact of Ketorolac vs Corticosteroid Intra-Articular Knee Injections for Osteoarthritis: A Randomized, Double-Blind, Prospective Study.

J Arthroplasty 2016 09 18;31(9 Suppl):293-7. Epub 2016 May 18.

South Texas Bone and Joint Institute, San Antonio, Texas.

Background: Knee osteoarthritis is a disabling disease that costs billions of dollars to treat. Corticosteroid gives varying pain relief and costs $12 per injection, whereas ketorolac costs $2 per injection, per institutional costs. The aim of this study was to compare ketorolac with corticosteroid based on pain relief using patient outcome measures and cost data.

Methods: A total of 35 patients were randomized to ketorolac or corticosteroid intra-articular knee injection in a double-blind, prospective study. Follow-up was 24 weeks. Osteoarthritis was evaluated using Kellgren-Lawrence grading. Visual analog scale (VAS) was the primary outcome measure. A query of the institutional database was performed for International Classification of Diseases, Ninth Revision codes 715.16 and 719.46, and procedure code 20610 over a 3-year period. Two-way, repeated measures analysis of variance and Spearman rank correlation were used for statistical analysis.

Results: Mean VAS for ketorolac and corticosteroid decreased significantly from baseline at 2 weeks, 6.3-4.6 and 5.2-3.6, respectively and remained decreased for 24 weeks. There was no correlation between VAS and demographics within treatments. There were 220, 602, and 405 injections performed on patients with the International Classification of Diseases, Ninth Revision codes 715.16 and 719.46 during 2013, 2014, and 2015, respectively. The cost savings per year using ketorolac instead of corticosteroid would be $2259.40, $6182.54, and $4159.35 for 2013, 2014, and 2015, respectively, with a total savings of $12,601.29 over this period.

Conclusion: Pain relief was similar between ketorolac and corticosteroid injections. Ketorolac knee injection is safe and effective with a cost savings percentage difference of 143% when compared with corticosteroid.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2016.05.015DOI Listing
September 2016

Painful sequelae following limb salvage: etiology and management.

J Am Acad Orthop Surg 2011 ;19 Suppl 1:S23-7

Outpatient Pain Service, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, TX, USA.

Inadequately controlled pain is a significant problem during limb salvage and is associated with poor outcomes. This pain has several causes, and many management options exist. Chronic pain associated with limb salvage causes unnecessary suffering and negatively affects long-term function. Chronic pain and disability in this population may be prevented with early, aggressive, comprehensive treatment. Ongoing research into the cause and clinical course of limb salvage pain likely will lead to advances in pain management and functional improvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/00124635-201102001-00005DOI Listing
May 2011
-->