YouTube as a Source of Medical Information About Spinal Cord Stimulation.

BACKGROUND: Social media platforms may play an important role in the dissemination of medical information on interventional pain procedures. This cross-sectional study quantitatively assessed the reliability and quality of information from YouTube regarding spinal cord stimulation. MATERIALS AND METHODS: YouTube was queried on May 20, 2020 using keywords "spinal cord stimulator," "spinal cord stimulation experience," and "spinal cord stimulation risks." The top 50 viewed videos from each search were analyzed. The primary outcome was video quality, which was analyzed using the modified DISCERN (mDISCERN) criteria. RESULTS: Seventy-nine of 103 (77%) videos were classified as useful. Fifteen of 103 (14%) videos were classified as misleading and contained nonfactual information on spinal cord stimulation. Hospitals, group practices, or physicians produced a greater proportion of useful videos compared to misleading videos (63.3% vs. 26.7%, p = 0.008). Nonmedical independent users produced a greater proportion of misleading videos compared to useful videos (73.3% vs. 16.4%, p < 0.001). Useful videos had significantly higher mDISCERN scores compared to misleading videos (2.6 vs. 1.9, p = 0.009). Nonmedical independent users produced a greater proportion of low-quality videos (mDISCERN score < 3) than high-quality videos (mDISCERN score ≥ 3; 50.8% vs. 2.4%, respectively, p < 0.001). Educational videos from professional pain medicine societies were not captured. CONCLUSION: YouTube is an accessible platform for medical information on spinal cord stimulation, yet a significant amount of nonfactual information is present. As social media platforms continue to gain prominence in health care, future efforts to appraise the quality of medical content delivered to the public are warranted. In addition, reputable sources including professional pain medicine societies should consider collaborating with producers to disseminate high-quality video content that reaches a wider audience.

Characterizing Chronic Pain Episodes in Clinical Text at Two Health Care Systems: Comprehensive Annotation and Corpus Analysis.

BACKGROUND: Chronic pain affects more than 20% of adults in the United States and is associated with substantial physical, mental, and social burden. Clinical text contains rich information about chronic pain, but no systematic appraisal has been performed to assess the electronic health record (EHR) narratives for these patients. A formal content analysis of the unstructured EHR data can inform clinical practice and research in chronic pain. OBJECTIVE: We characterized individual episodes of chronic pain by annotating and analyzing EHR notes for a stratified cohort of adults with known chronic pain. METHODS: We used the Rochester Epidemiology Project infrastructure to screen all residents of Olmsted County, Minnesota, for evidence of chronic pain, between January 1, 2005, and September 30, 2015. Diagnosis codes were used to assemble a cohort of 6586 chronic pain patients; people with cancer were excluded. The records of an age- and sex-stratified random sample of 62 patients from the cohort were annotated using an iteratively developed guideline. The annotated concepts included date, location, severity, causes, effects on quality of life, diagnostic procedures, medications, and other treatment modalities. RESULTS: A total of 94 chronic pain episodes from 62 distinct patients were identified by reviewing 3272 clinical notes. Documentation was written by clinicians across a wide spectrum of specialties. Most patients (40/62, 65%) had 1 pain episode during the study period. Interannotator agreement ranged from 0.78 to 1.00 across the annotated concepts. Some pain-related concepts (eg, body location) had 100% (94/94) coverage among all the episodes, while others had moderate coverage (eg, effects on quality of life) (55/94, 59%). Back pain and leg pain were the most common types of chronic pain in the annotated cohort. Musculoskeletal issues like arthritis were annotated as the most common causes. Opioids were the most commonly captured medication, while physical and occupational therapies were the most common nonpharmacological treatments. CONCLUSIONS: We systematically annotated chronic pain episodes in clinical text. The rich content analysis results revealed complexity of the chronic pain episodes and of their management, as well as the challenges in extracting pertinent information, even for humans. Despite the pilot study nature of the work, the annotation guideline and corpus should be able to serve as informative references for other institutions with shared interest in chronic pain research using EHRs.

Bleeding Complications in Patients Undergoing Celiac Plexus Block.

BACKGROUND AND OBJECTIVES: Celiac plexus blockade has known risks including bleeding and neurologic injury because of the close proximity of vascular and neuraxial structures. The aim of this study was to determine the incidence of bleeding complications in patients undergoing celiac plexus block (CPB), with an emphasis on preprocedural antiplatelet medication use and coagulation status. METHODS: This is a retrospective study from 2005 to 2014 of adult patients undergoing CPB by the pain medicine division at a tertiary care center. The primary outcome was red blood cell (RBC) transfusion within 72 hours of needle placement, with a secondary outcome of bleeding complications requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days. RESULTS: A total of 402 procedures were performed on 298 unique patients, with 58 patients (14.4%) receiving aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively. Five patients (1.2%) received RBC transfusion within 72 hours, of which one had received preprocedure NSAIDs. A platelet count measured within 30 days was available for 268 patients, with 7 patients (2.6%) having platelet counts of 100 × 10/L or less at the time of needle placement. A total of 187 patients had a valid preoperative international normalized ratio (INR), with 9 (4.8%) having an INR of 1.5 or higher (range, 1.5-2.6). One patient (11.1%) required RBC transfusion compared with an RBC transfusion rate of 2.3% (4 of 178) in those with normal INR (P = 0.221). We identified no bleeding complications requiring emergency medicine, neurology, or neurosurgical evaluation. CONCLUSIONS: This study suggests that CPBs may be safely performed in patients receiving aspirin and/or NSAID therapy.