Spinal Cord Stimulation Waveforms for the Treatment of Chronic Pain.

PURPOSE OF REVIEW: Since the advent of spinal cord stimulation (SCS), advances in technology have allowed for improvement and treatment of various conditions, especially chronic pain. Additionally, as the system has developed, the ability to provide different stimulation waveforms for patients to treat different conditions has improved. The purpose and objective of the paper is to discuss basics of waveforms and present the most up-to-date literature and research studies on the different types of waveforms that currently exist. During our literature search, we came across over sixty articles that discuss the various waveforms we intend to evaluate. RECENT FINDINGS: There are several publications on several waveforms used in clinical practice, but to our knowledge, this is the only educational document teaching on waveforms which provides essential knowledge. There is a gap of knowledge related to understanding wave forms and how they work.

A Comprehensive Literature Review of Digital Health Interventions in the Treatment of Substance Use Disorder With Special Focus on Mobile Applications.

COVID-19 quarantine showed an increase in opioid-related deaths partially due to the limited capacity of clinics and treatment centers. Digital health interventions (DHIs) such as telehealth have improved access to treatment, reduced psychosocial barriers, and helped patients with substance use disorder (SUD). An in-depth literature review was conducted to gauge the efficacy and usefulness of DHIs on substance use disorder. PubMed was used with string search terms to identify studies analyzing telehealth for substance use disorders. Studies were eligible and selected if they used health interventions (HIs) and reported outcomes on the efficacy of DHIs, benefits of DHIs, and limitations of DHIs. The Agency of Healthcare Research and Quality (AHRQ) was used to analyze the impact of DHIs on SUD. Lastly, Apple's App Store was used to identify the current DHI available. The analysis indicated that mobile phone apps were the most appropriate sources to use for patients with substance use disorders. The search also found 36 mobile applications available on the market for patients, containing mainly pain medication diaries and trackers. The study did not find any apps for clinical usage that met the standards necessary for adequate healthcare in the opioid crisis, largely due to a lack of clinician involvement in using applications. Developing adequate DHIs has the potential to improve outcomes in patients with SUD and aid in recovery time. The research concluded that physicians looking to develop DHIs should take into consideration the mode of delivery of DHI, the aim to produce specific health outcomes as opposed to multiple outcomes, and clinician involvement in DHI development. DHIs can become a vital tool for medical professionals, especially during the COVID-19 crisis, as the use of healthcare technology has limited in-person contact, maintained current doctor-patient relationships, and allowed for contact tracing of the disease.

Successful buprenorphine transition while overlapping with a full opioid agonist to treat chronic pain: a case report.

Buprenorphine is a partial mu opioid agonist that has been increasingly utilized to treat patients with chronic pain and opioid use disorder (OUD). The drug has proven to provide significant chronic pain relief at low doses ranging from 75 to 1800 mcg. The conventional buprenorphine transitional process delays its introduction until patients begin withdrawal. However, this process can pose a barrier to both patients and providers due to some patients' inability to tolerate traditional prerequisite withdrawal. To our knowledge, this is a rare reported case to describe a transitional process utilizing buccal buprenorphine in which a patient with chronic pain simultaneously tapered completely off an extended-release (ER) full opioid agonist and uptitrated buprenorphine. The patient was weaned from oxycodone ER 30 mg every 12 h and oxycodone/acetaminophen 10/325 mg 3x/day for breakthrough pain utilizing an unconventional approach. Tapering down to oxycodone ER 20 mg 2x/day for the first 2 weeks was successful. However, reducing to oxycodone ER 10 mg 2x/day for the following 2 weeks presented adherence difficulty and increased breakthrough pain. At this time, buccal buprenorphine was added at 300 mcg daily for 3 days. From days 4 to 6, buprenorphine was increased to 300 mcg 2x/day and oxycodone ER decreased to 10 mg daily. Six days later, oxycodone ER was discontinued and oxycodone/acetaminophen continued as needed. The patient exhibited no signs of withdrawal and adequate relief of symptoms through this tapering process. At the 1-month follow-up, the patient was doing well and was being treated solely with buprenorphine and oxycodone/acetaminophen to control her breakthrough pain. After 5 months, buprenorphine was increased to 600 mcg 2x/day and her oxycodone/acetaminophen decreased to 5/325 mg 3x/day as needed. From the start of the patient's taper to her current transition, the patient reduced her morphine milligram equivalent (MME) dosage from 135 MME to 22.5 MME. The Clinical Opioid Withdrawal Scale (COWS), which measures the severity of a patient's opioid withdrawal symptoms, was consistently less than 5. This buprenorphine schedule demonstrated a successful tapering approach for this patient because she had reported improved quality of life and function. A patient-centered osteopathic treatment approach was utilized when the patient presented with mid-taper adherence difficulty. Transitioning patients from full to partial opioid agonists could become an important practice standard for patient safety not only for formal pain management practices but also in primary care, family practice, and even geriatric offices.

Risk of Cardiovascular Disease in Male Farmers Over the Age of 45: A Review of Literature.

The prevalence of heart disease in farmers is well documented, but there is limited research characterizing the diverse risk factors associated specifically with male farmers over the age of 45 in the United States, while also providing a multifactorial strategy to address these concerns. The majority of current research either focuses on the general rural population or does not take into account different demographic variables. Hence, this review looked to address those gaps by focusing on those specific variables. A literature review was generated looking at risk factors associated with cardiovascular disease in farmers using key search terms. Next, an additional search was conducted focusing on treatment plans to address these concerns. The articles were then sorted based on the inclusion and exclusion criteria. The initial articles were sorted by one researcher and then reassessed on two separate occasions. The literature review was performed using these databases: PubMed, CINAHL, Cochrane, and Ovid Medline. A total of 221 articles were generated, of which 12 articles matched the criteria. The articles highlighted important risk factors that were either social or non-social determinants of health that negatively impacted the target population. These were followed up by offering solutions that attempted to provide a holistic approach, including clinical and community-based interventions. Male farmers over the age of 45 years are at an increased risk of being diagnosed with heart disease compared to non-farmers in the same demographic. When attempting to implement interventions, stress management should be incorporated into the treatment plan. In addition, a multifaceted approach targeting clinical and community concerns is recommended.

Concentric and Eccentric Force Changes with Elastic Band and Isotonic Heavy Resistance Training: A Randomized Controlled Trial.

BACKGROUND: Inclusion of resistance training as part of a general fitness program to improve health, and lower risk of disease and injury is well established. Two common options to improve strength are elastic bands and weights. Comparison between elastic bands (as the sole resistance) to isotonic strengthening for concentric and eccentric strength outcomes following the use of low repetitions/heavy resistance has not been reported. HYPOTHESIS/PURPOSE: The purpose was to examine the effects of a four-week isotonic low repetitions/heavy resistance strengthening program compared to a low repetitions/heavy resistance elastic band strengthening program on shoulder external rotation, hip abduction, and elbow flexion concentric and eccentric isokinetic force production in college aged untrained females. STUDY DESIGN: Randomized Trial. METHODS: Twenty healthy females performed pre-and-post isokinetic (60 degrees/second) concentric/eccentric testing of the elbow flexors, shoulder external rotators, and hip abductors. Participants were randomly assigned to a four-week independent low repetitions/heavy resistance strengthening program performed with either elastic bands or isotonic exercises. RESULTS: A significant (p < 0.05) effect of time was found for eccentric elbow flexor and concentric and eccentric hip abduction force production in the elastic band group with post-test values greater than pre-test values. A significant (p < 0.05) effect of time was found for elbow flexor concentric and eccentric force production in the isotonic group with post-test values greater then pre-test values. No significant (p>0.05) effect of time was found for shoulder external rotator concentric and eccentric forces for both groups, the isotonic group's hip abduction concentric and eccentric force production and elastic band group's elbow flexion concentric force production. No significant effect of intervention (p >0.05) on concentric or eccentric elbow flexors, shoulder external rotators, or hip abductors force production was found, with pre-test and post-test values being similar between groups. CONCLUSION: Health care practitioners and coaches can consider the prescription of a heavy resistance training program with elastic bands or isotonic exercises for an independent exercise program and expect similar concentric and eccentric muscle force changes. LEVEL OF EVIDENCE: Level 2b.