Sustained Relief of Complex Regional Pain Syndrome (CRPS) Pain Following a 60-Day Peripheral Nerve Stimulation: A Report of Three Cases.

Patients who present to pain clinics with complex regional pain syndrome (CRPS) typically have debilitating pain, including hyperalgesia and allodynia, and additional substantial quality-of-life concerns related to the motor and autonomic-related symptoms of CRPS. Present treatments for CRPS such as neuropathic pain medications and sympathetic blocks are often unsatisfactory for managing symptoms. The present cases highlight the use of a 60-day percutaneous peripheral nerve stimulation (PNS) treatment for three patients with CRPS Type I affecting the foot. In all three patients, the tibial and common peroneal nerves were targeted separately at the popliteal fossa with two percutaneous leads each placed a remote distance (~1 cm) from the target nerve under ultrasound guidance. All three patients reported substantial pain relief and resolution of autonomic symptoms (e.g., swelling, edema, erythema), with sustained relief lasting 8-10 months in two patients, and 34 months (as of this writing) in the third patient. There were no medical complications. These three cases suggest that 60-day PNS is a safe and efficacious treatment for CRPS.

Clinical study of a micro-implantable pulse generator for the treatment of peripheral neuropathic pain: 3-month and 6-month results from the COMFORT-randomised controlled trial.

BACKGROUND: We report the results from the first large, postmarket, multicentre, randomised controlled trial (RCT) evaluating peripheral nerve stimulation (PNS) for the treatment of chronic peripheral pain with a micro-implantable pulse generator (micro-IPG). METHODS: Subjects meeting eligibility were randomised (2:1) to either the active arm receiving PNS and conventional medical management (CMM) or the control arm receiving CMM alone. Treatments were limited to the following areas: lower back, shoulder, knee and foot/ankle. RESULTS: At 6 months, the active arm achieved an 88% responder rate with a 70% average reduction in pain. At the 3-month primary endpoint, the active arm achieved an 84% responder rate with an average pain reduction of 67% compared with the control arm, which achieved a 3% responder rate with an average pain reduction of 6%. Both responder rate and pain reduction in the active arm were significantly better than in the control arm (p<0.001). A majority of patient-reported outcomes also reached statistical significance. There have been no reports of pocket pain and no serious adverse device effects. 81% of subjects found the external wearable component of the PNS system to be comfortable. CONCLUSIONS: This study successfully reached its primary endpoint-the active arm achieved a statistically significant superior responder rate as compared with the control arm at 3 months. These RCT results demonstrated that PNS, with this micro-IPG, is efficacious and safe. This ongoing study will follow subjects for 3 years, the results of which will be reported as they become available.

Percutaneous Spinal Cord Stimulation Lead Placement Under Deep Sedation and General Anesthesia.

INTRODUCTION: Spinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) has recommended that the placement of percutaneous SCS leads be performed in an awake patient capable of providing feedback. It is not currently known how commonly this recommendation is adhered to by physicians in clinical practice. This article presents the findings of a survey designed to answer this important question. METHODS: We conducted a survey of the active membership of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Spine Intervention Society (SIS) regarding practice patterns with SCS therapy. We analyzed the percent of respondents who indicated that they use deep sedation and general anesthesia during SCS placement as well as any reported complications. RESULTS: Many practitioners frequently utilize deep sedation as well as general anesthesia when performing SCS implants. Our findings demonstrate that 77% of physicians reported that they utilize deep sedation for permanent SCS implants at times, and 45% of physicians reported the use of general anesthesia for 10 kHz implants. Additionally, 94% of physicians reported that they have never had a complication related to the use of general anesthesia for a spinal cord stimulator placement. CONCLUSIONS: This survey provides initial data on SCS practices among a large cohort of clinicians who utilize SCS. SCS lead placement under deep sedation and general anesthesia appears to be common practice for many physicians who perform implants. This survey should stimulate further research on this topic, given that the current safety guidelines and the rate of physicians reporting the use of deep sedation and general anesthesia for spinal cord stimulator placement remain at odds.

Demonstration of Lesions Produced by Cooled Radiofrequency Neurotomy for Chronic Osteoarthritic Knee Pain: A Case Presentation.

This case presentation demonstrates radiographic evidence of lesions created following cooled radiofrequency (cRF) neurotomy of the knee. A 67-year-old man presented with chronic left knee osteoarthritis, pain, and disability. After a failed trial of conservative treatments, the patient underwent diagnostic genicular nerve blocks and subsequent cRF neurotomy of the left knee. Shortly after cRF, magnetic resonance imaging (MRI) of the left knee was performed. On MRI, lesions created by cRF ablation were identified. The images presented in this case offer a visual explanation for the success of cRF in the treatment of knee osteoarthritis. LEVEL OF EVIDENCE: V.

Stevia rebaudiana loaded titanium oxide nanomaterials as an antidiabetic agent in rats

Abstract Stevia rebaudiana (Bertoni) Bertoni, Asteraceae, is a plant with hypoglycemic and antihyperlipidemic properties. S. rebaudiana (SrB) has become a lead candidate for the treatment of the diabetes mellitus. However, chronic administrations of S. rebaudiana are required to cause the normoglycemic effect. Importantly, nanomaterials in general and titanium dioxide (TiO2) in particular have become effective tools for drug delivery. In this work, we obtained TiO2 nanomaterials with SrB at different concentrations (10, 20 and 30 µM) by sol–gel method. After this nanomaterials were characterized by Fourier transform infrared spectroscopy and transmission electron microscopy. Where it was demonstrated, the presence of the S. rebaudiana in TiO2 nanomaterials, which were observed as hemispherical agglomerated particles of different sizes. The nanomaterials were evaluated in male rats whose diabetes mellitus-phenotype was induced by alloxan (200 mg/kg, i.p.). The co-administration of TiO2-SrB (20 and 30 µM) induced a significant and permanent decrease in the glucose concentration since 4 h, until 30 days post-administration. Likewise, the concentrations of insulin, glycosylated hemoglobin, cholesterol, and triacylglycerides showed a significant recovery to basal levels. The major finding of the study was that the TiO2-SrB (20 and 30 µM) has a potent and prolonged activity antidiabetic. TiO2 can be considered like an appropriated vehicle in the continuous freeing of active substances to treat of diabetes mellitus.