Utility of MR Neurography for the Evaluation of Peripheral Trigeminal Neuropathies in the Postoperative Period.

Peripheral trigeminal neuropathies are assessed by MR neurography for presurgical mapping. In this clinical report, we aimed to understand the utility of MR neurography following nerve-repair procedures. We hypothesized that postoperative MR neurography assists in determining nerve integrity, and worsening MR neurography findings will corroborate poor patient outcomes. Ten patients with peripheral trigeminal neuropathy were retrospectively identified after nerve-repair procedures, with postsurgical MR neurography performed from July 2015 to September 2023. Postsurgical MR neurography findings were graded as per postintervention category and subcategories of the Neuropathy Score Reporting and Data System (NS-RADS). Descriptive statistics of demographics, inciting injury, injury severity, NS-RADS scoring, and clinical outcomes were obtained. There were 6 women and 4 men (age range, 25-73 years). Most injuries resulted from third molar removals (8/10), with an average time from the inciting event to nerve-repair surgery of 6.1 (SD, 4.6) months. In Neuropathy Score Reporting and Data System-Injury (NS-RADS I), NS-RADS I-4 injuries (neuroma in continuity) were found in 8/10 patients, and NS-RADS I-5 injuries were found in the remaining patients, all confirmed at surgery. Surgeries performed included microdissection with neurolysis, neuroma excision, and nerve allograft with Axoguard protection. Three patients with expected postsurgical MR neurography findings experienced either partial improvement or complete symptom resolution, while among 7 patient with persistent or recurrent neuropathy on postsurgical MR neurography, one demonstrated partial improvement of sensation, pain, and taste and one experienced only pain improvement; the remaining 5 patients demonstrated no improvement. Postsurgical MR neurography consistently coincided with clinical outcomes related to pain, sensation, and lip biting and speech challenges. Lip biting and speech challenges were most amenable to recovery, even with evidence of persistent nerve pathology on postsurgical MR neurography.

Pain catastrophizing and risk of progression to widespread pain among patients with chronic low back pain: A retrospective cohort study.

BACKGROUND: Chronic low back pain often progresses to widespread pain. Although many factors are associated with progression, their roles in contributing to chronic widespread pain (CWP) are often unclear. OBJECTIVE: To determine if pain catastrophizing is an independent risk factor for CWP. DESIGN: Retrospective cohort study within a national pain research registry from April 2016 through August 2022. METHODS: A total of 1111 participants with chronic low back pain, but without CWP, were included. Participants were followed at quarterly intervals for up to 48 months to measure CWP risk. Survival analyses involved Kaplan-Meier plots and the Cox proportional hazards model to measure CWP risk according to pain catastrophizing and subscale scores for rumination, magnification, and helplessness. RESULTS: Crude CWP risks for moderate pain catastrophizing (HR, 2.13; 95% CI, 1.54-2.95; P < 0.001) and high pain catastrophizing (HR, 3.98; 95% CI, 2.95-5.35; P < 0.001) were each elevated in comparison with low pain catastrophizing. Adjusted CWP risks for moderate pain catastrophizing (HR, 1.80; 95% CI, 1.27-2.53; P < 0.001) and high pain catastrophizing (HR, 2.82; 95% CI, 1.98-4.02; P < 0.001) remained elevated in analyses that controlled for potential confounders. Corresponding results were observed in the survival analyses involving rumination, magnification, and helplessness. CONCLUSIONS: Pain catastrophizing appears to be an independent risk factor for progression to CWP among patients with chronic low back pain. These findings provide a rationale for interventions aimed at reducing pain catastrophizing, including rumination, magnification, and helplessness, among patients with chronic low back pain.

Efficacy of MR Neurography of Peripheral Trigeminal Nerves: Correlation of Sunderland Grade versus Neurosensory Testing.

BACKGROUND AND PURPOSE: The current reference standard of diagnosis for peripheral trigeminal neuropathies (PTN) is clinical neurosensory testing (NST). MR neurography (MRN) is useful for PTN injury diagnosis, but it has only been studied in small case series. The aim of this study was to evaluate the agreement of Sunderland grades of nerve injury on MRN and NST by using surgical findings and final diagnoses as reference standards. MATERIALS AND METHODS: A total of 297 patient records with a chief complaint of PTN neuralgia were identified from the university database, and 70 patients with confirmed NST and MRN findings who underwent surgical nerve repair were included in the analysis. Cohen weighted kappa was used to calculate the strength of the agreement between the 3 modalities. RESULTS: There were 19 men and 51 women, with a mean age of 39.6 years and a standard deviation of 16.9 years. Most (51/70, 73%) injuries resulted from tooth extractions and implants. MRN injury grades agreed with surgical findings in 84.09% (37/44) of cases, and NST injury grades agreed with surgical findings in 74.19% (23/31) of cases. MRN and NST both showed similar agreement with surgery for grades I to III (70% and 71.43%). However, MRN showed a higher rate of agreement with surgery (88.24%) for injury grades IV and V than did NST (75%). CONCLUSIONS: MRN can objectively improve preoperative planning in patients with higher-grade nerve injuries.

Dual use of alcohol and cannabis among college students: A reinforcer pathologies approach.

The reinforcer pathologies model proposes 2 behavioral economic constructs interact in addiction: operant demand and delay discounting. These constructs manifest as behavioral markers of addiction in the form of excessive reinforcer value and strong preference for immediate access and consumption of this reinforcer despite suboptimal long-term outcomes. The first aim of this investigation was to identify the degree to which delay discounting (of money and alcohol) and demand for alcohol differ between college student drinkers (N = 185) who do and do not co-use cannabis. As a second aim, we sought to replicate the 2-factor solution for alcohol and cannabis demand within a college sample. Results suggest dual users have significantly stronger Persistence and Amplitude for alcohol, demonstrate steeper delay discounting of alcoholic drinks, and are at greater risk for alcohol use disorder than individuals who drink yet do not use cannabis. These results provide further support for the reinforcer pathologies model and contribute to the literature on dual-substance use in the college population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).