A low-cost ultrasound phantom of the lumbosacral spine.

BACKGROUND AND OBJECTIVES: This report describes the production of a low-cost ultrasound phantom of the lumbosacral spine. The phantom should be a very useful tool to teach the basic skills for ultrasound-guided procedures of the lumbosacral spine. METHODS: A lumbosacral spine model is secured to the bottom of a microwave-safe container and is immersed in a concentrated gelatin solution. After the gelatin hardens, the model can be used for scanning practice as well as needle placement. The phantom can be recovered after use by melting the gelatin in a microwave to "erase" any needle track marks. RESULTS: A transparent and durable gelatin block is produced. This allows trainees to have direct visual access to the lumbosacral spine model to correlate with the ultrasound images as well as to confirm proper needle placement. Disadvantages of the model include lack of simulated soft tissue structures and an absence of simulated haptic feedback during needle placement. Metamucil can be added to the gelatin to simulate the appearance of soft tissue, although this increases the opacity and thus decreases the visual access of the gelatin. CONCLUSIONS: This teaching tool can provide trainees with an opportunity to familiarize themselves with sonoanatomy of the lumbosacral spine in addition to practicing probe handling techniques and needle placement.

Duloxetine: a review of its pharmacology and use in chronic pain management.

Duloxetine is a serotonin and norepinephrine reuptake inhibitor that possesses antidepressant and pain-relieving properties. Compared with other antidepressants, it has a high affinity for both norepinephrine and serotonin reuptake transporters, which are relatively balanced. Analgesic onset has been observed within the first week of administration in randomized controlled trials and is likely obtained by enhancing the tone of the descending pain inhibition pathways of the central nervous system. Randomized trials have documented significant analgesic effects for managing chronic pain associated with fibromyalgia and diabetic peripheral neuropathic pain. Studies have also suggested that pain associated with major depressive disorder can be reduced with this medication. Modest effects for headache, osteoarthritic pain, and pain secondary to Parkinson disease have also been documented, but data are obtained from single-blinded or open-label trials that require further corroboration with larger randomized studies. Duloxetine has not yet been directly compared with other antidepressants or anticonvulsants for the treatment of pain syndromes.