Not a match: Why women are not choosing pain medicine.

BACKGROUND: Despite a long history of disparities in medicine, women have made significant progress toward gender equity in medical schools, training programs, and many fields in recent years. However, pain medicine has remained behind most specialties in female recruitment and representation. METHODS: We reviewed the latest demographic data on practicing physicians, trainees, and applicants with the aim of analyzing gender trends and identifying potential factors contributing to the shortage of women in our specialty. RESULTS: Based on data from the past 10 years, the percentages of women among pain physicians, fellows, and applicants have remained stagnant, in contrast to the increases seen not only in the general medical workforce but also in other interventional specialties. CONCLUSIONS: Given these trends, it is likely that persistent gender disparities and biases play a role in preventing women from pursuing careers in pain, and unlikely that the current trajectory will change unless we take steps to address these and other relevant factors.

Risk factors for surgical site infection in advanced neuromodulation pain procedures: a retrospective study.

Aim: To assess the effects of diabetes mellitus (DM) and related variables on surgical site infection (SSI) risk in neuromodulation. Methods: This retrospective study followed patients who underwent neuromodulation procedures for at least 9 months to identify postoperative infections. Demographics, clinical characteristics and surgical outcomes were compared. Results: Of 195 cases included, 5 (2.6%) resulted in SSIs. Median HbA1c was significantly higher for the cases with SSIs (8.2 vs 5.6%; p = 0.0044). The rate of SSI was significantly higher among patients with DM (17.9 vs 0%; p = 0.0005), HbA1c≥7% (37.5 vs 0%; p = 0.0009), and perioperative glucose ≥200 mg/dl (40 vs 2.3%; p = 0.0101). Conclusion: DM, elevated HbA1c and perioperative hyperglycemia may all contribute to increased risk of SSIs with neuromodulation procedures.

Infections are feared complications of surgery. It is important to identify factors that increase the risk of infection to prevent these complications. This study looked at the effects of diabetes and high blood sugar on the risk of infection associated with pain procedures. The researchers followed patients who had these procedures and looked for any infections that occurred afterward. They found that patients with diabetes and high blood sugar levels before surgery were more likely to develop infections after these procedures. More research can help establish blood sugar targets so that physicians can better manage this risk for their patients.

Dorsal root ganglion stimulation for chemotherapy-induced peripheral neuropathy.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common consequence of cancer treatment that can be persistent and difficult to manage. Dorsal root ganglion stimulation (DRG-S) is a recently introduced but understudied treatment modality. This study explored the effect of DRG-S on pain and symptom burden associated with CIPN. METHODS: Patients with CIPN who underwent a DRG-S trial between January 2017 and August 2022 were identified through chart review after IRB approval was obtained. Demographic data, procedure details, pre-and postoperative scores, including the Numerical Rating Scale (NRS) and Edmonton Symptom Assessment System (ESAS), and duration of follow-up were recorded. Statistical analysis included descriptive statistics and paired t-tests to compare pre-and postoperative scores. RESULTS: Nine patients with an even mix of solid and hematologic malignancies underwent DRG-S trial and had a statistically significant decrease in NRS scores, with a mean reduction of 2.3 in their average pain (p = 0.014), 2.6 in worst pain (p = 0.023), and 2.1 in least pain (p = 0.018). Eight patients (88.9%) underwent permanent DRG-S implantation. Mean NRS scores remained lower than preoperative baselines through the first year of follow-up. Statistically significant reductions were noted at 3 months in average (2.1, p = 0.006) and least pain scores (1.9, p = 0.045), which further decreased after 6-12 months (average: 3.6, p = 0.049; least: 3.4, p = 0.023). Only the pain component of ESAS scores showed a significant reduction with DRG-S (2.0, p = 0.021). All patients endorsed improved sensation, 75% decreased their pain medication usage, and 37.5% reported complete pain relief by 2 years. CONCLUSION: Dorsal root ganglion stimulation can be an effective treatment for pain related to CIPN and deserves further investigation.

A Bibliometric Analysis of Top-Cited Journal Articles Related to Neuromodulation for Chronic Pain.

OBJECTIVES: Since its foundation in the 1960s, neuromodulation has become an increasingly used treatment option for chronic pain. This bibliometric analysis examines the most cited research in this field with the aim of uncovering existing trends and future directions. MATERIALS AND METHODS: Clarivate's Web of Science data base was searched for the top 25 most cited studies focusing on neuromodulation for chronic pain. Various bibliometric parameters were then extracted and analyzed. Randomized controlled trials (RCTs) were compared with non-RCTs. RESULTS: The top 25 articles had a mean of 347 citations and 22.2 citations per year, with more recent articles having a higher citation rate. Most were published in the last two decades and predominantly originated from the United States. There were 13 RCTs, which were significantly more recent (p = 0.004) and more cited per year (p = 0.001) than the 12 non-RCTs. Sources included 15 journals with a mean impact factor of 13.896. The most studied modality was spinal cord stimulation with 20 articles (76.9%), followed by intrathecal drug delivery (15.4%), dorsal root ganglion stimulation (3.8%), and peripheral nerve stimulation (3.8%). CONCLUSIONS: Analysis of the most cited articles on neuromodulation reveals a focal shift from historical reports to innovative RCTs that have increasingly guided pain practice in the recent years. As novel techniques and technologies continue to develop, high-quality evidence coupled with broadening indications will likely direct further expansion of this field.

Delayed onset of anterior spinal artery syndrome caused by retropulsed bone fragment after kyphoplasty: Case report and literature review.

Background: Percutaneous balloon kyphoplasty is a minimally invasive technique to treat refractory symptomatic osteoporotic vertebral compression fractures. A rare complication called anterior spinal artery syndrome has been documented several times in the literature after the procedure from cement embolism; however, the authors report an unusual case of anterior spinal artery syndrome following kyphoplasty through retropulsion of bone fragmentation. Case presentation: An 83-year-old male was admitted to an acute care hospital for severe low thoracic back pain without neurological symptoms. Computed tomography imaging showed T8 vertebral body compression fracture with 75% height loss. Kyphoplasty was performed four days after the admission without complications. On day nine postoperatively, the patient developed acute onset paraparesis of the lower extremities dissociated sensory deficits involving bilateral loss of temperature and pain, but preserved proprioception and vibratory sense. Magnetic resonance imaging of the spine revealed T2 intramedullary hyperintensity spanning from T7-9 and retropulsion of the bone fragments from a refracture of the T8 vertebral body. Conclusion: This study highlights a rare complication from a standard pain procedure through an unusual mechanism of injury. Clinicians who suspect acute myelopathy following vertebral augmentation procedures should obtain a computed tomography angiogram to identify a potential occluded vessel. If negative, individuals should proceed to magnetic resonance imaging to rule out retropulsion of bone fragmentation into the spinal cord.

Venous Thromboembolism Prophylaxis in Plastic Surgery.

Background: In 2011, the American Society of Plastic Surgery (ASPS) formed the Venous Thromboembolism Task Force Report, which encouraged the use of the 2005 Caprini score and was amended in 2013. Still, there have been several studies that have questioned the validity of the Caprini score. As a result, the goal of this study is to present our experience with chemoprophylaxis in cosmetic patients compared with the current recommendations for venous thromboembolism (VTE) chemoprophylaxis endorsed by the ASPS. Methods: A retrospective analysis was conducted in all patients operated on by a single surgeon from 2006 to 2016. Exclusion criteria were surgery length >6 hours, patients with known hypercoagulable states, or a personal history of deep vein thrombosis (DVT)/pulmonary embolism (PE). Demographic data were collected and analyzed. Results: There were 1272 patients from a single institution who met the inclusion criteria. We determined that 71% of patient VTE scores were in the high to highest risk categories (n = 657), median age was 46 years, 79% of the population was Caucasian, 35% of patients had a body mass index of overweight or obese, and the average length of stay was 1 day. The rate of VTE in our patient population was found to be 0.08% (1 patient), which was uncomplicated and resolved with conservative therapy. Conclusions: This retrospective study found no significant difference in the incidence of VTE by providing chemophrophylaxis to patients without utilizing a scoring system. Our study suggests that the Caprini Scoring system might not be optimal in predicting VTE in patients undergoing aesthetic surgery.

Ultrasound-guided superficial cervical plexus block for cancer-related clavicle pain.

Pain is one of the most feared conditions a cancer patient may face. Bone is a common site of metastasis in many malignancies, including breast, prostate, kidney, and lung cancer. Conventional therapy for tumor-related bone pain involves the use of opioids, non-steroidal anti-inflammatory drugs, and bisphosphonates. Palliative radiation therapy may be incorporated for refractory bone pain. We describe an innovative case of cancer-related clavicle pain successfully managed with a superficial cervical plexus block in an opioid-intolerant patient. Considering the lack of guidelines for pain interventions in this setting, such peripheral nerve blocks may be a useful adjunctive tool in refractory cancer pain management.