Ultrasound guided platelet rich plasma injections for post-traumatic greater occipital neuralgia following concussion: a pilot randomized controlled trial.

Background: Treatment for post-traumatic greater occipital neuralgia (GON) includes serial injections of steroid/anesthetic. While these injections can alleviate pain, effects can be transient, frequently lasting only 1 month. As a potential alternative, platelet-rich plasma (PRP) injections are an emerging biological treatment with beneficial effects in peripheral nerve disorders. We investigated the feasibility, safety, and effectiveness of a single PRP injection for post-traumatic GON in comparison to saline or steroid/anesthetic injection. Methods: In this pilot randomized, double-blinded, placebo-controlled trial, 32 adults with post-traumatic GON were allocated 1:1:1 to receive a single ultrasound-guided injection of (1) autologous PRP (2) steroid/anesthetic or (3) normal saline. Our primary outcome was feasibility (recruitment, attendance, retention) and safety (adverse events). Exploratory measures included headache intensity and frequency (daily headache diaries) and additional questionnaires (headache impact, and quality of life) assessed at pre-injection, 1 week, 1 month, and 3 months post-injection. Results: We screened 67 individuals, 55% were eligible and 95% of those participated. Over 80% of daily headache diaries were completed with 91% of participants completing the 3-month outcome questionnaires. No serious adverse events were reported. There were no significant differences between groups for headache intensity or frequency. Headache impact on function test-6 scores improved at 3 month in the PRP (ß = -9.7, 95% CI [-15.6, -3.74], p = 0.002) and saline (ß = -6.7 [-12.7, -0.57], p = 0.033) groups but not steroid/anesthetic group (p = 0.135). Conclusion: PRP is a feasible and safe method for treating post-traumatic GON with comparable results to saline and steroid/anaesthetic. Further trials with larger sample sizes are required.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT04051203.

Ultrasound-guided platelet-rich plasma injections for post-traumatic greater occipital neuralgia: study protocol for a pilot randomized controlled trial.

BACKGROUND: Post-traumatic headaches (PTH) are a common sequelae of traumatic brain injury (TBI) and greatly impact patient function and quality of life. Post-traumatic greater occipital neuralgia (GON) is a type of post-traumatic headache. Conventional treatment includes steroid/anesthetic injections which typically alleviate pain but have a short duration of effect. Platelet-rich plasma (PRP) is an emerging biological treatment for numerous degenerative disorders, including peripheral nerve disorders. The primary aim of this pilot study is to evaluate whether a randomized control trial of PRP for the treatment of GON in patients with post-traumatic headaches is feasible in regard to recruitment, adherence, retention, and adherence and adverse events. Exploratory aims include improvement in pain, function, and quality of life in patients with post-traumatic GON receiving PRP compared to steroid/anesthetic and normal saline injections. METHODS: Thirty adults (over 18 years of age) with post-traumatic GON will be randomized into one of three groups: (1) autologous PRP injection, (2) steroid/anesthetic injection (standard care), or (3) placebo injection with normal saline. Injections will be performed to the greater occipital nerve under ultrasound guidance by a trained physician. Daily headache intensity and frequency data will be collected pre-injection and for the duration of the study period. Feasibility will be defined as greater than 30% recruitment, 70% completion of intervention, 70% retention, and less than 2 minor adverse events. Exploratory outcomes will be explored using the Headache Impact Test-6 (HIT-6, a valid and reliable 6-item questionnaire for assessment of the impact of headaches across different diagnostic groups of headaches) and the quality of life in following brain injury questionnaire (QOILIBRI). DISCUSSION: This pilot study will be the first to evaluate the feasibility of PRP as a potential treatment of GON in patients with post-traumatic headache. TRIAL REGISTRATION: ClinicalTrials.gov - NCT04051203 (registered August 9, 2019).

Honorary authorship: frequency and associated factors in physical medicine and rehabilitation research articles.

OBJECTIVES: To estimate the prevalences of perceived honorary authorship and International Committee of Medical Journal Editors (ICMJE)-defined honorary authorship, and identify factors affecting each rate in the physical medicine and rehabilitation literature. DESIGN: Internet-based survey. SETTING: Not applicable. PARTICIPANTS: First authors of articles published in 3 major physical medicine and rehabilitation journals between January 2009 and December 2011 were surveyed in June and July 2012 (N=1182). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The reported prevalences of perceived and ICMJE-defined honorary authorship were the primary outcome measures, and multiple factors were analyzed to determine whether they were associated with these measures. RESULTS: The response rate was 27.3% (248/908). The prevalences of perceived and ICMJE-defined honorary authorship were 18.0% (44/244) and 55.2% (137/248), respectively. Factors associated with perceived honorary authorship in the multivariate analysis included the suggestion that an honorary author should be included (P<.0001), being a medical resident or fellow (P=.0019), listing "reviewed manuscript" as 1 of the nonauthorship tasks (P=.0013), and the most senior author deciding the authorship order (P=.0469). Living outside North America was independently associated with ICMJE-defined honorary authorship (P=.0079) in the multivariate analysis. In the univariate analysis, indicating that the most senior author decided authorship order was significantly associated with ICMJE-defined honorary authorship (P=<.001). CONCLUSIONS: Our results suggest that honorary authorship does occur in a significant proportion of the physical medicine and rehabilitation literature. Additionally, we found several factors associated with perceived and ICMJE-defined honorary authorship and a discrepancy between the 2 rates. Further studies with larger response rates are recommended to further explore this topic.

Cardiomyopathy presenting as severe fatigue in a person with chronic spinal cord injury.

BACKGROUND/OBJECTIVE: To describe a case of fatigue associated with cardiomyopathy in a man with spinal cord injury. STUDY DESIGN: Case report. SUBJECT: An obese 35-year-old man with long-term ASIA A L2 paraplegia, accompanied by a 2-year history of progressive severe fatigue. METHODS: Physical examination showed obesity, hypertension, tachycardia, and pitting edema. An echocardiogram showed a 20% ejection fraction, severe dilation, and global hypokinesis in the left ventricle and mild to moderate mitral regurgitation. RESULTS: Symptoms improved after treatment with furosemide, warfarin, ramipril, and continuous positive airway pressure for obstructive sleep apnea. CONCLUSION: Severe progressive fatigue in a patient with chronic SCI may signal cardiomyopathy. Diagnostic studies may be warranted in patients with progressive fatigue.