Clinical evidence for dorsal root ganglion stimulation in the treatment of chronic neuropathic pain. A review.

Treating chronic neuropathic pain remains a challenge, despite the existing therapies. Recent years have seen the emergence of promising new technologies, such as the neurostimulation of the dorsal root ganglion (DRG). In the present article, we review the clinical evidence for the efficacy and safety of DRG neurostimulation in the treatment of chronic pain. While the results from a number of small observational studies are promising, it is not yet possible to conclude on the long-term effectiveness and safety of DRG stimulation and it is too early to recommend its widespread use outside of a research protocol. To improve the level of proof, larger randomized controlled trials are needed. These should include well-described populations, a sufficiently long follow-up and a detailed description of concurrent treatments (pharmacologic and patient integration in a multidisciplinary approach).

[Preoperative psychological experience and beliefs in adult patients scheduled for surgery at the University Hospital of Parakou in Benin]. / Vécu psychologique préopératoire et croyances chez les patients adultes programmés pour une intervention chirurgicale à l'hôpital universitaire de Parakou au Bénin.

OBJECTIVE: To study the preoperative psychological experience and beliefs in adult patients scheduled for surgery at the University Hospital of Parakou. PATIENTS AND METHODS: A descriptive and analytical study with prospective data collection conducted over three months (June 1st to August 30, 2012) and involved 75 patients. RESULTS: Of the 108 patients scheduled for surgery, 75 patients (69.44%) had been chosen. The average age was 44.11±16.24 years with a male predominance (56%). Fifty-five patients (73.3%) were anxious and 32 patients (46.7%) were afraid of dying. Forty-five patients (60%) had not received any information about the procedure they should undergo and 60 patients (80%) were not informed of the possible complications of surgery. Fifty-eight patients (77.3%) were aware of the anesthetic technique and 5.2% of patients were aware of the possible complications of anesthesia. In 56 patients (74.7%), the disease was of natural origin, in 18.6% of cases there was an enchantment and 5 patients (6.7%) the disease is due to a deity. In the context of spiritual care, 15 patients (20%) had consulted a marabout, 11 patients (14.7%) a healer and 10 patients (13.3) a fetish. CONCLUSION: The preoperative period induces a significant burden of anxiety among patients and their families. In Benin, the announcement of surgery is an opportunity for confrontation of the patient to an obsession with death which he manages to escape despite the countless sacrifices of traditional conjuring.

Diagnostic reference levels for X-ray investigations in pain management units in Belgium.

X-rays are commonly used in pain treatment centres where infiltrative techniques are performed. Although X-rays are useful in increasing the precision of infiltrative techniques, their use puts patients and staff at risk of radiation exposure. As a result, medical staff now have to obtain a certificate of training on the use of X-rays before being allowed to use X-rays in practice. This analysis was based on 373 detailed registrations of procedure-related parameters in the six centres that participated in this study between January 2009 and July 2009. Examinations chosen for inclusion in this study were the most commonly performed fluoroscopic imaging-guided procedures in a pain management unit: epidurals (cervical/lumbar), facet joint nerve blocks (cervical/lumbar) and transforaminal (cervical/lumbar). The sample size, the dose-area product (DAP) range for whole population, the mean and the third quartile DAP corrected for patient size (DAP(corr)), the screening time range, the mean and the third quartile screening time are presented. The proposed DRLs for epidurals, facet joint nerve blocks and transforaminal are 0.5, 2.5 and 3 Gy cm² for DAP values and 12, 60 and 50 s for screening times, respectively. In the absence of national diagnostic reference levels (DRLs) for pain management fluoroscopic procedures, these DAP and screening time values provide a possible way of establishing provisional DRLs for local use. The values for each examination type could be used as a baseline against which to monitor the effectiveness of dose reduction strategies as part of the optimisation process that is the goal of any quality control and patient dose monitoring system.

Anesthesia in French-speaking Sub-Saharan Africa: an overview.

The situation of Anesthesiology in Sub-Saharan Africa is unique in that nowhere else in the world has the absolute numbers of anesthesiologists decreased during the nineties. Most anesthesia services to the populations of these 17 poor countries are provided by nurse-anesthetists, either certified or trained on the job. Their mean age often exceeds 40, which leads to expect an acute shortage within fifteen years. Experienced anesthesiologists are now so few that, in most countries, the critical mass of knowledgeable specialists no longer exists to train new anesthesia professionals. This summary of local surveys provides a brief overview of current workforce, institutions, drugs and material constituting the daily environment of our colleagues. Challenges are outlined, with special emphasis on brain drain. Solutions are proposed, underlining the promising role of a few anesthesia schools, the need for young anesthesiologists to enter teaching, and the expectations they are supposed to meet.

Discrepant time course of cranial and spinal subdural collections in a case of SIH treated by EBP.

The MR monitoring of a patient with acute spontaneous intracranial hypotension successfully treated by epidural blood patch revealed strikingly different time course of the initially concomitant cranial and spinal subdural fluid collections. This undescribed feature suggested different pathophysiological mechanisms for the disorder in the two locations and should be kept in mind when imaging patients with the condition.