Extended reality navigation for pain procedures: a narrative review.

BACKGROUND: Extended reality (XR) technology, encompassing virtual reality, augmented reality, and mixed reality, has been widely studied for procedural navigation in surgical specialties. Similar to how ultrasound transformed regional anesthesia, XR has the potential to reshape how anesthesiologists and pain physicians perform procedures to relieve pain. OBJECTIVE: This narrative review examines the clinical benefits of XR for navigation in various pain procedures. It defines key terms and concepts related to XR technology and explores characteristics of procedures that are most amenable to XR-based navigation. Finally, it suggests best practices for developing XR navigation systems and discusses the role of emerging technology in the future of XR in regional anesthesia and pain medicine. EVIDENCE REVIEW: A search was performed across PubMed, Embase, and Cochrane Central Register of Controlled Trials for primary literature investigating the clinical benefits of XR navigation for pain procedures. FINDINGS: Thirteen studies using XR for procedural navigation are included. The evidence includes randomized controlled trials, retrospective studies, and case series. CONCLUSIONS: Early randomized controlled trials show potential for XR to improve procedural efficiency, but more comprehensive research is needed to determine if there are significant clinical benefits. Case reports demonstrate XR's utility in generating patient-specific navigation plans when difficult anatomy is encountered. Procedures that facilitate the generation and registration of XR images are most conducive to XR navigation, whereas those that rely on frequent re-imaging will continue to depend on traditional modes of navigation.

Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review.

PURPOSE OF REVIEW: This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS: Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.

Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review.

(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations.

Telehealth and Virtual Reality Technologies in Chronic Pain Management: A Narrative Review.

PURPOSE OF REVIEW: This review provides medical practitioners with an overview of the present and emergent roles of telehealth and associated virtual reality (VR) applications in chronic pain (CP) management, particularly in the post-COVID-19 healthcare landscape. RECENT FINDINGS: Accumulated evidence points to the efficacy of now well-established telehealth modalities, such as videoconferencing, short messaging service (SMS), and mobile health (mHealth) applications in complementing remote CP care. More recently, and although still in early phases of clinical implementation, a wide range of VR-based interventions have demonstrated potential for improving the asynchronous remote management of CP. Additionally, VR-associated technologies at the leading edge of science and engineering, such as VR-assisted biofeedback, haptic technology, high-definition three-dimensional (HD3D) conferencing, VR-enabled interactions in a Metaverse, and the use of wearable monitoring devices, herald a new era for remote, synchronous patient-physician interactions. These advancements hold the potential to facilitate remote physical examinations, personalized remote care, and innovative interventions such as ultra-realistic biofeedback. Despite the promise of VR-associated technologies, several limitations remain, including the paucity of robust long-term effectiveness data, heterogeneity of reported pain-related outcomes, challenges with scalability and insurance coverage, and demographic-specific barriers to patient acceptability. Future research efforts should be directed toward mitigating these limitations to facilitate the integration of telehealth-associated VR into the conventional management of CP. Despite ongoing barriers to widespread adoption, recent evidence suggests that VR-based interventions hold an increasing potential to complement and enhance the remote delivery of CP care.

ReActiv8 Stimulation Therapy vs. Optimal Medical Management: A Randomized Controlled Trial for the Treatment of Intractable Mechanical Chronic Low Back Pain (RESTORE Trial Protocol).

INTRODUCTION: Chronic low back pain (CLBP) is the leading cause of years lived with disability globally. The role of restorative neurostimulation in the treatment of patients with refractory mechanical CLBP and multifidus muscle dysfunction has been established in one randomized controlled trial (RCT) and several clinical studies that demonstrated both safety and clinical benefit. This post-market trial provides a direct comparison to optimized medical management to test the hypothesis that the addition of restorative neurostimulation to current care paradigms results in significant improvements in back pain-related disability. METHODS AND ANALYSIS: This trial will include people who have reported significant levels of back pain and back pain-related disability with symptoms that have persisted for longer than 6 months prior to enrollment and resulted in pain on most days in the 12 months prior to enrollment. Eligible patients will be randomized to either optimal medical management or optimal medical management plus ReActiv8® restorative neurostimulation therapy. Patient-reported outcomes will be collected at regular intervals out to the 1-year primary endpoint, at which time the patients in the control arm will be offered implantation with the ReActiv8 system. Assessment of each group will continue for an additional year. ETHICS AND DISSEMINATION: The RESTORE trial follows the principles of the Declaration of Helsinki. The WCG IRB acts as the Central Institutional Review Board (IRB) for most sites and some sites will receive local IRB approval prior to enrollment of patients. Each IRB assessed the protocol and related documentation. The protocol complies with Good Clinical Practice (GCP). All patients provide written informed consent to participate in the trial. PROTOCOL VERSION: Version C, 07 Sep 2022. CLINICALTRIALS: gov registration number. NCT04803214 registered March 17, 2021.

Restorative neurostimulation is a treatment for intractable CLBP associated with dysfunction of the multifidus muscle, which normally provides functional stability to the lumbar spine. To date, ReActiv8^® (Mainstay Medical) is the only neurostimulator specifically developed and approved for this indication. Electrical stimulation of the muscle's nerve overrides the dysfunction and reactivates it. Several prior studies demonstrated that the most of participants experienced clinically substantial and durable symptom relief compared to baseline. This protocol describes a second RCT in which all participants are on individualized optimal medical management and half of them are randomly selected to be implanted with a ReActiv8 system to receive restorative neurostimulation. The purpose of this design is to measure if there is any clinical benefit of restorative neurostimulation over individualized optimal medical management alone over the course of a full year.

Long single pulse NQR for broad resonance lines.

This paper describes the experimental application of long single pulses to strongly inhomogeneously broadened NQR spectral lines, where the pulse length significantly exceeds the transverse relaxation time. A63Cu NQR resonance in the mineral covellite (CuS) was used as an exemplar for study in this specific regime, which was motivated by the requirement to obtain useful signals in very large volume applications having radiofrequency power limitations. In this study, signal transients that followed the application of the long single pulses were measured over a large range of radiofrequency field strength and pulse width. The results indicate effective generation of signal amplitudes. This is in contrast to previously reported studies involving long pulses applied to relatively narrow resonances. The results are found to be well described by simulations of the modified Bloch equations.

Prevalence of chronic pain among adults in the United States.

ABSTRACT: Chronic pain is associated with reduced quality of life, increased medical expenditures, and significant economic costs. Chronic pain is among the most common chronic conditions in the United States, although estimates vary widely regarding its precise prevalence. Understanding the scope of the problem using the most contemporaneous data is therefore an important goal. This study sought to determine the prevalence of chronic pain and its impacts among adults in the United States using the National Health Interview Survey, a household-based annual survey of self-reported health status of U.S. adults that can be used to generate national-level estimates. Using a chronic pain module introduced in the 2019 edition of National Health Interview Survey, we found that 50.2 million adults (20.5%) reported pain on most days or every day. The most common pain locations were back pain and hip, knee, or foot pain. The most commonly used management strategies for chronic pain were physical therapy and massage. Respondents with chronic pain reported limitations in daily functioning, including social activities and activities of daily living. Respondents with chronic pain reported significantly more workdays missed compared with those without chronic pain (10.3 vs 2.8, P < 0.001). Overall, these findings indicate that more than 1 in 5 adults in America experiences chronic pain; additional attention to managing the burden of this disease is warranted.

Two new species of threadlike blood flukes (Aporocotylidae), with a molecular revision of the genera Ankistromeces Nolan & Cribb, 2004 and Phthinomita Nolan & Cribb, 2006.

Ankistromeces Nolan & Cribb, 2004 and Phthinomita Nolan & Cribb, 2006 are sister genera of threadlike blood flukes (Trematoda: Aporocotylidae) infecting teleost fishes of the tropical Indo-west Pacific. Here, we report new collections of these genera from Australia, Indonesia, and Japan. A new species of Ankistromeces, Ankistromeces kawamurai n. sp., is described from Siganus spinus (Linnaeus) off Okinawa, Japan, and a new species of Phthinomita, Phthinomita abdita n. sp., from Choerodon cephalotes (Castelnau), in Moreton Bay, Australia; the new species are morphologically cryptic within their respective genera and are delineated by molecular and ecological data. Ankistromeces olsoni Nolan & Cribb, 2006 is reported from Siganus fuscescens (Houttuyn) off Heron Island (southern Great Barrier Reef), Lizard Island (northern Great Barrier Reef), and Okinawa and Wakayama Prefectures, Japan and from Siganus spinus (Linnaeus) from off Bali, Indonesia. Ankistromeces mariae Nolan & Cribb, 2004 is re-reported from the type-host, Meuschenia freycineti (Quoy & Gaimard), from a new location, Gypsy Bay, Tasmania. Phthinomita poulini Nolan & Cribb, 2006 is re-reported from its type-locality, Lizard Island, from a range of mullids, including five new host species, and its range is extended to include Moreton Bay. Phthinomita symplocos Nolan & Cribb, 2006 is reported from Bali and P. hallae Nolan & Cribb, 2006, P. jonesi Nolan & Cribb, 2006, P. littlewoodi Nolan & Cribb, 2006, and P. munozae Nolan & Cribb, 2006 are each re-reported from their type-host and type-localities. New cox1 mtDNA data were generated for all known species of these two genera from new and archival material. Analyses of these data enabled an evaluation of all known Phthinomita species; P. robertsthomsoni Nolan & Cribb, 2006 is synonymised with P. adlardi Nolan & Cribb, 2006, and P. brooksi Nolan & Cribb, 2006 is synonymised with P. sasali Nolan & Cribb, 2006. We highlight the failure of ITS2 data to delineate closely related aporocotylid species. In contrast, cox1 sequence data are proving reliable and effective in this context and we recommend their incorporation in future studies of blood fluke taxonomy.

Spinal Cord Stimulation for Painful Diabetic Peripheral Neuropathy: A Systematic Review.

Painful diabetic neuropathy is a common disease that results in significant pain and disability. Treatment options have traditionally consisted of conservative measures including topical and oral medication management as well as transcutaneous electrical stimulation units. These treatments demonstrate various degrees of efficacy, and many times initial treatments are discontinued, indicating low levels of satisfaction or poor tolerability. Spinal cord stimulation has been proposed as an alternative therapy for treatment of painful diabetic neuropathy of the lower extremities. We performed a systematic literature review to evaluate the safety and effectiveness of this procedure. A literature search identified 14 prospective studies. Based on our analysis of the available evidence, there is moderate-quality evidence for the safety and efficacy of spinal cord stimulation for painful diabetic neuropathy. However, further high-quality research, including a large-scale randomized controlled trial is warranted.

Racial and Ethnic Disparities in the Treatment of Chronic Pain.

OBJECTIVE: To summarize the current literature on disparities in the treatment of chronic pain. METHODS: We focused on studies conducted in the United States and published from 2000 and onward. Studies of cross-sectional, longitudinal, and interventional designs were included. RESULTS: A review of the current literature revealed that an adverse association between non-White race and treatment of chronic pain is well supported. Studies have also shown that racial differences exist in the long-term monitoring for opioid misuse among patients suffering from chronic pain. In addition, a patient's sociodemographic profile appears to influence the relationship between chronic pain and quality of life. Results from interventional studies were mixed. CONCLUSIONS: Disparities exist within the treatment of chronic pain. Currently, it is unclear how to best combat these disparities. Further work is needed to understand why disparities exist and to identify points in patients' treatment when they are most vulnerable to unequal care. Such work will help guide the development and implementation of effective interventions.

Enhancement of cement-based solidification/stabilization of a lead-contaminated smectite clay.

The cement-based solidification/stabilization is commonly used to remediate heavy-metal-contaminated clayey soils. The major problem associated with this method is heavy-metal precipitation, which retards cement hydration. The objectives of this paper are to study the influence of pH-dependent lead solubility patterns on the solidification/stabilization of contaminated smectite and to overcome the problems associated with cement hydration in this process through NaOH treatment. A series of physicochemical experiments were performed on untreated and NaOH-enhanced samples. Contaminated smectite with 5-100 cmol/kg-soil of lead nitrate was solidified/stabilized by 10-50% cement. This research demonstrates that solidification/stabilization is a pH-dependent phenomenon. Enhancement increases the pH of contaminated soil in which lead components transfer to a soluble form. Hereafter, as the results of XRD reveal, a decrease in lead precipitation on cement components is observed. Consequently, a noticeable increase in CSH formation is detected. The capsulation of lead ions by CSH improves the setting-time and unconfined compressive strength of solidified/stabilized samples. Furthermore, the TCLP results show a significant reduction in samples' lead-leaching abilities. Therefore, enhancement has changed the governing retention phenomena from precipitation/stabilization in lead carbonate form to mainly capsulation/solidification by CSH. Moreover, the results show a noticeable reduction in the required cement content.

Expression of IFN-λ1 from Congjiang pigs and its effect on anti-PRRSV proliferation.

An eukaryotic expression system of Congjiang pigs IFN-λ1 was constructed to obtain its expression in CHO-K1 cells and the inhibition effect of Congjiang pig IFN-λ1 on PRRSV proliferation was verified. The eukaryotic expression plasmid pEGFP-PoIFN-λ1 was constructed from the pig IFN-λ1 gene fragment and transfected into CHO-K1 cells. Expression was detected by fluorescence microscopy and Western blotting. The influence on the proliferation of PRRSV was assessed. The results of the study showed that the recombinant plasmid pEGFP-PoIFN-λ1 was constructed correctly. After transfection, green fluorescent signal was detected in CHO-K1 cells by fluorescence microscopy. Western blot analysis revealed that in cells at different time periods after transfection, porcine IFN-λ1 was expressed, with the highest expression observed 36 h after transfection. The antiviral activity of the supernatant after 36 h of transfection was determined by the micro cytopathic inhibition method, and the biological activity was 2.1×103 U/mL. Quantitative PCR was used to detect the proliferation of PRRSV, and the results showed that Congjiang pigs IFN-λ1 significantly inhibited the mRNA expression of PRRSV and viral proliferation in a dose- and time-dependent manner. This study established a Congjiang pig IFN-λ1 eukaryotic expression system, and the quantitative PCR method showed that it has a significant inhibitory effect on the proliferation of PRRSV, which lays a foundation for the future production of antiviral drugs and clinical application.

Evidence in Support of the Border-Ownership Neurons for Representing Textured Figures.

We presented one eye with a monocular-boundary-contour (MBC) square, created by phase-shifting a central region of grating relative to a larger uniform grating surround, and the fellow eye with the larger uniform grating. In addition, the grating within the MBC region was rendered with lower contrast relative to the remaining stimulus. Despite this, we found the lower contrast MBC region dominated the perceived cyclopean contrast, with the corresponding region in the fellow eye being suppressed. Secondly, we found for dichoptic stimuli with half-images having square grating regions of different BC strengths, the interocular BC strength ratio determined the perceived contrast of the cyclopean square. Thirdly, we found perceived spatial phase of the cyclopean square was dominated by the spatial phase of the MBC half-image. Altogether, these psychophysical findings provided evidence for a border-to-interior representation strategy, that constructing surface begins at the boundary contour (BC), in binocular contrast and phase integration.

Perioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview.

PURPOSE OF REVIEW: Point of care ultrasound (POCUS) has played a role across almost every medical specialty. Although anesthesiologists have been using bedside ultrasound for nerve blocks and vascular access for many years now, there has been a recent push to incorporate whole-body POCUS into anesthesiologists' training and daily practice. This article provides a brief overview of the indications, techniques for image acquisition, and general principles in interpreting basic images. RECENT FINDINGS: Whole-body POCUS can provide quick diagnoses and impact clinical management across relevant pre-, intra-, and post-operative settings. Anesthesia providers need to understand different applications for POCUS, including focused cardiac ultrasound (FoCUS), lung ultrasound (LUS), gastric ultrasound, abdominopelvic ultrasound, and the use of ultrasound for airway management. Currently, there is no standard ultrasound curriculum for anesthesiology residents, and teaching methods include informal bedside teaching, structured expert demonstration, didactic lectures, and simulations. Model/simulation-based lecture series may be effective in teaching ultrasound to anesthesiology residents, and e-learning and traditional didactics are both equally effective in teaching POCUS applications such as LUS and focused assessment with sonography in trauma (FAST). Creating protocol-guided frameworks for POCUS, such as I-AIM (indication, acquisition, interpretation, medical decision making), can also ensure more consistent and reliable diagnoses and interpretations of findings. Applications of POCUS should be focused, goal-oriented, easily learned, rapidly performable at bedside, accurate, and reliable. A variety of studies have shown this potential for POCUS in assessing cardiac, pulmonary, and intraabdominal pathologies, making it an emerging area of interest in medicine. The incorporation of POCUS into perioperative medicine provides an important tool to ensure continued improvement in coordinating care for patients in the perioperative period.

Patient and Surgery-Related Predictors of Acute Postoperative Pain.

PURPOSE OF REVIEW: The purpose of the present investigation is to provide a comprehensive review of both patient and procedure specific predictors of acute postoperative pain. RECENT FINDINGS: As the global number of surgeries continues to increase, as well as evidence of worse patient outcomes in those who suffer from poorly controlled postoperative pain, it is becoming more critical for perioperative physicians to have a deep understanding of the risks which might lead to increased pain in the immediate postoperative settings. It is also important to recognize potential tools to prevent the development and intensity of surgical pain. This manuscript begins with an investigation of the theorized mechanisms of postoperative pain, at the peripheral and central levels, which is followed by a discussion of current pain evaluation in humans. Additionally, an evaluation of patient- and procedure-specific predictors for the development of acute pain is summarized. As operative and patient specific risk factors continue to be revealed, they will ultimately serve as important tools to provide high-quality individualized patient care aimed at reducing incidence of severe postsurgical pain.

An Analysis of Predictors of Persistent Postoperative Pain in Spine Surgery.

PURPOSE OF REVIEW: This review aims to identify perioperative patient-related factors that are associated with the development of persistent postoperative pain (PPP) in patients undergoing spine surgery. RECENT FINDINGS: Twenty-one studies published between 2000 and 2019 were included in this literature review. The following five patient-related factors were identified to be associated with the development of PPP after spine surgery: anxiety, depression, pain catastrophizing, pain sensitivity, and preoperative opioid consumption. The existing literature suggests that the risk factors for developing chronic pain after spine surgery appear to be similar to those for other types of surgery. Psychological factors and preoperative opioid consumption are associated with developing chronic pain after spinal surgery. Other factors such as gender, age, preoperative pain intensity, and immediate postoperative pain may also be involved but the evidence on this is limited.

Minimally Invasive Lumbar Decompression and Interspinous Process Device for the Management of Symptomatic Lumbar Spinal Stenosis: a Literature Review.

PURPOSE OF REVIEW: Symptomatic lumbar spinal stenosis (LSS) is a condition affecting a growing number of individuals resulting in significant disability and pain. Traditionally, treatment options have consisted of conservative measures such as physical therapy, medication management, epidural injections and percutaneous adhesiolysis, or surgery. There exists a treatment gap for patients failing conservative measures who are not candidates for surgery. Minimally invasive lumbar decompression (MILD®) and interspinous process device (IPD) with Superion® represent minimally invasive novel treatment options that may help fill this gap in management. We performed a literature review to separately evaluate these procedures and assess the effectiveness and safety. RECENT FINDINGS: The available evidence for MILD and Superion has been continuously debated. Overall, it is considered that while the procedures are safe, there is only modest evidence for effectiveness. For both procedures, we have reviewed 13 studies. Based on the available evidence, MILD and Superion are safe and modestly effective minimally invasive procedures for patients with symptomatic LSS. It is our recommendation that these procedures may be incorporated as part of the continuum of treatment options for patients meeting clinical criteria.

The Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence.

PURPOSE OF REVIEW: Given the growing challenges in chronic pain management coupled with the ongoing consequences of the opioid epidemic, pain management practitioners are looking into more effective, innovative, and safer alternatives to treat pain. Cannabis-based medicine had been described for hundreds of years but only recently have we seen the more scientific, evidence-based approach to its use, and ongoing investigations continue to explore its potential medical benefits. While historically more attention has been paid to the psychoactive component of the cannabis plant Δ9-tetrahydrocannabinol (THC), there have been fewer scientific studies on the medical use of the cannabidiol (CBD) - a non-psychoactive component of the cannabis plant. RECENT FINDINGS: By examining recent literature, we investigated the use of CBD and its potential role in pain management. Since there are currently no approved pharmaceutical products that contain CBD alone for the management of pain, this review focused on nabiximols (which is a combined product of THC/CBD in a 1:1 ratio) as the only pharmaceutical product available that contains CBD and is being used for the management of pain. It is difficult to definitely attribute the therapeutic properties to CBD alone since it is always administered with THC. Based on the available literature, it is difficult to make a recommendation for the use of CBD in chronic pain management. It is also important to note that there are many CBD products currently available as supplements, but these products are non-pharmaceuticals and lack the appropriate clinical studies to support their efficacy claims.