The Ethical Stewardship of Artificial Intelligence in Chronic Pain and Headache: A Narrative Review.

PURPOSE OF REVIEW: As artificial intelligence (AI) and machine learning (ML) are becoming more pervasive in medicine, understanding their ethical considerations for chronic pain and headache management is crucial for optimizing their safety. RECENT FINDINGS: We reviewed thirty-eight editorial and original research articles published between 2018 and 2023, focusing on the application of AI and ML to chronic pain or headache. The core medical principles of beneficence, non-maleficence, autonomy, and justice constituted the evaluation framework. The AI applications addressed topics such as pain intensity prediction, diagnostic aides, risk assessment for medication misuse, empowering patients to self-manage their conditions, and optimizing access to care. Virtually all AI applications aligned both positively and negatively with specific medical ethics principles. This review highlights the potential of AI to enhance patient outcomes and physicians' experiences in managing chronic pain and headache. We emphasize the importance of carefully considering the advantages, disadvantages, and unintended consequences of utilizing AI tools in chronic pain and headache, and propose the four core principles of medical ethics as an evaluation framework.

Use of a Sheath and Stylet for a Difficult Dorsal Root Ganglion Stimulation Lead Extraction: A Case Report.

Dorsal root ganglion stimulation (DRG-S) is a relatively new neuromodulation technique that has shown promising results in the treatment of chronic pain conditions. We present a case of a difficult lead extraction during the explantation of a DRG-S device. The lead was unable to be removed despite multiple attempts until a sheath and stylet were used to facilitate extraction. As DRG-S utilization becomes more widespread, DRG-S device explantation will inevitably become more common. The technique described in this report may be beneficial in certain cases of difficult DRG-S lead extraction.

A novel interventional pain simulation-based education curriculum: Implementation to enhance procedural training.

Several studies have demonstrated the benefits of simulation-based education (SBE) across all trainee levels in various medical fields. These benefits include allowing trainees greater autonomy and the opportunity to learn from mistakes in bioethical and procedural scenarios without compromising patient safety. While much progress has been made, there is little research on the implementation of SBE in pain medicine. This study investigated the effects of interventional pain SBE on 37 pain medicine fellows at the Brigham and Women's Hospital Pain Medicine Fellowship. The study found that fellows' performance, knowledge, and comfort were enhanced by the implementation of this curriculum.

Impact of demographic factors on chronic pain among adults in the United States.

Introduction: Chronic pain affects more than 1 in 5 American adults, and its effects are not evenly distributed throughout the population. Methods: Using the National Health Interview Survey (NHIS), a household-based annual survey of self-reported health status of U.S. adults, this cross-sectional study describes differences in the prevalence of chronic pain and its effects across socioeconomic groups. Results: In univariate analyses, chronic pain was more prevalent among female respondents, persons with lower educational attainment, non-Hispanic White individuals, and those who were insured as well as those who were married. After accounting for all other demographic factors, age, female sex, and lower educational attainment were associated with higher odds of having chronic pain, whereas Hispanic and non-Hispanic Black race were associated with lower odds. Despite lower odds of having chronic pain, Hispanic and non-Hispanic Black race were associated with greater odds of reporting more severe pain than White race. There were no significant differences across race in the effects of pain on life, work, or family, although female sex and lower educational attainment were associated with greater effects of pain on these domains. Educational attainment was the only characteristic associated with greater odds of ineffective pain management after accounting for all other demographic factors. Conclusions: Implications for reducing disparities in the treatment of chronic pain are discussed.

Treatment of Chronic Refractory Neuropathic Pelvic Pain with High-Frequency 10-kilohertz Spinal Cord Stimulation.

Chronic neuropathic pelvic pain remains a recalcitrant problem in the field of pain management. Case series on application of 10 kHz spinal cord stimulation is presented. High frequency stimulation can improve chronic neuropathic pain states that are known to be mediated at the conus medullaris and offers another avenue for the treatment of these patients.

Simple and effective ultrasound needle guidance system.

In this paper, we describe our prototype of an ultrasound guidance system to address the need for an easy-to-use, cost-effective, and portable technology to improve ultrasound-guided procedures. The system consists of a lockable, articulating needle guide that attaches to an ultrasound probe and a user-interface that provides real-time visualization of the predicted needle trajectory overlaid on the ultrasound image. Our needle guide ensures proper needle alignment with the ultrasound imaging plane. Moreover, the calculated needle trajectory is superimposed on the real-time ultrasound image, eliminating the need for the practitioner to estimate the target trajectory, and thereby reducing injuries from needle readjustment. Finally, the guide is lockable to prevent needle deviation from the desired trajectory during insertion. This feature will also allow the practitioner to free one hand to complete simple tasks that usually require a second practitioner to perform. Overall, our system eliminates the experience required to develop the fine hand movement and dexterity needed for traditional ultrasound-guided procedures. The system has the potential to increase efficiency, safety, quality, and reduce costs for a wide range of ultrasound-guided procedures. Furthermore, in combination with portable ultrasound machines, this system will enable these procedures to be more easily performed by unskilled practitioners in non-ideal situations such as the battlefield and other disaster relief areas.