Multi-Institutional Journal Club as a Component of Diversity, Equity, and Inclusion Curricula in Residency Programs.

Topics of diversity, equity, and inclusion (DEI) are an integral component of post-graduate medical education. However, it is currently unclear the extent to which physical medicine and rehabilitation residency programs have incorporated a DEI curriculum into their training programs. Here, a novel, multi-institutional DEI journal club is described. This journal club format can be an important component of the DEI curriculum as it provides non-local perspectives and insights into specific issues and allows for a simple way to introduce DEI training in programs currently without such training. The virtual format also provides further opportunities for discussion and networking.

The Impact of Local Corticosteroid Administration on the Incidence of Post-Neurotomy Neuritis: A Prospective Investigation.

BACKGROUND: Since its adoption as a treatment for neuropathic pain in the 1960s, radiofrequency ablation (RFA) has continued to gain popularity for the management of various pain etiologies. Although RFA is considered to be a safe procedure, post-neurotomy neuritis (PNN), a neuropathic-type pain, is one of the most common side effects. Due to the increasing recognition of PNN, some providers have attempted to mitigate the risk of PNN by injecting local corticosteroids at the site of RFA following the procedure. Recent studies have generally concluded that corticosteroids do not protect against the development of PNN, however, they have been limited by their retrospective study designs and the low incidence of PNN. OBJECTIVES: We aimed to add to the growing literature regarding the role of post-RFA corticosteroid administration in preventing the development of PNN. STUDY DESIGN: We conducted a prospective study evaluating the incidence of PNN as well as the efficacy of post-RFA corticosteroid administration in preventing the development of PNN. SETTING: All RFAs were performed by the same board-certified, pain medicine fellowship-trained, attending physician at the University of Wisconsin who performed the initial patient evaluation at the pain medicine clinic. METHODS: Thirty-nine patients (47 RFAs) were included in the study. All patients were between the ages of 30 and 81; 23 (59.0%) patients were women comprising 28 (59.6%) of the RFAs performed. RFA was performed for a variety of conditions, including facet joint pain, osteoarthritic knee pain, and occipital nerve pain. The 19 patients (25 RFAs) completed prior to February 2020 received post-RFA corticosteroids; the remaining 21 patients (22 RFAs) completed after this date did not receive corticosteroids. The Numeric Rating Scale (NRS-11) and Douleur Neuropathique 4 Questions (DN4) questionnaire scores were collected before and after completion of an RFA. After their procedure, patients were either called or seen in clinic for re-evaluation of their symptoms, at which time NRS-11 and DN4 scores were collected again. RESULTS: There were no statistically significant differences between groups when comparing post-RFA DN4 scores. Additionally, the incidence of PNN in our study population was 0% for both treatment groups. The NRS-11 scores were similar between groups prior to completing an RFA. When comparing the post-RFA pain scores, the average NRS-11 scores in the steroid group decreased from 5.8 to 3.4, while the average NRS-11 scores in the nonsteroid group decreased from 5.4 to 3.8. However, the average NRS-11 reductions were similar between groups. LIMITATIONS: The primary limitation of this study is small sample size, which likely limited our ability to diagnose PNN. Additionally, we utilized the 7-item DN4 and required a DN4 score of  ? 4 to diagnose PNN, and therefore, it is likely that our protocol significantly reduced our sensitivity for diagnosing PNN. CONCLUSIONS: Overall, our study is in agreement with prior studies that RFA is effective for the treatment of facet and osteoarthritic knee pain and that the incidence of PNN is likely small.

Effect of Genicular Nerve Radiofrequency Ablation for Knee Osteoarthritis: A Retrospective Chart Review.

BACKGROUND: Genicular nerve block and radiofrequency ablation improve pain and function in patients with knee osteoarthritis. We aimed to evaluated the efficacy of these procedures and to identify factors predicting outcomes. METHODS: We conducted a chart review of 18 patients referred for these procedures from our clinic. Pain scores were collected before and after the procedure and at a follow-up visit. Functional measures were recorded before the procedure. RESULTS: Both procedures reduced pain in the post-procedure and follow-up settings, and the Western Ontario and McMaster Universities Osteoarthritis Index correlated with the paired differences of pre- and follow-up pain scores. DISCUSSION: These procedures provided significant pain relief, and the Western Ontario and McMaster Universities Osteoarthritis Index may help identify appropriate candidates for these procedures.

Genicular Radiofrequency Ablation for the Treatment of Post-traumatic Knee Pain: A Case Presentation.

This is the first reported case presentation utilizing cooled genicular radiofrequency ablation (C-RFA) for the treatment of post-traumatic knee pain. The patient is a 29-year-old man who sustained open right femoral and tibial fractures following 2 motor vehicle collisions. He was deemed too young to undergo total knee arthroplasty by orthopedic surgery. It was recommended he trial diagnostic genicular nerve blocks followed by C-RFA. The procedure provided a >50% reduction in average pain with an increase in activity tolerance lasting 9 months. In this case, C-RFA of the genicular nerves was a safe, effective, and durable treatment modality for post-traumatic knee pain. LEVEL OF EVIDENCE: V.

Chronic Pain Management: An Overview of Taxonomy, Conditions Commonly Encountered, and Assessment.

Chronic pain has multiple mechanisms that result in pain amplification and maintenance, including central and peripheral sensitization and altered modulation of pain perception. Assessment of pain requires comprehensive assessment of symptoms and signs, suspected pain mechanisms, and the patient's biopsychosocial context. Multiple validated measures exist for the assessment of pain symptoms, pain-related disability, psychological impact of pain, and candidacy for opioid management.