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World Neurosurgery Feb 2021The treatment of neuropathic pain (NP) continues to be controversial as well as an economic health issue and a challenge to health care. Neurosurgery can offer different...
BACKGROUND
The treatment of neuropathic pain (NP) continues to be controversial as well as an economic health issue and a challenge to health care. Neurosurgery can offer different methods of neuromodulation that may improve patients' condition, including deep brain stimulation (DBS), motor cortex stimulation (MCS), spinal cord stimulation (SCS), and posterior insula stimulation (PIS). There is no consensus of opinion as to the final effects of these procedures, which stimulation parameters to select, the correct timing, or how to select the patients who will best benefit from these procedures.
OBJECTIVE
To review the evidence available regarding these 4 procedures and the management of NP.
METHODS
We conducted a PubMed, Embase, and Cochrane Library database search from 1990 to 2020. The strategy of the search concentrated on the following keywords: "neuropathic pain," "chronic pain," "deep brain stimulation," "motor cortex stimulation," "spinal cord stimulation," "insula stimulation," and "neuromodulation." Studies that provided data regarding the immediate and long-term effectiveness of the procedure, anatomic stimulation target, percentage of pain control, and cause of the NP were included.
RESULTS
The most frequent causes of NP were phantom limb pain and central poststroke pain in the MCS group; central poststroke pain, phantom limb pain, and spinal cord injury (SCI) in the DBS group; and complex regional pain syndrome and failed back surgery syndrome in the SCS group. Pain improvement varied between 35% and 80% in the MCS group and 50% and 60% in the DBS group. In the SCS group, successful rates varied between 38% and 89%.
CONCLUSIONS
This systematic review highlights the literature supporting SCS, DBS, MCS, and PIS methods for the treatment of NP. We found consistent evidence supporting MCS, DBS, and SCS as possible treatments for NP; however, we were not able to define which procedure should be indicated for each cause. Furthermore, we did not find enough evidence to justify the routine use of PIS. We conclude that unanswered points need to be discussed in this controversial field and emphasize that new research must be developed to treat patients with NP, to improve their quality of life.
Topics: Cerebral Cortex; Clinical Trials as Topic; Deep Brain Stimulation; Electric Stimulation Therapy; Humans; Motor Cortex; Neuralgia; Spinal Cord Stimulation; Treatment Outcome
PubMed: 33217591
DOI: 10.1016/j.wneu.2020.11.048 -
Clinical Neurology and Neurosurgery Nov 2021Different Dorsal root entry zone (DREZ) lesion techniques have been reported as effective treatment for intractable painful conditions, though with contradictory...
BACKGROUND
Different Dorsal root entry zone (DREZ) lesion techniques have been reported as effective treatment for intractable painful conditions, though with contradictory results. Overall, good results were reported especially in specific conditions, such as pain due to brachial plexus avulsion, spinal cord injuries and oncological pain management. However, data on long term results in different clinical conditions are still missing.
OBJECTIVE
This study aims to systematically review the pertinent literature to evaluate indications, clinical outcomes, and complications of DREZ lesion (DREZotomy), in chronic pain management.
METHODS
A systematic literature review was conducted according to the PRISMA statement. Papers on DREZotomy for chronic pain in cancer, brachial plexus avulsion, spinal cord injury, post herpetic neuralgia, and phantom limb pain were considered for eligibility. For each category we further identified two sub-group according to the length of follow up: medium term and long term follow up (more than 3 years) respectively.
RESULTS
46 papers, and 1242 patients, were included in the present investigation. When considering long term results DREZotomy provided favorable clinical outcomes in brachial plexus avulsion and spinal cord injury, in 60.8% and 55.8% of the cases respectively. Conversely, the success rate was 35.3% in phantom limb pain and 28.2% in post herpetic neuralgia. A poor clinical outcome was reported in over than 25% of the patients suffering from phantom limb pain, post herpetic neuralgia and spinal cord injury. The mean complications rate was 23.58%. While BPA and SCI patients presented stable improvement over time, good outcomes among PHN and PLP groups dropped by - 46.2%; and - 14.7% at long term follow up respectively.
CONCLUSION
DREZotomy seems to be an effective treatment for chronic pain conditions, especially for brachial plexus avulsion, spinal cord injury and intractable cancer/post-radiation pain. According to the low level of evidence of the pertinent literature, further studies are strongly recommended, to better define potential benefits and limitations of this technique.
Topics: Humans; Pain, Intractable; Spinal Nerve Roots; Treatment Outcome
PubMed: 34739884
DOI: 10.1016/j.clineuro.2021.107004 -
Prosthetics and Orthotics International Apr 2024Phantom limb pain (PLP) can be defined as pain in a missing part of the limb. It is reported in 50%-80% of people with amputation.
BACKGROUND
Phantom limb pain (PLP) can be defined as pain in a missing part of the limb. It is reported in 50%-80% of people with amputation.
OBJECTIVES
To provide an overview of the effectiveness of graded motor imagery (GMI) and the techniques which form it on PLP in amputees.
STUDY DESIGN
Systematic review.
METHODS
Two authors independently selected relevant studies, screened the articles for methodological validity and risk of bias, and extracted the data. Inclusion criteria used were clinical studies, written in English or Spanish, using GMI, laterality recognition, motor imagery, mirror therapy, or a combination of some of them as an intervention in amputated patients, and one of the outcomes was PLP, and it was assessed using a validated scale. The databases used were PubMed, Scopus, Web of Science, CINAHL, and PEDro.
RESULTS
Fifteen studies were included in the review. After the intervention, all the groups in which the GMI or one of the techniques that comprise it was used showed decrease in PLP.
CONCLUSION
The 3 GMI techniques showed effectiveness in decreasing PLP in amputees, although it should be noted that the application of the GMI showed better results.
Topics: Humans; Phantom Limb; Amputees; Amputation, Surgical; Imagery, Psychotherapy
PubMed: 37870365
DOI: 10.1097/PXR.0000000000000293 -
The European Journal of Prosthodontics... Apr 2024Robotic-assisted techniques have the potential to revolutionize dental implantology by offering enhanced precision, accuracy, and clinical outcomes compared to...
PURPOSE/AIM
Robotic-assisted techniques have the potential to revolutionize dental implantology by offering enhanced precision, accuracy, and clinical outcomes compared to computer-assisted implant placement techniques. This study aimed to evaluate the accuracy of dental implant placement using robot-assisted implant surgery in vitro settings.
METHODS
An unrestricted search of indexed databases along with a manual search was performed up to March 2024. In vitro, studies comparing the positioning accuracy of robotic systems in dental implant placement of planned pre-operative coordinates and postoperative outcomes in phantom and simulated models were included. QUIN Tool was used to assess the quality of the included studies.
RESULT
A total of 13 in vitro studies were included. All studies except one used entry, exit, or angle deviation as parameters to assess the accuracy of implants placed on phantom models or simulated virtual implant placement. Overall, pooled entry deviations were 0.72 ± 0.68 mm, exit deviations were 0.86 ± 0.92 mm, and angular deviations were 1.47 ± 1.610 favoring robot-assisted implant surgery.
CONCLUSION
Based on the current evidence, robotic-placed implants have the potential to revolutionize dental implantology by offering enhanced precision, accuracy, and clinical outcomes compared to dynamic and static computer-assisted implant surgery techniques.
PubMed: 38691616
DOI: 10.1922/EJPRD_2669Ravipati14