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The Journal of Pain Dec 2023Refractory persistent spinal pain syndrome after surgery (PSPS-T2) can be successfully addressed by spinal cord stimulation (SCS). While conventional stimulation... (Randomized Controlled Trial)
Randomized Controlled Trial
Refractory persistent spinal pain syndrome after surgery (PSPS-T2) can be successfully addressed by spinal cord stimulation (SCS). While conventional stimulation generates paresthesia, recent systems enable the delivery of paresthesia-free stimulation. Studies have claimed non-inferiority/superiority of selected paresthesia-free stimulation compared with paresthesia-based stimulation, but the comparative efficacy between different waveforms still needs to be determined in a given patient. We designed a randomized controlled 3-month crossover trial to compare pain relief of paresthesia-based stimulation versus high frequency versus burst in 28 PSPS-T2 patients implanted with multiwave SCS systems. Our secondary objectives were to determine the efficacy of these 3 waveforms on pain surface, quality of life, functional capacity, psychological distress, and validated composite multidimensional clinical response index to provide holistic comparisons at 3-, 6-, 9-, and 15-month post-randomization. The preferred stimulation modality was documented during the follow-up periods. No difference between the waveforms was observed in this study (P = .08). SCS led to significant pain relief, quality of life improvement, improvement of multidimensional clinical response index, and of all other clinical outcomes at all follow-up visits. Forty-four percent of the patients chose to keep the paresthesia-based stimulation modality after the 15-month follow-up period. By giving the possibility to switch and/or to combine several waveforms, the overall rate of SCS responders further increased with 25%. In this study, high frequency or burst do not appear superior to paresthesia-based stimulation, wherefore paresthesia-based stimulation should still be considered as a valid option. However, combining paresthesia-based stimulation with paresthesia-free stimulation, through personalized multiwave therapy, might significantly improve SCS responses. PERSPECTIVE: This article assesses clinical SCS efficacy on pain relief, by comparing paresthesia-based stimulation and paresthesia-free stimulation (including high frequency and burst) modalities in patient presenting with PSPS-T2. Switching and/or combining waveforms contribute to increasing the global SCS responders rate.
Topics: Humans; Spinal Cord Stimulation; Cross-Over Studies; Paresthesia; Prospective Studies; Quality of Life; Pain Measurement; Treatment Outcome; Pain, Intractable; Spinal Cord; Chronic Pain
PubMed: 37473903
DOI: 10.1016/j.jpain.2023.07.015 -
The Pan African Medical Journal 2022Benign schwannomas are uncommon and their intraosseous location is even rarer counting for less than 1% of all benign primary bone tumors. They exceptionally occur in...
Benign schwannomas are uncommon and their intraosseous location is even rarer counting for less than 1% of all benign primary bone tumors. They exceptionally occur in the oral cavity with the tongue being the most common site of involvement. We report here a case of intramandibular schwannoma derived from the inferior alveolar nerve, in a 57-year-old patient with a 3 months history of inferior left lip paresthesia. The oral examination showed a firm, painless and non-pulsatile swelling located in the inferior vestibule. The panoramic X-ray revealed a circumscribed and homogeneous radiolucent image. Treatment consisted of total excision of the tumor with preservation of the nerve bundles. The histological examination confirmed the diagnosis of schwannoma. The patient recovered a normal sensory function 6 months post-operatively without any recurrence up to 2 years after surgery. The treatment of intramandibular schwannoma is basically surgical with the conservative approach being the most advocated by majority of authors.
Topics: Humans; Mandibular Nerve; Middle Aged; Neurilemmoma; Paresthesia; Tongue
PubMed: 35910057
DOI: 10.11604/pamj.2022.42.24.34713 -
European Journal of Cardio-thoracic... Jul 2011The use of radial artery conduits in coronary artery bypass grafting (CABG) surgery is associated with improved long-term patency and patient survival rates as compared... (Review)
Review
OBJECTIVE
The use of radial artery conduits in coronary artery bypass grafting (CABG) surgery is associated with improved long-term patency and patient survival rates as compared with saphenous vein conduits. Despite increasing popularity, relative incidence of local harvest-site complications and subjective perception of adverse long-term sequelae remain poorly described.
METHODS
To allow for direct comparison, we investigated a consecutive series of patients in whom both the radial artery and the saphenous vein had been harvested for isolated CABG during a 36-month period. Patients were identified from a prospective database that collects baseline clinical information. The patients' own perceptions were assessed by a standardized direct telephone survey regarding any persistent functional impairment from their arm and leg operation sites.
RESULTS
Out of 1756 CABG patients during the study period, 168 (10%) were eligible (78% men, median age: 60.1 ± 9.6 years, range: 29.6-82.4 years). Of these, 123 (73%) could be contacted and interviewed at a median follow-up time of 2.5 ± 0.9 years. Surgical wound complications at harvest sites (arms and legs) had occurred in 3% and 12%, respectively, and persistent symptoms (arms and legs) were self-reported as follows: chronic pain (5% and 8%), numbness (32% and 34%) and paresthesia/dysesthesia (14% and 7%). Overall, 39% of the patients reported persistent discomfort at the arm and 39% at the leg. Both sites were simultaneously affected in 21% (P = n.s., paired testing). Logistic regression modeling showed that patients with adverse long-term sequelae were younger (P < 0.005), had a higher body mass index (P < 0.05) and a lower EuroSCORE (P < 0.001) at the time of operation (EuroSCORE, European System for Cardiac Operative Risk Evaluation). Perioperative wound complications, however, did not predict persistence of symptoms.
CONCLUSIONS
Persistent harvest-site discomfort occurs with astonishing frequency after CABG surgery and affects arms and legs equally. Although usually considered a minor complication, long-term limitation to quality of life may be substantial, particularly in younger and relatively healthy patients. Thus, harvest-site discomfort clearly belongs to the list of possible post-CABG complications of which patients need to be aware.
Topics: Adult; Aged; Aged, 80 and over; Arm; Coronary Artery Bypass; Epidemiologic Methods; Female; Humans; Hypesthesia; Leg; Male; Middle Aged; Pain, Postoperative; Paresthesia; Peripheral Nerve Injuries; Radial Artery; Saphenous Vein; Sensation Disorders; Switzerland; Tissue and Organ Harvesting
PubMed: 21177115
DOI: 10.1016/j.ejcts.2010.11.020 -
Nutricion Hospitalaria Oct 2014Carnosine, dipeptide formed by amino acids ß-alanine and L-histidine, has important physiological functions among which its antioxidant and related memory and learning.... (Review)
Review
Carnosine, dipeptide formed by amino acids ß-alanine and L-histidine, has important physiological functions among which its antioxidant and related memory and learning. However, in connection with the exercise, the most important functions would be associated with muscle contractility, improving calcium sensitivity in muscle fibers, and the regulatory function of pH. Thus, it is proposed that carnosine is the major intracellular buffer, but could contribute to 7-10% in buffer or buffer capacity. Since carnosine synthesis seems to be limited by the availability of ß-alanine supplementation with this compound has been gaining increasing popularity among the athlete population. Therefore, the objective of this study literature review was to examine all those research works have shown the effect of ß-alanine supplementation on athletic performance. Moreover, it also has attempted to establish a specific dosage that maximizing the potential benefits, minimize paresthesia, the main side effect presented in response to supplementation.
Topics: Athletic Performance; Carnosine; Dietary Supplements; Humans; Muscle Contraction; Muscle, Skeletal; Paresthesia; beta-Alanine
PubMed: 25561107
DOI: 10.3305/nh.2015.31.1.7517 -
Neurologic Clinics Nov 1998This article presents recent observations about different recognized central pain syndromes (CPS) and discusses them in light of contemporary microelectrode and imaging... (Review)
Review
This article presents recent observations about different recognized central pain syndromes (CPS) and discusses them in light of contemporary microelectrode and imaging findings. Different theories regarding the generation of CPS are reviewed, with an emphasis on difficulties in diagnosis and treatment. The author discourages destructive procedures for treatment of CPS, favoring, instead, reversible procedures such as stimulation techniques and drug delivery systems.
Topics: Analgesics; Central Nervous System Diseases; Diagnosis, Differential; Humans; Neuralgia; Pain Measurement; Paresthesia; Syndrome
PubMed: 9767069
DOI: 10.1016/s0733-8619(05)70104-3 -
The Cochrane Database of Systematic... Apr 2017Post-dural puncture headache (PDPH) is one of the most common complications of diagnostic and therapeutic lumbar punctures. PDPH is defined as any headache occurring... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Post-dural puncture headache (PDPH) is one of the most common complications of diagnostic and therapeutic lumbar punctures. PDPH is defined as any headache occurring after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of the patient lying down. Researchers have suggested many types of interventions to help prevent PDPH. It has been suggested that aspects such as needle tip and gauge can be modified to decrease the incidence of PDPH.
OBJECTIVES
To assess the effects of needle tip design (traumatic versus atraumatic) and diameter (gauge) on the prevention of PDPH in participants who have undergone dural puncture for diagnostic or therapeutic causes.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, CINAHL and LILACS, as well as trial registries via the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal in September 2016. We adopted the MEDLINE strategy for searching the other databases. The search terms we used were a combination of thesaurus-based and free-text terms for both interventions (lumbar puncture in neurological, anaesthesia or myelography settings) and headache.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) conducted in any clinical/research setting where dural puncture had been used in participants of all ages and both genders, which compared different tip designs or diameters for prevention of PDPH DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included 70 studies in the review; 66 studies with 17,067 participants were included in the quantitative analysis. An additional 18 studies are awaiting classification and 12 are ongoing. Fifteen of the 18 studies awaiting classification mainly correspond to congress summaries published before 2010, in which the available information does not allow the complete evaluation of all their risks of bias and characteristics. Our main outcome was prevention of PDPH, but we also assessed the onset of severe PDPH, headache in general and adverse events. The quality of evidence was moderate for most of the outcomes mainly due to risk of bias issues. For the analysis, we undertook three main comparisons: 1) traumatic needles versus atraumatic needles; 2) larger gauge traumatic needles versus smaller gauge traumatic needles; and 3) larger gauge atraumatic needles versus smaller gauge atraumatic needles. For each main comparison, if data were available, we performed a subgroup analysis evaluating lumbar puncture indication, age and posture.For the first comparison, the use of traumatic needles showed a higher risk of onset of PDPH compared to atraumatic needles (36 studies, 9378 participants, risk ratio (RR) 2.14, 95% confidence interval (CI) 1.72 to 2.67, I = 9%).In the second comparison of traumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH, with the exception of one study comparing 26 and 27 gauge needles (one study, 658 participants, RR 6.47, 95% CI 2.55 to 16.43).In the third comparison of atraumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH.We observed no significant difference in the risk of paraesthesia, backache, severe PDPH and any headache between traumatic and atraumatic needles. Sensitivity analyses of PDPH results between traumatic and atraumatic needles omitting high risk of bias studies showed similar results regarding the benefit of atraumatic needles in the prevention of PDPH (three studies, RR 2.78, 95% CI 1.26 to 6.15; I = 51%).
AUTHORS' CONCLUSIONS
There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect.
Topics: Back Pain; Equipment Design; Headache; Humans; Needles; Paresthesia; Post-Dural Puncture Headache; Randomized Controlled Trials as Topic; Sensitivity and Specificity; Spinal Puncture
PubMed: 28388808
DOI: 10.1002/14651858.CD010807.pub2 -
Actas Dermo-sifiliograficas Sep 2007Capecitabine is an antineoplastic agent used for the treatment of patients with metastatic solid tumors (breast and colon). Different adverse effects have been...
Capecitabine is an antineoplastic agent used for the treatment of patients with metastatic solid tumors (breast and colon). Different adverse effects have been recognized, among which we find the muco-cutaneous ones and, specifically, hyperpigmentation. We report a case of localized cutaneous hyperpigmentation secondary to capecitabine in a woman that underwent surgery for breast cancer and was receiving this drug for a month. The start of therapy was associated with dysesthesias and hyperpigmentation of the hands and feet. The pathogenesis of such manifestations is unknown. Other reported cutaneous adverse effects associated with this drug involve the nails producing onycholysis, fragility, discoloration and dystrophy.
Topics: Antimetabolites, Antineoplastic; Breast Neoplasms; Capecitabine; Carcinoma; Deoxycytidine; Female; Fluorouracil; Foot Dermatoses; Hand Dermatoses; Humans; Hyperpigmentation; Mastectomy, Radical; Middle Aged; Paresthesia
PubMed: 17669305
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Nov 2020Public interest in autonomous sensory meridian response (ASMR) is growing on digital media platforms. Some people can elicit the response by watching videos containing... (Review)
Review
Public interest in autonomous sensory meridian response (ASMR) is growing on digital media platforms. Some people can elicit the response by watching videos containing triggering sounds and images. People susceptible to ASMR's effects report tingling sensations on the head and neck, as well as feelings of euphoria, relaxation, and mood elevation. Underlying mechanisms of the phenomenon are not well understood, but physiologic evidence corroborates some of the self-reported positive effects. Healthcare professionals should be aware of this emerging topic, and the potential for therapeutic applications should be investigated.
Topics: Acoustic Stimulation; Emotions; Humans; Illusions; Paresthesia; Photic Stimulation; Pleasure; Sensation; Suggestion
PubMed: 33229391
DOI: 10.3949/ccjm.87a.20005 -
Acta Bio-medica : Atenei Parmensis Dec 2023According to the most current theories, chronic inflammation of some cranial nerves give rise to an inflammatory chain that would result in migraines. As for frontally...
BACKGROUND
According to the most current theories, chronic inflammation of some cranial nerves give rise to an inflammatory chain that would result in migraines. As for frontally located attacks, the nerves involved are two (on each side): the supraorbital and the supratrochlear. Surgical treatment includes complete neurolysis of both of these nerves.
METHODS
In this work, we describe our experience with this type of surgery. From 2011 to 2022, we treated 98 cases suffering from chronic migraine not responsive to drugs with frontal localization. The results were evaluated through a specific questionnaire three months and one year after surgery.
RESULTS
After three months post-surgery, we observed a success rate (reduction of monthly attacks equivalent to or greater than 50%) in 87% of patients (32% complete recovery). These results were essentially confirmed one year after surgery. The rare complications (mainly paresthesias and dysesthesias of the frontal area) have always resolved spontaneously within a few months.
CONCLUSION
The surgical approach allowed to obtain good therapeutic results with a low rate of complications.
Topics: Humans; Neurosurgical Procedures; Migraine Disorders; Paresthesia; Treatment Outcome
PubMed: 38054685
DOI: 10.23750/abm.v94i6.14777 -
Computational and Mathematical Methods... 2022To analyze the clinical intervention effect of transoral endoscopic thyroidectomy on the neck and face during perioperative period. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To analyze the clinical intervention effect of transoral endoscopic thyroidectomy on the neck and face during perioperative period.
METHOD
From January 2019 to January 2020, 60 patients included in this study were randomly divided into observation group and control group according to the ratio of 1 : 1, with 30 cases in each group. Both groups underwent rapid surgical intervention during the perioperative period. The patients in the observation group received neck and face management. The degree of jaw swelling, the degree of facial microexpression completion, and the changes in jaw and neck sensation were compared between the two groups.
RESULTS
There was no significant difference in neck and face swelling, pain, facial microexpression, and feeling between the two groups before operation. Patients with facial I/II swelling degree in the observation group were significantly more than in the control group, and the patients with III swelling degree were less than in the control group. There was significant difference for facial swelling between the two groups in the three intervention periods after the operation, and the difference was statistically significant ( < 0.05). The scores of facial microexpression in the observation group were higher than those in the control group during the three postoperative intervention periods, with statistical significance ( < 0.05). There was no significant difference in the pain score of the first day after surgery between the two groups ( = 0.298). In the other two postoperative intervention periods, the pain score of the observation group was lower than that of the control group, with a statistically significant difference, and the difference was statistically significant ( < 0.05). The threshold of chin and neck sensory pressure in the two groups was statistically significant ( < 0.05) except that the "cheek in area 4" ( = 0.290).
CONCLUSION
The results showed that these interventions, such as the elevation of bed after operation, 24-hour intermittent cryotherapy, ice cubes in mouth, and the "meter" functional training, have good clinical effects on the symptoms of facial swelling and abnormal sensation of neck and face. It can accelerate the speed of edema dissipation, improve the patients' postoperative comfort, and improve the satisfaction and quality of life of patients with the effect of surgery and beauty.
Topics: Edema; Humans; Ice; Pain; Paresthesia; Perioperative Period; Quality of Life; Thyroidectomy
PubMed: 36213587
DOI: 10.1155/2022/4775264