BACKGROUND: Sacroiliac joint (SIJ) pain accounts for a large portion of low back pain within the population. Management for this SIJ pain consists of many non-invasive treatments including physical therapy, nerve ablatio...BACKGROUND: Sacroiliac joint (SIJ) pain accounts for a large portion of low back pain within the population. Management for this SIJ pain consists of many non-invasive treatments including physical therapy, nerve ablation, intra-articular SIJ injections, bracing, and manipulative therapy. Pain that proves to be resistant to these modalities has previously been considered for surgical stabilization through a transiliac approach, which involves placement of screws. AIMS: To describe the anterior extrusion of a SIJ implant following arthrodesis, which is a unique complication of a minimally invasive SIJ fusion via the posterior approach. MATERIALS AND METHODS: A 52 year old female with a past medical history of psoriatic arthritis and alanto-axial instability presented with a year-long history of bilateral lower back and right-sided posterior thigh and buttock pain. Evaluation included lumbar MRI and pelvic CT. Based on these findings, she underwent minimally invasive posterior SIJ fusion using the LinQ allograft. Her symptoms and response to treatment were documented throughout her clinic follow-ups. RESULTS: Imaging revealed degenerative SIJ changes. She subsequently underwent several rounds of SIJ steroid injections. Due to continued pain, she opted to have a minimally invasive SIJ fusion via the posterior approach, first on the right side and then on the left side. After several months of persistent, reaggravated SIJ pain, a repeat pelvic CT showed anterior extrusion of the right SIJ allograft. DISCUSSION: More recently, multiple minimally invasive techniques for SIJ fusions have been developed, one of them being posterior insertion of an orthobiologic implant. Minimally invasive SIJ fusion has been shown to provide pain relief and decrease disability. Posterior implant insertion to partially fuse the SIJ carries minimal risk of complications, one of which is posterior dislodgment of the implant. However, anterior extrusion of the implant has not, to our knowledge, been described or reported.
Nakaso Y, Inoue S, Makita K
… +13 more, Arai YC, Shimo K, Inoue M, Wakabayashi T, Miyagawa H, Iwamoto K, Niwa K, Torimoto H, Tsuchiya M, Ota Y, Kawai E, Hirai Y, Ushida T
BACKGROUND: Chronic pain is associated with functional disability and reduced work participation. This study aimed to evaluate the long-term effects of a multidisciplinary chronic pain management program adapted to the J...BACKGROUND: Chronic pain is associated with functional disability and reduced work participation. This study aimed to evaluate the long-term effects of a multidisciplinary chronic pain management program adapted to the Japanese healthcare system on work-related status, pain-related assessments, and physical function in patients with chronic pain classified under ICD-11. METHODS: One hundred patients participated in a 5-week program comprising exercise therapy, cognitive behavioral therapy (CBT), pain education, and nature-based activities. The program was delivered in a mixed inpatient-outpatient format, with all participants completing both components as part of an integrated program, allowing participants to practice and apply pain coping skills in their daily lives between sessions. Outcomes were assessed at baseline, post-treatment, 3, and 12 months. Self-reported assessments included pain severity (NRS), self-efficacy (PSEQ), catastrophizing (PCS), disability (PDAS), quality of life (EQ-5D-3L), anxiety/depression (HADS), and sleep quality (PSQI). Physical function was assessed through standardized tests. Missing data were addressed using multiple imputations, and repeated-measures ANOVA with Bonferroni correction was used to examine changes over time. Effect sizes (Cohen's d) were calculated. RESULTS: All self-reported assessments improved significantly post-treatment and were sustained at 3 and 12 months (p < 0.05, Bonferroni-corrected). Effect sizes ranged from small to large, with particularly large effects observed for self-efficacy, catastrophizing, and several physical functions. Among those not working at baseline, 66% had returned to work at 3 months and 81% at 12 months. No significant group × time interaction was observed between chronic primary and secondary pain groups, although baseline anxiety levels (HADS-A) were higher in the chronic primary group. CONCLUSIONS: Our multidisciplinary chronic pain management program demonstrated significant effectiveness in enhancing long-term outcomes and facilitating return-to-work in patients with refractory chronic pain, including chronic primary pain.
BACKGROUND: We evaluated the immediate and long-term therapeutic efficacy of transcranial direct current stimulation (tDCS) using two distinct montages of anodal and cathodal electrical stimulation over the primary visua...BACKGROUND: We evaluated the immediate and long-term therapeutic efficacy of transcranial direct current stimulation (tDCS) using two distinct montages of anodal and cathodal electrical stimulation over the primary visual cortex compared with a sham tDCS in patients with chronic migraines. METHODS: In this randomized, double-blind, controlled trial, 72 eligible patients with resistant chronic migraine were randomly assigned to one of three groups, receiving anodal or cathodal (2 mA for 20 min), or sham tDCS (0.5 mA for 30 s), over the pain-dominant side of the primary visual cortex. Clinical features including the number of migraine attacks per month, attack duration, pain intensity, and frequency of painkiller use at baseline, 2 months after starting and ending tDCS therapy were recorded using a personal questionnaire. RESULTS: Both anodal and cathodal real tDCS protocols resulted in a significant reduction in the number of attacks, pain intensity, attack duration, and frequency of painkiller use during the treatment period compared to baseline. There was no significant difference between the two treatment groups regarding the therapeutic efficacy. However, only anodal tDCS significantly maintained the beneficial therapeutic effects on the number of migraine attacks and painkiller use at the follow-up phase. The sham protocol did not produce any significant clinical utility in this population. CONCLUSIONS: The study supports the analgesic effects of the proposed real tDCS approaches in patients with resistant chronic migraine. Anodal tDCS may offer superior benefits to cathodal tDCS, likely by stabilizing therapeutic outcomes through reorganizing the thalamocortical pathway.
BACKGROUND AND OBJECTIVE: Chronic pain is common and difficult to treat, with opioid analgesics continuing to be the most common treatment. However, opioids have only modest benefits. Research suggests that cognitive- an...BACKGROUND AND OBJECTIVE: Chronic pain is common and difficult to treat, with opioid analgesics continuing to be the most common treatment. However, opioids have only modest benefits. Research suggests that cognitive- and behaviorally-focused treatments may improve pain and reduce opioid use. The aim of this randomized feasibility trial was to determine if a fully powered clinical trial to evaluate the effects of three psychological chronic pain treatments-behavioral activation (BA), cognitive therapy (CT), and mindfulness meditation (MM)-on opioid use in individuals with chronic pain is warranted. METHODS: The primary feasibility outcomes were enrollment to randomization rates, treatment expectancy, treatment engagement, study retention, treatment satisfaction, and the proportion of individuals decreasing their mean daily morphine milligram equivalents (MMEs). RESULTS: Of 115 participants enrolled, 91 were randomized (79%). Average expectancy scores in all conditions were above the mean. While ≥ 75% of participants in CT and MM attended ≥ 4 treatment sessions, 74% did in BA which was just below the ≥ 75% feasibility threshold. At posttreatment, ≥ 90% of participants provided outcome data and most participants (76%, 79%, and 93% in MM, CT, and BA) reported they were either "satisfied" or "very satisfied" with treatment. At posttreatment, 21% in the BA group, 32% in CT, and 54% in MM reported decreased MMEs. CONCLUSION: CT and MM met all feasibility criteria for inclusion in an appropriately powered comparative trial, however, BA failed to meet the threshold for one criterion, indicating necessary adjustments. The findings inform design specifications for a future definitive trial. TRIAL REGISTRATION: The trial was preregistered on clinicaltrials.gov (Identifier: NCT03916276) prior to commencing participant enrollment.
OBJECTIVE: To evaluate the role of Autologous Fat Transfer (AFT) for secondary occipital neuralgia (SON). BACKGROUND: Secondary occipital neuralgia manifests as neuropathic pain developing after traumatic tissue injury....OBJECTIVE: To evaluate the role of Autologous Fat Transfer (AFT) for secondary occipital neuralgia (SON). BACKGROUND: Secondary occipital neuralgia manifests as neuropathic pain developing after traumatic tissue injury. Multidisciplinary management mainly relies on analgesic medications and local anesthetic and steroid infiltrations. Autologous fat transfer restores subcutaneous tissue, mechanically releasing scar from nerve fibers. In this study, we show the therapeutic uses of AFT for secondary, drug-resistant headaches. MATERIALS AND METHODS: In this retrospective study, 19 patients with secondary occipital neuralgia associated with occipital scalp scarring were included. All patients presented with symptoms of unremitting greater or lesser occipital neuralgia, which temporarily improved (> 50% temporary reduction in pain intensity) following local anesthesia infiltration of the scar. Patients' evaluation of pain by visual analog scale (VAS), number of acute spasmodic pain events and medication intake per month were assessed before and 12 months after AFT. Evolution of tactile detection thresholds and allodynia patches was determined by Weinstein monofilaments. RESULTS: A comprehensive clinical follow-up was made 12 months after AFT. Eighteen patients experienced a reduction of symptoms > 50%. Ten of these were pain-free. The pain level reduced from 8.7 to 3. A reduction of 85% of acute pain events per month was noted after surgery (from 23.6 to 4.6). Finally, a 74% reduction in medication intake was also seen. No complications were observed. CONCLUSIONS: AFT is a novel, regenerative approach for secondary occipital neuralgia. While more studies are needed to better understand the mechanisms of action, the results from this minimally invasive technique should be regarded as an important asset in regenerative medicine for treating post-traumatic headaches.
BACKGROUND: In 2021, the term persistent spinal pain syndrome (PSPS) was introduced. PSPS type 2 (PSPS-T2) replaced the unsatisfactory term failed back surgery syndrome (FBSS). PSPS type 1 (PSPS-T1) is a clinical picture...BACKGROUND: In 2021, the term persistent spinal pain syndrome (PSPS) was introduced. PSPS type 2 (PSPS-T2) replaced the unsatisfactory term failed back surgery syndrome (FBSS). PSPS type 1 (PSPS-T1) is a clinical picture of signs and symptoms of FBSS but without prior surgery. PSPS applies to any spinal level. There are multiple underlying mechanisms and treatments within PSPS. Therapeutic choices are not based on a common nomenclature. One consequence is that the desired outcomes of interventions are not reliably achieved. There is a need to redefine diagnostic clusters of PSPS based on the pain mechanism rather than just anatomic factors or a history of previous surgery. This manuscript provides mechanism-based recommendations to improve treatment selection through the use of the PSPS concept. METHODS: An international task force of pain and neurosurgical specialists was established and met at the International Neuromodulation Society Congress 2024, at the North American Neuromodulation Society Congress 2024, and online. RESULTS: An overview of classification systems (i.e., PSPS; P), anatomical structure (A), neural mechanism (M), and degree of certainty (C), is discussed and combined to generate a novel categorization approach to assist with PSPS classification and diagnosis. The PAMC scale was developed to assist with the diagnosis clustering and consequently to improve treatment selection. CONCLUSION: The proposed recommendations should support future research by better defining study populations and by assisting the clinician to select the appropriate therapy.