Objectives: The primary objective of this article was to examine literature from the last 10 years surrounding cardiovascular risks associated with NSAID use. Methods: A systematic search was developed to include randomized control trials and systematic review meta-analyses that focused on the cardiovascular effects associated with NSAID use. Results: The search and screen identified 10 articles published in the last 10 years to be included in the review. Discussion: The most common cardiovascular risks studied in the included literature were hemodynamic effects and myocardial infarction. The evidence in the included studies suggests that concerns of adverse hemodynamic effects may be overstated with short-term NSAID use. Myocardial infarction was shown to be a very serious, but rare, side effect associated with NSAID use. Practitioners should weigh this risk when using NSAIDs in patients with an increased risk of MI at baseline. Other included studies described risks of Kounis syndrome, QTc prolongation, and potential reversal of right ventricular dysfunction in patients using NSAIDs.
Background There are few efficacious treatments for mechanical neck pain, with controlled trials suggesting efficacy for muscle relaxants and topical nonsteroidal anti-inflammatory drugs. Although studies evaluating topical lidocaine for back pain have been disappointing, the more superficial location of the cervical musculature suggests a possible role for topical local anesthetics. Methods This study was a randomized, double-blind, placebo-controlled crossover trial performed at four U.S. military, Veterans Administration, academic, and private practice sites, in which 76 patients were randomized to receive either placebo followed by lidocaine patch for 4-week intervals (group 1) or a lidocaine-then-placebo patch sequence. The primary outcome measure was mean reduction in average neck pain, with a positive categorical outcome designated as a reduction of at least 2 points in average neck pain coupled with at least a 5-point score of 7 points on the Patient Global Impression of Change scale at the 4-week endpoint. Results For the primary outcome, the median reduction in average neck pain score was −1.0 (interquartile range, −2.0, 0.0) for the lidocaine phase versus −0.5 (interquartile range, −2.0, 0.0) for placebo treatment (P = 0.17). During lidocaine treatment, 27.7% of patients experienced a positive outcome versus 14.9% during the placebo phase (P = 0.073). There were no significant differences between treatments for secondary outcomes, although a carryover effect on pain pressure threshold was observed for the lidocaine phase (P = 0.015). A total of 27.5% of patients in the lidocaine group and 20.5% in the placebo group experienced minor reactions, the most common of which was pruritis (P = 0.36). Conclusions The differences favoring lidocaine were small and nonsignificant, but the trend toward superiority of lidocaine suggests more aggressive phenotyping and applying formulations with greater penetrance may provide clinically meaningful benefit. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
Frozen shoulder or adhesive capsulitis is a difficult to treat disorder characterized by pain and loss of movement. Novel therapies such as hydraulic distension with orthobiologics may improve outcomes among individuals with this debilitating condition. The clinical case in this article describes the treatment of a patient with frozen shoulder using a series of joint injections using high volumes of sugar water. The positive outcome of this novel injection technique is an invitation to design clinical trials using orthobiologics for frozen shoulder.
Differential Target Multiplexed spinal cord stimulation is an advanced SCS therapy inspired by preclinical research demonstrating that multiplexed signals can differentially modulate neurons and glial cells.1 Differential Target Multiplexed SCS has shown superior back pain relief to traditional SCS.2 Derivatives of the Differential Target Multiplexed waveform are being investigated to understand opportunities for therapy personalization. Energy-conserving approaches altering amplitude, frequency, and pulse width, have the potential to impact patient experience with rechargeable and non-rechargeable devices.
