Spinal cord stimulation (SCS) is a well-established treatment for patients with chronic pain. With increasing healthcare costs, it is important to determine the benefits of SCS in healthcare utilization (HCU). This retrospective, single-center observational study involved 160 subjects who underwent implantation of a high-frequency (10 kHz) SCS device. We focused on assessing trends in HCU by measuring opioid consumption in morphine milligram equivalents (MME), as well as monitoring emergency department (ED) and office visits for interventional pain procedures during the 12-month period preceding and following the SCS implant. Our results revealed a statistically significant reduction in HCU in all domains assessed. The mean MME was 51.05 and 26.52 pre- and post-implant, respectively. There was a 24.53 MME overall decrease and a mean of 78.2% statistically significant dose reduction (p < 0.0001). Of these, 91.5% reached a minimally clinically important difference (MCID) in opioid reduction. Similarly, we found a statistically significant (p < 0.01) decrease in ED visits, with a mean of 0.12 pre- and 0.03 post-implant, and a decrease in office visits for interventional pain procedures from a 1.39 pre- to 0.28 post-10 kHz SCS implant, representing a 1.11 statistically significant (p < 0.0001) mean reduction. Our study reports the largest cohort of real-world data published to date analyzing HCU trends with 10 kHz SCS for multiple pain etiologies. Furthermore, this is the first and only study evaluating HCU trends with 10 kHz SCS by assessing opioid use, ED visits, and outpatient visits for interventional pain procedures collectively. Preceding studies have individually investigated these outcomes, consistently yielding positive results comparable to our findings.

IntroductionChronic low back pain (CLBP) is the leading cause of disability in the United States and is associated with a steadily increasing burden of healthcare expenditures. Given this trend, it is essential to evaluate interventions aimed at reducing disability and optimizing healthcare utilization (HCU) in affected populations. This study investigates the impact of prior spinal surgery on functional outcomes and HCU patterns following high-frequency (10 kHz) spinal cord stimulation (SCS) therapy.MethodsThis retrospective observational study included 160 subjects who underwent implantation of a 10 kHz SCS device. Participants were divided into surgical and non-surgical cohorts for comparative analysis. Pain relief was assessed using the Numeric Rating Scale (NRS), while disability levels were evaluated using the Oswestry Disability Index (ODI). HCU was examined through the frequency of emergency department (ED) visits, outpatient visits for interventional pain procedures, and opioid consumption measured in morphine milliequivalents (MME).ResultsNo statistically significant differences were observed between the surgical and non-surgical groups regarding pain relief and disability outcomes. Additionally, ED visits and outpatient visits for interventional pain procedures did not show significant differences between the two cohorts.DiscussionThis study represents the first comparative analysis of pain, disability, and HCU trends between surgical and non-surgical populations following 10 kHz SCS therapy. The results suggest that prior spinal surgery may not substantially affect the efficacy of 10 kHz SCS therapy in terms of pain relief, disability reduction, or HCU patterns.

INTRODUCTION:The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention. MATERIALS AND METHODS:This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences. RESULTS:The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant. CONCLUSION:Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.

Non-response to 10kHz spinal cord stimulation (SCS) treatment has been documented in the literature as less than 50% subjective improvement in pain at 3-months post-implant1-5. Appropriateness in selection criteria is one of the most important factors associated with successful outcomes, but limited literature reports predictive factors in non-responders. Therefore, we aim to identify such variables and help distinguish the subset less likely to benefit from SCS.

Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Many interventional procedures can be performed in both an acute and chronic pain setting to address myofascial pain syndromes. Trigger point injections can be performed with or without imaging guidance such as fluoroscopy and ultrasound; however, the use of imaging in years past has been recommended to improve patient outcome and safety. Injections can be performed using no injectate (dry needling), or can involve the administration of local anesthetics, botulinum toxin, or corticosteroids.

CONTEXT:Shoulder and neck pain are leading causes of disability worldwide. Rotator cuff pathology has strong associations with such pain and is extensively targeted by healthcare practitioners. A dysfunctional lower trapezius muscle has also been shown to contribute to neck and shoulder pain, yet it is often overlooked. OBJECTIVES:This systematic review analyzes those with a history of, or who are currently managing, shoulder or neck pain to indicate differences in measures of lower trapezius function when compared to subjects without that pain. METHODS:Studies with no age restrictions were included in the study. Studies could determine lower trapezius muscle function with any quantifiable measurement tool or clinical assessment. If the study included a control group (no pain) and a comparator group (pain), and if lower trapezius muscle function was assessed in both, the study was typically included. The significance of the lower trapezius muscle function change was summarized in these pain patients. From a final total of 18 studies identified, level of muscle activity, muscle activation, time to onset, muscle strength, and muscle thickness were reported. RESULTS:The 18 included articles involved 485 participants with shoulder and/or neck pain and 455 without. Half of the shoulder pain studies (6/12), and all of the neck pain studies (6/6), demonstrated that the lower trapezius had a noticeable impact. The lower trapezius muscle in participants with shoulder and neck pain tended to show decreased muscle strength, and decreased time to onset/latency. CONCLUSIONS:The findings from this systematic review should be taken into consideration when assessing and treating patients with shoulder and neck pain. Future studies that define the type and duration of shoulder and neck pain, as well as prospectively assessing lower trapezius muscle function in those with and without that pain, are needed.

Objective: While the effect of triamcinolone acetonide extended-release (TA-ER) on reducing knee osteoarthritis (OA) pain has been reported, the effects on physical performance are incompletely understood. This open label clinical trial systematically evaluated the effects of intra-articular TA-ER on physical performance, self-reported function, and quality of life in participants with bilateral symptomatic knee OA 6, 12 (primary) and 24 weeks following bilateral injection of TA-ER (32 mg). Methods: Seventy participants were enrolled (61.4% women; age 64.0 +/- 11.7; BMI 31.8 +/- 5.7 kg/m 2 ). Physical performance was measured by 30-s chair stand test, 40 m fast paced walk test (FPWT), and stair negotiation test at baseline and each follow-up visit. Physical function and quality of life (QOL) were measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS) and pain was measured with numeric rating scale (NRS). Results: In comparison with baseline, self-reported pain, function, and quality of life were improved at each follow-up through 24 weeks and the number of chair-stands signi ficantly improved following treatment by (mean +/- SE) 1.9 +/- 0.6 at 6-week (p = 0.0048) and by 1.8 +/- 0.5 at 12-week follow-up (p = 0.0011) but was not statistically signi ficant at 24-week follow-up (0.6 +/- 0.6; p = 0.4711). Stair negotiation times were 7.2 +/- 3.7, 7.1 +/- 3.8, and 5.4 +/- 4.0 s lower at the three respective follow-up timepoints, although these changes did not reach statistical signi ficance (p = 0.0530, p = 0.0599, and p = 0.1793 respectively). The 40m-FPWT time did not signi ficantly improve. Conclusion: These data indicate improvement in chair stand performance through 12 weeks post-injection and sustained improvement in participant-reported physical function through 24-week follow-up in adults with bilateral painful knee OA treated with TA-ER.

ABSTRACT:Swimming is one of the most popular sports in the world with open-water swimming (OWS) gaining more and more prominence since being featured in the Federation Internationale De Natation World Aquatics Championships in 1992 and the Olympic Games in 2000. The aim of this review is to analyze the existing literature on heat injury in OWS. Relevant literature was located via computer-generated citations during November of 2020 through online computer searches of multiple major databases. Athletes participating in OWS are exposed to environmental conditions that place them at risk for unique medical conditions such as heat injury. Clinicians providing care for OWS athletes should be educated and trained to recognize these conditions and minimize risks to optimize athlete safety. This article identifies medical challenges related to heat injury in OWS while investigating water temperature recommendations, physiological effects of hyperthermia, risk mitigation strategies, and treatment measures.

PM&RVolume 12, Issue 4 p. 423-424 Clinical Letter Cryoneurolysis for the Treatment of Lateral Femoral Cutaneous Nerve Pain: A Case Report Ciara Johnson MD, Ciara Johnson MD Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSSearch for more papers by this authorJason-Flor Sisante PhD, Jason-Flor Sisante PhD Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSSearch for more papers by this authorJohn Alm DO, John Alm DO Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSSearch for more papers by this authorMcCasey Smith MD, McCasey Smith MD Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSSearch for more papers by this authorNeil A. Segal MD, Corresponding Author Neil A. Segal MD nsegal@kumc.edu orcid.org/0000-0002-8294-080X Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSAddress correspondence to: N. A. S.; email: nsegal@kumc.eduSearch for more papers by this author Ciara Johnson MD, Ciara Johnson MD Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSSearch for more papers by this authorJason-Flor Sisante PhD, Jason-Flor Sisante PhD Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSSearch for more papers by this authorJohn Alm DO, John Alm DO Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSSearch for more papers by this authorMcCasey Smith MD, McCasey Smith MD Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSSearch for more papers by this authorNeil A. Segal MD, Corresponding Author Neil A. Segal MD nsegal@kumc.edu orcid.org/0000-0002-8294-080X Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KSAddress correspondence to: N. A. S.; email: nsegal@kumc.eduSearch for more papers by this author First published: 09 August 2019 https://doi.org/10.1002/pmrj.12234Citations: 1 Funding: None. Disclosures: The University of Kansas has received funds to complete clinical trials involving the Myoscience Iovera device. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume12, Issue4April 2020Pages 423-424 RelatedInformation