Tag: nevin manimala

Pain Physician. 2022 Jan;25(1):E73-E86.

ABSTRACT

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous endoscopic TLIF (PE-TILF) have been widely used in spine surgery. The use of a robot-guided technique provided several advantages; however, few studies have investigated the clinical outcomes of robot-assisted PE-TLIF (PE RA-TLIF).

OBJECTIVE: The aim of this prospective cohort study was to compare the clinical outcomes of PE RA-TLIF with MIS-TLIF for the treatment of lumbar 4-5 (L4-5) spondylolisthesis.

STUDY DESIGN: Prospective cohort study.

SETTING: Qilu Hospital of Shandong University.

METHODS: Fifty-eight cases diagnosed with L4-5 spinal stenosis with instability and Meyerding grade I spondylolisthesis (degenerative spondylolisthesis or isthmic spondylolisthesis) were included in this study. Twenty-six patients (group A) were treated with PE RA-TLIF, and the others (group B) underwent MIS-TLIF. The surgical procedures for PE RA-TLIF included the percutaneous implantation of pedicle screws (PS) under robot guidance, percutaneous fully endoscopic transforaminal decompression, and interbody fusion. The Japanese Orthopedic Association (JOA) score, the visual analog scale (VAS) for low back pain (LBP), the VAS for leg pain/numbness, and the Oswestry disability index (ODI) were used as follow-up clinical outcomes, and the lumbar interbody fusion rate was evaluated by CT. All statistical analyses were performed with SPSS 22.0, and the results were presented as mean ± standard deviation (SD).

RESULTS: There were 4 cases of spinal stenosis with instability, 17 cases of degenerative spondylolisthesis, and 5 cases of isthmic spondylolisthesis in group A. For group B, there were 6 cases of spinal stenosis with instability, 19 cases of degenerative spondylolisthesis, and 7 cases of isthmic spondylolisthesis. The preoperative scores for the JOA, ODI, VAS for LBP, and VAS for leg pain were not statistically comparable between the 2 groups (P > 0.05). The incision length for decompression and interbody fusion, estimated blood loss (EBL), and 1-day and 3-day incision pain were significantly higher in group B than in group A (P < 0.05). The mean operative time was longer in group A than in group B (P < 0.05). The operation time of the first 10 cases (251 ± 24 min) was much longer than that of the last 16 cases (200 ± 17 min) in group A. The misplacement rate of percutaneous pedicle screw placement was higher in group B (P < 0.05). No infections of incisions and interbody or nerve root or dural injuries were found in either group A or B. No differences were found between the 2 groups in the JOA scores, ODI, leg pain VAS score, or lumbar interbody fusion rate at the 2-year follow-up. The VAS for back pain was better in group A than in group B (P < 0.05).

LIMITATIONS: The PE RA -TLIF procedure is technically challenging and has a steep learning curve, and the study was not strictly randomized.

CONCLUSION: PE RA-TLIF is a safe and effective procedure that can significantly improve the accuracy of pedicle screw placement, reduce surgical trauma, and facilitate rapid postoperative recovery. However, this technique has a steep and long learning curve and requires long-term follow-ups.

PMID:35051154

Pain Physician. 2022 Jan;25(1):E121-E126.

ABSTRACT

BACKGROUND: Since its adoption as a treatment for neuropathic pain in the 1960s, radiofrequency ablation (RFA) has continued to gain popularity for the management of various pain etiologies. Although RFA is considered to be a safe procedure, post-neurotomy neuritis (PNN), a neuropathic-type pain, is one of the most common side effects. Due to the increasing recognition of PNN, some providers have attempted to mitigate the risk of PNN by injecting local corticosteroids at the site of RFA following the procedure. Recent studies have generally concluded that corticosteroids do not protect against the development of PNN, however, they have been limited by their retrospective study designs and the low incidence of PNN.

OBJECTIVES: We aimed to add to the growing literature regarding the role of post-RFA corticosteroid administration in preventing the development of PNN.

STUDY DESIGN: We conducted a prospective study evaluating the incidence of PNN as well as the efficacy of post-RFA corticosteroid administration in preventing the development of PNN.

SETTING: All RFAs were performed by the same board-certified, pain medicine fellowship-trained, attending physician at the University of Wisconsin who performed the initial patient evaluation at the pain medicine clinic.

METHODS: Thirty-nine patients (47 RFAs) were included in the study. All patients were between the ages of 30 and 81; 23 (59.0%) patients were women comprising 28 (59.6%) of the RFAs performed. RFA was performed for a variety of conditions, including facet joint pain, osteoarthritic knee pain, and occipital nerve pain. The 19 patients (25 RFAs) completed prior to February 2020 received post-RFA corticosteroids; the remaining 21 patients (22 RFAs) completed after this date did not receive corticosteroids. The Numeric Rating Scale (NRS-11) and Douleur Neuropathique 4 Questions (DN4) questionnaire scores were collected before and after completion of an RFA. After their procedure, patients were either called or seen in clinic for re-evaluation of their symptoms, at which time NRS-11 and DN4 scores were collected again.

RESULTS: There were no statistically significant differences between groups when comparing post-RFA DN4 scores. Additionally, the incidence of PNN in our study population was 0% for both treatment groups. The NRS-11 scores were similar between groups prior to completing an RFA. When comparing the post-RFA pain scores, the average NRS-11 scores in the steroid group decreased from 5.8 to 3.4, while the average NRS-11 scores in the nonsteroid group decreased from 5.4 to 3.8. However, the average NRS-11 reductions were similar between groups.

LIMITATIONS: The primary limitation of this study is small sample size, which likely limited our ability to diagnose PNN. Additionally, we utilized the 7-item DN4 and required a DN4 score of ? 4 to diagnose PNN, and therefore, it is likely that our protocol significantly reduced our sensitivity for diagnosing PNN.

CONCLUSIONS: Overall, our study is in agreement with prior studies that RFA is effective for the treatment of facet and osteoarthritic knee pain and that the incidence of PNN is likely small.

PMID:35051159

Pain Physician. 2022 Jan;25(1):77-85.

ABSTRACT

BACKGROUND: Post-traumatic stress disorder (PTSD) is a prevalent and debilitating condition in the United States. Success rates for evidence-based therapies are inconsistent, and many suffer in silence due to the stigmata associated with seeking traditional mental health care. This has led clinicians to explore new therapeutic options, with cervical sympathetic blockade (CSB), performed at the stellate and/or superior cervical ganglion levels, recently emerging as a promising treatment option. Rapid therapeutic onset, improved compliance, and high clinical efficacy rates have made this an attractive approach for both providers and patients. However, to date, CSB as a treatment of PTSD has primarily been used in male patients with military-related trauma.

OBJECTIVE: To evaluate the efficacy of CSB as a treatment option for PTSD in both genders and multiple etiologies of psychological trauma.

STUDY DESIGN: Retrospective cohort study.

SETTING: An established anesthesia pain clinic in Chicago, IL, USA.

METHODS: Following retroactive IRB approval, 484 consecutive cases of patients diagnosed with PTSD and treated with CSB, performed by a single provider (December 2016 – February 2020) were analyzed. The primary outcome measurement was the PTSD Checklist Score version DSM IV (PCL-4). Patient demographic and clinical information collected included age, gender, type of trauma leading to PTSD, history of suicidal attempts, and psychiatric medication use.

RESULTS: After exclusion of cases due to missing data points, 327 patients were included in the final statistical analysis, having completed both PCL-4 pre and post CSB, between 7- and 30-days post-intervention. The patient population included military men (n = 97), civilian men (n = 85), military women (n = 13) and civilian women (n = 132). We identified 21 types of self-reported trauma leading to PTSD. Average decrease in PCL score for men and women was 28.59 and 29.2, respectively. Statistical analysis of the male population with a military background showed a significantly greater change in corresponding PCL scores than civilians (PCL-M change = -31.83 vs PCL-C change = -24.89). Likewise, women who had a military background had a significantly greater reduction in PCL score than civilians (39.15 vs 28.23). Statistically significant improvements in PTSD symptoms were noted independent of the causative trauma type, gender, age greater than 20, previous suicide attempts, or use of prescription medications for PTSD. Among the 21 types of reported trauma, 19 types reached statistical significance.

LIMITATIONS: Limitations include the limited scope of observation giving exclusive focus on pre- and post-PCL data, the limited duration of observation, the self-reported nature of the patient-provided data, and the provision of treatment by a single physician.

CONCLUSION: CSB seems to be an effective treatment for PTSD symptoms irrespective of gender, trauma type, PTSD-related drug use, suicide attempt, or age.

PMID:35051147

Pain Physician. 2022 Jan;25(1):87-93.

ABSTRACT

BACKGROUND: It is well established that the experience of chronic pain significantly differs among ethnic-racial groups. There is mixed evidence to suggest that societal influences may contribute to pain prevalence among cultural groups and their treatment response. One possible explanation for differences in pain experience are the differences in socioeconomic status among patients with chronic pain.

OBJECTIVE: To determine whether there is any difference in pain scores or treatment responses among patients with different socioeconomic status.

STUDY DESIGN: Retrospective analysis.

SETTING: Outpatient pain clinic.

METHODS: After approval from the Advocate Healthcare Institutional Review Board, we included 1,149 patients treated for different chronic pain conditions who were followed for at least 12 months. Patients were stratified into quartiles determined by median income according to ZIP code.

RESULTS: Of the sampled patients, 207 patients lived in ZIP codes with median incomes > $51,294; 515 in ZIP codes with median incomes between $40,083 and $51,294; 332 in ZIP codes with median incomes between $30,625 and $40,083; and 95 in ZIP codes with median incomes < $30,625. Groups differed in age (P = 0.047), race (P < 0.001), body mass index (BMI) (P = 0.019), utilization of opioid medications (P = 0.011), morphine milligram equivalents (MME) on first visit (P = 0.036), and utilization of membrane stabilizers such as gabapentin (P = 0.019). There were no significant differences among groups in terms of gender (P = 0.531), type of pain experienced (P = 0.679), or time since pain onset (P = 0.174). Groups were treated similarly, with no statistically significant differences in the proportions of patients who had taken various nonopioid medications throughout their treatment course other than membrane stabilizers, the number of patients who received interventional pain management procedures, or MME at last visit. Average pretreatment numeric rating scale pain scores were not significantly different among quartiles (P = 0.079), posttreatment pain scores (P = 0.767), and subjective percent improvement (P = 0.434).

LIMITATIONS: This is a single center study and may have limitations in extrapolating to the general population.

CONCLUSION: The results of our study show that there are no differences in pain perception or treatment responses in patients from different socioeconomic statuses despite differences among groups in age, BMI, race, utilization of opioid medications, and MME at first visit. Patients at this pain practice appear to have been treated with similar modalities regardless of socioeconomic status.

PMID:35051148

Oral Health Prev Dent. 2022 Jan 20;20(1):41-50. doi: 10.3290/j.ohpd.b2585655.

ABSTRACT

PURPOSE: To investigate inflammatory responses in peri-implant crevicular fluid (PICF) in comparison to periodontal tissue.

MATERIALS AND METHODS: Nineteen participants with healthy implants restored with titanium or gold-casting abutment were included. PICF and gingival crevicular fluid (GCF) were collected for inflammatory cytokine detection by ELISA. Cytokine levels in PICF or GCF of the same individual were compared using the paired t-test, and those from titanium or gold-casting (UCLA) abutment were compared using the independent t-test. Human gingival fibroblast responses to PICF and GCF were then evaluated with one-way ANOVA.

RESULTS: The results demonstrated that IL-6, IL-8, TNFα, and IFNγ expressed in PICF are similar to GCF in the same individual. However, IL-1β (p = 0.032) and IL-1α (p = 0.030) was statistically significantly higher in PICF than in GCF. IL-8 level was statistically significantly higher with gold-casting than with titanium abutments (p = 0.003). PICF statistically significantly stimulated higher expression of RANKL, IL-1β, IL-6, and IL-8 mRNA in human gingival fibroblasts (HGF), while focal adhesion kinase (FAK) suppressed mRNA.

CONCLUSION: The inflammatory cytokines, including IL-1α and IL-1β, are higher in healthy peri-implant tissues. Abutment materials may also influence the level of inflammatory cytokines in PICF. Inflammatory mediators in crevicular fluid may affect HGF inflammatory responses and peri-implant tissue integration.

PMID:35049254 | DOI:10.3290/j.ohpd.b2585655

Oral Health Prev Dent. 2022 Jan 20;20(1):51-60. doi: 10.3290/j.ohpd.b2573053.

ABSTRACT

PURPOSE: To determine acid-formation potential of saliva and evaluate whether this method corresponds with microbiome composition of individuals with and without caries.

MATERIALS AND METHODS: A clinical, controlled pilot study was performed with two groups: individuals without caries (n = 25; DMFT = 0) and individuals with at least one active carious lesion (n = 25; DMFT>0). A detailed intraoral examination was performed, and the gingival bleeding index (GBI) and plaque index (PI) were recorded. The acid-formation potential was measured (ΔpH) after 1 h. Streptococcus mutans (SM) and lactobacilli (LB) were also quantified. Intergroup comparisons were made using the Mann-Whitney U-test. The diagnostic value was evaluated using the receiver operating characteristics (ROC) method and area under the curve (AUC) values were calculated. The saliva microbiome was analysed by 16S rDNA next-generation sequencing.

RESULTS: A statistically significant difference was found in ΔpH, with the ‘caries’ group showing a higher mean value after 1 h (‘healthy’ = 1.1,’caries’ = 1.4; p = 0.035). The AUC values were moderate to good (ΔpH = 0.67; SM = 0.83; LB = 0.83;1 = ideal). Streptococcus mutans and Lactobacilli were more frequently detected in the ‘caries’ group (p < 0.001), as were statistically significantly higher GBI (p = 0.006) and PI (p = 0.001). The saliva microbiome had a higher α-diversity and greater richness in individuals with active caries. The incidence of the genera Alloprevotella, Prevotella, Campylobacter and Veillonella was statistically significantly higher in the ‘healthy’ group. The incidence of the genera Fretibacterium, Lactobacillus, and Leptotrichia, as well as the phyla Spirochaetes and Synergistetes, was statistically significantly higher in the ‘caries’ group.

CONCLUSION: Further studies must be carried out to determine the extent to which both tests are suitable for predicting future caries development.

PMID:35049252 | DOI:10.3290/j.ohpd.b2573053

Oral Health Prev Dent. 2022 Jan 20;20(1):61-68. doi: 10.3290/j.ohpd.b2580291.

ABSTRACT

PURPOSE: A number of disinfectants and sanitisers are used in dentistry, and there are numerous commercial solutions available. Nonetheless, because each cleaning solution has its own set of indications and limits, there is no one-size-fits-all approach for processing all types of dental equipment. Functional water, such as electrolysed hypochlorite microbubbled water, efficiently eliminates and sterilises biofilms. The objective of the study was to evaluate whether ozonated water could be used to sterilise and disinfect dental-unit water pipelines (DUWP) that had been contaminated with micro-organisms, including Gram-positive and Gram-negative bacilli and cocci.

MATERIALS AND METHODS: Three different groups were formed: group A – ozonated water (Cantoosh); group B – 1% povidine iodine; and group C: conventional distilled water. Group A was the test group, group B the control group, and group C was the positive control group. The water sterilising system was replaced with the appropriate sterilising agent as per the allocated group classification, with 2 min of purging, so that the complete DUWP was filled with the water sterilising system. Samples were collected and analysed, along with a 2-min purge after 24 h, 7 days and 21 days, at the 3 outlet (OL) points: the 3-way syringe at the dental tray(OL1), the cup filler (OL2), and the 3-way syringe of the assistant zone (OL3). Repeated measures ANOVA was used to test for statistical significance between colony-forming units of control and experimental groups (p < 0.05).

RESULTS: The cup filler yielded higher counts than did the 3-way syringe at the dental tray (OL1) (6.40 and 8.05 on the log scale, respectively). A statistically significant difference in the CFUs was also observed between samples taken after 24 h vs 21 days between groups A, B and C.

CONCLUSION: The findings showed that exposing DUWP tube systems to ozonated water for an extended length of time drastically lowered the number of microorganisms adhering to their surfaces.

PMID:35049253 | DOI:10.3290/j.ohpd.b2580291

Oral Health Prev Dent. 2022 Jan 20;20(1):19-26. doi: 10.3290/j.ohpd.b2572979.

ABSTRACT

PURPOSE: To compare the analgesic efficacy of orally administered Curcuma longa (curcumin) and mefenamic acid (MA) after surgical periodontal therapy (SPT).

MATERIALS AND METHODS: Seventy-six periodontitis patients were randomly divided into two groups. In the test group, patients received curcumin capsules (200 mg), and in the control group, patients received MA (500 mg). All patients underwent post-operative antibiotic therapy using 500 mg amoxicillin and 400 mg metronidazole for 7 days. Post-operative pain and discomfort were evaluated using the numerical rating scale (NRS) and verbal rating scale (VRS), respectively. Evaluation were performed after 24 (T1), 48 (T2), and 72 h (T3). Group comparisons were done using Student’s t-test and the Mann-Whitney U-test. The level of statistical significance was established at p < 0.05.

RESULTS: All patients had stage 3/grade C periodontitis. The mean age of individuals in the test and control groups were 58.4 ± 7.3 and 57.2 ± 5.2 years, respectively. A family history of periodontal diseases was reported by 37.5% and 47.4% individuals in the test and control groups, respectively. In the test and control groups, the total mean duration of periodontal surgery was 168.2 ± 12.2 and 173.4 ± 10.7 min, respectively. There was no statistically significant difference in the mean NRS and VRS scores among patients in the test and control groups. In both groups, there was no statistically significant difference in the change in NRS scores at any time point.

CONCLUSIONS: Compared with MA, curcumin is ineffective for pain and discomfort management after SPT. The possibility of the results being biased due to lack of operator blinding cannot be overlooked.

PMID:35049249 | DOI:10.3290/j.ohpd.b2572979

Oral Health Prev Dent. 2022 Jan 20;20(1):1-10. doi: 10.3290/j.ohpd.b2572911.

ABSTRACT

PURPOSE: To determine if an interactive electric toothbrush and smartphone application (app) can reduce self-reported gingival bleeding and promote better brushing behaviour based on global, in-market usage data.

MATERIALS AND METHODS: Anonymised data were collected worldwide between July 2020 and January 2021 from users of interactive oscillating-rotating electric toothbrushes and app (Oral-B Genius, GeniusX and iO). Self-reported gingival bleeding and brushing behaviour data captured via the app were sent to Google Firebase and Google BigQuery to aid processing and analysis.

RESULTS: Data from 16.7 million brushing sessions were analysed. 439,481 new users responded at least once to the app question: ‘Do you have gum bleeding?’ Of users answering the question over their first two weeks of app use (153,201), the proportion reporting bleeding decreased statistically significantly from week 1 to 2 (28.8% to 17.1%, p < 0.0001). Of users answering the question over each of the first five weeks (43,060) a further statistically significant decrease in those reporting bleeding was seen in each consecutive week, with the week-5 rate being 12.7% (p < 0.0001 vs any previous week). Decreases in duration of excessive pressure (i.e. > 2.5 N – 3.0 N depending on the handle) decreased the proportion of self-reported gingival bleeding (p < 0.0001). Users brushed longer and with less overpressure (p < 0.0001) with vs without live feedback from the app, and showed 94.4% average coverage with live feedback.

CONCLUSION: The interactive oscillating-rotating electric toothbrushes and app, particularly with live feedback, promote good brushing behaviour. Self-reported gingival bleeding occurred less frequently the longer the system was used.

PMID:35049247 | DOI:10.3290/j.ohpd.b2572911

Oral Health Prev Dent. 2022 Jan 20;20(1):11-17. doi: 10.3290/j.ohpd.b2395059.

ABSTRACT

PURPOSE: To evaluate the use of hydrogen peroxide as an adjunct to ultrasonication (US) in biofilm removal and whether it can limit the spread of viable microorganisms in the aerosol.

MATERIALS AND METHODS: Multi-species biofilms were formed on dentin disks and titanium disks fixed on a plastic surface. After placing the specimens in a periodontal pocket model, an ultrasonic scaler was applied for 30 s, in part combined with 0.25% or 0.5% H2O2. After treatment, the remaining biofilm was analysed for bacterial counts (colony forming units [CFU]), biofilm quantity and metabolic activity. Further, the cytotoxic effect of hydrogen peroxide on periodontal ligament fibroblasts was assessed and the spread of bacteria in aerosol was quantified.

RESULTS: Ultrasonication reduced bacterial counts in biofilm, biofilm mass and metabolic activity on both dentin and titanium disks. Adjunctive use of 0.25% and 0.5% H2O2 more effectively reduced the viable bacteria in biofilm than ultrasonication alone; this was also found on both dentin and titanium. The different concentrations of H2O2 did not lead to corresponding differences in bacterial mass and metabolic activity. The spread of bacteria through aerosols was statistically significantly reduced when adjunctive H2O2 was used. However, a certain cytotoxic effect on periodontal ligament fibroblasts by H2O2 could not be ruled out.

CONCLUSIONS: Irrigating with H2O2 during periodontal instrumentation with an ultrasonic scaler increases the reduction of viable bacteria within biofilms. It might limit bacterial spreading via aerosols.

PMID:35049248 | DOI:10.3290/j.ohpd.b2395059