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Abd-Elsayed A, Stark CW, Topoluk N, Isaamullah M, Uzodinma P, Viswanath O, Gyorfi MJ, Fattouh O, Schlidt KC, Dyara O. A brief review of complex regional pain syndrome and current management. Ann Med 2024; 56:2334398. [PMID: 38569195 PMCID: PMC10993759 DOI: 10.1080/07853890.2024.2334398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that, although exceedingly rare, carries a significant burden for the affected patient population. The complex and ambiguous pathophysiology of this condition further complicates clinical management and therapeutic interventions. Furthermore, being a diagnosis of exclusion requires a diligent workup to ensure an accurate diagnosis and subsequent targeted management. The development of the Budapest diagnostic criteria helped to consolidate existing definitions of CRPS but extensive work remains in identifying the underlying pathways. Currently, two distinct types are identified by the presence (CRPS type 1) or absence (CRPS type 2) of neuronal injury. Current management directed at this disease is broad and growing, ranging from non-invasive modalities such as physical and psychological therapy to more invasive techniques such as dorsal root ganglion stimulation and potentially amputation. Ideal therapeutic interventions are multimodal in nature to address the likely multifactorial pathological development of CRPS. Regardless, a significant need remains for continued studies to elucidate the pathways involved in developing CRPS as well as more robust clinical trials for various treatment modalities.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of WI School of Medicine and Public Health, Madison, WI, USA
| | - Cain W. Stark
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Natasha Topoluk
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Mir Isaamullah
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Paul Uzodinma
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Omar Viswanath
- Anesthesiology, LSU Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Michael J. Gyorfi
- Department of Anesthesiology, University of WI School of Medicine and Public Health, Madison, WI, USA
| | - Osama Fattouh
- Department of Neurobiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin C. Schlidt
- Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Omar Dyara
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
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Abd-Elsayed A, Robinson CL, Peters T. Narrative review of radiofrequency ablation applications in peripheral nerves. Ann Palliat Med 2024; 0:apm-24-8. [PMID: 38735691 DOI: 10.21037/apm-24-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
BACKGROUND AND OBJECTIVE Chronic pain is a pervasive and often-complex condition that can severely detract from an individual's quality of life. When conservative measures of treatment fail, radiofrequency ablation (RFA) has emerged as a potential alternative. This narrative review subsequently explores recent advancements in the use of RFA on peripheral nerves as a means of attenuating chronic pain and providing relief to patients. METHODS A comprehensive literature search was conducted on the PubMed database using the keywords "Radiofrequency", "Ablation", "Pain", "Chronic", "Peripheral", and "Nerve". The search focused on articles published between 2018 to 2023 that discussed an application of RFA in a peripheral nerve. In total, 30 articles were selected for inclusion in this review. KEY CONTENT AND FINDINGS Results indicate the successful use of RFA in an array of chronic pain conditions and anatomical sites. Applications include the treatment of trigeminal neuralgia (TN), occipital neuralgia, cluster headaches, knee pain derived from osteoarthritis (OA), hip pain, abdominal pain associated with pancreatic cancer, and several other chronic pain conditions. CONCLUSIONS These findings suggest RFA is a viable option for reducing patient's pain scores and improving quality of life. Future research should build off extensive case reports/series with double-blind, randomized controlled studies to further investigate anecdotal successes.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Theodore Peters
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Chitneni A, Jain E, Sahni S, Mavrocordatos P, Abd-Elsayed A. Spinal Cord Stimulation Waveforms for the Treatment of Chronic Pain. Curr Pain Headache Rep 2024:10.1007/s11916-024-01247-1. [PMID: 38607547 DOI: 10.1007/s11916-024-01247-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Since the advent of spinal cord stimulation (SCS), advances in technology have allowed for improvement and treatment of various conditions, especially chronic pain. Additionally, as the system has developed, the ability to provide different stimulation waveforms for patients to treat different conditions has improved. The purpose and objective of the paper is to discuss basics of waveforms and present the most up-to-date literature and research studies on the different types of waveforms that currently exist. During our literature search, we came across over sixty articles that discuss the various waveforms we intend to evaluate. RECENT FINDINGS There are several publications on several waveforms used in clinical practice, but to our knowledge, this is the only educational document teaching on waveforms which provides essential knowledge. There is a gap of knowledge related to understanding wave forms and how they work.
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Affiliation(s)
- Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | - Esha Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
| | | | | | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, WI, B6/319 CSC53792-3272, USA.
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Moreau S, Thérond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01246-2. [PMID: 38587725 DOI: 10.1007/s11916-024-01246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.
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Affiliation(s)
- Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Alexandra Thérond
- Department of Psychology, Université du Québec a Montréal, 100 Sherbrooke St W, Montréal, QC, H2X 3P2, Canada.
| | - Ivo H Cerda
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Alicia Pan
- Northeastern University, Boston, MA, USA
| | - Jacob Tharpe
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Silva-Ortiz VM, Chapman KB, Chang Chien GC, Diwan S, Abd-Elsayed A. Sacroiliac Joint Denervation-A Novel Approach to Target Sacral Lateral Branches: A Practical Approach. Pain Ther 2024; 13:281-286. [PMID: 38407769 DOI: 10.1007/s40122-024-00585-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/12/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Sacroiliac joint (SIJ) pain is a relatively common cause of low back pain. Percutaneous radiofrequency (RF) techniques for SIJ are limited to ablation of the posterior SIJ innervation. Different techniques have been described for SIJ radiofrequency ablation, including conventional thermal, cooled RF, pulsed RF, bipolar RF, and specialized tip RF needle (i.e., multi-tined); however, additional costs may limit these applications. METHODS This new technique for SIJ denervation uses anatomical landmarks and a single RF cannula. Two spinal needles are placed lateral to the posterior S1 and S2 sacral foramina; then, with caudal tilt we get a coaxial view of the sacral bone, we advance an 18-G curved 15-mm active tip RF cannula just lateral to the aligned finder needles. Ablation is performed, and then the RF cannula is retracted 2 cm and ablation is repeated for a total of four lesions. RESULTS The two spinal needles placed lateral to the posterior sacral foramina S1 and S2 guide the final needle in the posterior aspect of the sacrum, lateral to the sacral foramina, where the lateral sacral branches are located. CONCLUSION We introduce a cost and time efficient technique to perform radiofrequency ablation of the sacral lateral branches using a single RF needle. This technique utilizes the sacrum's reliable anatomy and angulation and maximizes the surface area of the active tip lesioning. This technique creates a strip lesion lateral to the sacral foramina and reduces time and cost efficacy compared to several of the other techniques and/or commercially available special devices designed for sacroiliac denervation.
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Affiliation(s)
- Victor M Silva-Ortiz
- Department of Pain Management, Hospital Zambrano Hellion, Tec Salud, Batallon de San Patricio 112, Real San Agustín, San Pedro Garza Garcia, Nuevo León, México.
| | - Kenneth B Chapman
- Department of Anesthesiology, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | | | | | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
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Abd-Elsayed A, Henjum LJ, Shiferaw BT, Yassa PE, Fiala KJ. Infrapatellar Branch of the Saphenous Nerve: Therapeutic Approaches to Chronic Knee Pain. Curr Pain Headache Rep 2024; 28:279-294. [PMID: 38294640 DOI: 10.1007/s11916-024-01217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW The infrapatellar branch of the saphenous nerve (IPS) is an under-investigated nerve that can be a source of chronic knee pain. This literature review aims to deliver an up-to-date review of chronic pain transmitted via the IPS along with therapeutic approaches available for pain refractory to conservative measures. RECENT FINDINGS Knee pain transmitted via the IPS can arise from several etiologies. Damage to the IPS is often iatrogenic and develops following total knee arthroplasty, anterior cruciate ligament reconstruction, and other knee surgical procedures. Other causes of IPS-derived pain include entrapment of the nerve, neuromas, Schwannomas, and pain from knee osteoarthritis transmitted through the IPS.This article investigated therapeutic approaches to pain derived from the IPS. Common approaches included radiofrequency ablation, neuroma excisions, Schwannoma excision, nerve blocks, surgical exploration, surgical release of an entrapped nerve, cryoablation, and peripheral nerve stimulation. Pain scores, duration of pain relief, adverse events, and secondary outcomes were all included in this review. A subset of the patient population experiences chronic pain deriving from the IPS that is refractory to conservative treatment measures. This review aims to evaluate the etiologies and therapeutic approaches for chronic pain arising from the IPS refractory to conservative treatments.
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Affiliation(s)
- Alaa Abd-Elsayed
- Anesthesiology Department, University of Wisconsin, 600 Highland Avenue, Madison, WI, B6/319 CSC, USA.
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Abd-Elsayed A, Robinson CL, Marshall Z, Diwan S, Peters T. Applications of Artificial Intelligence in Pain Medicine. Curr Pain Headache Rep 2024; 28:229-238. [PMID: 38345695 DOI: 10.1007/s11916-024-01224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW This review explores the current applications of artificial intelligence (AI) in the field of pain medicine with a focus on machine learning. RECENT FINDINGS Utilizing a literature search conducted through the PubMed database, several current trends were identified, including the use of AI as a tool for diagnostics, predicting pain progression, predicting treatment response, and performance of therapy and pain management. Results of these studies show promise for the improvement of patient outcomes. Current gaps in the research and subsequent directions for future study involve AI in optimizing and improving nerve stimulation and more thoroughly predicting patients' responses to treatment.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA.
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Sudhir Diwan
- Albert Einstein College of Medicine, Lenox Hill Hospital, New York City, NY, USA
| | - Theodore Peters
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA
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Pak R, Cho M, Pride K, Abd-Elsayed A. The Gut Microbiota and Chronic Pain. Curr Pain Headache Rep 2024; 28:259-269. [PMID: 38345694 DOI: 10.1007/s11916-024-01221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/16/2024]
Abstract
PURPOSE OF REVIEW To examine the effects and interactions between gut microbia and chronic pain. RECENT FINDINGS The gut microbiome has been an area of interest in both the scientific and general audience due to a growing body of evidence suggesting its influence in a variety of health and disease states. Communication between the central nervous system (CNS) and gut microbiome is said to be bidirectional, in what is referred to as the gut-brain axis. Chronic pain is a prevalent costly personal and public health burden and so, there is a vested interest in devising safe and efficacious treatments. Numerous studies, many of which are animal studies, have been conducted to examine the gut microbiome's role in the pathophysiology of chronic pain states, such as neuropathy, inflammation, visceral pain, etc. As the understanding of this relationship grows, so does the potential for therapeutic targeting of the gut microbiome in chronic pain.
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Affiliation(s)
- Ray Pak
- Department of Physical Medicine and Rehabilitation, New York Medical College/Metropolitan, New York, NY, USA
| | - Michelle Cho
- Department of Physical Medicine and Rehabilitation, New York Medical College/Metropolitan, New York, NY, USA
| | - Keth Pride
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA.
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Abd-Elsayed A, Robinson CL, Shehata P, Koh Y, Patel M, Fiala KJ. Neuromodulation's Role in Functional Restoration in Paraplegic and Quadriplegic Patients. Biomedicines 2024; 12:720. [PMID: 38672076 PMCID: PMC11047848 DOI: 10.3390/biomedicines12040720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/09/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Neuromodulation is an alternative, minimally invasive treatment option that, at times, is used as a last resort for chronic pain conditions that are often refractory to other treatment modalities. Moreover, it offers promising prospects for individuals grappling with the formidable challenges posed by paraplegia and quadriplegia resulting from spinal cord injuries. This review article provides a comprehensive assessment of current treatment modalities specifically tailored for paraplegic and quadriplegic patients. We aim to evaluate the existing surgical and non-surgical interventions while delving into the role of neuromodulation in the restoration of function for individuals afflicted with these debilitating conditions. Additionally, we review the efficacy, limitations, and comparative outcomes of diverse treatment strategies available for the management of paraplegia and quadriplegia. Emphasizing the critical need for effective interventions beyond the initial 24 h surgical window, we elucidate the challenges associated with conventional therapies and their limited success in achieving comprehensive functional restoration. Central to this review is an in-depth exploration of neuromodulation's transformative potential in ameliorating the deficits caused by spinal cord injuries. With a particular focus on spinal cord stimulation (SCS), we analyze and compare the outcomes of neuromodulation modalities and traditional treatment regimens, shedding light on the promising strides made in fostering sensory perception, motor function, and patient satisfaction.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Christopher L. Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA 02115, USA;
| | - Peter Shehata
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Yerin Koh
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Milan Patel
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Kenneth J. Fiala
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
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10
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Abd-Elsayed A, Vardhan S, Aggarwal A, Vardhan M, Diwan SA. Mechanisms of Action of Dorsal Root Ganglion Stimulation. Int J Mol Sci 2024; 25:3591. [PMID: 38612402 PMCID: PMC11011701 DOI: 10.3390/ijms25073591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
The dorsal root ganglion (DRG) serves as a pivotal site for managing chronic pain through dorsal root ganglion stimulation (DRG-S). In recent years, the DRG-S has emerged as an attractive modality in the armamentarium of neuromodulation therapy due to its accessibility and efficacy in alleviating chronic pain refractory to conventional treatments. Despite its therapeutic advantages, the precise mechanisms underlying DRG-S-induced analgesia remain elusive, attributed in part to the diverse sensory neuron population within the DRG and its modulation of both peripheral and central sensory processing pathways. Emerging evidence suggests that DRG-S may alleviate pain by several mechanisms, including the reduction of nociceptive signals at the T-junction of sensory neurons, modulation of pain gating pathways within the dorsal horn, and regulation of neuronal excitability within the DRG itself. However, elucidating the full extent of DRG-S mechanisms necessitates further exploration, particularly regarding its supraspinal effects and its interactions with cognitive and affective networks. Understanding these mechanisms is crucial for optimizing neurostimulation technologies and improving clinical outcomes of DRG-S for chronic pain management. This review provides a comprehensive overview of the DRG anatomy, mechanisms of action of the DRG-S, and its significance in neuromodulation therapy for chronic pain.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA
| | - Swarnima Vardhan
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06605, USA; (S.V.); (A.A.)
- Advanced Spine on Park Avenue, New York, NY 10461, USA;
| | - Abhinav Aggarwal
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06605, USA; (S.V.); (A.A.)
| | - Madhurima Vardhan
- Argonne Leadership Computing Facility, Argonne National Laboratory, Lemont, IL 60439, USA;
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Ruan QZ, Chang J, Pak D, Supra R, Yazdi C, Kollenburg L, Kurt E, Reece D, Fonseca ACG, Abd-Elsayed A, Robinson CL. Literature Review: Mechanism, Indications, and Clinical Efficacy of Peripheral Nerve Stimulators in Lower Extremity Pain. Curr Pain Headache Rep 2024:10.1007/s11916-024-01240-8. [PMID: 38512600 DOI: 10.1007/s11916-024-01240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW Lower extremity pain is deemed by Center for Disease Control and Prevention (CDC) to be a significant source of chronic pain in adults. If not appropriately managed, patients are subjected to risks of prolonged musculoskeletal dysfunction, disruption to quality of life, and elevated healthcare expenditures. Peripheral nerve stimulation (PNS) has shown great potential in recent years demonstrating efficacy in multiple diagnoses ranging from acute post-surgical pain to complex regional pain syndrome (CRPS). This study seeks to delineate efficacy of peripheral neuromodulation in the context of chronic lower extremity pain. RECENT FINDINGS Prevailing clinical studies demonstrate evidence levels ranging from II to V (Oxford Centre of Level of Evidence) in lower limb PNS, attaining positive outcomes in pain scores, opioid use, and quality of life measures. Nerves most frequently targeted are the sciatic and femoral nerves with post-amputation pain and CRPS most commonly investigated for efficacy. PNS is a promising therapeutic modality demonstrated to be effective for a variety of nociceptive and neuropathic pain conditions in the lower extremity. PNS offers chronic pain physicians a powerful tool in the multi-modal management of lower limb chronic pain.
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Affiliation(s)
- Qing Zhao Ruan
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA.
| | - Jason Chang
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA
| | - Daniel Pak
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA
| | - Rajesh Supra
- Georgetown University School of Medicine, Washington, DC, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Linda Kollenburg
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Reece
- Absolute Pain Management, Rockville, MD, USA
| | - Alexandra C G Fonseca
- Harvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA, USA
| | - Alaa Abd-Elsayed
- Chronic Pain Medicine, Department of Anesthesiology, University of Wisconsin-Madison, Madison, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
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Jani M, Mehta N, Yu S, Ju R, Yener U, Abd-Elsayed A, Kohan L, Wahezi SE. Mitigating Factors in L4 and L5 Medial Branch Motor Stimulation During Radiofrequency Ablation. Curr Pain Headache Rep 2024:10.1007/s11916-024-01232-8. [PMID: 38512601 DOI: 10.1007/s11916-024-01232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW Radiofrequency ablation (RFA) is a minimally invasive procedure for facet joint pain. The targets for the procedure are the medial branches of the dorsal spinal nerves which innervate the facet joints. Before RFA, patients undergo diagnostic meal branch blocks to ensure appropriate pain relief and confirm the utility of proceeding to RFA. The success of RFA relies heavily on procedural technique and accurate placement near the medial branch. RECENT FINDINGS Motor testing is utilized in the lumbar region to assess the response of the multifidus and ensure proper placement of the RFA probe to prevent inadvertent damage to surrounding spinal anatomy. However, relying on motor responses in this area presents challenges given the frequency of lack of muscle twitching. Factors contributing to limited muscle twitch responses include muscle atrophy, excessive lordosis, facet arthropathy, local anesthetic use before ablation, and previous surgical neurotomy. These complexities highlight the challenges in ensuring precise motor stimulation during RFA. Despite these obstacles, accurate anatomical placement remains crucial. For RFA cases that prove challenging, relying on anatomical placement can be adequate to proceed with the procedure. Bridging knowledge gaps is vital for standardized practices and safer procedures. Further research is necessary to refine techniques, understand patient-specific factors, and enhance the efficacy of RFA in managing chronic lumbar facet joint pain.
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Affiliation(s)
- Mihir Jani
- Department of Pain Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nimesha Mehta
- Department of Pain Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sandra Yu
- Department of Pain Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ricky Ju
- Department of Rehabilitation, Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Ugur Yener
- Department of Pain Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Sayed Emal Wahezi
- Department of Pain Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, 1250 Waters Place, Tower #2 8Th Floor, Bronx, NY, 10461, USA.
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Abd-Elsayed A, Gyorfi MJ. Peripheral Nerve Stimulation for the Treatment of Superior Cluneal Neuralgia: A Cadaver Demonstration of a Novel Technique for Lead Placement. J Pain Res 2024; 17:1235-1241. [PMID: 38532992 PMCID: PMC10964024 DOI: 10.2147/jpr.s450177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
Superior cluneal neuralgia (SCN) is a distinct cause of lower back and/or leg pain related to pathology of the superior cluneal nerve. When assessing a patient with low back pain (LBP), superior cluneal neuralgia is frequently misdiagnosed. The pathophysiology of SCN ranges from myofascial compression brought on by aberrant muscle tone to direct iatrogenic injury or trauma. In this technical report we will discuss the anatomy of superior cluneal nerve, superior cluneal neuralgia, current treatment modalities, and a novel approach to peripheral nerve stimulation (PNS) lead placement via a cadaver demonstration for SCN.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael J Gyorfi
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Lam CM, Keim SA, Sayed D, Abd-Elsayed A, Gulati A, Schatman ME, Deer T, Latif U. Novel Implantation Technique for Thoracoabdominal Peripheral Nerve Stimulation via a Transversus Abdominal Plane Approach for Treatment of Chronic Abdominal Pain. J Pain Res 2024; 17:981-987. [PMID: 38500814 PMCID: PMC10946280 DOI: 10.2147/jpr.s451955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
Background Chronic abdominal pain (CAP) is a common and challenging to treat condition with a global prevalence of up to 25%. Despite extensive evaluation, approximately 40% of patients with CAP have an unknown diagnosis. Medications may be ineffective, and surgery is rarely indicated. Interventional treatment including sympathetic blocks, sympathetic neurolysis, and transversus abdominal plane (TAP) blocks may be an option, but their efficacy can wane over time. Neuromodulation has emerged as an option for these patients, as there is evidence of success with dorsal column spinal cord and dorsal root ganglion (DRG) stimulation. Peripheral nerve stimulation (PNS) may be an alternative option, particularly in higher risk patients or in patients for whom neuraxial access may be unsafe or too technically challenging. Thoracoabdominal nerve peripheral nerve stimulation via a TAP approach may be more specifically targeted in comparison to dorsal column or DRG stimulation. In this short report, we detail a technique that the authors have successfully used for thoracoabdominal nerve PNS via a TAP approach for management of CAP. Methods This article describes a novel medial to lateral ultrasound guided thoracoabdominal nerve PNS via a TAP approach technique for lead placement and implantation. Results A medial to lateral ultrasound guided TAP approach as described to successfully implant percutaneous thoracoabdominal nerve PNS leads for management of CAP. Conclusion The thoracoabdominal nerve PNS via a TAP approach lead placement technique noted in this report has been used as a means for management of CAP utilizing peripheral neuromodulation. Here, we present a short report detailing a potential technique for PNS utilization for management of CAP. Further studies are needed to validate the safety and efficacy of this therapy modality, although the authors have found it to be a viable management option for patients with medically refractory neuropathic CAP.
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Affiliation(s)
- Christopher M Lam
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sarah A Keim
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dawood Sayed
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology and Perioperative Medicine, University of Wisconsin, Madison, WI, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Usman Latif
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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15
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Gyorfi MJ, Abd-Elsayed A. Pudendal nerve blockade for persistent genital arousal disorder (PGAD): A clinical review and case report. Pain Pract 2024. [PMID: 38462787 DOI: 10.1111/papr.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Persistent genital arousal disorder (PGAD) is a condition characterized by unwanted and potentially painful genital sensations or spontaneous orgasms without stimulation. We present a case of a 55-year-old woman with refractory genital arousal disorder that was treated with serial pudendal nerve blocks. CASE RW is a 55-year-old woman with chronic pelvic pain, pudendal neuralgia, MDD, SI, GAD, CRPS, and persistent genital arousal disorder for 11 years. Her PGAD was refractory to conservative management, physical therapy, and bilateral clitoral artery embolization. We performed bilateral pudendal nerve blocks with Kenalog and Bupivacaine, which provided almost complete relief for 2-3 months. We performed a bilateral pudendal nerve radiofrequency ablation; however, there was minimal benefit. RW continues to have significant relief with serial pudendal nerve blocks. SUMMARY AND CONCLUSION Persistent genital arousal disorder is often refractory to medication and physical therapy requiring significant intervention such as entrapment surgery or artery embolization. Our case demonstrates pudendal nerve blocks as a potential treatment modality with minimal side effects.
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Affiliation(s)
- Michael J Gyorfi
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Abd-Elsayed A, Storlie NR, Smith MH. A Guide for Physicians Serving as an Expert Witness for Personal Injury Cases and Other Litigations. Curr Pain Headache Rep 2024; 28:65-72. [PMID: 38117460 DOI: 10.1007/s11916-023-01203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW To provide a guide for physicians serving as an expert witness in all kinds of cases. RECENT FINDINGS Different societies proposed different guidelines for physicians serving as an expert witness. We wanted to summarize all recommendations in our article to provide a comprehensive guide to all physicians from different specialties. There is some overlap in recommendations, and it is important for physicians from different specialties to be aware of all recommendations proposed. It is very important for any health care provider who serves as an expert witness for personal injury or other cases to understand the guidelines around this process and best practices.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | | | - Micah H Smith
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Freeman J, Nikjou D, Maloney J, Covington S, Pew S, Wie C, Strand N, Abd-Elsayed A. The Role of Orthoses in Chronic Axial Spinal Conditions. Curr Pain Headache Rep 2024:10.1007/s11916-024-01233-7. [PMID: 38407764 DOI: 10.1007/s11916-024-01233-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE OF REVIEW Bracing represents a prevalent conservative, non-surgical approach used in the management of chronic spinal conditions such as spondylosis, degenerative disc disease, and spondylolisthesis. A wide variety of orthoses are available to aid in addressing cervical, thoracic, lumbar, thoracic, and SI joint pain. In this review, we aim to comprehensively examine brace types with their current applications and implications of usage. RECENT FINDINGS There are multiple cervical bracing options, such as soft and rigid collars, to assist in managing acute trauma and chronic degenerative conditions. The review highlights the nuanced decision-making process between hard and soft collars based on the severity of bone or ligamentous injury and neurological findings. Orthoses for low back pain are commonly used. The review highlights the challenges of chronic neck and lower back pain, emphasizing the importance of clinicians exploring all treatment strategies including braces which can improve function and reduce pain.
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Affiliation(s)
- John Freeman
- Mayo Clinic Department of Anesthesiology, Phoenix, AZ, USA
| | - Devin Nikjou
- Mayo Clinic Department of Anesthesiology, Phoenix, AZ, USA
| | | | | | - Scott Pew
- Mayo Clinic Department of Anesthesiology, Phoenix, AZ, USA
| | | | - Natalie Strand
- Mayo Clinic Department of Anesthesiology, Phoenix, AZ, USA
| | - Alaa Abd-Elsayed
- Anesthesiology Department, University of Wisconsin, Madison, WI, USA.
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18
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Covington S, Strand N, Pew S, Dawodu A, Dunn T, Johnson B, Hand B, Abd-Elsayed A. Cervical Spinal Cord Stimulation for Failed Neck Surgery Syndrome. Curr Pain Headache Rep 2024:10.1007/s11916-024-01214-w. [PMID: 38308745 DOI: 10.1007/s11916-024-01214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE OF REVIEW Cervical spine pain with or without radicular symptoms is a common condition leading to high utilization of the healthcare system with over 10 million medical visits per year. Many patients undergo surgical interventions and unfortunately are still left with neck and upper extremity pain, sometimes referred to as "Failed Neck Surgery Syndrome." When these options fail, cervical spinal cord stimulation can be a useful tool to decrease pain and suffering as well as reduce prescription medication use. RECENT FINDINGS Spinal cord stimulation is a well-established therapy for chronic back and leg pain and is becoming more popular for neck and upper extremity pain. Recent studies have explored cervical spinal cord stimulation with successful outcomes regarding improved pain scores, functional outcomes, and reduction of prescription medication use. Continued research into cervical spinal cord stimulation is essential for maximizing its therapeutic potential for patients with chronic neck and upper extremity pain. This review highlights the importance of cervical spinal cord stimulation as an option for patients with failed neck surgery syndrome.
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Affiliation(s)
- S Covington
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA.
| | - N Strand
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - S Pew
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - A Dawodu
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - T Dunn
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - B Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - B Hand
- Mayo Alix School of Medicine, Scottsdale, AZ, USA
| | - A Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
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19
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Abd-Elsayed A, Gilligan C. Chemotherapy-induced peripheral neuropathy: Role of dorsal root ganglion stimulation. Pain Pract 2024; 24:383-384. [PMID: 37849069 DOI: 10.1111/papr.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christopher Gilligan
- Brigham and Women's Spine Service Line, Harvard Medical School, Boston, Massachusetts, USA
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Abd-Elsayed A, Gilligan C. Efficacy of percutaneous lumbar decompression and interspinous spacers. Pain Pract 2024; 24:386. [PMID: 37849077 DOI: 10.1111/papr.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christopher Gilligan
- Brigham and Women's Spine Service Line, Harvard Medical School, Boston, Massachusetts, USA
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21
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Abd-Elsayed A, Gilligan C. Chronic pelvic pain and role of dorsal root ganglion stimulation. Pain Pract 2024; 24:385. [PMID: 37860925 DOI: 10.1111/papr.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christopher Gilligan
- Brigham and Women's Spine Service Line, Harvard Medical School, Boston, Massachusetts, USA
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22
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Reffat N, Pusec C, Price S, Gupta M, Mavrocordatos P, Abd-Elsayed A. Neuromodulation Techniques for Headache Management. Life (Basel) 2024; 14:173. [PMID: 38398683 PMCID: PMC10890676 DOI: 10.3390/life14020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
This narrative review aims to summarize evidence regarding the current utilization and future applications of neuromodulation in patients with headaches, with special attention paid to migraine and chronic cluster headache. A search was conducted in PubMed in August of 2023 to survey the current literature on neuromodulation for the treatment of headache. In total, the search yielded 1989 results, which were further filtered to include only systematic reviews published between 2022 to 2023 to capture the most up-to-date and comprehensive research on this topic. The citation lists of these articles were reviewed to find additional research on neuromodulation and supplement the results presented in this paper with primary literature. Research on the use of neuromodulation for the treatment of headache has predominantly focused on four neuromodulation techniques: peripheral nerve stimulation (PNS), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and spinal cord stimulation (SCS). Outcome measures reported in this article include impact on migraine and headache frequency and/or pain intensity, adverse effects of the neuromodulation technique, and associated costs, when available. We found that neuromodulation has developed utility as an alternative treatment for both chronic cluster headaches and migraines, with a reduction in frequency and intensity of headache most elucidated from the articles mentioned in this review.
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Affiliation(s)
- Noora Reffat
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (N.R.)
| | - Carolina Pusec
- Department of Neurology, University of Wisconsin Health, Madison, WI 53705, USA
| | - Scott Price
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (N.R.)
| | - Mayank Gupta
- Kansas Pain Management & Neuroscience Research Center, Kansas City, KS 66214, USA
| | | | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin Health, Madison, WI 53705, USA
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Fajardo Pérez M, Yamak-Altinpulluk E, Díez Tafur R, Salazar-Zamorano CH, Espinosa Morales K, Oliver-Fornies P, Rocha-Romero A, Aguilar Ureña R, Juarez-Lemus A, Galluccio F, Abd-Elsayed A. Novel ultrasound-guided supraclavicular stellate ganglion block. Pain Pract 2024. [PMID: 38251786 DOI: 10.1111/papr.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Stellate ganglion block (SGB) provides diagnostic and therapeutic benefits in pain syndromes in the head, neck, and upper extremity, including complex regional pain syndrome Types I and II, Raynaud's disease, hyperhidrosis, arterial embolism in the region of the arm. METHODS We present a novel ultrasound-guided supraclavicular stellate ganglion block. Considering the existing anatomical structures of the targeted area. RESULTS AND CONCLUSIONS We hope that we can provide fewer complications and additional benefits with this new approach.
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Affiliation(s)
- Mario Fajardo Pérez
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
| | - Ece Yamak-Altinpulluk
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Rodrigo Díez Tafur
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Centro MDRS - Sports, Spine & Pain Center: Lima Pain Institute, Lima, Peru
- Clínica Angloamericana British American Hospital, Lima, Peru
- Latin American Pain Society (LAPS), New York, New York, USA
| | - Carlos H Salazar-Zamorano
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Karla Espinosa Morales
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia and Pain Medicine, Hospital de Trauma, Centro Integral de Salud de Puriscal, San José, Costa Rica
| | - Pablo Oliver-Fornies
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesiology, Critical Care and Pain Medicine, Móstoles University Hospital, Móstoles, Spain
- Aragon Institute for Health Research, Zaragoza, Spain
| | - Andrés Rocha-Romero
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia and Pain Medicine, Hospital de Trauma, Centro Integral de Salud de Puriscal, San José, Costa Rica
- Department of Anesthesia and Pain Management, Centro Nacional de Rehabilitacion, Hospital de Trauma, San José, Costa Rica
| | - Ricardo Aguilar Ureña
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesiology, Critical Care and Pain Medicine, Centro Nacional de Rehabilitacion, San José, Costa Rica
| | - Angel Juarez-Lemus
- Department of Pain Medicine, National Cancer Institute, Mexico City, Mexico
| | - Felice Galluccio
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Fisiotech Lab Studio, Rheumatology and Pain Management, Firenze, Italy
- Center for Regional Anesthesia and Pain Medicine (CRAPM), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Alaa Abd-Elsayed
- Anesthesiology Department, University of Wisconsin, Madison, Wisconsin, USA
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Abd-Elsayed A, Moghim R, Reffat N. Dorsal root ganglion stimulation (DRG-s) for potential resolution of restless leg syndrome symptoms and increased cost savings for patients: A case study. Pain Pract 2024. [PMID: 38239056 DOI: 10.1111/papr.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
INTRODUCTION We report successful use of dorsal root ganglion stimulation (DRG-s) to treat a patient with persistent symptoms of restless leg syndrome (RLS). METHODS The treatment involved the placement of a small device millimeters away from the patient's DRG, which are nerves near the spinal cord that carry sensory information from the periphery of the body to the brain. The device automatically delivers electrical impulse to the DRG to alter and decrease pain perception in the brain. RESULTS Our case report elucidates the use of this procedure as a targeted therapy for RLS, with a nearly 90% reduction in reported symptoms in our patient, thus potentially reducing morbidity associated with this condition. Furthermore, we report a 10-year cost savings of nearly $90,000 following DRG-s for our patient. CONCLUSION This case study aims to demonstrate the effectiveness of DRG-s neuromodulation in managing RLS, a condition that is often difficult and costly to treat.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Noora Reffat
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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D’Souza RS, Abd-Elsayed A. Perioperative management and best practices. Spinal Fusion Techniques 2024:46-49. [DOI: 10.1016/b978-0-323-88223-1.00013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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26
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Abd-Elsayed A, González DA, Salom CA. Spinal cord stimulation implant (percutaneous leads). Neuromodulation Techniques for the Spine 2024:67-90. [DOI: 10.1016/b978-0-323-87584-4.00018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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27
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Abbasi HR, Abd-Elsayed A, Storlie NR. Anatomic/physiologic (indirect) decompression. Decompressive Techniques 2024:76-104. [DOI: 10.1016/b978-0-323-87751-0.00018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abd-Elsayed A, González DA, Salom CA. Intrathecal pump implant. Neuromodulation Techniques for the Spine 2024:194-210. [DOI: 10.1016/b978-0-323-87584-4.00032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Gyorfi M, Viswanath O, Abd-Elsayed A. Minimally invasive posterior lumbar fusion—a novel approach to facet fusion. Spinal Fusion Techniques 2024:50-58. [DOI: 10.1016/b978-0-323-88223-1.00014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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30
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Zhou S, Nerusu LA, Hussain N, Abd-Elsayed A. Sacral neuromodulation. Neuromodulation Techniques for the Spine 2024:137-149. [DOI: 10.1016/b978-0-323-87584-4.00026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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31
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Martens JM, Fiala KJ, Kalia H, Abd-Elsayed A. Radiofrequency ablation and pulsed radiofrequency ablation for the sympathetic nervous system. Radiofrequency Ablation Techniques 2024:186-201. [DOI: 10.1016/b978-0-323-87063-4.00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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32
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Abd-Elsayed A, Abdallah RT, Angara P, Bulat E, Caparo MA, Darji J, Dhall R, Engle AM, Fiala KJ, Fishman MA, Grabnar M, Gulati A, Habibi B, Hussain N, Jassal NS, Kalia H, Kim C, Kitei PM, Kodsy M, Lambert J, Larson L, Malik T, Martens JM, Mata N, Mehta N, Mueller MR, Pendem K, Rakesh N, Rausch DK, Rosenblum D, Schwartz GS, Sehmbi H, Shehata P, Silva J, Suric V, Tanios M, Tybout C, Vodapally S, Wahezi SE, Zhou S, Zhu X. Contributors. Radiofrequency Ablation Techniques 2024:vi-ix. [DOI: 10.1016/b978-0-323-87063-4.00004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Gyorfi M, Falowski SM, Abd-Elsayed A. Interspinous fusion with lateral percutaneous technique. Spinal Fusion Techniques 2024:63-70. [DOI: 10.1016/b978-0-323-88223-1.00016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Tybout C, Zhou S, Hussain N, Abd-Elsayed A. Radiofrequency ablation for headache. Radiofrequency Ablation Techniques 2024:169-185. [DOI: 10.1016/b978-0-323-87063-4.00024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Busch C, Hussain N, Abd-Elsayed A. Vertebral augmentation with osteotome. Vertebral Augmentation Techniques 2024:53-58. [DOI: 10.1016/b978-0-323-88226-2.00015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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36
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Bawany MH, Visnjevac O, Abd-Elsayed A. Vertebral anatomy. Vertebral Augmentation Techniques 2024:1-24. [DOI: 10.1016/b978-0-323-88226-2.00010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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37
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Habibi M, Fiala KJ, Abd-Elsayed A. Patient selection for vertebral augmentation. Vertebral Augmentation Techniques 2024:25-28. [DOI: 10.1016/b978-0-323-88226-2.00011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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38
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Silva J, Sehmbi H, Fiala KJ, Shehata P, Abd-Elsayed A. Radiofrequency ablation and pulsed radiofrequency of the upper extremities. Radiofrequency Ablation Techniques 2024:97-139. [DOI: 10.1016/b978-0-323-87063-4.00022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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39
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Abd-Elsayed A. Preface. Spinal Fusion Techniques 2024:viii. [DOI: 10.1016/b978-0-323-88223-1.00006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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40
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Abd-Elsayed A. Preface. Vertebral Augmentation Techniques 2024:viii. [DOI: 10.1016/b978-0-323-88226-2.00005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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41
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Abd-Elsayed A. Preface. Decompressive Techniques 2024:viii. [DOI: 10.1016/b978-0-323-87751-0.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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42
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Abd-Elsayed A, Tanios M, Kodsy M. Ankle joint articular nerves. Radiofrequency Ablation Techniques 2024:78-87. [DOI: 10.1016/b978-0-323-87063-4.00020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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43
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Habibi M, Martens JM, Abd-Elsayed A. Outcome measurement for vertebral augmentation. Vertebral Augmentation Techniques 2024:89-92. [DOI: 10.1016/b978-0-323-88226-2.00019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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44
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Martens JM, Fiala KJ, Abd-Elsayed A, Gilligan C. Multifidus muscle neurostimulator implant. Neuromodulation Techniques for the Spine 2024:125-129. [DOI: 10.1016/b978-0-323-87584-4.00024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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45
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Abd-Elsayed A, Chitneni A. Basivertebral nerve ablation. Vertebral Augmentation Techniques 2024:83-88. [DOI: 10.1016/b978-0-323-88226-2.00018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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46
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Abbasi HR, Abd-Elsayed A, Storlie NR. Laminotomy. Decompressive Techniques 2024:67-75. [DOI: 10.1016/b978-0-323-87751-0.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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47
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Abd-Elsayed A, Fishman MA, Larson L. Measuring outcomes. Radiofrequency Ablation Techniques 2024:209-212. [DOI: 10.1016/b978-0-323-87063-4.00028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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48
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Abbasi HR, Abd-Elsayed A, Aiyer R, Budwany R, Engle A, Hussain N, Kodsy M, Naji M, Navalgund YA, Patel AM, Robinson C, Schupper AJ, Speer J, Steinberger JM, Storlie NR, Tanios M. Contributors. Decompressive Techniques 2024:vi-vii. [DOI: 10.1016/b978-0-323-87751-0.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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49
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Abd-Elsayed A, Beal C, Brenner BR, Budwany R, D’Souza RS, Darji J, Ericson T, Falowski SM, Fishman MA, Gupta M, Gyorfi M, Habibi B, Hamamoto J, Kim C, Kohan L, Olsen A, Singla P, Viswanath O. Contributors. Spinal Fusion Techniques 2024:vi-vii. [DOI: 10.1016/b978-0-323-88223-1.00005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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50
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Speer J, Tanios M, Kodsy M, Abd-Elsayed A. Cervical and lumbar foraminotomy for the management of chronic radicular back pain. Decompressive Techniques 2024:62-66. [DOI: 10.1016/b978-0-323-87751-0.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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