scholarly journals Long-Term Outcomes in the Management of Central Neuropathic Pain Syndromes: A Prospective Observational Cohort Study

2018 ◽  
Vol 45 (5) ◽  
pp. 545-552 ◽  
Author(s):  
Michael D. Staudt ◽  
Alexander John Clark ◽  
Allan S. Gordon ◽  
Mary E. Lynch ◽  
Pat K. Morley-Forster ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Primary Outcome ◽  
Data Sets ◽  
Long Term Outcomes ◽  
Peripheral Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Pain Syndromes ◽  
Observational Cohort

AbstractBackground:Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, traumatic spinal cord injury, or multiple sclerosis. These syndromes are distinctly less common than peripheral neuropathic pain, and less is known regarding the underlying pathophysiology, appropriate pharmacotherapy, and long-term outcomes. The objective of this study was to determine the long-term clinical effectiveness of the management of central neuropathic pain relative to peripheral neuropathic pain at tertiary pain centers.Methods:Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified for analysis from a prospective observational cohort study of patients with chronic neuropathic pain recruited from seven Canadian tertiary pain centers. Data regarding patient characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome measure was the composite of a reduction in average pain intensity and pain interference. Secondary outcome measures included assessments of function, mood, quality of life, catastrophizing, and patient satisfaction.Results:At 12-month follow-up, 13.5% (95% confidence interval [CI], 5.6-25.8) of patients with central neuropathic pain and complete data sets (n=52) achieved a ≥30% reduction in pain, whereas 38.5% (95% CI, 25.3-53.0) achieved a reduction of at least 1 point on the Pain Interference Scale. The proportion of patients with central neuropathic pain achieving both these measures, and thus the primary outcome, was 9.6% (95% CI, 3.2-21.0). Patients with peripheral neuropathic pain and complete data sets (n=463) were more likely to achieve this primary outcome at 12 months (25.3% of patients; 95% CI, 21.4-29.5) (p=0.012).Conclusion:Patients with central neuropathic pain syndromes managed in tertiary care centers were less likely to achieve a meaningful improvement in pain and function compared with patients with peripheral neuropathic pain at 12-month follow-up.

scholarly journals A.02 Long-term outcomes in the management of central neuropathic pain syndromes

2018 ◽  
Vol 45 (s2) ◽  
pp. S9-S9
Author(s):  
MD Staudt ◽  
AJ Clark ◽  
AS Gordon ◽  
ME Lynch ◽  
PK Morley-Forster ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Primary Outcome ◽  
Pain Interference ◽  
Peripheral Neuropathic Pain ◽  
Central Neuropathic Pain ◽  
Pain Syndromes ◽  
Cord Injury ◽  
Patient Reported

Background: Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, spinal cord injury, or multiple sclerosis. These syndromes are much less common than peripheral etiologies, with less known regarding optimal treatment. The objective of this study was to determine the long-term clinical effectiveness of the management of central relative to peripheral neuropathic pain at tertiary pain centers. Methods: Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified from a prospective observational cohort from seven Canadian tertiary centers. Data regarding patient -characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome was the composite of reduced average pain intensity and pain interference. Secondary outcomes included assessments of function, mood, and quality-of-life. Results: At 12-month follow-up, 13.5% (95%CI,5.6-25.8) of patients achieved ≥30% reduction in pain, whereas 38.5% (95%CI,25.3-53.0) achieved a ≥1 point reduction in pain interference; 9.6% (95%CI,3.2-21.0) of patients achieving both these measures. Patients with peripheral neuropathic pain were more likely to achieve this primary outcome at 12-months (25.3% of patients; 95%CI,21.4-29.5) (p=.012). Conclusions: Patients with central neuropathic pain were less likely to achieve a meaningful improvement in pain and function compared to patients with peripheral neuropathic pain at 12-month follow-up.

"Post-Pulmonary Embolism Syndrome" after a First Episode of PE: Results of the E.L.O.P.E. Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 650-650 ◽  
Author(s):  
Susan R Kahn ◽  
Andrew Hirsch ◽  
Margaret Beddaoui ◽  
Arash Akaberi ◽  
David Anderson ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Primary Outcome ◽  
Walking Distance ◽  
Long Term Outcomes ◽  
Exercise Limitation ◽  
Sf 36 ◽  
Male Sex ◽  
Acute Pe

Abstract Background: Most pulmonary embolism (PE) research has focused on acute and short-term outcomes such as mortality and PE recurrence. Whether long-term morbidity such as exercise limitation, impaired quality of life (QOL) and persistent dyspnea occurs after PE is largely unstudied. To address this knowledge gap, we performed the ELOPE study, a prospective, observational, multicenter cohort study of long-term outcomes after acute PE (www.clinicaltrials.gov NCT01174628). Objectives: The objectives of the ELOPE (Evaluation of Long-term Outcomes after PE) Study were: (1) to describe and quantify degree of exercise limitation, QOL impairment and persistent dyspnea at 1 year after PE; and (2) to identify predictors of poor functional status at 1 year. Methods: Patients ≥18 years old with a 1st episode of acute PE diagnosed within the previous 10 days screened at 5 Canadian recruiting centers were potentially eligible to participate. Exclusion criteria were subsegmental-only PE, preexisting severe cardiopulmonary comorbidity, previous proximal DVT, contraindication to CT pulmonary angiography (CTPA), life expectancy <1 year, unable to read questionnaire in English and French or to attend follow-up visits, and unable or unwilling to consent. After the Baseline (B) visit, patients attended follow-up (FU) visits at 1, 3, 6 and 12 months to measure QOL (SF-36, PEmbQoL), dyspnea (UCSD SOBQ), and 6-minute walk test (6MWT) [all FU visits]; undergo CTPA [B, 12], echocardiogram [B, 12], Q scan [6, 12], cardiopulmonary exercise testing (CPET) [1, 12] and pulmonary function tests [1, 12]; and measure biomarkers (BNP, ddimer, troponin) [B, 6]. The primary study outcome was maximal aerobic capacity defined by peak oxygen uptake (VO2) as a percent of predicted maximal VO2 (VO2max) on 1-year CPET, with <80% predicted VO2max considered abnormal, as per American Thoracic Society guidelines. For the present analysis, we summarized demographic and clinical characteristics of study subjects, the proportion of patients with VO2max <80% predicted on 1 year CPET (primary outcome), and compared mean QOL and dyspnea scores in patients with vs. without the primary outcome. Multivariate logistic regression analyses were done to identify demographic, clinical and functional predictors of abnormal VO2max at 1 year, with adjustment for relevant confounding variables. Results: 984 patients were screened for participation; of these, 150 were eligible and 100 (67%) consented to participate. Mean (SD) age was 50 (15) years, 57% were male, 80% were outpatients and 33% had concomitant DVT. PE was provoked in 21% and unprovoked in 79%; none were cancer-related. At 1 year, 40/86 (46.5%) of patients had <80% predicted VO2max on CPET; these patients had worse 1-year SF-36 MCS (mental) (p=0.002) and PCS (physical) (p=0.009) scores, PEmbQoL scores (p=0.002) and SOBQ scores (p=0.003), compared to patients with >80% predicted VO2max at 1 year. Independent baseline predictors of abnormal VO2max at 1 year included: male sex (relative risk (RR)= 3.2 [95% CI 1.3-8.1]; p=0.015), age (RR 0.98 [95% CI 0.96-0.99] per 1 year age increase; p=0.002), BMI (RR 1.1 [95% CI 1.01-1.2] per 1 kg/m2 BMI increase; p=0.023), and smoker (RR 1.8 [95% CI 1.1-2.9]; p=0.023). In addition, VO2max <80% predicted at 1 month and 6MWT distance at 1 month were significantly associated with risk of abnormal VO2max at 1 year (RR 3.8 [95% CI 1.9-7.2; p<0.0005] and RR 0.82 [95% CI 0.7-0.9; p=0.001] per 30m increased walking distance, respectively). Inpatient status at enrolment, previous lung disease, unprovoked vs. provoked PE, concurrent DVT, and number of days with symptoms before PE diagnosis did not influence VO2max at 1 year. Conclusions: PE is a common and serious cardiovascular illness, yet clinically relevant information on characteristics and determinants of long-term outcome after PE have been lacking. Results of the ELOPE Study indicate that almost half of PE patients can be considered to have a "post-PE syndrome" characterized by exercise limitation at 1 year, which influences their QOL and degree of dyspnea. Predictors of this post-PE syndrome include male sex, younger age, higher BMI and smoking. CPET testing or 6MWT testing at 1 month may help to identify patients with a higher risk of post-PE syndrome at 1 year. Funding: Canadian Institutes of Health Research (MOP-93627) Disclosures Wells: Bayer: Honoraria; BMS/Pfizer: Research Funding.

scholarly journals Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

2020 ◽  
Vol 184 (1) ◽  
pp. 173-183
Author(s):  
Shan S. Qiu ◽  
Tim Pruimboom ◽  
Anouk J. M. Cornelissen ◽  
Rutger M. Schols ◽  
Sander M. J. van Kuijk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Primary Outcome ◽  
Lymphatic Drainage ◽  
Long Term Outcomes ◽  
Compression Garments

Abstract Purpose Lymphedema is a debilitating condition that significantly affects patient’s quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema. Methods A single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the Lymph-ICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes. Results One hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group. Conclusions LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented.

scholarly journals Biodegradable polymer drug eluting stents versus durable polymer drug eluting stents for percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Kheifets ◽  
A Levi ◽  
T Bental ◽  
L Perl ◽  
P Codner ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Outcome ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Long Term Outcomes ◽  
Durable Polymer ◽  
Percutaneous Coronary ◽  
Drug Eluting

Abstract Background Invasive angiography with subsequent revascularization is a widely used treatment method in patients with coronary heart disease. Although biodegradable polymer drug eluting stents (BP-DES) have been used for almost a decade now, clinical trials regarding their long-term outcomes are both sparse and inconsistent. We aimed to compare the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with BP-DES versus durable polymer drug eluting stents (DP-DES). Methods Among 11,517 PCIs with second generation drug eluting stents preformed in our institution between 2007 and 2019, we identified 8042 procedures performed using DP-DES and 3475 using BP-DES. The primary outcome was the composite of all-cause mortality, recurrent myocardial infarction (re-MI), target vessel revascularization (TVR) and coronary artery bypass grafting (CABG). Propensity score matching was used to create a well-balanced cohort. Results Mean follow up was 4.8 years. Of the 3,413 matched pairs, 21% were females, and the mean age was 66. At one year, the primary outcome occurred in 9.6% patients versus 8.3% (p=0.05), and TVR rate was 4.1% versus 3% (p=0.005) in patients with DP-DES and BP-DES respectively. Within 5 years, the primary outcome occurred in in 24.9% versus 24.8% (p=0.83), and the rate of TVR was 9.8% versus 9.1% (p=0.07) in patients with DP-DES and BP-DES respectively. Conclusions Similar rates of the composite outcome were observed throughout the entire follow-up. TVR rates were lower in the DP-DES group at 1-year but equalized within 5 years. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Excision of elongated cervix during reconstructive surgery in patients with pelvic organ prolapse – pro et contra

2019 ◽  
Vol 4 (3) ◽  
pp. 34-40
Author(s):  
I. A. Eizenach ◽  
V. V. Vlasova ◽  
V. G. Mozes
Keyword(s):  
Pelvic Organ Prolapse ◽  
Reconstructive Surgery ◽  
Primary Outcome ◽  
Pelvic Organ ◽  
Cervical Length ◽  
Long Term Outcomes ◽  
Cervical Elongation ◽  
Mesh Surgery

Aim. To determine whether the cervical elongation affects long-term outcomes of reconstructive surgery of pelvic organ prolapse.Materials and Methods. We consecutively enrolled 99 patients with grade 2-3 pelvic organ prolapse (Pelvic Organ Prolapse Quantification System) who underwent vaginal mesh surgery. Volume and length of the cervix were measured using vaginal ultrasonography immediately before the surgery. Cervical elongation was defined as cervix > 6 cm in length (n = 55). Upon 1 year of follow-up, we evaluated the primary outcome (pelvic organ prolapse) and secondary outcomes (cervical length and volume).Results. After 1 year of follow-up, cervical elongation was still detected in 18.1% of patients with cervical elongation before the surgery but not in those without (p = 0.008). Dyspareunia was documented in 14.5% and 2.2% of women with and without cervical elongation, respectively (p = 0.034). In patients with cervical elongation, the length of the cervix before the surgery and after 1 year of follow-up was 7.6 (7; 7.9) cm and 8.4 (7.9; 8.9) cm, respectively (p = 0.001); the respective values of cervical volume were 23.7 (23.4; 24.4) cm3 and 26.9 (25.7; 31.9) cm3 , respectively (p = 0.001); however, these differences were insignificant in patients without cervical elongation.Conclusion. Cervical excision may be recommended for the patients with pelvic organ prolapse and concurrent cervical elongation (length of the cervix > 6 cm). Cervical preservation in such patients may lead to progression of the elongation even after the correction of pelvic organ prolapse. 

scholarly journals Acute flaccid myelitis: long-term outcomes recorded in the CAPTURE study compared with paediatric transverse myelitis

2021 ◽  
Vol 3 (1) ◽  
pp. e000127
Author(s):  
Benjamin Greenberg ◽  
Patricia Plumb ◽  
Gary Cutter ◽  
Janet Dean ◽  
Allen Desena ◽  
...  
Keyword(s):  
Transverse Myelitis ◽  
Motor Deficits ◽  
Long Term Outcomes ◽  
Radiographic Findings ◽  
Acute Flaccid Myelitis ◽  
Restricted Form ◽  
The Usa ◽  
Observational Cohort

BackgroundSince 2014, the USA has documented three outbreaks of acute flaccid myelitis (AFM). Unique features and treatment responses of this myelitis variant have not been prospectively studied. This study prospectively measured outcomes in paediatric myelitis patients relative to treatments.MethodsThis was a prospective, multicentre, non-randomised, observational cohort study. The study duration was 5 years and the length of follow-up was 1 year. This study collected data from children and families in North America. Patients were enrolled at academic centres with expertise in myelitis or online via a web portal. Paediatric patients diagnosed with myelitis were eligible for enrolment in the study within 6 months of onset of symptoms. Patients were characterised as transverse myelitis (TM) or the AFM variant based on clinical and radiographic findings.ResultsThe cohort of 90 patients included patients with AFM and TM. Of the 51 patients with AFM there was evidence of two clinically relevant patterns. This included a grey matter restricted form of AFM and a cohort with concomitant white matter that could explain lower extremity motor deficits in patients with lesions restricted to the cervical spine. The improvement in deficits with the use of corticosteroids was similar to what was observed in the TM cohort (p=0.97).ConclusionsClinicians should consider on a case by case basis the approach to therapy for AFM patients. Prospective controlled studies of long-term outcomes would be useful in this growing patient population.

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