Stereotactic Radiosurgery for the Treatment of Chronic Intractable Pain: A Systematic Review

2017 ◽  
Vol 13 (5) ◽  
pp. 543-551 ◽  
Author(s):  
Dustin G. Roberts ◽  
Nader Pouratian
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Stereotactic Radiosurgery ◽  
Clinical Success ◽  
Controlled Vocabulary ◽  
Intractable Pain ◽  
Patients With Cancer ◽  
Short And Long Term

Abstract BACKGROUND: Since the advent of neuromodulation, the role and efficacy of stereotactic radiosurgery (SRS) for chronic pain has not been carefully scrutinized. OBJECTIVE: To perform a systematic review to evaluate the clinical efficacy, both short- and long-term, of SRS for the treatment of chronic intractable pain. METHODS: A systematic search in PubMed, Web of Science, and PsycINFO was performed using keywords and controlled vocabulary. The search included peer-reviewed articles reporting clinical outcomes of SRS for chronic pain with a minimum 3-mo follow-up for nonmalignant and 1 mo for malignant pain. RESULTS: Six articles (113 patients) were evaluated on the basis of radiation target (thalamus vs pituitary) and pain etiology (malignant vs nonmalignant). Across studies, at least 35% of patients were reported to have lasting significant pain relief. By cohort, clinical success was achieved in 51% of pituitary SRS, at least 23% of thalamic SRS, 39% of nonmalignant, and at least 33% of malignant pain patients. Adverse events were noted in 21% of patients; the majority related to hormonal deficits from pituitary SRS. CONCLUSION: Despite decreased utilization, SRS is effective for select patients with chronic pain and is associated with an acceptable complication rate. Pituitary SRS is superior in patients with cancer-related pain (87% success), while thalamic SRS is superior in patients with nonmalignant pain (65% success). Because reports of SRS for pain largely stem from a period before the common use of neuromodulatory and intrathecal therapies, the efficacy in patients who fail such therapies remains unclear and requires further characterization.

scholarly journals Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available

Cartilage ◽  
2020 ◽  
pp. 194760352094294
Author(s):  
Mylène P. Jansen ◽  
Tim A.E.J. Boymans ◽  
Roel J.H. Custers ◽  
Rutger C.I. Van Geenen ◽  
Ronald J. Van Heerwaarden ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Joint ◽  
Structural Parameters ◽  
Meta Analysis ◽  
Tibial Osteotomy ◽  
Control Groups ◽  
Joint Distraction ◽  
Short And Long Term

Objective Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD. Design MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. Results Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response. Conclusions Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.

scholarly journals Analysis of a 10-year period of lead removal in a referral centre

2020 ◽  
Vol 31 (2) ◽  
pp. 166-173
Author(s):  
Rita Marinheiro ◽  
José Pedro Neves ◽  
Francisco Morgado ◽  
Márcio Madeira ◽  
Pedro Magro ◽  
...  
Keyword(s):  
Open Surgery ◽  
Heart Surgery ◽  
Clinical Success ◽  
Open Heart Surgery ◽  
Lead Extraction ◽  
Lead Removal ◽  
Long Term Follow Up ◽  
Short And Long Term

Abstract OBJECTIVES Our goal was to analyse all lead extraction procedures (transvenous or open surgery) performed in our centre and the short- and long-term follow-up data from these patients. METHODS All lead extractions performed from 2008 to 2017 were retrospectively reviewed for patient characteristics and indications for device implantation; indications for lead extraction; techniques used; peri- and postprocedural complications and short- and long-term follow-up data. RESULTS A total of 159 patients (282 leads) were included [age 70 (62–78) years; 72% men]. The median follow-up time was 57 (25–90) months. Patients with lead explants were excluded. The most common indication for lead removal was infection (77%). A surgical approach was necessary in 14 patients (9%) owing to unsuccessful transvenous removal (n = 3), large vegetation in the lead (n = 4), concomitant valvular endocarditis (n = 2), other indications for open surgery (n = 4) and complicated transvenous removal (n = 1). Removal was tried for 282 leads. Of those, 256 were completely removed. Clinical success was achieved in 155 individual patients (98%). Complications occurred in 6 patients: 3 persistent infections, 1 stroke and 2 blood vessel ruptures. The procedure-related mortality rate was 2% (n = 3). CONCLUSIONS Lead removal was associated with a high success rate and low all-cause complication and mortality rates. Emergency surgery because of acute complications was rare, and open-heart surgery was most frequently elective and not associated with a worse outcome.

scholarly journals Short- and long-term follow-up outcomes of patients with Brucella endocarditis: a systematic review of 207 Brucella endocarditis Cases

Bioengineered ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 5162-5172
Author(s):  
Xiufeng Li ◽  
Tan Wang ◽  
Yuanzhi Wang ◽  
Songsong Xie ◽  
Wenbo Tan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Long Term Follow Up ◽  
Short And Long Term

scholarly journals Long-term and serious harms of medical cannabis and cannabinoids for chronic pain: A systematic review of non-randomized studies

2021 ◽  
Author(s):  
Dena Zeraatkar ◽  
Matthew Cooper ◽  
Arnav Agarwal ◽  
Robin Vernooij ◽  
Gareth Leung ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Adverse Events ◽  
Cochrane Central Register ◽  
Medical Cannabis ◽  
Management Options ◽  
Serious Adverse Events ◽  
Randomized Studies

Objective: To establish the risk and prevalence of long-term and serious harms of medical cannabis and cannabinoids for chronic pain. Design: Systematic review and meta-analysis. Data sources: MEDLINE, EMBASE, PsycInfo, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 1, 2020. Study selection: Non-randomized studies reporting on harms of medical cannabis or cannabinoids in people living with chronic pain with ≥4 weeks of follow-up. Data extraction and synthesis: A parallel guideline panel provided input on the design and interpretation of the systematic review, including selection of adverse events for consideration. Two reviewers, working independently and in duplicate, screened the search results, extracted data, and assessed risk of bias. We used random-effects models for all meta-analyses and the GRADE approach to evaluate the certainty of evidence. Results: We identified 39 eligible studies that enrolled 12,143 patients with chronic pain. Very low certainty evidence suggests that adverse events are common (prevalence: 26.0%; 95% CI 13.2 to 41.2) among users of medical cannabis or cannabinoids for chronic pain, particularly any psychiatric adverse events (prevalence: 13.5%; 95% CI 2.6 to 30.6). However, very low certainty evidence indicates serious adverse events, adverse events leading to discontinuation, cognitive adverse events, accidents and injuries, and dependence and withdrawal syndrome are uncommon and typically occur in fewer than one in 20 patients. We compared studies with <24 weeks and ≥ 24 weeks cannabis use and found more adverse events reported among studies with longer follow-up (test of interaction p < 0.01). Palmitoylethanolamide was usually associated with few to no adverse events. We found insufficient evidence addressing the harms of medical cannabis compared to other pain management options, such as opioids. Conclusions: There is very low certainty evidence that adverse events are common among people living with chronic pain who use medical cannabis or cannabinoids, but that few patients experience serious adverse events. Future research should compare long-term and serious harms of medical cannabis with other management options for chronic pain, including opioids.

scholarly journals Anterior Cingulotomy for the Treatment of Chronic Intractable Pain: A Systematic Review

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. 537-550
Author(s):  
Nader Pouratian
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Adverse Effects ◽  
Key Words ◽  
Case Reports ◽  
Individual Case ◽  
Emotional Reaction ◽  
Controlled Vocabulary ◽  
Personality Change ◽  
Intractable Pain

Background: Anterior cingulotomy for chronic pain aims to modulate patients’ attention or emotional reaction to pain rather than to modulate pain intensity. Objectives: To evaluate the clinical efficacy, both short- and long-term, of anterior cingulotomy in the treatment of chronic pain. Study Design: Systematic review. Setting: This systematic review assessed studies reporting anterior cingulotomy for the treatment of chronic pain. Methods: A systematic search of Web of Science, Scopus, PubMed, and PsychINFO was performed using both key words and controlled vocabulary. Articles included in this review included peerreviewed articles describing clinical outcomes or efficacy of cingulotomy in the treatment of chronic pain with minimum follow-up of 3 months for non-malignant and 2 weeks for malignant pain. Articles reporting cingulectomies or cingulotomy only as combined with other ablative procedures were excluded, as were individual case reports. Results: A total of 11 articles encompassing 224 patients are included in the review, with age ranging 22 to 85 (mean: 56) years at the time of the operation, 59% of which were men. Greater than 60% of patients across all studies were reported to have significant pain relief post-operatively as well as at one year after surgery. Common transient adverse effects included urinary incontinence and confusion/disorientation, subsiding within days postoperatively. Serious/permanent adverse effects included seizure in less than 5%, hemiparesis in less than 1%, and personality change in less than 1% of operations reported across all studies, all of which occurred primarily in operations where magnetic resonance (MR)-guidance was not used. Limitations: The limitations of this systematic review include the lack of studies other than observational reports and the inevitable heterogeneity between included studies. Conclusions: Despite decreased utilization in recent years, anterior cingulotomy is an effective neurosurgical intervention in the treatment of pain and carries little risk of permanent or serious adverse effects. Key words: Anterior cingulotomy, chronic pain, stereotaxis, systematic review, pain, cingulate gyrus, cingulotomy, intractable pain

scholarly journals The Prevalence of Suicidal Ideation after the Earthquake: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Katayoun JAHANGIRI ◽  
Kosar YOUSEFI ◽  
Aliashraf MOZAFARI ◽  
Ali SAHEBI
Keyword(s):  
Systematic Review ◽  
Suicidal Ideation ◽  
Suicide Ideation ◽  
Meta Analysis ◽  
Recovery Phase ◽  
Psychological Consequences ◽  
Short And Long Term

Background: Disasters have many health consequences such as suicide ideation as one of the relatively common psychological consequences after natural disasters, especially earthquakes. This study aimed to determine the prevalence of post-earthquake suicidal ideation in affected people. Methods: Related keywords of this systematic review and meta-analysis in English and their Persian equivalents were searched in the data resources including Google Scholar, SID, Magiran, Scopus, PubMed, and Web of Science from Jan 2014 to May 2019. The STROBE checklist was used to evaluate the quality of the articles. The I 2 index was used to determine the heterogeneity and the random-effects model was used in meta-analysis. Statistical analysis was conducted in the STATA software version 14. Results: Overall, 14347 subjects including 6662 males and 7715 females with the mean age of 23.88 ± 15.81yr old were assessed. The prevalence of post-earthquake suicidal ideation was 20.34% (95% CI: 13.60-27.08, P<0.001, I2=99.1). The prevalence of suicidal ideation showed a decreasing trend based on the year of the study and the duration of post-earthquake follow-up. Conclusion: Although the prevalence of post-earthquake suicidal ideation showed a decreasing trend, the probability of incidence of these thoughts in the long-term is still noticeable. Therefore, implementing a surveillance system is recommended to monitor the mental health status of earthquakes survivors for the possibility of suicidal thoughts in the short and long term recovery phase.

Short- and Long-Term Results of Total vs Subtotal Thyroid- ectomies in the Surgical Treatment of Graves' Disease

Swiss Surgery ◽  
2001 ◽  
Vol 7 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Robert ◽  
Mariéthoz ◽  
Pache ◽  
Bertin ◽  
Caulfield ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Long Term Results ◽  
Graves Disease ◽  
Laryngeal Nerve Palsy ◽  
Short And Long Term

Objective: Approximately one out of five patients with Graves' disease (GD) undergoes a thyroidectomy after a mean period of 18 months of medical treatment. This retrospective and non-randomized study from a teaching hospital compares short- and long-term results of total (TT) and subtotal thyroidectomies (ST) for this disease. Methods: From 1987 to 1997, 94 patients were operated for GD. Thirty-three patients underwent a TT (mostly since 1993) and 61 a ST (keeping 4 to 8 grams of thyroid tissue - mean 6 g). All patients had received propylthiouracil and/or neo-mercazole and were in a euthyroid state at the time of surgery; they also took potassium iodide (lugol) for ten days before surgery. Results: There were no deaths. Transient hypocalcemia (< 3 months) occurred in 32 patients (15 TT and 17 ST) and persistent hypocalcemia in 8 having had TT. Two patients developed transient recurrent laryngeal nerve palsy after ST (< 3 months). After a median follow-up period of seven years (1-15) with five patients lost to follow-up, 41 patients having had a ST are in a hypothyroid state (73%), thirteen are euthyroid (23%), and two suffered recurrent hyperthyroidism, requiring completion of thyroidectomy. All 33 patients having had TT - with follow-ups averaging two years (0.5-8) - are receiving thyroxin substitution. Conclusions: There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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