Cognitive behavioral therapy for managing depressive and anxiety symptoms after brain injury: a meta-analysis.

BACKGROUND: Individuals with traumatic brain injury (TBI) are at increased risk of depression and anxiety, leading to impaired recovery. While cognitive-behavioral therapy (CBT) addresses anxiety and depression maintenance factors, its efficacy among those with TBI has not been clearly demonstrated. This review aims to bridge this gap in the literature. METHODS: Several databases, including Medline, PsycInfo and EMBASE, were used to identify studies published between 1990 and 2021. Studies were included if: (1) trials were randomized controlled trials (RCT) involving CBT-based intervention targeting anxiety and/or depression; (2) participants experienced brain injury at least 3-months previous; (3) participants were ≥18 years old. An SMD ± SE, 95% CI and heterogeneity were calculated for each outcome. RESULTS: Thirteen RCTs were included in this meta-analysis. The pooled-sample analyses suggest that CBT interventions had small immediate post-treatment effects on reducing depression (SMD ± SE: 0.391 ± 0.126, p < 0.005) and anxiety (SMD ± SE: 0.247 ± 0.081, p < 0.005). Effects were sustained at a 3-months follow-up for depression. A larger effect for CBT was seen when compared with supportive therapy than control. Another sub-analysis found that individualized CBT resulted in a slightly higher effect compared to group-based CBT. CONCLUSION: This meta-analysis provides substantial evidence for CBT in managing anxiety and depression post-TBI.

Parasagittal needle placement approach for lumbar medial branch denervation: a brief technical report.

Radiofrequency denervation of lumbar medial branches is a viable treatment option to manage chronic facetogenic low back pain. Traditionally, lumbar medial branch denervation involves placement of the electrode's active tip at a 20-degree angulation away from the parasagittal plane. However, more recent anatomical studies have provided evidence supporting the feasibility of an alternative parasagittal approach targeting the posterior half of the lateral neck of the superior articular process to capture the lumbar medial branches. Currently, there is a lack of clinical data on the effectiveness of the alternative parasagittal needle placement technique. Therefore, in this brief technical report, the parasagittal needle placement technique and the pain relief outcomes in four consecutive patients following treatment with the parasagittal approach are described.

Quantification of needle angles for lumbar medial branch denervation targeting the posterior half of the superior articular process: an osteological study.

BACKGROUND: Lumbar medial branch radiofrequency ablation (RFA) is a common intervention to manage chronic axial low back pain originating from the facet joints. A more parasagittal approach targeting the posterior half of the lateral neck of superior articular process (SAP) was previously proposed. However, specific needle angles to achieve parallel placement at this target site have not been investigated. OBJECTIVE: To quantify and compare the needle angles, on posterior and lateral views, to achieve parallel placement of electrodes along the medial branch at the posterior half of the lateral neck of SAP at each lumbar vertebral level (L1-L5) and sacrum. DESIGN: Osteological Study. METHODS: Twelve disarticulated lumbosacral spines (n = 72 individual bones) were used in this study. Needles were placed along the periosteum of the posterior half of the lateral neck of SAP, bilaterally and photographed. Mean needle angles for each vertebral level (L1-L5) and sacrum were quantified, and statistical differences were analyzed. RESULTS: The posterior view provided the degrees of lateral displacement from the parasagittal plane (abduction angle), while the lateral view provided the degrees of declination (cranial-to-caudal angle) of the needle. Mean needle angles at each level varied, ranging from 5.63 ± 5.76° to 14.50 ± 14.24° (abduction angle, posterior view) and 40.17 ± 7.32° to 64.10 ± 9.73° (cranial-to-caudal angle, lateral view). In posterior view, a < 10-degree needle angle interval was most frequently identified (57.0% of needle placements). In lateral view, the 40-50-degree (L1-L2), 50-60-degree (L3-L5), and 60-70-degree (sacrum) needle angle intervals occurred most frequently (54.2%, 50.0%, and 41.7% of needle placements, respectively). CONCLUSIONS: Targeting the posterior half of the lateral neck of SAP required <10-degree angulation from parasagittal plane in majority of cases. However, variability of needle angles suggests a standard "one-size-fits-all" approach may not be the optimal technique.

The effect of neuropathic pain treatments on pain interference following spinal cord injury: A systematic review.

CONTEXT: Neuropathic pain is a common and debilitating condition following SCI. While treatments for neuropathic pain intensity have been reviewed, the impact on pain interference has not been summarized. OBJECTIVE: To systematically review the effect of neuropathic pain interventions on pain interference in individuals with spinal cord injury. METHODS: This systematic review included randomized controlled trials and quasi-experimental (non-randomized) studies which assessed the impact of an intervention on pain interference in individuals with spinal cord injury and neuropathic pain. Articles were identified by searching MEDLINE (1996 to April 11, 2022), EMBASE (1996 to April 11, 2022), PsycInfo (1987 to April, week 2, 2022). Studies were assessed for methodologic quality using a modified GRADE approach and were given quality of evidence (QOE) scores on a 4-point scale ranging from very low to high. RESULTS: Twenty studies met the inclusion criteria. These studies fell into the following categories: anticonvulsants (n = 2), antidepressants (n = 1), analgesics (n = 1), antispasmodics (n = 1), acupuncture (n = 2), transcranial direct current stimulation (n = 1), active cranial electrotherapy stimulation (n = 2), transcutaneous electrical nerve stimulation (n = 2), repetitive transcranial magnetic stimulation (n = 1), functional electrical stimulation (n = 1), meditation and imagery (n = 1), self-hypnosis and biofeedback (n = 1), and interdisciplinary pain programs (n = 4). CONCLUSION: When considering studies of moderate to high quality, pregabalin, gabapentin, intrathecal baclofen, transcranial direct current stimulation, and transcutaneous electrical nerve stimulation (in 1 of 2 studies) were shown to have beneficial effects on pain interference. However, due to the low number of high-quality studies further research is required to confirm the efficacy of these interventions prior to recommending their use to reduce pain interference.

Internet-based sexual health resources for those living with spinal cord injury: A content analysis.

CONTEXT: Spinal cord injuries (SCIs) disrupt physiological functioning which can significantly impact sexuality. Those with SCI may rely heavily on Internet sexual health resources for many reasons. Evaluation of current internet health resources is warranted to identify the gaps in the literature. OBJECTIVES: The aim of this study was to conduct a purposive review of available Internet sexual health resources for those with SCI. METHODS: A Google search was completed with search terms such as: "SCI and sexual functioning", "SCI and sexuality", "SCI and pregnancy" and "SCI and sexual pleasure". Resources were selected if they: (1) provided sexual health education to those with SCI; (2) were designed to increase skills-based learning or influence attitudes and beliefs; and (3) in English language. All identified resources were imported to NVivo 1.5.1 where a thematic content analysis was conducted. RESULTS: The search resulted in 123 resources meeting the criteria. The most common themes included: Sexual functioning (in 83.7% of resources), Reproductive health (67.5%) and Impact of Secondary Complications (61.8%). The least common themes were Psychosocial (24.4%), Stigma (13.8%), and Quality of Life (12.2%). No information was coded for LGBTQ+. DISCUSSION: Sexual health and SCI information focuses primarily on heterosexual males and specifically on sexual functioning. Resources addressing female sexuality were extremely limited and focused largely on reproduction. There was a complete absence of resource aimed to address LGBTQ+ people. CONCLUSION: The results demonstrate a need for Internet-based sexual health education resources to meet the needs of diverse individuals including women and gender non-conforming people.

The potential effects of untreated sleep-related breathing disorders on neuropathic pain, spasticity, and cardiovascular dysfunction following spinal cord injury: A cross-sectional prospective study protocol.

INTRODUCTION: Sleep-related breathing disorders (SRBDs), neuropathic pain, spasticity and cardiovascular autonomic dysfunction are common after spinal cord injury (SCI). Prior studies suggest that systemic inflammation following SCI may be implicated in the development of neuropathic pain, spasticity and cardiovascular dysfunction. Given that SRBDs also cause a systemic inflammatory response, we hypothesized that individuals with SCI who develop more severe SRBDs would experience more intense neuropathic pain, more severe spasticity and more significant cardiovascular autonomic dysfunction. METHODS: This cross-sectional prospective study will explore the previously understudied hypothesis that SRBDs are associated with increased neuropathic pain, spasticity, and cardiovascular autonomic dysfunction in adult individuals with low-cervical/high-thoracic (injury level at C5 to T6), complete/incomplete (ASIA Impairment Scale A, B, C or D) SCI. DISCUSSION: To our knowledge, no prior study has addressed this clinically relevant question on whether the degree of SRBDs affects the intensity of neuropathic pain, spasticity, and cardiovascular autonomic dysfunction in individuals with SCI. We anticipate that the results of this original study will provide key information for a future clinical trial on the use of continuous positive airway pressure (CPAP) therapy for moderate-to-severe SRBDs, which may better control neuropathic pain, spasticity, and cardiovascular autonomic dysfunction among individuals with SCI. TRIAL REGISTRATION: The research protocol for this study was registered in the ClinicalTrials.gov website (NCT05687097). https://clinicaltrials.gov/ct2/show/NCT05687097.

Quantification of Needle Angles for Traditional Lumbar Medial Branch Radiofrequency Ablation: An Osteological Study.

BACKGROUND: Clinical outcomes following lumbar medial branch radiofrequency ablation (RFA) have been inconsistent. One possible reason is less-than-optimal placement of the electrode along the medial branch at the lateral neck of superior articular process (SAP). Needle angles that define optimal placement (i.e., parallel to the medial branch) may be helpful for consistent technical performance of RFA. Despite its importance, there is a lack of anatomical studies that quantify RFA needle placement angles. OBJECTIVE: To quantify and compare needle angles to achieve parallel placement along the medial branch as it courses on the middle two-quarters of the lateral neck of the SAP at the L1-L5 vertebrae. DESIGN: Osteological Study. METHODS: Ten lumbar vertebral columns were used in this study. Needles were placed along the periosteum of the middle two-quarters of the lateral neck of SAP. Mean needle angles for L1-L5 were quantified and compared using posterior (n = 100) and lateral (n = 100) photographs. RESULTS: Mean needle angles varied ranging from 29.29 ± 17.82° to 47.22 ± 16.27° lateral to the parasagittal plane (posterior view) and 33.53 ± 10.23° to 49.19 ± 10.69° caudal to the superior vertebral endplate (lateral view). Significant differences in mean angles were found between: L1/L3 (P = .008), L1/L4 (P = .003), and L1/L5 (P = .040) in the posterior view and L1/L3 (P = .042), L1/L4 (P < .001), L1/L5 (P < .001), L2/L4 (P = .004), and L2/L5 (P = .004) in lateral view. CONCLUSIONS: Variability of needle angles suggest a standard "one-size-fits-all" approach may not be the optimal technique. Future research is necessary to determine optimal patient-specific needle angles from a more detailed and granular analysis of fluoroscopic landmarks.

Online psychosocial intervention for persons with spinal cord injury: A meta-analysis.

BACKGROUND: Delivery of psychosocial interventions via the Internet has the potential to overcome barriers and increase access; however, effectiveness is yet to be established among those with spinal cord injury (SCI). METHODS: The objective of this meta-analysis is to evaluate the efficacy of Internet-based psychosocial interventions on the symptoms of anxiety, depression, and pain amongst those with SCI. The databases Medline, PsycInfo, and EMBASE were used to locate studies published between 1990 and December 2020. A study was included if (1) the study involved the application of an online psychosocial intervention; (2) adults with SCI; and (3) reported outcomes on depression and/or anxiety. From each study, participant characteristics and study details were extracted. A standardized mean difference (SMD) ± standard error and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed-effects model. RESULTS: The search yielded 920 studies, of which five were included in the final meta-analysis; It was revealed that Internet-based psychosocial interventions had a small effect on reducing overall anxiety (SMD: 0.42 ± 0.09, p < 0.001) and depression (SMD: 0.41 ± 0.09, p < 0.001) symptoms at the end of the study period. Online psychosocial interventions also had a moderate effect in maintaining reduction of anxiety (SMD: 0.50 ± 0.1, p < 0.001) and depressive (SMD: 0.64 ± 0.10, p < 0.001) symptoms at 3-month follow-up. CONCLUSION: The results of this meta-analysis provide evidence for the use of internet-based psychosocial interventions to manage anxiety and depression symptoms among those with spinal cord injuries.

Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention.

INTRODUCTION: Fluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A detailed understanding of the course of medial branches in relation to bony and soft tissue landmarks is paramount to optimizing lumbar denervation procedures, particularly parallel placement of the radiofrequency electrode. The objectives of this study were to investigate the relationship of medial branches to anatomical landmarks and discuss the implications for lumbar denervation. METHODS: Ten cadaveric specimens were meticulously dissected. The origin, course, and relationship of lumbar medial branches to bony and soft tissue landmarks were documented. RESULTS: The medial branches followed the lateral neck of superior articular process deep to the intertransversarii mediales muscle at each lumbar vertebral level. In all specimens, the medial branches coursed laterally on the anterior half of the neck and transitioned from parasagittal-to-medial on the posterior half to reach the mamillo-accessory notch. The mamillo-accessory ligament was found to not occlude the nerve on the posterior quarter of the lateral neck but rather at the mamillo-accessory notch located at the posterior margin of the superior articular process. DISCUSSION: A detailed understanding of the relationship of medial branches to anatomical landmarks is essential to optimizing needle placement for lumbar denervation procedures. The current study suggests that a parasagittal placement, with increased cranial-to-caudal angulation of the electrode, may improve parallel tip alignment with the targeted medial branch and represent a potential alternative to the traditional technique.

The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord injury: 2021 update.

STUDY DESIGN: Clinical practice guidelines. OBJECTIVES: The objective was to update the 2016 version of the Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI). SETTING: The guidelines are relevant for inpatient, outpatient and community SCI rehabilitation settings in Canada. METHODS: The guidelines were updated in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations. RESULTS: The working group identified and reviewed 46 additional relevant articles published since the last version of the guidelines. The panel agreed on 3 new screening and diagnosis recommendations and 8 new treatment recommendations. Two key changes to these treatment recommendations included the introduction of general treatment principles and a new treatment recommendation classification system. No new recommendations to model of care were made. CONCLUSIONS: The CanPainSCI recommendations for the management of neuropathic pain after SCI should be used to inform practice.

Publication Rate of Presentations at a National Physical Medicine and Rehabilitation Scientific Conference From 2009 to 2018.

ABSTRACT: Conferences are important platforms for sharing research, but full-text publication is necessary for broader dissemination and impact. Few studies have examined the abstract-to-publication rate for physical medicine and rehabilitation. This study aimed to determine the abstract-to-publication rate of research abstracts presented from 2009-2018 at the Canadian Association of Physical Medicine and Rehabilitation annual scientific meetings. Using the official book of abstracts from 2009 to 2018, year of conference, abstract title, author names, and the affiliation/level of training of the first author were extracted. Systematic searches of abstract key words, authors' names, and the abstract title were performed using PubMed and Google Scholar to determine whether an abstract proceeded to full-text publication; if so, the date and journal of publication were extracted. Of the 524 total abstracts presented at the Canadian Association of Physical Medicine and Rehabilitation from 2009 to 2018, 187 went on to full-text publication for an abstract-to-publication rate of 35.8%. The mean time to full-text publication was 23.4 ± 8.63 mos. The abstract-to-publication rate was 18.6% for medical students, 28.7% for residents, 41.1% for physical medicine and rehabilitation consultants, and 49.4% for nonphysician presenters. This study highlights that low abstract-to-publication rates for novel research presented at the Canadian Association of Physical Medicine and Rehabilitation disproportionately affects trainees. Further research is needed to identify and remedy barriers to publication.

A pilot living clinical practice guidelines approach was feasible and acceptable to guideline panel members.

OBJECTIVES: Clinical practice guidelines (CPGs) help to translate best available evidence into clinical practice but can be challenging to keep current due to their resource intensive nature. A "living" process that is used to continually update CPGs may therefore be of value. STUDY DESIGN AND SETTING: This pilot study assesses the development of a living CPG protocol based on the CanPainSCI CPG. Two "living CPG" update searches were performed; resource costs and acceptability were assessed by a research team across Australia and Canada RESULTS: Two updates were completed over 3 years. Literature searches and data extraction were completed by trainees on 119 and 58 papers. Eight papers were included and reviewed by 14 expert panel members. Resource usage included a total 43 hours of screening by trainees at $2,356 (USD), 24 hours of expert panel review at $3,141 (USD) and 30 hours of project management at $3,241 (USD). Reviewers were generally satisfied with the process. All reviewers agreed that incorporating a living guidelines approach would be useful. CONCLUSION: This paper outlines the process of maintaining a CPG through a living guideline process and provides resource costs and acceptability data which may aid stakeholders in the development of future CPGs.

Feasibility of a virtual service delivery model to support physical activity engagement during the COVID-19 pandemic for those with spinal cord injury.

BACKGROUND: The current pandemic has reduced access to safe, monitored physical activity (PA) programs for persons with spinal cord injury (SCI). The use of telerehabilitation has the potential for continuing activity engagement without risking virus exposure. The present study evaluates the feasibility and efficacy of an online group-based PA program for persons with SCI. METHODS: This preliminary pre-post study delivered an online group-based PA program to persons with SCI. The program consisted of 1-hour sessions twice weekly for six weeks. Online PA satisfaction questionnaires were assessed at post-treatment. Psychosocial subscales from the NeuroQOL-SF were assessed. RESULTS: Participants were adult females between 3 and 32 years post-injury, 1 tetraplegic and 3 paraplegics (n = 4). All participants were highly satisfied with the online instruction, overall content, and videoconferencing platform. Participants stated that the online program was beneficial for their overall physical and psychosocial wellbeing. The program resulted in improvement in anxiety and satisfaction with social roles and activities. CONCLUSION: The current pilot study demonstrates the acceptability and limited efficacy of an online PA program for those with SCI. The program resulted in improved overall perceived wellbeing and satisfaction with social roles and activities. These results have important implications for the clinical implementation of online PA programs in a hospital and community setting.

Sacroiliac Joint Diagnostic Block and Radiofrequency Ablation Techniques.

Radiofrequency ablation (RFA) is a potential treatment for those with sacroiliac joint (SIJ) pain. There is no consensus on the optimal procedural techniques for SIJ diagnostic blocks, or RFA. This article describes different techniques for SIJ diagnostic blocks and RFA, including the relevant innervation that underlies these techniques. SIJ RFA techniques differ in important ways, including lesioning techniques, needle placements, and type of RFA cannula used. Clinicians utilize a variety of image guidance modalities for SIJ RFA; fluoroscopic guidance is standard, although endoscopic and ultrasound-guided techniques are described. Additional studies are necessary to delineate potential differences between SIJ RFA techniques.

A Retrospective Cohort Study of Healthcare Utilization Associated with Paravertebral Blocks for Chronic Pain Management in Ontario.

Background: Injections, particularly paravertebral blocks (PVBs), are frequently performed procedures in Ontario, Canada, for the management of chronic pain, despite limited evidence and risk of complications. Aim: This study examines usage patterns of PVBs to evaluate their effects on healthcare utilization and opioid prescribing. Methods: A retrospective cohort study in Ontario using administrative data. Ontario residents receiving their initial PVBs between July 1, 2013 and March 31, 2018 were included. Changes in use of other interventions, physician visits, and opioids were compared to the 12-month periods before and after index PVBs. Data use was authorized under section 45 of Ontario's Personal Health Information Protection Act. Results: 47,723 patients received their initial PVBs in the study period. The rate of index PVBs increased from 1.61 per 10,000 population (2013) to 2.26 per 10,000 (2018). Initial PVBs were performed most commonly by family physicians (N = 25,042), followed by anesthesiologists (N = 14,195). 23,386 patients (49%) received 1 to 9 repeat PVBs in the 12 months after index PVB; 12,474 patients (26.15%) received 10 or more. Use of other nonimage guided interventional pain procedures per patient (mean±SD) increased from 2.19 ± 9.35 to 31.68 ± 52.26 in the year before and after index PVB. Relevant physician visits per patient (mean±SD) also increased from 2.92 ± 3.61 to 9.64 ± 11.77. Mean opioid dosing did not change significantly between the year before and the year after index PVB. Conclusion: PVBs are associated with increases in healthcare utilization and no change in opioid use patterns.

Contexte: Les injections, en particulier les blocs paravertébraux (BPV), sont des procédures fréquemment effectuées en Ontario, Canada, pour la prise en charge de la douleur chronique, malgré des données probantes limitées et le risque de complications.Objectif: Cette étude examine les modes d'utilisation des BPV afin d'évaluer leurs effets sur l'utilisation des soins de santé et la prescription d'opioïdes.Méthodes: Étude de cohorte rétrospective utilisant les données administratives en Ontario. Les résidents de l'Ontario ayant reçu leur BPV initial entre le 1er juillet 2013 et le 31 mars 2018 ont été inclus. Les changements dans l'utilisation des autres interventions, les visites aux médecins et les opioïdes ont été comparés 12 mois avant et 12 mois après les BPV de référence. L'utilisation des données a été autorisée en vertu de la Loi sur la protection des renseignements personnels sur la santé de l'Ontario.Résultats: 47 723 patients ont reçu leur BPV initial au cours de la période étudiée. Le taux de BPV est passé de 1,61 pour 10 000 habitants (2013) à 2,26 pour 10 000 (2018). Les BPV de référence étaient effectués le plus souvent par des médecins de famille (N = 25 042), suivis par les anesthésistes (N = 14 195). 23 386 patients (49 %) ont reçu de 1 à 9 BPV répétés dans les 12 mois suivant le BPV de référence ; 12 474 patients (26,15 %) en ont reçu 10 ou plus. L'utilisation d'autres procédures interventionnelles pour la douleur non guidées par l'image par patient (moyenne ± ET) est passée de 2,19 ± 9,35 à 31,68 ± 52,26 l'année précédant et suivant le BPV. Les visites médicales pertinentes par patient (moyenne ± ET) ont également augmenté de 2,92 ± 3,61 à 9,64 ± 11,77. La dose moyenne d'opioïdes n'a pas changé de manière significative entre l'année précédant et suivant le BPV de référence.Conclusion: Les BPV sont associés à une augmentation de l'utilisation des soins de santé et ne sont associés à aucun changement dans les modes d'utilisation des opioïdes.

The Relationship between Higher Chronic Opioid Therapy Dose and Specific Personality Traits in Individuals with Chronic Pain.

Objective: To evaluate the relationship between opioid use and specific personality traits among individuals with chronic pain stratified by morphine equivalent doses (MEQ). Design: Observational cohort study. Setting. Chronic pain outpatient clinic in Canada (2017-2019). Patients. Participants were included if they (1) were at least 18 years old, (2) had been diagnosed with chronic pain (pain >3 months), and (3) were able to read and write in English. Interventions. None. Main Outcome Measures. Completion of the following outcome measures: Acceptance and Action Questionnaire, Anxiety Sensitivity Index, Brief-Coping with Problems Experience 28-item, Brief Pain Inventory Short Form, CAGE-AID substance misuse screening tool, EuroQol-5D, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire 9-item. One-way analysis of variance compared outcomes between MEQ groups. Results: 215 individuals (64.2% female) were included with a mean age of 52.7 ± 11.7 years and time since pain onset of 14.1 ± 10.2 years (range 1-45). There were no significant differences between MEQ groups with respect to sociodemographic and clinical health variables except for gender and employment status and time since pain onset. After controlling for gender, time since pain onset, and average pain severity, patients with MEQ 90+ mg had significantly higher scores for experiential avoidance and anxiety sensitivity in addition to increased pain interference, greater depressive and anxiety symptoms, more dysfunctional coping, and poorer QoL than those with MEQ 1-89 mg or MEQ 0 mg. Conclusions: Compared to individuals using no or lower-dose opioids to treat chronic pain, those using high-dose opioids had higher scores on two maladaptive personality traits (i.e., anxiety sensitivity and experiential avoidance) which was associated with poorer mood, greater pain interference, lower quality of life, and dysfunctional coping. These maladaptive personality traits may help to explain how individuals with chronic pain utilize higher doses of opioid analgesics.

A Controlled Trial Evaluating the Safety and Effectiveness of Ultrasound-Guided Looped Thread Carpal Tunnel Release.

Background: Open carpal tunnel release typically requires several weeks of recovery. A less invasive, ultrasound-guided percutaneous technique of releasing the transverse carpal ligament using a thread (thread carpal tunnel release [TCTR]) has been described. To date, its clinical effectiveness and safety have been evaluated exclusively by the group that developed the technique, using a single outcome measure without a control comparison. The objective of this study was to independently evaluate the safety and effectiveness of TCTR using multiple outcome measures and a control comparison. Methods: A convenience sample of 20 participants with refractory moderate or severe carpal tunnel syndrome underwent TCTR of their most symptomatic hand. Outcome measures included pre-TCTR and 1-, 3-, and 6-month post-TCTR Boston questionnaire; pre-, 3-, and 6-month post-TCTR monofilament sensibility, strength, ultrasound, and electrodiagnostic testing; weekly post-TCTR phone interviews for 1 month; and satisfaction surveys at 3 and 6 months post-TCTR. Results: No complications were reported. During the month post-TCTR, significant prompt improvements in hand pain and dysfunction occurred. The following significant improvements were demonstrated in the treated versus control hand: Boston Questionnaire scores, median nerve distal motor latency, transcarpal tunnel motor and sensory conduction velocities and sensory nerve action potential amplitudes. No significant differences in sensibility, pinch or grip strength, median nerve cross-sectional area (CSA) at the carpal tunnel inlet, or wrist: forearm median nerve CSA ratio were documented between TCTR and control sides. Satisfaction with the TCTR procedure was high (85%-90%). Conclusions: This study supports previous reports that the TCTR procedure is safe and effective.

Cannabinoids and an anti-inflammatory diet for the treatment of neuropathic pain after spinal cord injury (The CATNP Study): study protocol for a randomized controlled trial.

STUDY DESIGN: Multicenter, randomized, double-blind, placebo controlled, clinical trial. OBJECTIVE: The objective of this paper is to evaluate the effectiveness of cannabinoids and an anti-inflammatory diet, alone and in combination, for the management of neuropathic pain (NP) after spinal cord injury (SCI). SETTING: Two Canadian SCI rehabilitation centers. METHODS: A sample of 144 individuals with SCI will receive either an anti-inflammatory diet, cannabinoids or a placebo for 6 weeks. Following this, a combined effect of these treatments will be evaluated for a further 6 weeks. The primary outcome measure will be the change in NP as assessed by the numeric rating scale (NRS). Secondary outcomes will include changes in inflammation, mood, sleep, spasticity, cost-effectiveness, and function. CONCLUSION: This study will assess the efficacy of an anti-inflammatory diet and cannabinoids (individually and in combination) for the treatment of NP following SCI. Results may reveal a cost-effective, side-effect free intervention strategy which could be utilized for the long-term management of NP following SCI.