Can Blockchain technologies help tackle the opioid epidemic: A Narrative Review.

OBJECTIVE: To introduce the basic concepts of blockchain technologies in tackling the opioid epidemic. DESIGN: A narrative review. SETTING/BACKGROUND: The opioid epidemic is taking a big toll in terms of lives and livelihood in America. Various public and private sector agencies are actively implementing different strategies to contain the epidemic. Development of robust real-time databases that are secure and easily accessible to the stakeholders in the opioid/paincare ecosystem is essential. Blockchain technologies, with their inherent features of decentralization, immutability, and easy access are well suited to achieving these goals. Some practical applications of blockchain technologies include data collection/aggregation/analysis, patient/provider identification, traceability/monitoring of opioids, supply chain provenance, prescription monitoring, licensure and credentialing, interoperability, seamless integration/communication, development of opioid alternatives, and research incentivization. CONCLUSIONS: Blockchain technologies may help support the efforts of different agencies in curtailing the opioid epidemic.

Priapism following a lumbar sympathetic nerve block.

OBJECTIVE: To understand an unusual complication of a common procedure. DESIGN: This article chronicles the side effect of a lumbar sympathetic nerve block (LSNB). SETTING: Loyola University Medical Center Outpatient Chronic Pain Clinic. PATIENTS: One. RESULTS: Our patient had several hours of priapism following a LSNB. CONCLUSIONS: A bilateral lumbar sympathetic nerve block can lead to unopposed parasympathetic penile stimulation and cause priapism.

A prospective evaluation of iodinated contrast flow patterns with fluoroscopically guided lumbar epidural steroid injections: the lateral parasagittal interlaminar epidural approach versus the transforaminal epidural approach.

BACKGROUND: Lumbar midline interlaminar and transforaminal (TF) epidural steroid injections are treatments for low back pain with radiculopathy secondary to degenerative disk disease. Since pain generators are located anteriorly in the epidural space, ventral epidural spread is the logical target for placement of antiinflammatory medications. In this randomized, prospective, observational study, we compared contrast flow patterns in the epidural space using the parasagittal interlaminar (PIL) and transforaminal approaches with continual fluoroscopic guidance. METHODS: Sixty adult patients with low back pain and unilateral radiculopathy from herniated or degenerated discs were enrolled. Subjects were randomly assigned to one of two groups: TF or PIL (30 in each). All procedures were performed using continual fluoroscopic guidance and 5 mL of contrast. Contrast spread was rated (primary outcome measure) by the interventionalist. Spread was scored 0-2, with 0 = no anterior spread; 1 = anterior spread, same level as needle insertion; and 2 = anterior spread at > or = 1 segmental level. The secondary outcome measure was analgesia at 2 wk, 1, 3, and 6 mo. RESULTS: One hundred percent (29 of 29) patients in the PIL group and 75% (21 of 28) patients in the TF group demonstrated anterior epidural spread. The mean spread grade was 1.93 (95% confidence interval [CI], 1.83-2.0) in the PIL group and 1.46 (95% CI, 1.17-1.46) in the TF group (P = 0.003). Mean fluoroscopy time was 28.96 s (95% CI, 23.9-34.1 s) in the PIL group and 46.25 s (95% CI, 36.27-56.23 s) in the TF group (P = 0.003). Visual analog scale scores were equivalent between groups. CONCLUSIONS: The PIL approach is superior to the TF approach for placing contrast into the anterior epidural space with reduction in fluoroscopy times and an improved spread grade. With increasing attention to neurological injury associated with TF, the PIL approach may be more suitable for routine use.