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Botulinum toxin type A treatment for depression, Raynaud's phenomenon, and other novel dermatologic therapeutic applications
Published in Anthony V. Benedetto, Botulinum Toxins in Clinical Aesthetic Practice, 2017
Irèn Kossintseva, Benjamin Barankin, Kevin Smith
The patient characterized her pain as coming predominantly from bone, and deep injections close to bone using a 30-gauge 1-inch needle, were of particular benefit. Subcutaneous and intramuscular injections of OnaBTX-A (a total of 120–400 units per session, about once a month) into the areas of discomfort in the right hand and arm gave substantial pain relief (for which the patient was very grateful) and also normalized skin color and temperature in the right hand and forearm within several minutes, but after one year of treatments there has not been any improvement in her ability to use the right hand. Even though the right hand remains useless, it is less of an impediment. It should be noted that reduction in pain and sensitivity has allowed this patient to take part in a greater range of activities of daily living and to participate more fully and effectively in physiotherapy and in society, so there has been an overall improvement in general functional ability. Treatment of the involved areas in the right lower leg and foot were also helpful. At times, the total dose of OnaBTX-A for treatment of headache and for treatment of RSDS in the right arm and leg reached 1200 units per month. This was well tolerated. After about 4 years of treatment her headaches, neck spasm, and RSDS in the right arm and lower leg improved to the point where OnaBTX-A in those areas was stopped, and the dose of OnaBTX-A declined to about 400 units every 2–3 months to control her headaches, neck spasm and pain in the right shoulder.
Chronic Pain and Posttraumatic Headaches
Published in Rolland S. Parker, Concussive Brain Trauma, 2016
The TMJ is particularly vulnerable to rear-end collisions or direct blows. It is identified by pain of the jaw precipitated by movement and/or clenching, decreased range of movement, noise during joint movements, and tenderness of the joint capsule. It includes a loose joint capsule and nonlimiting bony shape. As the head hyperextends backwards in a rear-end collision, the jaw opens on its hinge joint, reaches maximal extension, and rapidly closes, causing localized joint soft-tissue tearing and anterior meniscus dislocation (Nordhoff et al., 1996a). A blow can cause the jaw joints to be forced out of alignment or can create spasms of the muscles that operate the jaw (which is of greater etiological significance, according to Pincus & Tucker, 1985, p. 295). When the head is not in the proper position, it does not rest comfortably on the neck and shoulders, which causes headaches, muscle tension, spasms and trigger points, jaw clicking and other noises, earaches, pains in various parts of the head, various somatic symptoms, and also ringing in the ears, difficulties in swallowing, migraine-like pain of the head or face, dizziness, and neck spasms (Mackley, l999).
C1–C2 Transarticular Screw Technique
Published in Alexander R. Vaccaro, Christopher M. Bono, Minimally Invasive Spine Surgery, 2007
Thomas J. Puschak, Paul A. Anderson
A thorough history and physical exam is performed. Patients may present with symptoms ranging from mechanical complaints such as axial neck pain, neck spasm, torticollis, and headaches to myelopathy from spinal cord compression. Symptoms are usually worsened with neck flexion. The neurologic exam can range from normal to transient quadriparesis. Complete spinal cord injuries are rare as they are usually fatal at this level. Neurologic complaints may present late. In cases of severe atlantoaxial instability, patients may present with brain stem symptoms such as vertigo, syncope, respiratory distress, and stroke secondary to vertebrobasilar insufficiency from vertebral artery occlusion. Body habitus is important to assess when planning a C1–2 posterior arthrodesis. Excessive thoracic kyphosis or obesity may preclude correct screw trajectory for the C1–2 transarticular approach.
Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research
Published in Canadian Journal of Pain, 2023
Louise V. Bell, Sarah F. Fitzgerald, David Flusk, Patricia A. Poulin, Joshua A. Rash
Seven articles including 134 providers (88 primary care, 17 nurse practitioners, 2 physician assistants, 12 internal medicine, 12 specialists) discussed concerns over drug diversion when prescribing opioids.33–35,43,45,47,49 General practitioners felt that they were contributing to potential drug diversion within their community by prescribing opioids to their patients and reported reluctance to prescribe opioids as a result. In my first year here, I was very kindly giving benzodiazopenes to a woman for neck spasms and Percocet for her neck pain based on her records and what she told me. And when I found out I was also prescribing for her sister and her mother I realized that single-handedly I was probably prescribing for all of New Haven and immediately got them off.33
Endotracheal Tube Electrode Neuromonitoring for Placement of Vagal Nerve Stimulation for Epilepsy: Intraoperative Stimulation Thresholds
Published in The Neurodiagnostic Journal, 2022
Gennadiy A. Katsevman, Darnell T. Josiah, Joseph E. LaNeve, Sanjay Bhatia
Complications of VNS implantation may be early (surgical-related) or late (stimulation-related). Early complications, although rare, include intraoperative bradycardia and asystole during impedance testing, as well as hematomas, infections, and vagus nerve injury (Giordano et al. 2017). Chronic side effects of VNS are generally transient, parameter-dependent (i.e., increase with amplified settings), and occur during stimulus delivery; they include hoarseness, cough, voice changes, dyspnea, and less common symptoms such as neck spasms (Giordano et al. 2017; Heck et al. 2002; Iriarte et al. 2001; Rychlicki et al. 2006). Misplacement of the VNS electrodes or injury to the vagus nerve may lead to complications, ineffectiveness of the therapy, or need for increased stimulation to achieve a therapeutic response. Thorough knowledge of the anatomy and variations is critical, but perhaps surgical adjuncts can provide additional assistance. Various studies have demonstrated the use of endotracheal tube surface electrodes in thyroid/parathyroid surgery as well as neurosurgery as an adjunct to monitor the vagus nerve via its major branch, the recurrent laryngeal nerve (Dralle et al. 2008; Ito et al. 2013; Mikuni et al. 2004; Randolph and Dralle 2011; Randolph and Kamani 2017; Romagna et al. 2015; Topsakal et al. 2008). This study presents data from intraoperative vagus nerve stimulation with monitoring of the recurrent laryngeal nerve using the Nerve Integrity Monitor (NIM) endotracheal tube (ETT) during placement of VNS.