Purpose of Review This systematic review comprehensively compared balloon kyphoplasty and vertebroplasty with respect to height restoration and pain relief. Recent Findings PRISMA guidelines were utilized to compare balloon kyphoplasty and vertebroplasty, focusing on the primary outcome of height restoration and the secondary outcomes of pain relief and functionality. A total of 33 randomized controlled trials were included; 20 reviewed balloon kyphoplasty, 7 reviewed vertebroplasty, and 6 compared vertebroplasty to balloon kyphoplasty. Both treatments restored some vertebral body height and showed benefits in pain reduction and improved patient-reported functionality. Summary Balloon kyphoplasty and vertebroplasty are effective treatments for vertebral compression fractures and this review suggests that balloon kyphoplasty may be favored for vertebral height restoration. Further studies are needed to conclude whether balloon kyphoplasty or vertebroplasty is superior for alleviating pain.

Background: Prescribing opioids has become a challenge. The US Drug Enforcement Agency (DEA) and Centers for Disease Control and Prevention (CDC) have become more involved, culminating in the March 2016 release of the CDC’s “Guidelines for Prescribing Opioids for Chronic Pain.” Objectives: Given the new guidelines, we wanted to see if there have been any changes in the numbers, demographics, physician risk factors, charges, and sanctions involving the DEA against physicians who prescribe opioids, when compared to a previous DEA database review from 1998 to 2006. Study Design: This study involved an analysis of the DEA database from 2004 to 2017. Setting: The review was conducted at the Henry Ford Health System Division of Pain Medicine. Method: After institutional review board approval at Henry Ford Health System, an analysis of the DEA database of criminal prosecutions of physician registrants from 2004-2017 was performed. The database was reviewed for demographic information such as age, gender, type of degree (doctor of medicine [MD] or doctor of osteopathic medicine [DO]), years of practice, state, charges, and outcome of prosecution (probation, sentencing, and length of sentencing). An internet-based search was performed on each registrant to obtain demographic data on specialty, years of practice, type of medical school (US vs foreign), board certification, and type of employment (private vs employed). Results: Between 2004 and 2017, Pain Medicine (PM) had the highest percentage of in-specialty action at 0.11% (n = 5). There was an average of 18 prosecutions per year vs 14 in the previous review. Demographic risk factors for prosecution demonstrated the significance of the type of degree (MD vs. DO), gender, type of employment (private vs. employed), and board certification status for rates of prosecution. Having a DO degree and being male were associated with significantly higher risk as well as being in private practice and not having board certification (P < .001). In terms of type of criminal charges as a percent of cases, possession with intent to distribute (n = 90) was most prevalent, representing 52.3% of charges, with new charges being prescribing without medical purpose outside the usual course of practice (n = 71) representing 41.3% of charges. Comparison of US graduates (MD/DO) vs. foreign graduates showed higher rates of DEA action for foreign graduates but this was of borderline significance (P = .072). Limitations: State-by-state comparisons could not be made. Specialty type was sometimes selfreported, and information on all opioid prosecutions could not be obtained. The previous study by Goldenbaum et al included data beyond DEA prosecution, so direct comparisons may be limited. Conclusion: The overall risk of DEA action as a percentage of total physicians is small but not insignificant. The overall rates of DEA prosecution have increased. New risk factors include type of degree (DO vs. MD) and being in private practice with a subtle trend toward foreign graduates at higher risk. With the trend toward less prescribing by previously high-risk specialties such as Family Medicine, there has been an increase in the relative risk of DEA action for specialties treating patients with pain such as PM, Physical Medicine and Rehabilitation, neurology, and neurosurgery bearing the brunt of prosecutions. New, more subtle charges have been added involving interpretation of the medical purpose of opioids and standard of care for their use. Key words: Certification, CDC, criminal, DEA, opioid, prescribing, prosecution, sanctions

No abstract

Neuropathic pain (NP) is initiated or caused by a primary lesion or dysfunction in the nervous system. The NP in cancer patients is typically due to a combination of inflammatory, neuropathic, ischemic, infiltrative, and compression mechanisms that involve one or more anatomic sites. These patients will often have various types of co-existing pain syndromes and co-morbidities. Thus, any treatment plan needs to be individualized. After a thorough clinical assessment and evaluation, a combination therapy including anticonvulsants, antidepressants, N-methyl-D-aspartate antagonists, opiates, topical agents, and interventional procedures should be considered in these patients.

Background: Hip injections of hyaluronic acid (HA) have been used off-label to treat osteoarthritis (OA). The purpose of this retrospective cohort study of adults with OA was to review predictive factors and duration of action for patients who responded to HA hip injections. Methods: After institutional review board (IRB) approval, patients who had HA hip injections from 2014 to 2018 were retrospectively reviewed. Visual analog scale (VAS) scores obtained 1 mo after three injections were collected. Patients were classified into two groups: positive outcome (50% or greater reduction of VAS) and negative outcome (less than 50% reduction of VAS). Comparison of demographics, functional status, OA severity on Kellgren-Lawrence Grading Scale (KL), previous treatments, type of HA, and procedure techniques were performed. Continuous variables were summarized in mean and standard deviation (SD), and compared using two-sample t-test. Categorical variables were summarized in frequency and proportion, then compared using chi-square test or Fisher exact test. Results: The 157 patients who were reviewed had the following levels of OA severity: 24.3% mild (KL grade II), 25% moderate (KL grade III), 50.7% severe (KL grade IV). Positive outcomes were reported in 29.3% of patients, and 70.7% had “negative” outcomes. The positive outcome group had a mean duration (for 50% or greater decrease of VAS) of 4.24 mo (SD 3.62). The positive outcome group had milder OA (KL grades II to III) (P<0.001) and younger age (P=0.03). No difference was noted among the two groups for other variables. Conclusions: Injections of HA for hip OA using the full recommended dosage regimen of commercially available HA products can be beneficial in select patients. The main predictors of significant response were younger age and mild to moderate (KL grade II to III) OA. Level of Evidence: Level III.