Background: Given the range of subjective experiences reported by patients with chronic pain, Spinal Cord Stimulation (SCS) systems designed for tailored delivery of analgesic therapy may help improve treatment effectiveness and satisfaction. Research design and methods: This case-series evaluated 420 patients with chronic back and/or leg pain implanted with an SCS device capable of sequential or simultaneous delivery of neurostimulation (i.e. combination therapy) as well as multiple waveforms and/or field shapes. Following implantation, an array of standard programs (e.g. paresthesia-based SCS), and a custom set of sub-perception programs were provided per patient feedback. Pain scores (Numeric Rating Scale, NRS) were collected at baseline and during follow-up. Results: In this multicenter, observational series (n = 420, 53.1% female; Age: 64.2 ± 13.4 years), a mean overall pain score of 7.2 ± 1.8 (SD) was reported pre-trial (Baseline). At a mean follow-up duration of 208 ± 200 (SD) days, the mean overall pain score reduced to 2.4 (p < 0.0001). Overall pain was reduced by 5.1 ± 2.4 and 4.5 ± 2.4 points (NRS) at 3-months (N = 256) and at 12-months post-implant (N = 122) respectively (p < 0.0001). Conclusions: These results suggest that highly 'customizable' SCS approaches may allow for highly effective pain relief within the real-world clinical setting.

Spinal cord stimulation is increasingly utilized as a treatment to alleviate low back pain and lumbar radiculopathy, particularly in patients with failed back surgery syndrome. We present an illustrative case of early, rapidly progressive methicillin-resistant Staphylococcus aureus (MRSA) infection after a brief stimulator trial lead implantation. Operators should maintain a high level of suspicion for deep infection, including epidural abscess, even when only minor symptoms and signs are present. Because of the poor ability to clear infections in the presence of a retained foreign body, the device must be explanted immediately. Subsequent surgical intervention, however, may nevertheless still be needed. While a variety of bacteria may cause epidural abscess, methicillin sensitive Staphylococcus aureus, and increasingly, MRSA and community-associated MRSA, are the most likely etiologic organisms.A 46-year-old white man, who smoked and had a history of asthma and borderline hypertension, was being treated in our practice for failed back surgery syndrome. He was unresponsive to conservative therapy including methadone 10 mg, 6 tablets Q8hours, Oxycodone 15 mg, 4 tablets Q3hours prn, and pregabalin 75-mg capsule Q12hours, and presented for a spinal cord stimulator trial. Adhering to strict aseptic technique, the patient's thoracolumbar spine was prepped with 70% isopropyl rubbing alcohol followed by 10% povidone-iodine. The operative site was then surgically draped and the fluoroscopic image intensifier sterilely wrapped. Prophylactic systemic antibiotics were not administered. Wearing sterile gloves, mask, gown, and cap, we placed 2 percutaneous electrode leads (Advance Bionics, Sylmar, CA, U.S.A.) through separate insertion sites on a single attempt. After assuring successful stimulation coverage, the leads were secured to the back with steri-strips and Tegaderm. The procedure was uneventful and there was no break in sterility.

No abstract

Introduction: In response to the opioid crisis, New York State (NYS) mandated training for all licensed professionals authorized to prescribe controlled substances. Content included state and federal requirements for prescribing controlled substances, pain management, appropriate prescribing, managing acute pain, palliative care, prevention, screening and signs of addiction; responses to abuse and addiction; and end-of-life care. Training was required to be completed by 1 July 2017. Objectives: The primary aim of this analysis was to answer the question: Would a large-scale, enduring, online training program administered in an academic environment be feasible? Methods: An interdisciplinary team from the University at Buffalo developed a 4-hour accredited enduring training program which was launched on 15 March 2017. Pre-and posttests were required, with a score of ≥70% on the posttest set as successful completion of the course. Results: As of 1 July 2017, 31 909 participants had completed Module 1, with 26 511 (83.1%) originating from NYS. For Module 2, 29 450 participants completed the training, with 24 460 (83.1%) originating from NYS. A participant survey found that the overwhelming majority of participants were satisfied with the course. Prescribers (physicians, residents, dentists, nurse practitioners, midwives, and physician assistants) all demonstrated significant improvement for both course modules. Aggregate Module 1 scores improved from (mean ± SD) 79.88 (14.67) at baseline to 93.18 (7.45) postcourse (P < .0001). Aggregate Module 2 scores improved from 67.21 (14.8) to 89.13 (8.09; P < .0001). Conclusions: Our experience demonstrates the feasibility of deploying a credible, enduring, multiprofessional online educational program. The program has been wellaccepted, with a demonstration of increased knowledge across disciplines through pre-and posttraining assessment. Further study is needed to address the impact of this training on patterns of opioid prescribing.

No abstract