Peripherally Inserted Central Line Catheters following Hand and Wrist Infections

Park, Rachel H.; Stephens, Kristen L.; Forster, Grace L.; Freilich, Aaron M.; DeGeorge, Brent R.

doi:10.1097/gox.0000000000004657

Cited by 1 publication

(1 citation statement)

References 19 publications

(24 reference statements)

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“…While there are many reports of the success of mirror therapy (11,12), a systematic review highlighted a lack of evidence for its efficacy (13). Pharmacologic treatments often lose efficacy over time, have serious side effects, and can lead to addiction (6,14). Surgical interventions are typically explored when other treatment methods have been ineffective (15).…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Spinal Cord Stimulation to Reduce Phantom Limb Pain in People with a Transtibial Amputation

Dalrymple

Fisher

Weber

2023

Preprint

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Phantom limb pain (PLP) is debilitating and affects over 70% of people with a lower-limb amputation. In chronic pain conditions, there are plastic changes at the spinal cord level, typically causing increased excitability. Altered spinal excitability can be measured using reflexes, such as the posterior root-muscle (PRM) reflex. Neuromodulation of the spinal cord can be used to reduce chronic pain in a variety of conditions. Here we propose using a non-invasive neuromodulation method, transcutaneous spinal cord stimulation (tSCS), to reduce PLP in people with transtibial amputation. We recruited three participants, two males (5- and 9-years post-amputation; alcohol-induced neuropathy, traumatic) and one female (3 months post-amputation; diabetic dysvascular) for this 5-day study. We measured their pain using pain questionnaires and the pain pressure threshold test. We measured spinal reflex excitability using PRM reflexes. We provided neuromodulation using tSCS at 30 Hz with a carrier frequency of 10 kHz for 30 minutes/day for 5 days. Mean pain scores decreased from 34.0±7.0 on Day 1 to 18.3±6.8 on Day 5, which was a clinically meaningful difference. Two participants had increased pain pressure thresholds across the residual limb (Day 1: 5.4±1.6 lbf; Day 5: 11.4±1.0 lbf). PRM reflexes had high thresholds (59.5±6.1 μ C) and low amplitudes, suggesting that in PLP, reflexes are hypoexcitable. After 5 days of tSCS, reflex thresholds decreased significantly (38.6±12.2 μ C; p<0.001). Overall, tSCS is a non-invasive neuromodulation method that can reduce PLP and modulate spinal reflexes.

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