Faculty Bibliography

BACKGROUND/UNASSIGNED:Rapid relief of radiotherapy-related neuropathic pain (RRNP) in head and neck cancer (HNC) survivors is challenging when relying solely on pharmacologic treatments, especially in the early stages of medication. Whether transcutaneous auricular vagus nerve stimulation (taVNS) can effectively and rapidly control the RRNP in HNC survivors remains uncertain. METHODS/UNASSIGNED:The RELAX trial was a randomised, parallel, sham-controlled trial conducted at four centres in China. We randomly assigned (1:1) HNC survivors with moderate-to-severe RRNP (as defined by Numeric Rating Scale [NRS] score of ≥4) to receive taVNS or sham stimulation (concha of the left ear) for 30 min twice daily over 7 days. Participants, outcome assessors, and statisticians were blinded to assignment and intervention. All patients also received a basal dose of pregabalin (75 mg twice daily). The primary outcome was pain intensity reduction, as measured by the change of NRS scores from baseline to day 7. This trial is registered at ClinicalTrials.gov, NCT05543239. FINDINGS/UNASSIGNED:Between September 16, 2022, and December 1, 2023, 116 eligible patients (mean age, 50.8 [standard deviation (SD), 8.8] years; 40 [34.5%] were women) were randomly assigned into groups. All patients completed NRS score at baseline and day 7, and 112 (96.6%) completed 80% or more of the intervention course. The pain intensity at baseline was 5.79 (SD, 1.59) in the taVNS group and 5.66 (SD, 1.54) in the control group. At day 7, pain intensity decreased by 2.43 (SD, 2.19) in the taVNS group and 1.12 (SD, 1.64) in the Control group; between-group difference, 1.31 points (95% confidence interval [CI], 0.60-2.02; P = 0.00042). The most common adverse event (AE) related to taVNS was mild, transient local skin irritations at the electrode site (8.6% versus 1.7%, P = 0.21), and no serious AE were associated with the device. INTERPRETATION/UNASSIGNED:In this trial, taVNS for 7 days at the initial stage of pregabalin treatment resulted in significantly better pain relief in HNC survivors with moderate-to-severe RRNP with no serious AE. Further prospective investigations to observe the longer term effects of taVNS on RRNP are warranted. FUNDING/UNASSIGNED:This study was supported by Ministry of Science and Technology of the People's Republic of China, National Natural Science Foundation of China, Department of Science and Technology of Guangdong Province and Guangzhou Science and Technology Bureau.

BACKGROUND:Ultrasound guided nerve blocks have become a popular tool in the armamentarium for pain physicians because of its advantages over fluoroscopy by offering portable, radiation-free and real-time imaging. But ultrasound guided procedures require training and practice to gain the expertise. There is a scarcity of review articles describing ultrasound guided injections techniques for nerve blocks of the head and neck. OBJECTIVE:To elucidate the anatomy, sonoanatomy, indications, techniques, side effects and complications for the most frequently utilized nerve blocks of the head and neck in chronic pain management. STUDY DESIGN:Narrative review. SETTING:Academic medical center. METHODS:Literature review of publications in English language of the related topics using Medline (Ovid) search engine. RESULTS:Deep cervical plexus block, cervical sympathetic ganglion block, trigeminal nerve and pterygopalatine ganglion block at the pterygopalatine fossa, greater occipital nerve block, third occipital nerve and medial branch block, and cervical selective nerve root block are discussed in this paper. The review begins with in depth discussion about the anatomy of the target nerve, followed by reviewing the available literature on the indications for the procedures. Detailed description of the procedure techniques is also presented. The volume and selection of medications is also discussed if there is available research. The review will conclude with summary of side effects, complications and precautions. LIMITATION:We only review those nerve blocks of the head and neck that would benefit from ultrasound guided injections in chronic pain management. Other nerve blocks such as transnasal sphenopalatine ganglion block, the interscalene brachial plexus block, superficial and intermediate cervical plexus block, anterior suprascapular nerve block, superficial trigeminal nerve block are not discussed due to either that ultrasound guidance is not warranted or they are rarely utilized in chronic pain management. This paper is not a systematic review, thus it might not include all the available evidence. Many of the available evidence is case series and case reports. More randomized control studies are warranted in the future to validate these techniques. CONCLUSION:Ultrasound guided nerve blocks of the head and neck are useful techniques for pain physicians to learn.

In the spring of 2020, coronavirus disease 2019 evolved into a worldwide pandemic, forcing traditional face-to-face healthcare to a standstill. Telemedicine was quickly adopted as a major tool for pediatric rehabilitation services. This article describes the national legislative response of the United States to the coronavirus disease 2019 pandemic and the opportunities and challenges of implementing telemedicine in pediatric rehabilitation outpatient settings, consultations, as well as physician and patient education. The feasibility of performing a remote pediatric musculoskeletal and neurological tele-evaluation is also discussed. Although challenges exist, telemedicine has demonstrated its potential and has proven to be a practical system. Future developments in technology and accessibility, in addition to support from government and third-party payers, have the potential to make telemedicine an effective and vital platform in a coordinated healthcare system.