Comparison of trigger point injections versus traditional therapies in the management of post-surgical pain in patients who had anterior cervical surgery: A Retrospective Study

Introduction: The opioid epidemic has launched the United States into a public health crisis, resulting in a greater emphasis on non-opioid multimodal pain control methods. At our institution, postoperative posterior neck stiffness and myofascial pain is a common concern after anterior cervical discectomy and fusion or anterior cervical corpectomy with fusion surgery (hereinafter ACS), likely due to prolonged intraoperative positioning in neck extension. Studies have shown successful analgesic outcomes of trigger point injections with local anesthetic for generalized myofascial pain.1-2 This retrospective pilot study aimed to evaluate whether trigger point injections with bupivacaine decreases postsurgical pain compared with traditional therapies in patients undergoing ACS and thereby decrease the amount of opioid medication used. Methods: After IRB approval, we retrospectively reviewed medical records of all patients who received ACS from January 2019 to March 2020 at a single university hospital. We identified patients who received trigger point injections (TP) versus standard care (SC). We excluded patients if TP was performed \u3e3hr from surgery, in recovery for opioid use disorder, underwent a posterior approach, staged surgery, or sustained cervical trauma. The primary outcomes were pain control through the Visual Analog Scale (VAS) and calculated oral morphine equivalents (OME) taken at 6, 12, and 24 hours post-operatively. Secondary outcomes included length of stay (LOS). Results: 137 patients received anterior cervical surgery (100 SC, 37 TP), 62 were excluded. A total of 75 (47 SC, 28 TP) patients were included in this study. The average OME at 6 hours significantly decreased when comparing SC vs TP (32 vs 22, p=0.025). There was no significant difference in average VAS at all time points and average OME at 12 and 24 hours (Table 1). 50% of patients were discharged by 18 hours. Discussion: Our results suggest that TP with bupivacaine significantly reduce opioid consumption within 6 hours of the postoperative period, without increasing overall pain level. There is an opportunity for TP to be included in non-opioid multimodal pain regimens for postoperative myofascial neck pain, especially during the opioid crisis. Limitations of this retrospective study were the small number of study participants, that many patients were discharged before 18 hours and some may have been on chronic pain therapy. The identified limitations will help inform our future investigations and design a prospective randomized control study

A European competence framework for industrial pharmacy practice in biotechnology

Project Report: The PHAR-IN ("Competences for industrial pharmacy practice in biotechnology") looked at whether there is a difference in how industrial employees and academics rank competences for practice in the biotechnological industry. A small expert panel consisting of the authors of this paper produced a biotechnology competence framework by drawing up an initial list of competences then ranking them in importance using a three-stage Delphi process. The framework was next evaluated and validated by a large expert panel of academics (n = 37) and industrial employees (n = 154). Results show that priorities for industrial employees and academics were similar. The competences for biotechnology practice that received the highest scores were mainly in: . "Research and Development", . "Upstream" and "Downstream" Processing', " . "Product development and formulation", " . "Aseptic processing", ."Analytical methodology", . "Product stability", and . "Regulation". The main area of disagreement was in the category "Ethics and drug safety" where academics ranked competences higher than did industrial employees

John

Paintinghttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2018/1041/thumbnail.jp

Clare

Paintinghttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2018/1043/thumbnail.jp

Jen

Paintinghttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2018/1042/thumbnail.jp

Alan

Paintinghttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2018/1044/thumbnail.jp

Work-related musculoskeletal disorders in sonography and the Alexander technique

Work-related musculoskeletal disorder (WRMSD) is a problem affecting growing numbers of sonographers. The condition often leads to considerable pain for the individuals concerned and inconvenience for departments struggling to cope with increasing workloads. Employers and equipment manufacturers are making efforts, to address the problem, but the number of cases of WRMSD continues to increase. This study looks at a different approach to tackling the problem, introducing student sonographers to a technique often used in other professions to overcome stress and damage to the body caused by repetitive movements. The 'Alexander technique' (AT) is a method of increasing an individual's awareness of their body and mind when performing an activity. In a profession such as sonography, where the practitioner is concentrating for long periods of time on interpreting images on a television monitor, the position and movement of the body is usually ignored. By working with a skilled teacher, individuals can be shown how to work more effectively, leading to a possible reduction in stress to the body. Initial results indicate that AT has potential to be of benefit to sonographers in preventing or reducing the incidence of WRMSD; further work is planned. © British Medical Ultrasound Society 2008

A study of the experiences of participants following attendance at a workshop on methods to prevent or reduce work-related musculoskeletal disorders amongst sonographers

A growing number of sonographers are being affected by pain and disability associated with their working practices. Many of these individuals are scanning whilst in considerable discomfort, or having to take sick leave when the pain makes scanning impossible. Severe cases will result in sonographers being unable to scan, and forced into a change of career, or early retirement.In order to help address this problem it was decided in June 2009 to host a workshop for sonographers at the University of the West of England, to introduce participants to a variety of ideas and techniques which could potentially prevent or reduce musculoskeletal disorders associated with working practices.Following the overwhelming popularity of this first session, three further workshops were organized. A total of 96 students have attended these four workshops, and all participants have been asked to complete detailed evaluation questionnaires. In order to determine any long-term benefits of the workshops, participants were also asked for their permission to be followed up at six week and twelve week intervals after attendance. A total of 23 participants were telephoned six weeks after attending the workshop and ten were telephoned at twelve weeks.Results demonstrated that the workshop was extremely beneficial for the majority who attended. The positive effects lasted for several weeks following the event, however, after three months the majority felt they needed additional reinforcement of the information, ideas and techniques learnt during the original workshop. © 2011 The College of Radiographers

Cerebrovascular endothelium cell response to tumor-activated astrocytes in the perivascular stage of the brain metastasis process of HER2-overexpressing breast cancer cells

Brain metastasis is an important cause of death in patients with advanced cancer, and its development begins in a functional microenvironment regulated by cerebrovascular endothelium (CVE) cells and astrocytes of the blood-brain barrier (BBB). However, the molecular pathogenesis of brain metastasis is largely unknown, and there are no molecular biomarkers alerting us on the risk of suffering brain metastasis and that might represent good targets for therapy. The aim of the project was to study the neurovascular microenvironment and the growth pattern of experimental and clinical brain metastasis and the transcriptional activity of the CVE cells in response to soluble factors from cultured astrocytes activated by MDA-231 breast cancer (BC) cells with or without HER2 overexpression. Results showed that the initial growth of both experimental and clinical brain metastases occurred in the perivascular space, with the original BBB being split into two new barriers, an internal hemato-tumoral (between blood and metastatic tissue), and another external neuro-tumoral (between metastatic tissue and unaffected brain tissue). Next, by using an in vitro model recapitulating the functional interrelationship operating in the brain metastasis microenvironment among BC cells, perivascular astrocytes and CVE cells we demonstrated an altered gene expression in CVE cells induced by tumor-activated astrocytes. Interestingly, oxygen deprivation (1% hypoxia), oxidative stress (1 nM hydrogen peroxide), mechanical stimulation (induced by fluid flow) and inflammation (10 ng/ml TNFalpha) activated the production of astrocyte-stimulating factors from HER2-overexpressing BC cells. In turn, conditioned medium of such tumor-activated astrocytes induced a CVE cell transition into a neuroinflammatory phenotype, involving increased gene expression of Claudin-1, VCAM-1 and PECAM-1 (involved in the regulation of intercellular relationships), VEGFR-2, RAGE and Collagen- IV (involved in the regulation of endothelial differentiation) and P-Glycoprotein (involved in the regulation of transcellular molecular exchanges). In conclusion, early metastatic growth in the perivascular microenvironment of the brain remarkably altered astrocyte effects on BBB-forming CVE cells. In addition, overexpression of HER2 determined the functional response of BC cells to the perivascular tumor microenvironment, which in turn affected the action mechanism of BC cells on CVE cells via perivascular astrocytes