Rejected

Patients with chronic idiopathic axonal polyneuropathy (CIAP) can have neuropathic pain that significantly impacts quality of life. Oral neuropathic pain medication often has insufficient pain relief and side effects. Topical phenytoin cream could circumvent these limitations. The primary objectives of this trial are to evaluate (1) efficacy in pain reduction and (2) safety of phenytoin cream in patients with painful CIAP. The main secondary objective is to explore the usefulness of a double-blind placebo-controlled response test (DOBRET) to identify responders to sustained pain relief with phenytoin cream.

Partial rotator cuff tears can cause shoulder pain and dysfunction and are more common than complete tears. However, few studies examine partial injuries in small animals and, therefore a robust, clinically relevant model may be lacking. This study aimed to fully characterize the established rat model of partial rotator cuff injury over time and determine if it models human partial rotator cuff tears.

The post-bypass stroke risk factors and long-term outcomes of moyamoya patients are not well documented. Therefore, the authors studied 30-day stroke risks and patients' long-term physical, functional, and social well-being.

To the Editor, We read the article "Integrating IPACK (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) Block in an Enhanced Recovery after Surgery Pathway for Total Knee Arthroplasty-A Prospective Triple-Blinded Randomized Controlled Trial" by Pai et al in the Journal for Knee Surgery (2022) with great interest1. We applaud the authors in finding that when added to an enhanced recovery after surgery pathway consisting of a spinal anesthetic, adductor canal nerve catheter, and surgeon-administered periarticular joint infiltration (PAI), the IPACK block did not significantly impact postoperative opioid consumption or measured functional outcomes on postoperative day 1. Interestingly, the authors found that addition of the IPACK block did significantly decrease posterior knee pain. We found this notable as both the IPACK block and PAI target the posterior knee capsule. Innervation of the posterior knee capsule is complex and includes branches of the obturator, sciatic, common fibular, and tibial nerves2. PAI has variable effectiveness in this anatomical area3. Prior studies have shown that addition of the IPACK and adductor canal blocks to PAI provides superior analgesia and decreases opioid consumption in TKA4. This study found that the IPACK block resulted in improved posterior knee analgesia compared to PAI. This could signify that an ultrasound-guided approach may be more consistent in targeting the posterior knee capsule. The authors also astutely mention concern for local anesthetic toxicity (LAST). Peripheral nerve blocks, especially in the lower extremity, have a decreased risk of LAST compared to PAI5. Further study of the effectiveness of the IPACK block compared to PAI may show that the IPACK is a reasonable replacement of PAI, while also potentially decreasing the risk of LAST. We greatly appreciate the work Dr. Pai and team performed to further our understanding of posterior knee analgesia and its contribution toward the creation of patient care pathways that target analgesia and prioritize patient safety.

Thoracolumbar fascia mobility observed with ultrasound imaging and calculated as shear strain is lower in persons with chronic low back pain. This pilot and feasibility trial assessed thoracolumbar shear strain in persons with chronic low back pain following spinal manipulation and over an 8-week course of multimodal chiropractic care.

The interest in Para athletes' health continues to increase. Still, there are few studies that have evaluated health parameters beyond injury and illness in this athlete population.

Direct comparisons of childhood- and adulthood-onset eosinophilic esophagitis (EoE) are scarce.

The peculiar presentation of overlap syndrome in children makes precise diagnosis difficult. Children with overlap syndrome may or may not have specific antibodies. We present the case of a 12-year-old girl diagnosed with overlap syndrome of systemic lupus erythematosus (SLE) and juvenile polymyositis (JPM) who tested positive for anti-OJ antibodies.

Patients with severe burn injuries often require split thickness skin grafting to expedite wound healing with the thigh being a common donor site. Uncontrolled pain is associated with increased opioid consumption, longer lengths of stay, and delay in functional recovery. Peripheral nerve blocks are increasing in popularity although supportive literature is limited, and techniques vary. The purpose of this case series is to assess the safety, feasibility, and clinical efficacy of a recently demonstrated novel continuous LAM (lateral, anterior, medial) femoral cutaneous block technique in a larger cohort. The study was a dual IRB approved, observational case series from a single verified burn center. The electronic health record was retrospectively reviewed for patients admitted between June 2018 to May 2021 who had the continuous LAM block performed for donor site pain by the acute pain service team. Demographics were reported with descriptive statistics and morphine milligram equivalents (MME) were analyzed via Friedman analysis of variance. Forty-seven patients had a total of 53 blocks placed, where 2 patients received the LAM block on two separate occasions and 4 patients had bilateral LAM blocks placed. Most were African American males, but mechanism of injury varied. Over half had a neurologic (17 %) or psychiatric history (34 %) outside of substance use. Almost three-quarters had a history of substance use with 17 % being opioids, and a quarter had a history of polysubstance use. Median day from admission to LAM was 7 (2.5, 11.5) with a median duration of 4 (3, 5) days. Temperature and pressure sensation were reduced at the donor site. Quadricep strength remained intact, and median day until first ambulation after LAM placement was 2 (1, 3) days. Pain was adequately controlled, and there were no significant adverse events associated with the block. There was a significant reduction in MME after block placement (p < 0.001). Continuous peripheral nerve blocks offer an advantageous means of analgesia, while reducing potential adverse events associated with opioids or multimodal regimens. The novel LAM technique reduced sensation and pain without inhibiting early ambulation, and patients were able to fully participate in their rehabilitation.