No abstract

PurposeBrachial plexopathy can sometimes cause severe chronic pain. There are many possible treatments for such neuropathic pain, including neuromodulation. However, rigorous scientific evidence on the usefulness of spinal cord stimulation (SCS) is still scarce. Here, we report the use of high-frequency (10 kHz) SCS (HFSCS) in a patient with brachial plexus injury (root avulsion).ObjectiveTo assess the efficacy of HFSCS in root avulsion and to investigate the putative neurophysiological mechanisms of HFSCS.MethodsA 32-year-old woman visited our center following an iatrogenic brachial plexus injury. She underwent traditional, paresthesia-inducing, tonic SCS with cervical lead placement. She reported that stimulation-induced paresthesia was uncomfortable, without any pain reduction. After the successful trial of HFSCS, the patient was assessed at 1 month (T1) and 6 months (T6) after HFSCS implantation with pain and quality of life (QoL) scales. Moreover, she underwent a neurophysiological assessment (somatosensory evoked potentials [SEPs], reciprocal inhibition [RI], pain-motor integration [PMI], and the habituation of intraepidermal electrical stimulation-induced evoked potentials [IEPs]) with the stimulator switched on and switched off at T6.ResultsThe patient reported 100% paresthesia-free pain relief, a consistent improvement of QoL, and a complete discontinuation of her previous pain treatment at T1 and T6. Moreover, we found suppression of SEPs, restored habituation of IEPs, and strengthening of RI and PMI.ConclusionThis is the first report to illustrate the usefulness and safety of HFSCS for treating root avulsion in a patient with failed tonic SCS. Our data indicate that HFSCS may either block large-diameter fibers or stimulate medium-/small-diameter fibers, thus inducing analgesia without paresthesia, probably by reducing the activation of the wide-dynamic-range neurons. Moreover, HFSCS seems to modulate spinal inhibitory mechanisms and the descending corticospinal inhibitory output. Thus, HFSCS can be an effective option for treating refractory pain following root avulsion.

This study provides evidence that using polyurethane foam to prevent sores even inside plaster casts in populations at most risk is a simple and cost-effective strategy and decreases the discomfort, pain and risks in these patients.

Medical simulations are effective education complements for medical training, demonstrating effective learning, level of participation, and improvement in knowledge, skills and attitudes.In undergraduate medical education, simulation provides the potential for valid, cost-benefit teaching and assessment of clinical skills, especially clinical reasoning skills, bridging the gap between theory and practice. Simulation as a training tool in postgraduate medical training is a practical method to provide a kind of educational realistic significance for practicing specialty in order to improve quality of care and patient safety. In particular, simulation is an excellent opportunity to implement reports of security which can be considered a true strategy in order to minimize clinical risk and ensure appropriate levels of quality in daily clinical practice.