Nagy Mekhail - Academia.edu (original) (raw)

Papers by Nagy Mekhail

Pain Physician, 2009

Background: Patients with frozen shoulder who fail conservative therapy need surgical treatment a... more Background: Patients with frozen shoulder who fail conservative therapy need surgical treatment and aggressive post-operative rehabilitation. Objective: To evaluate the effect of continuous cervical epidural analgesia on pain scores and range of motion of the shoulder joint in patients undergoing surgery for treatment of refractory frozen shoulder. Methods: Twenty-one patients with refractory frozen shoulder who had failed conservative treatment and undergone surgical procedure (manipulation under anesthesia or capsular release) were identified and the data were collected retrospectively. These patients had cervical tunneled epidural catheter (TEC) placement for continuous infusion of a mixture of lowdose narcotic and local anesthetics at the time of surgery and were discharged home with the catheter in place. They were then involved in an active physical therapy program to increase the range of motion of the affected shoulder joint. The patients (N = 21) were followed for a median ...

Pain practice : the official journal of World Institute of Pain, Jan 27, 2018

Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back ... more Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer-reviewed literature as the basis for making Minimally Invasive Spine Treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using United States Preventive Services Task Force (USPSTF) criteria. The Consensus Group also created a treatment algorithm. Literature searches found 9 studies (2 randomized controlled trials or RCTs; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. The LSS tr...

Neuromodulation : journal of the International Neuromodulation Society, Jan 7, 2018

Dorsal root ganglion stimulation (DRGS) is a powerful tool in the treatment of chronic, neuropath... more Dorsal root ganglion stimulation (DRGS) is a powerful tool in the treatment of chronic, neuropathic pain. The premise of DRGS is similar to that of conventional spinal cord stimulation (cSCS), however, there is more variability in how it can be utilized. While it is this variability that likely gives it its versatility, DRGS is not as straightforward to implement as cSCS. The purpose of this study was to assess the efficacy of DRGS on a broad number of diagnoses, determine which dorsal root ganglia were associated with better outcomes for particular body parts/diagnoses, and evaluate what factors/parameters were associated with higher rates of trial success. This is a physician initiated, multicenter retrospective registry of 217 patients trialed with DRGS. Data were collected via an online questionnaire that assessed specifics regarding the patient's pain, distribution, size, and response to treatment. The data were analyzed to see if there were certain diagnoses and/or paramet...

Neuromodulation : journal of the International Neuromodulation Society, Jan 24, 2018

The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safe... more The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safety and efficacy of neuromodulation and thus improving the lives of patients undergoing neuromodulation therapies. With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion (DRG) stimulation has significantly improved the treatment of complex regional pain syndrome (CRPS), among other conditions. Through funding and organizational leadership by the International Neuromodulation Society (INS), the NACC reconvened to develop the best practices consensus document for the selection, implantation and use of DRG stimulation for the treatment of chronic pain syndromes. The NACC performed a comprehensive literature search of articles about DRG published from 1995 through June, 2017. A total of 2538 article abstracts were then reviewed, and selected articles graded for strength of evidence based on scoring criteria established by the ...

Neuromodulation : journal of the International Neuromodulation Society, Jan 20, 2017

Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation.... more Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the ...

Neuromodulation : journal of the International Neuromodulation Society, Jan 11, 2017

Spinal cord stimulation is an evidence-based treatment for a number of chronic pain conditions. W... more Spinal cord stimulation is an evidence-based treatment for a number of chronic pain conditions. While this therapy offers improvement in pain and function it is not without potential complications. These complications include device failure, migration, loss of therapeutic paresthesia, and infection. This article looked to establish a modern infection rate for spinal cord stimulators, assess the impact of known risk factors for surgical site infections and to determine the impact of certain preventative measures on the rate of infection. After institutional review board approval, a multisite, retrospective review was conducted on 2737 unique implants or revisions of SCS systems. Patient demographics, risk factors including diabetes, tobacco use, obesity, revision surgery, trial length, implant location, implant type, surgeon background, prophylactic antibiotic use, utilization of a occlusive dressing, and post-operative antibiotic use were recorded and analyzed. The overall infection...

Neuromodulation : journal of the International Neuromodulation Society, Jan 2, 2017

Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease stat... more Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. Th...

Neuromodulation : journal of the International Neuromodulation Society, Jan 2, 2017

Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or per... more Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or peripheral or cranial nerves for the purpose of modulating the neural activity of the targeted structures to achieve specific therapeutic effects. Surgical placement of neurostimulation devices is associated with risks of neurologic injury, as well as possible sequelae from the local or systemic effects of the intervention. The goal of the Neurostimulation Appropriateness Consensus Committee (NACC) is to improve the safety of neurostimulation. The International Neuromodulation Society (INS) is dedicated to improving neurostimulation efficacy and patient safety. Over the past two decades the INS has established a process to use best evidence to improve care. This article updates work published by the NACC in 2014. NACC authors were chosen based on nomination to the INS executive board and were selected based on publications, academic acumen, international impact, and diversity. In areas in w...

Pain Practice, 2016

Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high ra... more Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high rates, causing widespread impacts on quality of life. Although the medical community is beginning to recognize the role of surgical technique in the initiation and maintenance of postherniorrhaphy neuropathic pain, little information exists regarding pain management strategies for this condition. This review presents a summary of the pain condition state, its treatment options, and treatment recommendations. Both literature review and clinical experience were used to develop a proposed a treatment algorithm for the treatment of postherniorrhaphy pain. The development of chronic pain may be prevented via a number of perioperative measures. For pain that is already established, some surgical approaches including inguinal neurectomy can be effective, in addition to standard pharmacological treatments and local infiltrations. An unmet need may still exist with these options, however, leaving a role for neuromodulation for the treatment of intractable cases. A pain management algorithm for iterative interventions including stimulation of the dorsal root ganglion (DRG) is described. It is expected that cross-disciplinary awareness of surgeons for nonsurgical pain management options in the treatment of chronic neuropathic postherniorrhaphy pain will contribute to better clinical outcomes.

Evidence‐Based Interventional Pain Medicine, 2011

According to Clinical Diagnoses, 2011

Pain practice : the official journal of World Institute of Pain

Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality... more Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality of life and the socioeconomic functioning of the patient. The aim of this review is to provide recommendations for medical management of trigeminal neuralgia based on current evidence. Based upon the analyses of the literature combined with experience in pain management, symptoms, assessment, differential diagnosis, and treatment possibilities of trigeminal neuralgia are described and discussed. Recommendations for pain management are given and are displayed in a clinical practice algorithm. Treatment should be multidisciplinary. Various treatment options and their risks should be discussed with the patient. The first treatment of choice is carbamazepine or oxcarbazepine. In younger patients, the first choice of invasive treatment is probably microvascular decompression. For elderly patients, radiofrequency treatment of Gasserian ganglion is recommended and the technique is described in...

According to Clinical Diagnoses, 2011

According to Clinical Diagnoses, 2011

According to Clinical Diagnoses, 2011

... E-mail: maarten.van.kleef@mumc.nl. DOI. 10.1111/j.1533-2500.2010.00444.x ... 1994;4:525–534. ... more ... E-mail: maarten.van.kleef@mumc.nl. DOI. 10.1111/j.1533-2500.2010.00444.x ... 1994;4:525–534. 10. Wu M, Linderoth B, Foreman RD. Putative mecha-nisms behind effects of spinal cord stimulation on vascular diseases: a review of experimental studies. Auton Neurosci. ...

Neuromodulation : journal of the International Neuromodulation Society, 2014

The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulati... more The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications. The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar. Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medi...

Pain Physician, 2009

Background: Patients with frozen shoulder who fail conservative therapy need surgical treatment a... more Background: Patients with frozen shoulder who fail conservative therapy need surgical treatment and aggressive post-operative rehabilitation. Objective: To evaluate the effect of continuous cervical epidural analgesia on pain scores and range of motion of the shoulder joint in patients undergoing surgery for treatment of refractory frozen shoulder. Methods: Twenty-one patients with refractory frozen shoulder who had failed conservative treatment and undergone surgical procedure (manipulation under anesthesia or capsular release) were identified and the data were collected retrospectively. These patients had cervical tunneled epidural catheter (TEC) placement for continuous infusion of a mixture of lowdose narcotic and local anesthetics at the time of surgery and were discharged home with the catheter in place. They were then involved in an active physical therapy program to increase the range of motion of the affected shoulder joint. The patients (N = 21) were followed for a median ...

Pain practice : the official journal of World Institute of Pain, Jan 27, 2018

Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back ... more Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer-reviewed literature as the basis for making Minimally Invasive Spine Treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using United States Preventive Services Task Force (USPSTF) criteria. The Consensus Group also created a treatment algorithm. Literature searches found 9 studies (2 randomized controlled trials or RCTs; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. The LSS tr...

Neuromodulation : journal of the International Neuromodulation Society, Jan 7, 2018

Dorsal root ganglion stimulation (DRGS) is a powerful tool in the treatment of chronic, neuropath... more Dorsal root ganglion stimulation (DRGS) is a powerful tool in the treatment of chronic, neuropathic pain. The premise of DRGS is similar to that of conventional spinal cord stimulation (cSCS), however, there is more variability in how it can be utilized. While it is this variability that likely gives it its versatility, DRGS is not as straightforward to implement as cSCS. The purpose of this study was to assess the efficacy of DRGS on a broad number of diagnoses, determine which dorsal root ganglia were associated with better outcomes for particular body parts/diagnoses, and evaluate what factors/parameters were associated with higher rates of trial success. This is a physician initiated, multicenter retrospective registry of 217 patients trialed with DRGS. Data were collected via an online questionnaire that assessed specifics regarding the patient's pain, distribution, size, and response to treatment. The data were analyzed to see if there were certain diagnoses and/or paramet...

Neuromodulation : journal of the International Neuromodulation Society, Jan 24, 2018

The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safe... more The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safety and efficacy of neuromodulation and thus improving the lives of patients undergoing neuromodulation therapies. With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion (DRG) stimulation has significantly improved the treatment of complex regional pain syndrome (CRPS), among other conditions. Through funding and organizational leadership by the International Neuromodulation Society (INS), the NACC reconvened to develop the best practices consensus document for the selection, implantation and use of DRG stimulation for the treatment of chronic pain syndromes. The NACC performed a comprehensive literature search of articles about DRG published from 1995 through June, 2017. A total of 2538 article abstracts were then reviewed, and selected articles graded for strength of evidence based on scoring criteria established by the ...

Neuromodulation : journal of the International Neuromodulation Society, Jan 20, 2017

Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation.... more Surgical site infection is a potential complication of spinal cord stimulator (SCS) implantation. Current understanding of the epidemiology, diagnosis, and treatment of these infections is based largely on small clinical studies, many of which are outdated. Evidence-based guidelines for management of SCS-related infections thus rely instead on expert opinion, case reports, and case series. In this study, we aim to provide a large scale retrospective study of infection management techniques specifically for SCS implantation. A multicenter retrospective study of SCS implants performed over a seven-year period at 11 unique academic and non-academic institutions in the United States. All infections and related complications in this cohort were analyzed. Within our study of 2737 SCS implant procedures, we identified all procedures complicated by infection (2.45%). Localized incisional pain and wound erythema were the most common presenting signs. Laboratory studies were performed in the ...

Neuromodulation : journal of the International Neuromodulation Society, Jan 11, 2017

Spinal cord stimulation is an evidence-based treatment for a number of chronic pain conditions. W... more Spinal cord stimulation is an evidence-based treatment for a number of chronic pain conditions. While this therapy offers improvement in pain and function it is not without potential complications. These complications include device failure, migration, loss of therapeutic paresthesia, and infection. This article looked to establish a modern infection rate for spinal cord stimulators, assess the impact of known risk factors for surgical site infections and to determine the impact of certain preventative measures on the rate of infection. After institutional review board approval, a multisite, retrospective review was conducted on 2737 unique implants or revisions of SCS systems. Patient demographics, risk factors including diabetes, tobacco use, obesity, revision surgery, trial length, implant location, implant type, surgeon background, prophylactic antibiotic use, utilization of a occlusive dressing, and post-operative antibiotic use were recorded and analyzed. The overall infection...

Neuromodulation : journal of the International Neuromodulation Society, Jan 2, 2017

Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease stat... more Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. Th...

Neuromodulation : journal of the International Neuromodulation Society, Jan 2, 2017

Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or per... more Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or peripheral or cranial nerves for the purpose of modulating the neural activity of the targeted structures to achieve specific therapeutic effects. Surgical placement of neurostimulation devices is associated with risks of neurologic injury, as well as possible sequelae from the local or systemic effects of the intervention. The goal of the Neurostimulation Appropriateness Consensus Committee (NACC) is to improve the safety of neurostimulation. The International Neuromodulation Society (INS) is dedicated to improving neurostimulation efficacy and patient safety. Over the past two decades the INS has established a process to use best evidence to improve care. This article updates work published by the NACC in 2014. NACC authors were chosen based on nomination to the INS executive board and were selected based on publications, academic acumen, international impact, and diversity. In areas in w...

Pain Practice, 2016

Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high ra... more Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high rates, causing widespread impacts on quality of life. Although the medical community is beginning to recognize the role of surgical technique in the initiation and maintenance of postherniorrhaphy neuropathic pain, little information exists regarding pain management strategies for this condition. This review presents a summary of the pain condition state, its treatment options, and treatment recommendations. Both literature review and clinical experience were used to develop a proposed a treatment algorithm for the treatment of postherniorrhaphy pain. The development of chronic pain may be prevented via a number of perioperative measures. For pain that is already established, some surgical approaches including inguinal neurectomy can be effective, in addition to standard pharmacological treatments and local infiltrations. An unmet need may still exist with these options, however, leaving a role for neuromodulation for the treatment of intractable cases. A pain management algorithm for iterative interventions including stimulation of the dorsal root ganglion (DRG) is described. It is expected that cross-disciplinary awareness of surgeons for nonsurgical pain management options in the treatment of chronic neuropathic postherniorrhaphy pain will contribute to better clinical outcomes.

Evidence‐Based Interventional Pain Medicine, 2011

According to Clinical Diagnoses, 2011

Pain practice : the official journal of World Institute of Pain

Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality... more Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality of life and the socioeconomic functioning of the patient. The aim of this review is to provide recommendations for medical management of trigeminal neuralgia based on current evidence. Based upon the analyses of the literature combined with experience in pain management, symptoms, assessment, differential diagnosis, and treatment possibilities of trigeminal neuralgia are described and discussed. Recommendations for pain management are given and are displayed in a clinical practice algorithm. Treatment should be multidisciplinary. Various treatment options and their risks should be discussed with the patient. The first treatment of choice is carbamazepine or oxcarbazepine. In younger patients, the first choice of invasive treatment is probably microvascular decompression. For elderly patients, radiofrequency treatment of Gasserian ganglion is recommended and the technique is described in...

According to Clinical Diagnoses, 2011

According to Clinical Diagnoses, 2011

According to Clinical Diagnoses, 2011

... E-mail: maarten.van.kleef@mumc.nl. DOI. 10.1111/j.1533-2500.2010.00444.x ... 1994;4:525–534. ... more ... E-mail: maarten.van.kleef@mumc.nl. DOI. 10.1111/j.1533-2500.2010.00444.x ... 1994;4:525–534. 10. Wu M, Linderoth B, Foreman RD. Putative mecha-nisms behind effects of spinal cord stimulation on vascular diseases: a review of experimental studies. Auton Neurosci. ...

Neuromodulation : journal of the International Neuromodulation Society, 2014

The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulati... more The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications. The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar. Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medi...