Vwaire Orhurhu - Academia.edu (original) (raw)

Papers by Vwaire Orhurhu

Provide enhanced digital features for this article If you ... more Provide enhanced digital features for this article If you are an author of this publication and would like to provide additional enhanced digital features for your article then please contact adisrapidplus@springer.com. The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as 'peer reviewed' to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content. Other enhanced features include, but are not limited to: • Slide decks • Videos and animations • Audio abstracts • Audio slides

Current Pain and Headache Reports, 2021

Purpose of Review Opioid use disorder (OUD) remains a national epidemic with an immense consequen... more Purpose of Review Opioid use disorder (OUD) remains a national epidemic with an immense consequence to the United States' healthcare system. Current therapeutic options are limited by adverse effects and limited efficacy. Recent Findings Recent advances in therapeutic options for OUD have shown promise in the fight against this ongoing health crisis. Modifications to approved medication-assisted treatment (MAT) include office-based methadone maintenance, implantable and monthly injectable buprenorphine, and an extended-release injectable naltrexone. Therapies under investigation include various strategies such as heroin vaccines, gene-targeted therapy, and biased agonism at the G protein-coupled receptor (GPCR), but several pharmacologic, clinical, and practical barriers limit these treatments' market viability. Summary This manuscript provides a comprehensive review of the current literature regarding recent innovations in OUD treatment.

Pain and Therapy, 2021

Introduction: Spinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of n... more Introduction: Spinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) has recommended that the placement of percutaneous SCS leads be performed in an awake patient capable of providing feedback. It is not currently known how commonly this recommendation is adhered to by physicians in clinical practice. This article presents the findings of a survey designed to answer this important question. Methods: We conducted a survey of the active membership of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Spine Intervention Society (SIS) regarding practice patterns with SCS therapy. We analyzed the percent of respondents who indicated that they use deep sedation and general anesthesia during SCS placement as well as any reported complications. Results: Many practitioners frequently utilize deep sedation as well as general anesthesia when performing SCS implants. Our findings demonstrate that 77% of physicians reported that they utilize deep sedation for permanent SCS implants at times, and 45% of physicians

Neuromodulation: Technology at the Neural Interface, 2021

OBJECTIVES Chronic pain syndromes in children can carry significant threats to psychological well... more OBJECTIVES Chronic pain syndromes in children can carry significant threats to psychological well-being, opioid overuse, functional impairments, and severe disability. While several high-level studies, almost exclusively in adults, have demonstrated the utility of implantable electrical neuromodulation systems for treating various chronic pain syndromes, there exists a paucity of pediatric-specific evidence. Unfortunately, evidence and practice patterns established from adults may not be fully translatable to children given differences in disease manifestations and anatomical variances. MATERIALS AND METHODS We performed a systematic review using conventional PRISMA methodology to identify studies reporting use of implantable electrical neuromodulation systems in children. The primary outcome parameters collected were analgesic relief and functional benefits. Additionally, previous interventions attempted, neuromodulation parameters, and limitations were collected as reported. RESULTS A total of 11 studies was identified, which described 19 patients who were refractory to multidisciplinary pain management strategies. The cohort was mostly adolescent (18/19), suffered from CRPS (14/19), and received SCS (17/19). Nearly all patients, both those with CRPS (13/14) and non-CRPS conditions (4/4), reported significant pain relief and functional recovery following neuromodulation. There were no severe complications reported; limitations included suboptimal benefit or loss of analgesia (3/19), lead or device revision (3/19), and subcutaneous infection (1/19), all of which were congruent with adult outcomes. CONCLUSION There exist children with chronic pain refractory to standard of care approaches who could be considered for neuromodulation interventions. The existing data, which was limited and from a low tier of evidence, suggest that these interventions are relatively safe and provide meaningful pain reduction and functional improvements. While not previously reported, we recommend careful consideration of the pubertal growth spurt prior to device lead placement-if reasonable and appropriate-given the possibility of inferior lead migration with physiologic growth in patients with SCS devices or foraminal extrusion in patients with dorsal root ganglion stimulation devices.

Physical Medicine and Rehabilitation Clinics of North America, 2021

Chronic thoracic pain and chronic abdominal pain are common conditions that can significantly aff... more Chronic thoracic pain and chronic abdominal pain are common conditions that can significantly affect quality of life. Pain syndromes encompassing a variety of causes, including cancer pain, neuritis, and postsurgical pain, are traditionally managed by the use of pharmacologic therapy; however, many cases are refractory to these conservative methods. Radiofrequency ablation (RFA) has been increasingly used as a tool to treat resistant, chronic pain of both thoracic and abdominal origin. Multiple cases and trials have been reported that show the efficacy of RFA in the treatment of these chronic pain conditions.

Advances in Therapy, 2021

While radiation therapy is increasingly utilized in the treatment paradigm of many solid cancers,... more While radiation therapy is increasingly utilized in the treatment paradigm of many solid cancers, the chronic effects of radiation therapies are poorly characterized. Notably, understanding radiation-specific chronic pain syndromes is paramount given that the diagnosis and management of these conditions can serve to prevent long-standing functional impairments, optimize quality of life, and even allow for continued radiotherapy candidacy. These radiation-specific chronic pain phenomena include dermatitis, mucositis, enteritis, connective tissue fibrosis, lymphedema, and neuropathic pain syndromes. It is necessary to maintain a low threshold of suspicion for appropriately diagnosing these conditions as there exists a variance in when these symptoms arise after radiation. However, we present key epidemiological data delineating vulnerable cancer populations for each pain syndrome along with the available evidence for the management for each specific condition.

Current Pain and Headache Reports, 2020

Purpose of Review Chronic foot pain constitutes a large portion of the chronic pain burden in the... more Purpose of Review Chronic foot pain constitutes a large portion of the chronic pain burden in the overall population. Plantar fasciitis is one of the most common and most easily identifiable causes of chronic foot pain. The syndrome has been estimated to cause 11 to 15% of foot pain visits, requiring professional care. Moreover, studies have suggested that 1 in 10 people will develop plantar fasciitis at some point in their life. Conservative management has been shown to be effective and considered first-line treatment. Minimally invasive treatment options are typically reserved for those who fail conservative management. With the advent of new techniques and improvements in current therapeutic options, there has been an expansion of available minimally invasive treatment options. The purpose of this review is to provide a comprehensive update on the current understanding of minimally invasive treatments of plantar fasciitis. Recent Findings This review shows that conservative management continues to be the first-line therapy, whereas other treatment options were those who failed conservative management using modern techniques that have shown improving effectiveness, with successful restoration of patient functionality, recovery, and satisfaction. However, a multitude of these minimally invasive treatment options are evolving. Conclusion While conservative management continues to be the mainstay of treatment for plantar fasciitis, multiple minimally invasive treatment options are emerging with potential effectiveness in reducing pain and improving the function.

Asian Spine Journal, 2019

Current Pain and Headache Reports, 2020

Purpose of Review Urologic chronic pelvic pain syndrome (UCPPS) is a chronic, noncyclic pain cond... more Purpose of Review Urologic chronic pelvic pain syndrome (UCPPS) is a chronic, noncyclic pain condition which can lead to significant patient morbidity and disability. It is defined by pain in the pelvic region, lasting for greater than 3 to 6 months, with no readily identifiable disease process. The aim of this review is to provide a comprehensive update of diagnosis and treatment of UCPPS. Recent Findings UCPPS encompasses chronic pelvic pain syndrome or chronic prostatitis (CP/CPPS) in men and interstitial cystitis or painful bladder syndrome (IC/PBS) in women. Underlying inflammatory, immunologic, and neuropathic components have been implicated in the pathogenesis of UCPPS. Summary For optimal patient management, an individualized and multimodal approach is recommended. Medical management and physical therapy are the mainstays of treatment. Injection therapy may offer additional relief in medically refractory patients. Further minimally invasive management may include spinal cord and peripheral nerve stimulation, though evidence supporting efficacy is limited. Keywords Urologic chronic pelvic pain syndrome. Chronic prostatitis. Interstitial cystitis. Painful bladder syndrome This article is part of the Topical Collection on Other Pain

Turkish Journal of Anaesthesiology and Reanimation, 2019

the manuscript, references should be cited using Arabic numbers in parentheses. The reference sty... more the manuscript, references should be cited using Arabic numbers in parentheses. The reference styles for different types of publications are presented in the following examples.

Current Pain and Headache Reports, 2019

Purpose of Review Chronic knee pain remains a debilitating condition that remains difficult to ma... more Purpose of Review Chronic knee pain remains a debilitating condition that remains difficult to manage. The purpose of this review, therefore, is to summarize current understanding of alpha-2-microglobulin in the treatment of osteoarthritic knee pain. Furthermore, we investigate its role in the anti-inflammatory properties of platelet-rich plasma (PRP). Recent Findings Alpha-2-microglobulin, a 720-kD protein complex, is an active protease inhibitor with tremendous antiinflammatory properties in animal models. A growing body of evidence suggests that this complex is the most instrumental factor for cartilage preservation in PRP injections. Summary As an active component of platelet-rich plasma's anti-inflammatory properties, alpha-2-microglobulin has been shown to be an active inhibitor of joint degeneration, cartilage preservation, and improvement in quality of life for patients with knee osteoarthritis compared with a multitude of other modalities.

Neuromodulation: Technology at the Neural Interface, 2019

Introduction: Determining reduction in pain score during spinal cord stimulation (SCS) trial is i... more Introduction: Determining reduction in pain score during spinal cord stimulation (SCS) trial is important prior to permanent SCS implantation. However, this association remains elusive. We investigate the association between post-SCS pain scores and successful permanent SCS implants. Materials and Methods: This IRB-approved, retrospective study identified patients who underwent SCS trials and implantation. Predictive modeling with nonparametric regression and margins plot analysis was used to determine the threshold for post-SCS trial pain scores associated with successful permanent SCS implant (defined as >50% pain relief). Nonparametric sensitivity and specificity analysis was performed. p < 0.05 was considered significant. Results: Eighty-eight patients with SCS trials were retrospectively identified (57.95% female, median age 52.5 AE 15.5 years). Of the total cohort, 79% had successful permanent SCS implantation. Post-SCS trial pain scores less than or equal to 4.9 had greater than 50% probability of a successful permanent SCS implant (97.14% sensitivity, 44.44% specificity, ROC = 0.71). Post-SCS trial pain scores between 4 and 7 were associated with a significantly higher probability of a successful SCS implant among patients without spine surgery compared with those with a history of spine surgery. Compared with males, females with pain scores between 5 and 7 had a higher probability of a successful SCS implant. Conclusion: Low pain scores after SCS trial are predictive of successful SCS implants with high sensitivity. Males and surgical patients with higher pain scores had a lower probability of successful SCS implant than their counterparts. Larger studies are needed to further elucidate this relationship.

Pain and Therapy, 2019

Introduction: Total knee arthroplasty (TKA) is an effective treatment modality for severe osteoar... more Introduction: Total knee arthroplasty (TKA) is an effective treatment modality for severe osteoarthritis of the knee. Causes of pain following TKA are poorly understood; however, patient-specific biology and various neuropathic underlying mechanisms such as neuroma formation and complex regional pain syndrome (CRPS) have been suggested. Our case demonstrated the successful treatment of CRPS in the knee with the use of combination therapy in spinal cord stimulator. Case: We present a 71-year-old Caucasian non-Hispanic male who presented with chronic left knee pain after undergoing a total knee arthroplasty (TKA) 18 months prior. Following his TKA, he reported doing well in the acute postoperative period but began to develop progressively worsening left knee pain at approximately the third post-operative week. He underwent a successful spinal cord stimulator (SCS) trial and subsequent implantation of two 16-contact Boston Scientific leads with a Boston Scientific Spectra WaveWriterTM SCS system. Upon first post-procedural follow-up, and moreover at his 6-month follow-up, the patient reported complete resolution of his symptoms. Discussion: The development of persistent pain following TKA is a significant complication that is often challenging to treat. Our case demonstrated the successful treatment of CRPS in the knee with the use of combination therapy in spinal cord stimulator therapy. We anticipate that more data will continue to emerge to assess for the safety and efficacy of combination therapy.

Pain Practice, 2019

Objectives: The aim of this study was to determine if any of the factors recorded on a standard c... more Objectives: The aim of this study was to determine if any of the factors recorded on a standard clinical history of a patient considered for spinal cord stimulation (SCS) would be associated with reduction or cessation of opioids following implantation. Design: Retrospective, single academic center. Materials and Methods: Patient included in the chart analysis were implanted with percutaneous SCS devices from 1999-2015 with follow up until the end of September 2018. Patients who achieved at least an average of 50% pain reduction were included for analysis of daily opioid intake. Patients were then divided into 4 groups that included no opioid use, stable opioid daily dose, weaned opioid dose, and complete cessation of opioids. Statistical methods were used to analyze for associations between opioid intake after SCS insertion and usual elements of a clinical history including adjuvant medications, numeric pain rating, past medical, psychiatric illness, substance abuse, employment, and smoking history. Results: In a group of 261 implanted patients, 214 met the criteria for analysis and had a median age of 50 with majority having the diagnosis of failed back surgery syndrome and complex regional pain syndrome. The only factor that was associated with complete cessation of opioid use was a median dose of 30 milligrams of morphine per day (p<0.01) and was observed in 15% of subjects who used opioids preoperatively. Conclusion: The elimination of opioid dependence following initiation of SCS therapy is highly dependent on the daily dose.

Best Practice & Research Clinical Anaesthesiology, 2019

The facsia iliaca block (FIB) is a relatively new regional technique where local anesthetic is de... more The facsia iliaca block (FIB) is a relatively new regional technique where local anesthetic is delivered within the fascia iliaca region. Indications for a FIB include surgical anesthesia to the lower extremity after knee, femoral shaft, hip surgery, management of cancer pain or pain secondary to inflammatory conditions of the lumbar plexus, as well as treatment of acute pain in the setting of trauma, fracture, or burns. The FIB may be performed using either a loss of resistance technique or an ultrasound (US)-guided technique; however, the use of US has become commonplace and resulted in improved femoral nerve and obturator nerve motor blocks. The main targets of the FIB are the predominant nerves contained in the fascia iliaca compartment (FIC), namely the femoral nerve and the lateral femoral cutaneous nerve. The FIB US guided technique is beneficial to patients and the possibility to perform FIB should be discussed and coordinated with surgical staff appropriately, considering its superiority to general or epidural anesthesia.

Pain Practice, 2019

Patients with chronic pain treated with opioids are at an increased risk for opioid misuse or opi... more Patients with chronic pain treated with opioids are at an increased risk for opioid misuse or opioid use disorder (OUD). Recent years have seen a stark increase in abuse, misuse, and diversion of prescription opioid medications. The aim of this study was to investigate trends in changing rates of opioid use disorder among patients with chronic pain.

Current Pain and Headache Reports, 2019

Background Chronic pain of the lower extremity remains challenging to manage. Radiofrequency trea... more Background Chronic pain of the lower extremity remains challenging to manage. Radiofrequency treatment applies heat to nerve fibers with the goal of mitigating chronic pain conditions. The clinical efficacy has not yet been adequately established for pathologies of the ankle and foot. In this review paper, we report the use and efficacy of radiofrequency treatment applied to foot and ankle pain. Recent Findings PubMed and the Cochrane Controlled Trials Register were searched (final search 30 March 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," "plantar heel pain," "plantar fascitis," and "chronic pain" in the English literature. Of the 23 papers screened, 18 were further investigated for relevance. Our final search methodology yielded 15 studies that investigated the use of radiofrequency treatment at the ankle. Of these 15 studies, there were three randomized control trials, four prospective studies, three retrospective studies, and five case reports. The quality of selected publications was assessed using the Cochrane risk of bias instrument. Summary The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle. Conclusion The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.

Journal of Cardiac Surgery, 2019

Background: Opioid dependence has become a major health care issue. Pain management of invasive s... more Background: Opioid dependence has become a major health care issue. Pain management of invasive surgical procedures with opioids may potentially contribute to this epidemic. We sought to determine the association of opioid-prescribing patterns with chronic opioid use. Methods: We retrospectively reviewed all patients undergoing isolated coronary artery bypass graft (CABG) procedures during 2016 at a single institution. Prescribing patterns and medication usage were compared between opioid-naïve and opioid-exposed patients (patients with reported opioid use within 30 days prior to surgery). Chronic opioid dependence was defined as opioid usage beyond 90 days after discharge. Results: We included 284 opioid-naïve and 46 opioid-exposed patients. Although overall prescribing patterns were similar between groups, a higher proportion of opioid-exposed patients were prescribed a total dose >150 mg of oxycodone per discharge prescription (15.2% vs 4.9%; P = 0.024), and had a higher proportion of refills within 30 days (28.3% vs 10.9%; relative risk [RR] 3.2 [95% confidence interval (CI): 1.5-6.8]; all P < 0.05). The incidence of chronic opioid dependence was higher among opioid-exposed patients compared to opioid-naïve patients (21.7% vs 3.2%; RR 8.5 [95%CI: 3.2-22.3]; P = 0.001). Conclusions: Ongoing opioid use 3 months after CABG is present in 21.7% of opioidexposed patients and 3.2% of opioid-naïve patients. These preliminary findings highlight the burden of prescribing patterns on the overall opioid epidemic and the need to develop alternative pain management strategies. 1 | INTRODUCTION The opioid crisis has become a major public health concern worldwide, and has significant social and economic implications on the welfare and wellbeing of individuals exposed to opioids. 1-3 Within the United States, drug overdose is now the leading cause of accidental death, with opioid addiction playing a major part in driving this epidemic. 1 Likewise, several studies have demonstrated an increase in quantity of opioids (and therefore prescriptions) over time, and the majority of opioid abusers attribute their addiction to these prescription medications. 2,3 Although the exact etiology is yet to be defined, overprescribing by clinicians has been proposed as a major contributor to this burgeoning epidemic, with up to two-thirds of opioid abusers using diverted medication. 4,5 Surgical patients, in particular, are at increased

Current Pain and Headache Reports, 2021

Pain and Therapy, 2021

Neuromodulation: Technology at the Neural Interface, 2021

Physical Medicine and Rehabilitation Clinics of North America, 2021

Advances in Therapy, 2021

Current Pain and Headache Reports, 2020

Asian Spine Journal, 2019

Current Pain and Headache Reports, 2020

Turkish Journal of Anaesthesiology and Reanimation, 2019

Current Pain and Headache Reports, 2019

Neuromodulation: Technology at the Neural Interface, 2019

Pain and Therapy, 2019

Pain Practice, 2019

Best Practice & Research Clinical Anaesthesiology, 2019

Pain Practice, 2019

Current Pain and Headache Reports, 2019

Journal of Cardiac Surgery, 2019