Salim Ghazi | Mayo Clinic Graduate School (original) (raw)

Papers by Salim Ghazi

Curēus, Mar 5, 2024

Background This pilot study aims to examine the effectiveness of a spinal cord stimulator (SCS) s... more Background This pilot study aims to examine the effectiveness of a spinal cord stimulator (SCS) simulator training system in improving the confidence of pain fellows in SCS placement. Methodology Five Ukrainian physicians (neurologists, neurosurgeons, and an anesthesiologist) completed a 10-item survey regarding their confidence in various aspects of SCS placement and their opinions on how effective SCS models were for educational purposes. After placing SCS leads using the SCS simulator, the physicians took the same survey again. The Mann-Whitney U test was used to determine if there was a significant difference in total scores pre and post-simulator training. The software PAST (PAleontological STatistics) was used for statistical analysis. Results Overall, five participants had a 38% statistically significant increase in survey scores before and after the intervention (mean: 4.2 vs. 6.2, p = 0.0055). With regards to each item of the survey, participants had a significantly increased confidence in driving leads (2.6 vs. 5.2, p = 0.008) and in overall technical skills for the SCS procedure after the training (2.8 vs. 5.2, p = 0.0188). Although the other eight survey items were not statistically significant (p > 0.05), participants had a 28% increase in confidence when inserting epidural needles, a 20% increase in interpreting simulated X-rays, a 32% increase in navigating challenging anatomical variations, a 12% increase in identifying key anatomical landmarks, a 20% increase in ensuring the correct placement of the lead, or a 53% increase in preparedness for performing an SCS procedure in a real clinical setting. The participant's perspective on how valuable the stimulator training was for enhancing procedural skills increased by 38% and how well the simulator replicated real-life SCS procedure increased by 52%, although both were statistically insignificant (p > 0.05). Conclusions This pilot study shows that the utilization of simulated neuromodulation training is a viable means of augmenting neuromodulation education by increasing physician's confidence in aspects of the SCS placement procedure. The extent to which simulator training improves procedural skills in a real-life SCS placement needs to be investigated further.

Brain Stimulation, Mar 1, 2019

predetermined threshold outside of the ROI, showing the potential of this approach to optimize TI... more predetermined threshold outside of the ROI, showing the potential of this approach to optimize TI electrodeconfigurations. We are currently further improving our approach and adapting it for a realistic human head model.

Anesthesiology, Sep 1, 2002

Pain Medicine, 2019

ObjectiveThis study aimed to investigate the effectiveness of repeat cooled radiofrequency ablati... more ObjectiveThis study aimed to investigate the effectiveness of repeat cooled radiofrequency ablation (CRFA) in chronic posterior sacroiliac joint (SIJ) pain.DesignThe electronic records of 41 adult patients who had successful CRFA were reviewed for duration of pain relief and utilization of medical care for six months before and after each CRFA procedure.SettingAcademic, tertiary medical center.PatientsForty-one adult patients who had CRFA for chronic posterior SIJ pain.ResultsA repeat ipsilateral CRFA ablation procedure provided 9.0 months of pain relief compared with 5.5 months after the first CRFA procedure (P = 0.0378). The total number of medical treatments decreased after the first CRFA procedure (from 343 to 201). The medical cost decreased by 51.0% after the first CRFA and by 70.4% after the repeated CRFA procedure.ConclusionsUsing repeated nonsurgical, minimally invasive approach, CRFA relieves chronic posterior SIJ pain and reduces patients’ utilization of medical services.

Pain Medicine, 2017

Objective. Postherpetic neuralgia (PHN) is common in the United States. Current treatment options... more Objective. Postherpetic neuralgia (PHN) is common in the United States. Current treatment options for PHN are fairly limited. Spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) are considered mostly experimental and still rarely performed in patients with PHN. Design. Two case reports and a review of the literature. Setting. Tertiary academic medical center. Methods. 1) Pubmed, Ovid, and EBMR databases were searched for all reports that had the following key words: postherpetic neuralgia, spinal cord stimulation, and peripheral nerve stimulation. 2) A retrospective chart review was performed for all the patients that underwent PNS for PHN at Mayo Clinic Florida (MCF). Results. There were 20 original reports that described 309 patients with PHN who were treated with SCS. Sixteen reports had a permanent implantation of SCS, with a total of 255 patients, out of which 120 had long-term pain relief. There were six reports of subcutaneous PNS for PHN (in a thoracic area). Four reports provided data on success rates where all five patients received complete pain relief. In our practice, two patients underwent subcutaneous PNS for PHN (in the thoracic area) with good pain relief for 10 months and 2.5 years, respectively. Conclusions. Based on our review of the literature and the two cases at MCF, subcutaneous PNS seems to be a promising intervention in the treatment of PHN.

Pain Medicine, May 1, 2015

Objective. The cost of caring for patients with chronic pain conditions poses a significant burde... more Objective. The cost of caring for patients with chronic pain conditions poses a significant burden to both the healthcare system and patients. We were interested in analyzing the financial costs and benefits of treating these patients in a comprehensive outpatient pain rehabilitation program. Design. All participants completed the 3-week outpatient Mayo Clinic Florida Pain Rehabilitation Program (PRC) between October 2011 and September 2013. Healthcare costs were compared during the 3-, 6-, 12-, and 18-month periods pre-and post-treatment. Patients. The sample included 53 patients. Results. Medical costs decreased by 86, 68, 64, and 90% in the 3-, 6-, 12-, and 18-month post-treatment periods, respectively, when compared with the same pretreatment periods. Conclusions. The appropriate use of a comprehensive outpatient rehabilitation program for chronic pain patients can result in a significant reduction in medical costs.

Cancer control : journal of the Moffitt Cancer Center

The availability of various routes of administration of opioid analgesics can be confusing when d... more The availability of various routes of administration of opioid analgesics can be confusing when determining an appropriate, efficacious, and cost-effective regimen to manage cancer pain. The indications, contraindications, and pharmacokinetic properties of oral, intravenous, subcutaneous, transdermal, transmucosal, rectal, and perispinal routes of opioid administration are reviewed. To determine the most efficacious, cost-effective, and user-friendly option to manage cancer pain, several factors must be considered: the ability of the patient to use a specific type of delivery system, the efficacy of that system to deliver acceptable analgesia, the ease of use for the patient and family, the potential or actual complications associated with that system, and the cost. Administering opioids to manage cancer pain requires knowledge of potency relative to morphine and bioavailability of the route chosen. Changes in the route, dosage, or opioid used should be accompanied with close patien...

Mayo Clinic proceedings, 2004

Neuropathic pain (NP), caused by a primary lesion or dysfunction in the nervous system, affects a... more Neuropathic pain (NP), caused by a primary lesion or dysfunction in the nervous system, affects approximately 4 million people in the United States each year. It is associated with many diseases, including diabetic peripheral neuropathy, postherpetic neuralgia, human immunodeficiency virus-related disorders, and chronic radiculopathy. Major pathophysiological mechanisms include peripheral sensitization, sympathetic activation, disinhibition, and central sensitization. Unlike most acute pain conditions, NP is extremely difficult to treat successfully with conventional analgesics. This article introduces a contemporary management approach, that is, one that incorporates nonpharmacological, pharmacological, and interventional strategies. Some nonpharmacological management strategies include patient education, physical rehabilitation, psychological techniques, and complementary medicine. Pharmacological strategies include the use of first-line agents that have been supported by randomiz...

Pain physician

Piriformis syndrome is a pain syndrome originating in the buttock and is attributed to 6% - 8% of... more Piriformis syndrome is a pain syndrome originating in the buttock and is attributed to 6% - 8% of patients referred for the treatment of back and leg pain. The treatment for piriformis syndrome using fluoroscopy, computed tomography (CT), electromyography (EMG), and ultrasound (US) has become standard practice. The treatment of Piriformis Syndrome has evolved to include fluoroscopy and EMG with CT guidance. We present a case study of 5 successful piriformis injections using 3-D computer-assisted electromagnet needle tracking coupled with ultrasound. A 6-degree of freedom electromagnetic position tracker was attached to the ultrasound probe that allowed the system to detect the position and orientation of the probe in the magnetic field. The tracked ultrasound probe was used to find the posterior superior iliac spine. Subsequently, 3 points were captured to register the ultrasound image with the CT or magnetic resonance image scan. Moreover, after the registration was obtained, the n...

$Research paper thumbnail of The Use of Spinal Cord Stimulation in Refractory Abdominal Visceral Pain: Case Reports and Literature Review$

Pain Practice, 2006

Patients will commonly seek medical attention for refractory abdominal pain. The many causes of a... more Patients will commonly seek medical attention for refractory abdominal pain. The many causes of abdominal pain include pathologies of the gastrointestinal, genitourinary, musculoskeletal, and nervous systems. Unfortunately, a large number of patients will develop chronic abdominal pain that is recalcitrant to definitive therapies and nonspecific treatments such as cognitive-behavioral, physical, and pharmacologic therapies. Although spinal cord stimulation is classically used for neuropathic and ischemic conditions, a growing number of reports describe its efficacy in visceral disease. We describe our experience with spinal cord stimulation in two patients with refractory abdominal pain. Although the exact etiology in these complex patients is not defined, it is theorized that visceral hypersensitivity is at least one component. Finally, we will summarize the applicable literature in order to explain a possible mechanism of analgesia in visceral disease.

Pain Medicine, 2015

This is an open access article under the terms of the Creative Commons Attribution-Non-Commercial... more This is an open access article under the terms of the Creative Commons Attribution-Non-Commercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

PM&R, 2010

Objective: To determine if morphologic changes occur in the lumbar multifidus muscles, facet join... more Objective: To determine if morphologic changes occur in the lumbar multifidus muscles, facet joints, and intervertebral disks after medial branch radiofrequency neurotomy (RFN). Design: Retrospective review of medical records and magnetic resonance imaging (MRI). Setting: University spine center. Participants: 27 subjects treated with lumbar RFN who had both pre-and posttreatment MRIs completed at a single institution.

Pain Medicine, 2011

Investigate whether percutaneous spinal cord stimulator (SCS) leads migrate significantly during ... more Investigate whether percutaneous spinal cord stimulator (SCS) leads migrate significantly during a 3-day trial, and determine whether the skin anchoring method influences lead migration. Twenty patients were prospectively enrolled. Ten leads were anchored with suture and tape and 10 were anchored with tape only. A standardized X-ray protocol of lead position was obtained immediately following lead placement and upon completion of the trial. Using a standardized method, SCS leads were measured and movement was calculated. The average movement for leads anchored with tape only was 8.72 mm (SD=5.77), inferiorly; while movement for leads anchored with suture and tape was 24.49 mm (SD=11.3), inferiorly. A t-test revealed a significant difference between the groups (t=3.9, P=0.001). Percutaneous SCS trial electrodes migrate significantly, inferiorly, during a 3-day trial. Anchoring the trial electrodes to the skin with a suture and tape results in significantly greater inferior migration when compared with anchoring the lead with tape only.

Mayo Clinic Proceedings, 2004