Objective: Previous neuroimaging studies have demonstrated that pain-related diseases are associated with brain function and anatomical abnormalities, whereas altered synchronous neural activity in acute eye pain (EP) patients has not been investigated. The purpose of this study was to explore whether or not synchronous neural activity changes were measured with the regional homogeneity (ReHo) method in acute EP patients. Methods: A total of 20 patients (15 males and 5 females) with EP and 20 healthy controls (HCs) consisting of 15 and 5 age-, sex-, and education-matched males and females, respectively, underwent resting-state functional magnetic resonance imaging. The ReHo method was applied to assess synchronous neural activity changes. Results: Compared with HCs, acute EP patients had significantly lower ReHo values in the left precentral/postcentral gyrus (Brodmann area [BA]3/4), right precentral/postcentral gyrus (BA3/4), and left middle frontal gyrus (BA6). In contrast, higher ReHo values in acute EP patients were observed in the left superior frontal gyrus (BA11), right inferior parietal lobule (BA39/40), and left precuneus (BA7). However, no relationship was found between the mean ReHo signal values of the different areas and clinical manifestations, which included both the duration and degree of pain in EP patients. Conclusion: Our study highlighted that acute EP patients showed altered synchronous neural activities in many brain regions, including somatosensory regions. These findings might provide useful information for exploration of the neural mechanisms underlying acute EP.

Co-occurrence of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) symptoms are particularly prevalent in the special operations forces' community, along with other related conditions (e.g., endocrine dysregulation, sleep disorders, chronic pain). Ketamine infusion (KI) has been shown to increase neuroplasticity as well as memory improvement and cervical sympathetic block (CSB) has been shown to improve cognitive function, reduce sympathetic overactivity, and improve other symptoms of PTSD. We want to report the efficacious use of a single intervention consisting of bilateral CSB technique with subanesthetic KI X5 in a Special Operations Forces patient, diagnosed with PTSD with comorbid TBI, evaluated during treatment and at 1-year follow-up. We postulated KI and CSB would have a synergistic effect. Our patient received KI starting at 0.5 mg/kg, which was escalated daily. KI was combined with right-sided ultrasound-guided CSB (C6 and C4 levels). This was followed the next day by left-sided CSB and KI. Patient’s PTSD symptoms were evaluated using the Posttraumatic Stress Disorder Checklist (PCL-5), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), suicidal ideation and other related factors by Concise Health Risk Tracking Self Report (CHRTSR). All measures were assessed prior to treatment, during treatment, and 394 days after. KI combined with CSB showed immediate and prolonged benefits 394 days later regarding the symptoms of PTSD, anxiety, depression, suicidal ideation, and cognitive deterioration (patient report). KI combined with CSB can markedly reduce symptoms of PTSD, psychiatric comorbidities, and cognitive dysfunction.

Background/Objectives: To determine the incidence of and risk factors for uncomfortable paresthesia and/or dysesthesia after tonic percutaneous spinal cord stimulator implantation. Methods: A retrospective analysis was conducted on the prospectively collected data of patients that had permanent percutaneous tonic spinal cord stimulators implanted. Our primary objective was to assess the prevalence of complications over a period of 24 months after the implantation of this device. Results: The mean post-implantation follow-up time was 27.3 months. The mean pain score before spinal cord stimulator implantation was 8.05, which was reduced to 3.6 after 24 months. The most common complications in our study sample were the need for revision and the development of unpleasant paresthesia, which were reported by 34.95% and 27.86% of patients, respectively. There was no association between paresthesia and age, sex, or body mass index (BMI). The only risk factor of statistical significance was current tobacco use (p = 0.001). Conclusions: The development of uncomfortable paresthesia after SCS is associated with considerable morbidity, particularly the explantation of SCS, despite adequate pain relief. Focusing on strategies, such as appropriate waveform selection, might reduce the incidence of uncomfortable paresthesia requiring revision or explantation. Current tobacco use appears to be a significant risk factor for the development of unpleasant paresthesia/dysesthesia when compared with non-tobacco and former tobacco users after tonic percutaneous spinal cord stimulator implantation.

Background: Post-traumatic stress disorder (PTSD) is a prevalent and debilitating condition in Australia. Success rates for current therapies may be delayed and inconsistent. This has led clinicians to explore other options, with cervical sympathetic blockade (CSB) being one of potential promise due to its high efficacy and rapid therapeutic onset. The original paper describing CSB was published in the United States of America (USA), and this was followed by multiple reports of successful PTSD treatment using stellate ganglion block (SGB). To date, no report of CSB utility in Australia has entered the medical literature. Objective: To evaluate the efficacy of CSB as a treatment option for patients diagnosed with PTSD in multiple Australian cohorts. Study Design: Retrospective cohort study. Setting: An established anesthesia pain clinic in 4 Australian cities (Sydney, Brisbane, Perth, Melbourne). Methods: The total cohort included 99 consecutive cases of patients diagnosed with PTSD and treated with right-sided CSB, performed by eight providers across 4 cities (Sydney, Brisbane, Perth, Melbourne). The primary outcome measurement was the PTSD Checklist Score version DSM-5 (PCL-5), which established the initial diagnosis of PTSD. PCL-5 data collection commenced in July 2021 and data regarding trauma specifications was collected beginning in July 2022. Patient demographic and clinical information collected included age, gender, and type of trauma experienced. Results: After the exclusion of cases due to missing data points, 99 patients were included in the final statistical analysis, having completed PCL-5 pre and post-CSB, between 7 and 30-days post-intervention. The patient population included civilian men (n=49) and civilian women (n=50). We identified 22 types of self-reported trauma leading to PTSD. The average decrease in PCL scores for men and women was 23.69 and 21.64, respectively. Statistically significant improvements in PTSD symptoms were noted across varying sources of causative trauma type and gender. Limitations: Limitations include the limited scope of observation giving exclusive focus on pre-and post-PCL data, the limited duration of observation, the self-reported nature of the patient-provided data, and the provision of treatment by eight physicians across multiple locations. Conclusion: CSB seems to be an effective treatment for PTSD symptoms irrespective of gender, trauma type, PTSD-related drug use, suicide attempt, or age, in Australian cohorts.