Background: Chronic pain is among the most common conditions worldwide and requires a multidisciplinary treatment approach. Spinal cord stimulation is a possible treatment option for pain management; however, patients undergoing this intervention require close follow-up, which is not always feasible. eHealth apps offer opportunities for improved patient follow-up, although adherence to these apps tends to decrease over time, with rates dropping to approximately 60%. To improve adherence to remote follow-up, we developed a remote follow-up system consisting of a mobile app for patients, a website for health care professionals, and a remote support center. Objective: Our objective was to evaluate patient adherence to remote follow-up using a system that includes a mobile app and a remote support center. Methods: After review of the literature and approval of the design of the follow-up system by a multidisciplinary committee, a team of experts developed a system based on a mobile app, a website for health care professionals, and a remote support center. The system was developed in collaboration with health care professionals and uses validated scales to capture patients’ clinical data at each stage of treatment (ie, pretreatment phase, trial phase, and implantation phase). Data were collected prospectively between January 2020 to August 2023, including the number of total surveys sent, surveys completed, SMS text message reminders sent, and reminder calls made. Results: A total of 64 patients were included (n=40 women, 62.5%) in the study. By the end of the study, 19 (29.7%) patients remained in the pretreatment phase, 8 (12.5%) patients had completed the trial phase, and 37 (57.8%) reached the implantation phase. The mean follow-up period was 15.30 (SD 9.43) months. A total of 1574 surveys were sent, along with 488 SMS text message reminders and 53 reminder calls. The mean adherence rate decreased from 94.53% (SD 20.63%) during the pretreatment phase to 65.68% (SD 23.49%) in the implantation phase, with an overall mean adherence rate of 87.37% (SD 15.37%) for the app. ANOVA showed that adherence was significantly higher in the earlier phases of treatment (P<.001). Conclusions: Our remote follow-up system, supported by a remote support center improves adherence to follow-up in later phases of treatment, although adherence decreased over time. Further studies are needed to investigate the relationship between adherence to the app and pain management.

Background: Rare diseases affect fewer than 1 in 2000 people, but collectively, they impact millions. Their diagnosis and management present challenges due to low prevalence, clinical heterogeneity, and a lack of standardized protocols. Nurses play a key role in assisting and caring for these patients by providing direct care, emotional support, and health education. Objective: The objective of this systematic review is to update the existing knowledge on nurses’ level of understanding regarding rare diseases, as a decline in their training can compromise the quality of care and access to early detection. Methodology: A bibliographic search was conducted in Scopus, PubMed, CINAHL, SciELO, and Cochrane Library, selecting studies published between 2014 and 2024 on rare disease knowledge. The PRISMA model was followed, and the review was registered with PROSPERO under code CRD42024580656. Result: Ultimately, 24 studies were included. The main results showed a significant gap in nursing education concerning rare diseases. Conclusions: Continuous education, telemedicine, and the integration of health technologies were highlighted as improving competencies in rare diseases. Therefore, it is a priority to increase nursing training in rare diseases at all levels.

Background: Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain, offering a safe procedure with low complication rates. Both surgical and percutaneous leads can be effective, with similar complication rates. Methods: We analyzed all patients implanted at a reference center since 1996 to compare pain control and complications and determine whether one system was more effective than the other in patients who had experienced both systems. A retrospective observational study was designed. Results: A total of 188 SCS systems were implanted, with a follow-up period of 79.71 ± 60.39 months (mean ± SD). We analyzed data from 106 males (56.38%) and 82 females (43.62%), ranging from 15 to 76 years old. A total of 68 (36.17%) surgical leads and 120 (63.83%) percutaneous leads were implanted for failed back syndrome (120, 63.83%), complex regional pain syndrome (56, 29.79%), and other conditions (12, 6.38%). No statistically significant differences were found in any variables except for lead migration (p = 0.05). In patients who initially had a percutaneous system and later received a surgical system, we found a statistically significant difference in pain relief percentage (p = 0.03) and a trend toward statistical significance in the PGI-C score (p = 0.08). Conclusions: Both surgical and percutaneous leads have demonstrated similar pain control rates, but percutaneous leads have a higher migration rate. Complications can be minimized by performing the procedure in specialized centers with extensive experience. Further studies comparing both systems should be conducted to determine if one type of lead is superior.

Background: Managing pain with intrathecal infusion pumps has significantly improved the treatment of individuals whose pain is uncontrollable by other methods. Using ultrasound to locate the refill port of these infusion pumps may offer an improvement over traditional methods. Objective: The objective of this systematic review is to update existing knowledge on the use of ultrasound for locating the refill port in intrathecal infusion pumps. Methods: The PRISMA review protocol was followed, and the review was registered in PROSPERO under registration number CRD 42024595671. Results: The main findings indicate that this technique is primarily used only in complex cases where access is difficult. Pain assessment, patient satisfaction, and recharge time compared to the traditional method are crucial factors for selecting the type of process to implement. Conclusions: No conclusive data are presented regarding the technique’s effect on pain reduction, patient satisfaction, reduction in time spent refilling the pump, or the prior experience level of the professional performing it, but notable improvements in these aspects are observed in certain situations.

Background: There are multiple treatments and approaches available to manage pain. However, when these interventions fail to achieve adequate relief, pain management may involve the implantation of intrathecal infusion pumps. The use of ultrasound guidance may enhance nursing practice by improving procedural efficiency and patient comfort. This technique offers a more precise, safer, and less painful approach, potentially increasing patient satisfaction and reducing procedural complications. Aim: To evaluate patient pain levels during intrathecal infusion pump refills under ultrasound guidance compared to the traditional approach, also aiming to determine the time taken per technique and to assess related intra-procedural complications. Design: A prospective quasi-experimental pre-post study. Methods: The study population included individuals with intrathecal infusion pumps. Each participant underwent two refill visits: one using the traditional method and the subsequent refill using ultrasound guidance. The time required to complete the procedure, any complications, and pain related to the procedure were measured for both techniques. Time was measured using a stopwatch, and pain was assessed at the end of each procedure using a Visual Analogue Scale (VAS). Results: A total of 45 patients (25 men and 20 women), with a median age of 56.0 years were included. The estimated mean refill duration was 13.67 min for the traditional method versus 7.26 min for ultrasound-guided refills, representing a 53.2% reduction. The adjusted mean VAS was 2.76 (2.27–3.24) with ultrasound versus 5.91 (5.20–6.62) with the traditional method, yielding an adjusted mean difference of −3.16 (−4.02 to −2.30; p < 0.001). Reductions were consistent across subgroups defined by sex, refill duration, inter-procedural interval, intrathecal medication, and medical history. Complications occurred in 20.0% of traditional refills but in none of the ultrasound-guided procedures. Conclusions: Ultrasound guidance significantly reduces pain, complications, and procedure time, positioning it as the new standard of care for intrathecal pump refills. This mandates its immediate integration into nursing protocols and health management policies.

Background: Traditional refills of intrathecal infusion pumps rely on manual palpation and the use of external templates, a method that can be challenging in patients with anatomical variations or a high body mass index. Ultrasound guidance has emerged as a precision-based alternative. This study aimed to evaluate the impact of the ultrasound-guided technique versus the conventional template-based technique on patient satisfaction. Methods: A quasi-experimental before-and-after study was conducted on a cohort of 45 chronic pain patients. Immediate satisfaction with procedure duration (IPP-SQ), overall treatment efficacy (CRES-4), and pain interference via the Brief Pain Inventory (BPI) were assessed. Results: The use of ultrasound was associated with significantly higher satisfaction regarding procedure duration, with a mean score of 5.00 (95% CI: 4.35–5.65) compared to 3.22 (95% CI: 2.70–3.75) with the traditional method (p < 0.001). Overall satisfaction (CRES-4) also improved significantly (12.4 vs. 11.3; p = 0.001). Regarding patient-reported outcome measures (PROMs), the mean pain intensity in the subsequent week was lower following the ultrasound technique (mean difference −0.48; p = 0.040). Technically, no first-attempt failures were recorded under ultrasound guidance in this sample, compared to a 20% re-attempt rate observed with the manual method. Conclusions: The transition from the traditional method to ultrasound-guided refill optimizes technical precision and substantially enhances the patient experience. By reducing pain and increasing satisfaction, ultrasound guidance proves to be a valuable resource for improving procedural precision, representing an advancement toward a more personalized medicine approach.