Kohan L, Durbhakula S, Zaidi M, Phillips C, Rowan C, Brenner G, Cohen S

The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis of unprecedented proportions that has altered the practice of medicine. The pandemic has required pain clinics to transition from in-person visits to telemedicine, postpone procedures, and cancel face-to-face educational sessions. There are no data on how fellowship programs have adapted. A 17-question survey was developed covering topics including changes in education, clinical care, and psychological stress due to the COVID pandemic. Results showed a shift to online alternatives for clinical care and education, with correlations between per capita infection rates, and clinical care demands and redeployment, but not with overall trainee anxiety levels. It is likely that medicine in general, and pain medicine in particular, will change after COVID-19, with greater emphasis on telemedicine, virtual education, and greater national and international cooperation. Physicians should be prepared for these changes.

Kohan, L., Durbhakula, S., Zaidi, M., Phillips, C., Rowan, C., Brenner, G., & Cohen, S. (2021). Changes in Pain Medicine Training Programs Associated With COVID-19: Survey Results. Anesthesia & Analgesia. https://doi.org/10.1213/ANE.0000000000005314

Cohen S, Doshi T, Kurihara C, Dolomisiewicz E, Liu R, Dawson T, Hager N, Durbhakula S, Verdun A, Hodgson J, Pasquina P

The rising use of injections to treat low back pain (LBP) has led to efforts to improve selection. Nonorganic (Waddell) signs have been shown to portend treatment failure for surgery and other therapies but have not been studied for minimally invasive interventions. This study prospectively evaluated the association between Waddell signs and treatment outcome in 3 cohorts: epidural steroid injections (ESI) for leg pain and sacroiliac joint (SIJ) injections and facet interventions for LBP. Categories of Waddell signs included nonanatomic tenderness, pain during sham stimulation, discrepancy in physical examination, overreaction, and regional disturbances divulging from neuroanatomy. The primary outcome was change in patient-reported “average” numerical rating scale for pain intensity (average NRS-PI), modeled as a function of the number of Waddell signs using simple linear regression. Secondary outcomes included a binary indicator of treatment response. Secondary and sensitivity analyses were conducted to account for potential confounders. Whereas this study found no consistent relationship between Waddell signs and decreased mean pain scores, a significant relationship between the number of Waddell signs and treatment failure was observed.

Cohen, S., Doshi, T., Kurihara, C., Dolomisiewicz, E., Liu, R., Dawson, T., Hager, N., Durbhakula, S., Verdun, A., Hodgson, J., & Pasquina, P. (2021). Waddell (Nonorganic) Signs and Their Association with Interventional Treatment Outcomes for Low Back Pain. Anesthesia & Analgesia. https://doi.org/10.1213/ANE.0000000000005054

Cohen S, Provenzano D, Narouze S

Cohen SP, Provenzano DA, Narouze S. (2021). Facet guidelines, serial medial branch blocks and issues surrounding recommending procedures with no mechanistic foundation. Regional Anesthesia & Pain Medicine. https://doi.org/10.1136/rapm-2020-101634.

Miles R, Velasco T, Leggit J

This abstract won the Army Chapter of the American College of Physician's abstract competition and will be presented virtually in May 2021.

Chronic Exertional Compartment Syndrome (CECS) is a debilitating disorder that causes lower extremity pain most commonly in active populations. It is thought to arise from increased pressure in muscle compartments (commonly lower extremity anterior and lateral) leading to pain, paresthesia and an inability to tolerate exercise. The cause of CECS is unknown but is likely a combination of muscular, neurologic and vascular contributions. Current standard treatment is surgical fasciotomy, but it is only successful in 66% of patients. Many have complications and/or need repeat procedures. Efficacy is even worse in military members at 55%. Other alternative strategies have emerged such as botulinumtoxin A injections (BoNT-A) and gait retraining, but data is limited.

The objective of this study is to simultaneously assess the effectiveness of non-surgical treatments, BoNT-A injections and Supervised Gait Retraining (SGR), in terms of lower pain control and ability to return to full duty among adult active-duty service members suffering from lower extremity CECS, specifically of the anterior and/or lateral compartments.

Brad Isaacson, PhD, MBA, MSF, PMP, MIRROR Chief of Research and Operations, was featured in The Geneva Foundation’s press release, “14 Geneva Military Medical Researchers Who Inspired Us in 2020,” for his work on the Tri-Service Post-Operative Rehabilitation Consensus Meeting in January 2020.

Read the full article on The Geneva Foundation’s website here.

The Geneva Foundation recognized the MIRROR program for their facilitation of the publication of 11 Tri-Service musculoskeletal injury protocols in May 2020. In January 2021, the article was featured in The Geneva Foundation’s top ten most-read news stories of 2020.

Read the full article on The Geneva Foundation’s website here.