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Simopoulos, Thomas

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Simopoulos

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Thomas

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Simopoulos, Thomas
Author's Publications: search.filters.isAuthorOfPublication.49871c17-84c2-49a8-904a-fcdd326580e0

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    A Brief History of the Opioid Epidemic and Strategies for Pain Medicine
    (Springer Healthcare, 2018) Jones, Mark; Viswanath, Omar; Peck, Jacquelin; Kaye, Alan D.; Gill, Jatinder; Simopoulos, Thomas
    The opioid epidemic has resulted from myriad causes and will not be solved by any simple solution. Consequent to a staggering increase in opioid-related deaths in the USA, various governmental inputs and stakeholder strategies have been proposed and implemented with varying success. This article summarizes the history of opioid use and explores the causes for the present day epidemic. Recent trends in opioid-related data demonstrate an almost fourfold increase in overdose deaths from 1999 to 2008. Tragically, opioids claimed over 64,000 lives just last year. Some solutions have undergone legislation, including the limitation of numbers of opioids postsurgery, as well as growing national prevalence of enhanced recovery after surgery protocols which focus on reduced postoperative opioid consumption and shortened hospital stays. Stricter prescribing practices and prescription monitoring programs have been instituted in the recent past. Improvement in abuse deterrent strategies which is a major focus of the Food and Drug Administration (FDA) for all opioid preparations will likely play an important role by increasing the safety of these medications. Future potential strategies such as additional legislative policies, public awareness, and physician education are also detailed in this review.
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    Ultrasonographic Guidance and Characterization of Cryoanalgesic Lesions in Treating a Case of Refractory Sural Neuroma
    (Hindawi Publishing Corporation, 2011) Rhame, Ellen E.; DeBonet, Alexander F.; Simopoulos, Thomas
    The recurrent pain of a neuroma following surgical excision and burial of nerve endings can be clinically challenging to manage. Cryoanalgesia in conjunction with ultrasound guidance was used successfully to manage this type of pain. Furthermore, ultrasound provided visualization of the cryolesions, as well as the relationships of the ice ball to the surrounding tissue. Following the completion of the freeze cycle, the tissue can be monitored for return to its usual morphology during the thaw period.
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    Percutaneous Radiofrequency Lesioning of the Suprascapular Nerve for the Management of Chronic Shoulder Pain: A Case Series
    (Dove Medical Press, 2012) Simopoulos, Thomas; Nagda, Jyotsna; Aner, Musa
    Purpose: The objective of this study was to retrospectively evaluate the analgesic effects of continuous radiofrequency lesioning of the suprascapular nerve (SSN) for chronic shoulder pain. The authors sought to obtain insight into the time-sensitive analgesic success and complications of this therapy. Patients and methods: This study was a retrospective case series involving patients with unremitting shoulder pain that had lasted for at least 12 months. Patients were selected if they showed a reduction of at least 50% in pain intensity during the anesthetic phase after SSN block, no additional motor weakness of the shoulder, and pain relief lasting for less than 2 months after separate treatments of the SSN with depot corticosteroids and pulsed radiofrequency. Nine patients were referred to the Arnold Pain Management Center. Of these nine patients, six patients who had significant chronic shoulder pain unresponsive to oral medications and intra-articular injections and who were not considered surgical candidates were selected. These patients were treated with a single radiofrequency lesion of the SSN at 80\(^\circ\)C for 60 seconds. The primary outcome was a reduction in pain intensity by 50%, as determined by the numeric rating scale, and duration of this effect. The secondary outcome was improvement in either the passive or the active range of motion (ROM). Patients were also monitored for adverse effects such as weakness or increased pain. Results: The pooled mean numeric rating scale score before the procedure was 7.2 \(\pm\) 1.2; this fell to 3.0 \(\pm\) 0.9 at 5–7 weeks post procedure. The duration of pain relief ranged from 3 to 18 months, and all patients underwent at least one additional treatment. The change in baseline ROM improved from an average of 60\(^\circ\) \(\pm\) 28\(^\circ\) (flexion) and 58\(^\circ\) \(\pm\) 28\(^\circ\) (abduction) to 99\(^\circ\) \(\pm\) 46\(^\circ\) (flexion) and 107\(^\circ\) \(\pm\) 39\(^\circ\) (abduction). No adverse side effects were observed. Conclusion: Continuous radiofrequency lesioning of the SSN seems to be an effective treatment for chronic shoulder pain. There can be improved ROM of the shoulder following this treatment. More formal, controlled studies are required to confirm these observations.