Papers by Martine Puylaert
Frontiers in neuroscience, Mar 22, 2024
Introduction: Spinal cord stimulation is a common treatment option for neuropathic pain condition... more Introduction: Spinal cord stimulation is a common treatment option for neuropathic pain conditions. Despite its extensive use and multiple technological evolutions, long term efficacy of spinal cord stimulation is debated. Most studies on spinal cord stimulation include a rather limited number of patients and/or follow-ups over a limited period. Therefore, there is an urgent need for real-world, long-term data. Methods: In 2018, the Belgian government initiated a nationwide secure platform for the follow-up of all new and existing spinal cord stimulation therapies. This is a unique approach used worldwide. Four years after the start of centralized recording, the first global extraction of data was performed. Results: Herein, we present the findings, detailing the different steps in the centralized procedure, as well as the observed patient and treatment characteristics. Furthermore, we identified dropouts during the screening process, the reasons behind discontinuation, and the evolution of key indicators during the trial period. In addition, we obtained the first insights into the evolution of the clinical impact of permanent implants on the overall functioning and quality of life of patients in the long-term. Discussion: Although these findings are the results of the first data extraction, some interesting conclusions can be drawn. The long-term outcomes of neuromodulation are complex and subject to many variables. Future data extraction will allow us to identify these confounding factors and the early predictors of success. In addition, we will propose further optimization of the current process.
Regional Anesthesia: The Journal of Neural Blockade in Obstetrics, Surgery, & Pain Control, May 1, 1992
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > ...
Martine Puylaert, MD, FIPP*; Leonardo Kapural, MD, PhD, FIPP; Jan Van Zundert, MD, PhD, FIPP*; Di... more Martine Puylaert, MD, FIPP*; Leonardo Kapural, MD, PhD, FIPP; Jan Van Zundert, MD, PhD, FIPP*; Dirk Peek, MD; Arno Lataster, MSc; Nagy Mekhail, MD, PhD, FIPP**; Maarten van Kleef, MD, PhD, FIPP; Yolande C. A. Keulemans, MD, PhD *Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, U.S.A.; Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht; Department of Anesthesiology and Pain Medicine, St. Jans Gasthuis, Weert; Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands; **Department of Pain Management, Anesthesiology Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.; Department of Gastro-Enterology, Maastricht University Medical Centre, Maastricht, The Netherlands
Immunology and Its Impact on Infections in Surgery, 1995
Recent studies suggest that cytokines can participate in the pathophysiology of normal and abnorm... more Recent studies suggest that cytokines can participate in the pathophysiology of normal and abnormal pregnancy and parturition. Interleukin 6 (IL-6), an early and integral responder in the cascade of host mediators after injury, exerts multiple biological activities which comprise the induction of fever, the modulation of the synthesis of acute-phase proteins by the liver, activation of B and T lymphocytes, and the stimulation of hemopoietic progenitor and stem cells.
Regional Nerve Blocks in Anesthesia and Pain Therapy, 2015
Radiofrequency (RF) treatment adjacent to the cervical dorsal root ganglion (DRG) is particularly... more Radiofrequency (RF) treatment adjacent to the cervical dorsal root ganglion (DRG) is particularly indicated for the management of cervical radicular pain, refractory to conventional treatment. Cervical radicular pain is pain perceived in the arm, shooting or electric in quality, caused by irritation and/or injury of a cervical spinal nerve [1, 2]. It affects approximately 1 in 1,000 adults annually. There may be confusion between cervical radicular pain and cervical radiculopathy. The latter is a condition where an objective loss of sensory and/or motor function is present. Radicular pain and radiculopathy are therefore not synonymous, although they are frequently not differentiated in the literature. The former is a symptom caused by ectopic impulse generation. The latter also includes neurological signs. The two conditions may nonetheless coexist and may be caused by the same clinical entities, e.g., foraminal stenosis, intervertebral disc herniation, and radiculitis due to arteritis, infection, or inflammatory exudates [3]. The two syndromes can be part of a continuum, and radiculopathy may follow radicular pain as the underlying disease progresses.
Journal of Psychosomatic Research, 2004
Neuromodulation: Technology at the Neural Interface
Neuromodulation: Technology at the Neural Interface
Regional Anesthesia and Pain Medicine, 2010
Background and Objectives: Occipital neuralgia is a paroxysmal nonthrobbing, stabbing pain in the... more Background and Objectives: Occipital neuralgia is a paroxysmal nonthrobbing, stabbing pain in the area of the greater or lesser occipital nerve caused by irritation of these nerves. Although several therapies have been reported, no criterion standard has emerged. This study reports on the results of a prospective trial with 6 months of follow-up in which pulsed radiofrequency treatment of the greater and/or lesser occipital nerve was used to treat this neuralgia. Methods: Patients presenting with clinical findings suggestive of occipital neuralgia and a positive test block of the occipital nerves with 2 mL of local anesthetic underwent a pulsed radiofrequency procedure of the culprit nerves. Mean scores for pain, quality of life, and medication intake were measured 1, 2, and 6 months after the procedure. Pain was measured by the visual analog and Likert scales, quality of life was measured by a modified brief pain questionnaire, and medication intake was measured by a Medication Quantification Scale. Results: During a 29-month period, 19 patients were included in the study. Mean visual analog scale and median Medication Quantification Scale scores declined by 3.6 units (P = 0.002) and 8 units (P = 0.006), respectively, during 6 months. Approximately 52.6% of patients reported a score of 6 (pain improved substantially) or higher on the Likert scale after 6 months. No complications were reported. Conclusions: Pulsed radiofrequency treatment of the greater and/or lesser occipital nerve is a promising treatment of occipital neuralgia. This study warrants further placebo-controlled trials.
Regional Anesthesia & Pain Medicine, 2020
BackgroundThe innervation of the sacroiliac joint (SIJ) is complex, with a dual innervation origi... more BackgroundThe innervation of the sacroiliac joint (SIJ) is complex, with a dual innervation originating from the lumbosacral plexus anteriorly as well as the sacral lateral branches posteriorly. Nociceptors are found in intra-articular structures as well as periarticular structures. In patients with SIJ pain, a fluoroscopy-guided SIJ injection is usually performed posteriorly into the bottom one-third of the joint with local anesthetic and corticosteroids, but this does not always reach all intra-articular structures. The correlation between a cranial contrast spread and clinical success is undetermined in patients with SIJ pain.MethodsIn a tertiary referral pain center, electronic medical records of patients who underwent an SIJ injection were retrospectively analyzed. Only patients with at least three positive provocation maneuvers for SIJ pain were selected. Contrast images of the SIJ were classified as with or without cranial spread on fluoroscopy as a marker of intra-articular ...
Anesthesiology and Pain Medicine, 2017
Background: Spinal cord stimulation (SCS) is a proven and effective treatment for neuropathic pai... more Background: Spinal cord stimulation (SCS) is a proven and effective treatment for neuropathic pain conditions such as failed back surgery syndrome (FBSS). The hypothesis that different settings for SCS parameters activate unique, pain-relieving mechanisms has boosted the development of various SCS paradigms. High density spinal cord stimulation (HD-SCS) is one of those promising, novel stimulation forms characterized by subthreshold stimulation, delivering more pulses per second and a higher pulse density to the spinal cord than conventional SCS. Objectives: The aim of DISCOVER is to gather evidence about the effectiveness, feasibility, and (possible) side effects of HD stimulation. Methods: The prospective, non-interventional, multi-center, clinical study, DISCOVER, is currently restricted to Belgium where 19 neuromodulation centers were selected. Patient recruitment started in October 2016 and is expected to end in October 2017. Subjects included are (1) patients with insufficient pain relief from conventional SCS or (2) neurostimulation-naïve patients suited for SCS. Patients will be assessed 1 month, 3 months, and 12 months after conversion to HD-SCS settings. Each patient's visit will include: a numerical rating scale (NRS), Oswestry disability index (ODI), Pittsburgh sleep quality index (PSQI), EQ-5D, a pain map, registration of SCS settings, and a list of used pain medication. Conclusions: Although promising results have been reported, adequate registration of its effectiveness and (possible) side-effects remains an unmet need. Main results are expected in 2019.
An Interdisciplinary Case-Based Approach, 2015
European Journal of Anaesthesiology, 2014
European Journal of Anaesthesiology, 2014
Streszczenie: Kryzys jest zjawiskiem odwiecznym, to wielkie wyzwanie dla światowej gospodarki, to... more Streszczenie: Kryzys jest zjawiskiem odwiecznym, to wielkie wyzwanie dla światowej gospodarki, to stan, który z całą pewnością zagraża bytowi przedsiębiorstwa. Co należy więc robić w stanie zagrożenia? Zdecydowanie i bezwzględnie wprowadzać zmiany. Niniejsze opracowanie stanowi próbę ukazania, jak kryzys gospodarczy może wpływać na prace zarządzających przedsiębiorstwem oraz jakie zmiany wymusza w poszczególnych obszarach funkcjonowania przedsiębiorstwa. Wszyscy dzisiaj chcielibyśmy, aby to, co się wydarzyło w gospodarce globalnej i ciągle jeszcze trwa, było tylko złym snem, który nie ma żadnego wpływu na tak dobrze funkcjonujące gospodarki wielu krajów i trwającej dobrej koniunktury od kilkunastu lat. Z niedowierzaniem spoglądamy na to, co się dzieje i powoli zaczynamy rozumieć, że nasze przeświadczenie o tym, że naszego kraju, regionu, naszej rmy i w konsekwencji nas samych ten fakt nie dotyczy, stało się kcją. W różnym stopniu, w różnych dziedzinach i z różną intensywnością odczuwamy pewne symptomy związane ze złą sytuacją gospodarczą, co w konsekwencji przenosi się na działalność poszczególnych rm, a konkretnie na problemy i kłopoty związane z przystosowaniem się do nowej sytuacji w bardzo krótkim czasie i pod presją niebezpieczeństwa utraty zdolności normalnego funkcjonowania lub wręcz jego zaprzestania. W takim to okresie jednym z najważniejszych zadań, jakie stoją przed ludźmi sprawującymi władzę w organizacjach i odpowiadającymi za powodzenie ich funkcjonowania, jest właściwe przewodzenie i skuteczne zarządzanie podczas całego okresu dekoniunktury, mające na uwadze jeden zasadniczy cel -przygotować organizację do jej przetrwania z jak najmniejszymi stratami. Nie jest to zadanie łatwe, jak piszą R. Heifetz, A. Grashow, M. Linsky w artykule "Przywództwo w dobie permanentnego kryzysu", przewodzenie podczas długotrwałej dekoniunktury -niezależnie od tego, czy jesteś prezesem dużej korporacji, czy kierujesz jednym z jej przedsięwzięć -jest niebezpieczne. Kryzysowe przywództwo ma dwie odrębne fazy. Pierwsza z nich to faza ratunkowa, w której należy unormować sytuację i zyskać na czasie. W drugiej fazie, adaptacyjnej, trzeba wyeliminować przyczyny leżące u podłoża kryzysu i zbudować potencjał, który pozwoli rmie prosperować w nowej rzeczywistości 1 . Jak widać, skala i zakres działań do podjęcia w takich sytuacjach są olbrzymie, dają one możliwość do działania we wszystkich obszarach działalności organizacji i są swoistym sprawdzianem dla zarządzających, sprawdzianem, którego wynik niejednokrotnie może dla organizacji znaczyć bardzo wiele. Zasygnalizowana powyżej problematyka stanowi fragment szerszego
Anesthesiology, 2015
Background: Less than 50% of patients experience sufficient pain relief with current drug therapy... more Background: Less than 50% of patients experience sufficient pain relief with current drug therapy for neuropathic pain. Minocycline shows promising results in rodent models of neuropathic pain but was not studied in humans with regard to the treatment of neuropathic pain. Methods: In this randomized, double-blind, placebo-controlled clinical trial, patients with subacute lumbar radicular pain received placebo, amitriptyline 25 mg, or minocycline 100 mg once a day (n = 20 per group) for 14 days. Primary outcome measure was the pain intensity in the leg as measured by a numeric rating scale ranging from 0 to 10 on days 7 and 14. Secondary outcome measures were the reduction of neuropathic pain symptoms in the leg as determined with a neuropathic pain questionnaire, consumption of rescue medication, and adverse events on days 7 and 14. Results: Sixty patients were randomized and included in an intention-to-treat analysis. After 14 days, patients in the minocycline and amitriptyline gro...
Pain Practice, 2013
Chronic pain may recur after initial response to strong opioids in both patients with cancer and ... more Chronic pain may recur after initial response to strong opioids in both patients with cancer and patients without cancer or therapy may be complicated by intolerable side effects. When minimally invasive interventional pain management techniques also fail to provide satisfactory pain relief, continuous intrathecal analgesic administration may be considered. Only 3 products have been officially approved for longterm intrathecal administration: morphine, baclofen, and ziconotide. The efficacy of intrathecal ziconotide for the management of patients with severe chronic refractory noncancer pain was illustrated in 3 placebo-controlled trials. A randomized study showed this treatment option to be effective over a short follow-up period for patients with pain due to cancer or AIDS. The efficacy of intrathecal opioid administration for the management of chronic noncancer pain is mainly derived from prospective and retrospective noncontrolled trials. The effect of intrathecal morphine administration in patients with pain due to cancer was compared with oral or transdermal treatment in a randomized controlled trial, which found better pain control and fewer side effects with intrathecal opioids. Other evidence is derived from cohort studies. Side effects of chronic intrathecal therapy may either be technical (catheter or pump malfunction) or biological (infection). The most troublesome complication is, however, the possibility of granuloma formation at the catheter tip that may induce neurological damage. Given limited studies, the evidence for intrathecal drug administration in patients suffering from cancer-related pain is more compelling than that of chronic noncancer pain. &
Chronic Abdominal Pain, 2014
Chronic pancreatitis (CP) is a benign inflammatory disease of the pancreas. The mechanism of pain... more Chronic pancreatitis (CP) is a benign inflammatory disease of the pancreas. The mechanism of pain is incompletely understood although the knowledge of this disease starts with the study of Sarles et al. in 1965. Irreversible morphological changes take place with progressive loss of the exocrine and later endocrine function of the gland due to fibrosis.
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Papers by Martine Puylaert