In recent years, there has been a considerable increase in the number of image-guided interventio... more In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic-or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.
American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 1996
The firing rate of the nerves innervating interscapular brown adipose tissue (IBAT), IBAT and col... more The firing rate of the nerves innervating interscapular brown adipose tissue (IBAT), IBAT and colonic temperatures (TIBAT and TC), and O2 consumption were monitored in urethan-anesthetized male Sprague-Dawley rats. These variables were measured for 40 min before (baseline values) and 40 min after a neostigmine (5 x 10(-7) mol) or saline injection in the hippocampus. The blood level of 3,5,3'-triiodothyronine and L-thyroxine (T3 and T4) and the 5'-deiodinating activity of IBAT, liver, and kidneys were determined in other rats with neostigmine or saline injection. The results showed that neostigmine injection increased firing rate, TIBAT, TC, O2 consumption, blood level of T3, and 5'-deiodinating activity of IBAT. No change was found in the T4 level and in 5'-deiodinating activity of the liver and kidneys. These findings suggest that neostigmine injection in the hippocampus increases heat production by stimulating sympathetic nerves to IBAT and by elevating the blood l...
In patients where conservative approaches have failed to relieve from chronic pain, interventiona... more In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasoundguided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.
Context: Bone metastasis (BM) is a frequent complication of cancer, representing the third most c... more Context: Bone metastasis (BM) is a frequent complication of cancer, representing the third most common site of secondary spread in solid cancers behind the lung and liver. Bone metastasis is found in up to 90% of prostate and breast cancer patients. They can cause significant complications, such as pathological fractures and paralysis of the spine, which decrease daily functioning and quality of life (QoL) and worsen prognosis. The growing life expectancy of cancer patients due to improvements in systemic therapies may further increase BM's eventuality and clinical burden in cancer patients. Evidence Acquisition: Four physicians from five different specialties were interviewed and resumed the most relevant literature of the last 20 years focusing on pain treatment in BM patients. Results: Treatment for BM ideally involves various types of specialists and assessments. The disease status and patient background should be considered, requiring holistic care and expertise from variou...
The drafting of guidelines and good clinical practices in every medical field is becoming a prior... more The drafting of guidelines and good clinical practices in every medical field is becoming a priority for all scientific societies both for medical-legal reasons and for the need to spread a common quality standard. Pain therapy cannot be exempted from this even more so as it is still a "young" discipline without a "strong" core curriculum in Italy. With this document Federdolore-SICD wants to open a discussion with other scientific societies, to start a platform that can outline the best indications of one of the most used techniques in all surgeries, SPOKE and HUB of pain therapy: epidural blocks. This document is a summary of the work of the Federdolore-SICD National secretary on this topic and aims to help improve the clinical practice of every pain therapist.
Onco-hematologic patients are highly susceptible to SARS-CoV-2 infection and, once infected, freq... more Onco-hematologic patients are highly susceptible to SARS-CoV-2 infection and, once infected, frequently develop COVID-19 due to the immunosuppression caused by tumor growth, chemotherapy and immunosuppressive therapy. In addition, COVID-19 has also been recognized as a further cause of HBV reactivation, since its treatment includes the administration of corticosteroids and some immunosuppressive drugs. Consequently, onco-hematologic patients should undergo SARS-CoV-2 vaccination and comply with the rules imposed by lockdowns or other forms of social distancing. Furthermore, onco-hematologic facilities should be adapted to new needs and provided with numerically adequate health personnel vaccinated against SARS-CoV-2 infection. Onco-hematologic patients, both HBsAg-positive and HBsAg-negative/HBcAb-positive, may develop HBV reactivation, made possible by the support of the covalently closed circular DNA (cccDNA) persisting in the hepatocytic nuclei of patients with an ongoing or past...
Eagle's syndrome is a rare condition characterized by foreign body sensation in the throat, cervi... more Eagle's syndrome is a rare condition characterized by foreign body sensation in the throat, cervical pain, and dysphagia. It is commonly due to a pathological longer styloid process or ossification of the stylohyoid ligament. There are two classical therapeutic approaches: a conservative management, with a combination of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), anticonvulsants and antidepressants along with local injections of local anaesthetics/corticosteroids, or a surgical treatment i.e. the removal of the styloid process and stylohyoid ligament. We reported the case of a 52-years old woman presented with pain localized at the right side of the neck, back of the throat, tonsillar fossa, base of the tongue, soft palate and inferior part of the occipital bone together with sensation of foreign body in the throat. These symptoms started at the age of 29 after drinking some water with a pain intensity evaluated by numeric rating scale (NRS) of 10. Both pharmacological and surgical treatment didn't produce substantial relief. In 2017 the patient came to our attention and a 10KHz Spinal Cord Stimulator (SCS) was positioned between C2 and C7 with a significant pain relief (NRS4) and a complete relief from foreign body sensation in the throat. This is, to our knowledge, the first case of Eagle's syndrome treated with SCS. This case is here reported along with a short review of Eagle's syndrome and a description of mechanisms and potential applications of SCS.
Neuromodulation: Technology at the Neural Interface, 2016
Introduction: Assessing the feasibility, technical implications, and clinical benefits of periphe... more Introduction: Assessing the feasibility, technical implications, and clinical benefits of peripheral nerve stimulation (PNS) performed by an implantable pulse generator (IPG) located close to the stimulation site. Materials and Methods: Selected patients were affected by neuropathic pain associated with a documented peripheral nerve lesion, refractory to conventional surgical or pharmacological treatment. A PNS system specifically designed for peripheral placement (Neurimpulse, Padova, Italy) was implanted and followed for six months, recording the degree of patient's satisfaction (PGI-I questionnaire), the pain numerical rating scale (NRS) and the quality of life (SF36 questionnaire), as well as any change in drug regimen and work capability. The statistical significance of differences was determined by the paired Student's t-test. Results: A total of 58 patients were referred to permanent IPG implantation. Stimulation failure due to lead damage or dislocation was noticed in two cases (3.4%) in six months. At the follow-up end, the relative NRS reduction averaged 258 6 30% (p < 10 26) and was greater than 50% in 69% of the cases. Quality-of-life physical and mental indices were increased by 18% (p < 0.005) and 29% (p < 0.0005), respectively. The administration of antalgic drugs was stopped in 55% and reduced in 16% of the patients. Lowenergy stimulation was possible in most cases, resulting in an IPG estimated life of 80 6 35 months. Conclusions: Successful PNS was achieved with a stimulation system designed for peripheral location. This new technology reduced the incidence of lead-related adverse events and the energy cost of the treatment.
International Journal of Environmental Research and Public Health
Chronic lymphatic leukemia (CLL) is the most frequent type of leukemia in western countries and w... more Chronic lymphatic leukemia (CLL) is the most frequent type of leukemia in western countries and when association with del(11q) is correlated with a worse prognosis. We reported the clinical case of an 80-year-old patient with CLL related to del(11q) and a BMI of 16.4 kg/m2, who presented a voluminous mass in abdominal cavity (23 × 14 × 4 cm) which occupied the whole of the mesentery and the retroperitoneal space, treated with ibrutinib, adequate nutrition, and a program of physical activity. He showed a great improvement under ibrutinib therapy and took to artificial nourishment and adequate muscle rehabilitation until he recovered his autonomy. In August 2018, a 5-days-a-week training program was started: Physical activity for at least 20 min consisting of a fast walk in the open air three times a week and a moderate physical activity in the remaining two days of at least 20 consecutive minutes (cycling at a regular pace, carrying light weights). The exercise program included also ...
Neuromodulation is a treatment modality that shows promise and so far case reports have used peri... more Neuromodulation is a treatment modality that shows promise and so far case reports have used peripheral approaches to the trigeminal ganglion and its branches. We describe the use of high frequency spinal cord stimulation at the cervical spine as a novel approach to management of refractory trigeminal neuralgia. We have enrolled 3 patients, suffering from trigeminal neuralgia involving the first branch of nerve. All the patients had been implanted with one octopolar electrode such that the stimulating contacts were placed at the C2-C3 vertebral level; electrodes had been connected to an external trial lead extension, which was removed at the end of the trial with subsequent implantation of the definitive IPG. All the patients completed trial period with successful implantation because pain relief was about 70%. All the patients decreased analgesics consumption, especially for opioids.The application of electrical pulses directly onto the dorsal columns at the C2-C3 vertebral level p...
Even patients with lymphoproliferative diseases may develop a persistent chronic pain not respons... more Even patients with lymphoproliferative diseases may develop a persistent chronic pain not responsive to usual treatments due to changes in antibody production and to some treatments like radiotherapy, chemotherapy, and the administration of monoclonal antibodies, which further impair the immune defense and induce chronic inflammatory phenomena acting as a substrate for a persistent chronic pain. Five patients with indolent lymphoproliferative diseases were treated for severe pain nonresponsive to other pain reliever treatments with SCS applied with an All-in-One Shot (OS) procedure. For all patients, the estimated survival time was of 5 years or more. All patients showed a significant reduction of the intensity of pain: the mean Numerical Rating Scale was 7.4 before treatment and 2.2 after. No patient developed adverse events. Supported by the data of this study, we believe that the habit to deprive patients with an indolent form of lymphoproliferative diseases of the possibility to reduce the intensity of chronic pain by SCS treatment is extremely reductive and frustrating.
Retrieval of central venous catheters fragments often puts us in front of different situations. H... more Retrieval of central venous catheters fragments often puts us in front of different situations. Having more techniques available for strategic planning of the procedure is important. The authors propose the simultaneous use of two different approaches for the recovery of a CVC fragment from the pulmonary artery.
Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patient... more Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patients with lymphomas. Pathological neuronal mechanisms integrate with an overproduction of IL-6, TNF-α, IL1-β by macrophages and monocytes, which amplifies inflammation and pain. In consideration of this complex pathogenesis, international guidelines recommend diversified analgesia protocols: thoracic epidural, paravertebral block, and systemic administration of opioids. This study reports an attempt to reduce chest pain and prevent chronic pain in 51 patients undergoing trans-thoracic biopsy for mediastinal lymphoma. The entity of pain, measured 72nd hour after biopsy by the Numerical Rating Scale (NRS), was compared with that seen at a 6th month checkpoint in 46 patients. The pain decreased in all cases. At the 6th month checkpoint, among 31 opioid-treated patients, none of the 16 patients with NRS < 6 within the 72nd hour post biopsy had developed chronic chest pain, while 8 of the 15 ...
Introduction: In the last months of 2019, the advent of a new virus called SARS-CoV-2 caused the ... more Introduction: In the last months of 2019, the advent of a new virus called SARS-CoV-2 caused the spread of a pandemic disease, COVID-19, that has afflicted patients with chronic pain. Case Presentation: We describe a COVID-19 patient recently implanted with a spinal cord stimulator for FBSS, treated with Tocilizumab for cytokine storm complicating SARS-COV-2 infection. This patient developed a delayed hyperimmune reaction, causing an inflammatory reaction in the surgical pocket site, well treated with total remission. The total resolution of this local reaction occurred after the resolution of systemic COVID-19 infection by Tocilizumab. Conclusions: We discuss the balance between damage-associated molecular patterns (DAMPs) and pathogen-recognition receptors (PRRs), and the putative role of polymorphism in the IL-6/174 position of the promoter region.
In recent years, there has been a considerable increase in the number of image-guided interventio... more In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic-or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.
American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 1996
The firing rate of the nerves innervating interscapular brown adipose tissue (IBAT), IBAT and col... more The firing rate of the nerves innervating interscapular brown adipose tissue (IBAT), IBAT and colonic temperatures (TIBAT and TC), and O2 consumption were monitored in urethan-anesthetized male Sprague-Dawley rats. These variables were measured for 40 min before (baseline values) and 40 min after a neostigmine (5 x 10(-7) mol) or saline injection in the hippocampus. The blood level of 3,5,3'-triiodothyronine and L-thyroxine (T3 and T4) and the 5'-deiodinating activity of IBAT, liver, and kidneys were determined in other rats with neostigmine or saline injection. The results showed that neostigmine injection increased firing rate, TIBAT, TC, O2 consumption, blood level of T3, and 5'-deiodinating activity of IBAT. No change was found in the T4 level and in 5'-deiodinating activity of the liver and kidneys. These findings suggest that neostigmine injection in the hippocampus increases heat production by stimulating sympathetic nerves to IBAT and by elevating the blood l...
In patients where conservative approaches have failed to relieve from chronic pain, interventiona... more In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasoundguided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.
Context: Bone metastasis (BM) is a frequent complication of cancer, representing the third most c... more Context: Bone metastasis (BM) is a frequent complication of cancer, representing the third most common site of secondary spread in solid cancers behind the lung and liver. Bone metastasis is found in up to 90% of prostate and breast cancer patients. They can cause significant complications, such as pathological fractures and paralysis of the spine, which decrease daily functioning and quality of life (QoL) and worsen prognosis. The growing life expectancy of cancer patients due to improvements in systemic therapies may further increase BM's eventuality and clinical burden in cancer patients. Evidence Acquisition: Four physicians from five different specialties were interviewed and resumed the most relevant literature of the last 20 years focusing on pain treatment in BM patients. Results: Treatment for BM ideally involves various types of specialists and assessments. The disease status and patient background should be considered, requiring holistic care and expertise from variou...
The drafting of guidelines and good clinical practices in every medical field is becoming a prior... more The drafting of guidelines and good clinical practices in every medical field is becoming a priority for all scientific societies both for medical-legal reasons and for the need to spread a common quality standard. Pain therapy cannot be exempted from this even more so as it is still a "young" discipline without a "strong" core curriculum in Italy. With this document Federdolore-SICD wants to open a discussion with other scientific societies, to start a platform that can outline the best indications of one of the most used techniques in all surgeries, SPOKE and HUB of pain therapy: epidural blocks. This document is a summary of the work of the Federdolore-SICD National secretary on this topic and aims to help improve the clinical practice of every pain therapist.
Onco-hematologic patients are highly susceptible to SARS-CoV-2 infection and, once infected, freq... more Onco-hematologic patients are highly susceptible to SARS-CoV-2 infection and, once infected, frequently develop COVID-19 due to the immunosuppression caused by tumor growth, chemotherapy and immunosuppressive therapy. In addition, COVID-19 has also been recognized as a further cause of HBV reactivation, since its treatment includes the administration of corticosteroids and some immunosuppressive drugs. Consequently, onco-hematologic patients should undergo SARS-CoV-2 vaccination and comply with the rules imposed by lockdowns or other forms of social distancing. Furthermore, onco-hematologic facilities should be adapted to new needs and provided with numerically adequate health personnel vaccinated against SARS-CoV-2 infection. Onco-hematologic patients, both HBsAg-positive and HBsAg-negative/HBcAb-positive, may develop HBV reactivation, made possible by the support of the covalently closed circular DNA (cccDNA) persisting in the hepatocytic nuclei of patients with an ongoing or past...
Eagle's syndrome is a rare condition characterized by foreign body sensation in the throat, cervi... more Eagle's syndrome is a rare condition characterized by foreign body sensation in the throat, cervical pain, and dysphagia. It is commonly due to a pathological longer styloid process or ossification of the stylohyoid ligament. There are two classical therapeutic approaches: a conservative management, with a combination of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), anticonvulsants and antidepressants along with local injections of local anaesthetics/corticosteroids, or a surgical treatment i.e. the removal of the styloid process and stylohyoid ligament. We reported the case of a 52-years old woman presented with pain localized at the right side of the neck, back of the throat, tonsillar fossa, base of the tongue, soft palate and inferior part of the occipital bone together with sensation of foreign body in the throat. These symptoms started at the age of 29 after drinking some water with a pain intensity evaluated by numeric rating scale (NRS) of 10. Both pharmacological and surgical treatment didn't produce substantial relief. In 2017 the patient came to our attention and a 10KHz Spinal Cord Stimulator (SCS) was positioned between C2 and C7 with a significant pain relief (NRS4) and a complete relief from foreign body sensation in the throat. This is, to our knowledge, the first case of Eagle's syndrome treated with SCS. This case is here reported along with a short review of Eagle's syndrome and a description of mechanisms and potential applications of SCS.
Neuromodulation: Technology at the Neural Interface, 2016
Introduction: Assessing the feasibility, technical implications, and clinical benefits of periphe... more Introduction: Assessing the feasibility, technical implications, and clinical benefits of peripheral nerve stimulation (PNS) performed by an implantable pulse generator (IPG) located close to the stimulation site. Materials and Methods: Selected patients were affected by neuropathic pain associated with a documented peripheral nerve lesion, refractory to conventional surgical or pharmacological treatment. A PNS system specifically designed for peripheral placement (Neurimpulse, Padova, Italy) was implanted and followed for six months, recording the degree of patient's satisfaction (PGI-I questionnaire), the pain numerical rating scale (NRS) and the quality of life (SF36 questionnaire), as well as any change in drug regimen and work capability. The statistical significance of differences was determined by the paired Student's t-test. Results: A total of 58 patients were referred to permanent IPG implantation. Stimulation failure due to lead damage or dislocation was noticed in two cases (3.4%) in six months. At the follow-up end, the relative NRS reduction averaged 258 6 30% (p < 10 26) and was greater than 50% in 69% of the cases. Quality-of-life physical and mental indices were increased by 18% (p < 0.005) and 29% (p < 0.0005), respectively. The administration of antalgic drugs was stopped in 55% and reduced in 16% of the patients. Lowenergy stimulation was possible in most cases, resulting in an IPG estimated life of 80 6 35 months. Conclusions: Successful PNS was achieved with a stimulation system designed for peripheral location. This new technology reduced the incidence of lead-related adverse events and the energy cost of the treatment.
International Journal of Environmental Research and Public Health
Chronic lymphatic leukemia (CLL) is the most frequent type of leukemia in western countries and w... more Chronic lymphatic leukemia (CLL) is the most frequent type of leukemia in western countries and when association with del(11q) is correlated with a worse prognosis. We reported the clinical case of an 80-year-old patient with CLL related to del(11q) and a BMI of 16.4 kg/m2, who presented a voluminous mass in abdominal cavity (23 × 14 × 4 cm) which occupied the whole of the mesentery and the retroperitoneal space, treated with ibrutinib, adequate nutrition, and a program of physical activity. He showed a great improvement under ibrutinib therapy and took to artificial nourishment and adequate muscle rehabilitation until he recovered his autonomy. In August 2018, a 5-days-a-week training program was started: Physical activity for at least 20 min consisting of a fast walk in the open air three times a week and a moderate physical activity in the remaining two days of at least 20 consecutive minutes (cycling at a regular pace, carrying light weights). The exercise program included also ...
Neuromodulation is a treatment modality that shows promise and so far case reports have used peri... more Neuromodulation is a treatment modality that shows promise and so far case reports have used peripheral approaches to the trigeminal ganglion and its branches. We describe the use of high frequency spinal cord stimulation at the cervical spine as a novel approach to management of refractory trigeminal neuralgia. We have enrolled 3 patients, suffering from trigeminal neuralgia involving the first branch of nerve. All the patients had been implanted with one octopolar electrode such that the stimulating contacts were placed at the C2-C3 vertebral level; electrodes had been connected to an external trial lead extension, which was removed at the end of the trial with subsequent implantation of the definitive IPG. All the patients completed trial period with successful implantation because pain relief was about 70%. All the patients decreased analgesics consumption, especially for opioids.The application of electrical pulses directly onto the dorsal columns at the C2-C3 vertebral level p...
Even patients with lymphoproliferative diseases may develop a persistent chronic pain not respons... more Even patients with lymphoproliferative diseases may develop a persistent chronic pain not responsive to usual treatments due to changes in antibody production and to some treatments like radiotherapy, chemotherapy, and the administration of monoclonal antibodies, which further impair the immune defense and induce chronic inflammatory phenomena acting as a substrate for a persistent chronic pain. Five patients with indolent lymphoproliferative diseases were treated for severe pain nonresponsive to other pain reliever treatments with SCS applied with an All-in-One Shot (OS) procedure. For all patients, the estimated survival time was of 5 years or more. All patients showed a significant reduction of the intensity of pain: the mean Numerical Rating Scale was 7.4 before treatment and 2.2 after. No patient developed adverse events. Supported by the data of this study, we believe that the habit to deprive patients with an indolent form of lymphoproliferative diseases of the possibility to reduce the intensity of chronic pain by SCS treatment is extremely reductive and frustrating.
Retrieval of central venous catheters fragments often puts us in front of different situations. H... more Retrieval of central venous catheters fragments often puts us in front of different situations. Having more techniques available for strategic planning of the procedure is important. The authors propose the simultaneous use of two different approaches for the recovery of a CVC fragment from the pulmonary artery.
Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patient... more Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patients with lymphomas. Pathological neuronal mechanisms integrate with an overproduction of IL-6, TNF-α, IL1-β by macrophages and monocytes, which amplifies inflammation and pain. In consideration of this complex pathogenesis, international guidelines recommend diversified analgesia protocols: thoracic epidural, paravertebral block, and systemic administration of opioids. This study reports an attempt to reduce chest pain and prevent chronic pain in 51 patients undergoing trans-thoracic biopsy for mediastinal lymphoma. The entity of pain, measured 72nd hour after biopsy by the Numerical Rating Scale (NRS), was compared with that seen at a 6th month checkpoint in 46 patients. The pain decreased in all cases. At the 6th month checkpoint, among 31 opioid-treated patients, none of the 16 patients with NRS < 6 within the 72nd hour post biopsy had developed chronic chest pain, while 8 of the 15 ...
Introduction: In the last months of 2019, the advent of a new virus called SARS-CoV-2 caused the ... more Introduction: In the last months of 2019, the advent of a new virus called SARS-CoV-2 caused the spread of a pandemic disease, COVID-19, that has afflicted patients with chronic pain. Case Presentation: We describe a COVID-19 patient recently implanted with a spinal cord stimulator for FBSS, treated with Tocilizumab for cytokine storm complicating SARS-COV-2 infection. This patient developed a delayed hyperimmune reaction, causing an inflammatory reaction in the surgical pocket site, well treated with total remission. The total resolution of this local reaction occurred after the resolution of systemic COVID-19 infection by Tocilizumab. Conclusions: We discuss the balance between damage-associated molecular patterns (DAMPs) and pathogen-recognition receptors (PRRs), and the putative role of polymorphism in the IL-6/174 position of the promoter region.
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