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Objective: To examine the effect of intradermal local anesthetic (LA) injection as an adjunct to physical therapy and rehabilitation (PTR) on pain and functionality in patients with persistent spinal pain syndrome type 2 (PSPS-T2). Materials and Methods: A total of 80 patients aged between 18 and 75 years were included and randomized in this prospective, randomized, single-blind study. The first group (n=40) received PTR, while the second group received 3-sessions of intradermal LA injection at painful locations and scar areas in addition to PTR. Patients were assessed using the visual analog scale (VAS), Oswestry Disability index (ODI), Hospital Anxiety and Depression scale (HADS), and finger to ground distance. All tools were administered before, immediately after treatment, and 1 month after completion of treatment. Results: The VAS and ODI scores were significantly reduced in both groups and were maintained at the 1-month follow-up visit. The HADS scores and finger to ground distance did not change significantly in either group (p>0.05). Conclusion: PTR was associated with improved pain and functionality in patients with PSPS-T2, with no additional therapeutic contributions from intradermal LA injections. [ABSTRACT FROM AUTHOR]

Background: Spinal cord stimulation (SCS) has shown to be an effective treatment for patients with persistent spinal pain syndrome type 2 (PSPS Type 2). The method used to deliver electrical charge in SCS is important. One such method is burst stimulation. Within burst stimulation, a recharge pattern is used to prevent buildup of charge in stimulated tissues. Two variations of burst waveforms are currently in use: one that employs active recharge and one that uses passive recharge. It has been suggested that differences exist between active and passive recharge paradigms related to both efficacy of pain relief and their underlying mechanism of action. Active recharge has been shown to activate both the medial spinal pathway, engaging cortical sensorimotor areas involved in location and intensity of pain, and lateral pathway, reaching brain areas involved with cognitive-emotional aspects of pain. Passive recharge has been suggested to act via modulation of thalamic neurons, which fire in a similar electrical pattern, and thereby modulate activity in various cortical areas including those related to motivational and emotional aspects of pain. The objective of this randomized clinical trial is to assess and compare the effect of active versus passive recharge Burst SCS on a wide spectrum of pain in PSPS Type 2 patients.Methods: This multicentre randomized clinical trial will take place in 6 Dutch hospitals. PSPS Type 2 patients (n=94) will be randomized into a group receiving either active or passive recharge burst. Following a successful trial period, patients are permanently implanted. Patients complete the Pain Catastrophizing Scale (PCS) (primary outcome at 6 months), Numeric Pain Rating Scale (NRS), Patient Vigilance and Awareness Questionnaire (PVAQ), Hospital Anxiety and Depression Scale (HADS), Quality of Life (EQ-5D), Oswestery Disability Index (ODI), Patient Global Impression of Change (PGIC) and painDETECT questionnaires (secondary outcomes) at baseline, after trial, 1, 3, 6 and 12 months following implantation.Discussion: The BURST-RAP trial protocol will shed light on possible clinical differences and effectivity of pain relief, including emotional-motivational aspects between active and passive burst SCS in PSPS Type 2 patients.Trial Registration: ClinicalTrials.gov registration:  NCT05421273 . Registered on 16 June 2022. Netherlands Trial Register NL9194. Registered on 23 January 2021. [ABSTRACT FROM AUTHOR]