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Supplemental material, sj-docx-3-jebim-10.1177_2515690X221078006 for Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Amira E. Joseph, Rajat N. Moman, Ross A. Barman, Donald J. Kleppel, Nathan D. Eberhart, Danielle J. Gerberi, M. Hassan Murad and W. Michael Hooten in Journal of Evidence-Based Integrative Medicine

Supplemental material, sj-docx-2-jebim-10.1177_2515690X221078006 for Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Amira E. Joseph, Rajat N. Moman, Ross A. Barman, Donald J. Kleppel, Nathan D. Eberhart, Danielle J. Gerberi, M. Hassan Murad and W. Michael Hooten in Journal of Evidence-Based Integrative Medicine

Supplemental material, sj-docx-5-jebim-10.1177_2515690X221078006 for Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Amira E. Joseph, Rajat N. Moman, Ross A. Barman, Donald J. Kleppel, Nathan D. Eberhart, Danielle J. Gerberi, M. Hassan Murad and W. Michael Hooten in Journal of Evidence-Based Integrative Medicine

Supplemental material, sj-docx-4-jebim-10.1177_2515690X221078006 for Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Amira E. Joseph, Rajat N. Moman, Ross A. Barman, Donald J. Kleppel, Nathan D. Eberhart, Danielle J. Gerberi, M. Hassan Murad and W. Michael Hooten in Journal of Evidence-Based Integrative Medicine

James B Meiling,1 Rajat Moman,2 Robert Pagan-Rosado,1 Elissa Kinzelman-Vesely,3 Christine Hunt,2,4 W Michael Hooten2,4 1Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; 2Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; 3Mayo Clinic Libraries, Rochester, MN, USA; 4Division of Pain Medicine, Mayo Clinic, Rochester, MN, USACorrespondence: W Michael HootenDepartment of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USATel +1 507-266-9670Email hooten.william@mayo.eduAbstract: The association between electromyography (EMG)-confirmed lumbosacral (LS) radiculopathy and pain outcomes following epidural steroid injection (ESI) has not been systematically summarized. The primary objective of this systematic review was to summarize the effects of EMG-confirmed LS radiculopathy on pain intensity following ESI. A secondary objective was to summarize the effects of EMG-confirmed LS radiculopathy on physical functioning following ESI. An a priori protocol was registered and a database search conducted by a reference librarian from January 2000 through December 2020. The search was date-limited to ensure the results of the systematic review represented contemporary clinical practice. Study-inclusion criteria included randomized trials, prospective and retrospective studies, cross-sectional studies, case series, and case reports, age ≥ 18 years, and use of EMG as a prognostic tool prior to an ESI. Two independent reviewers screened all titles, abstracts, and full texts. Data were extracted using a templated electronic database. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool and certainty in evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Due to clinical heterogeneity in study characteristics, a meta-analysis was not performed. A total of 454 studies were screened, and eight nonrandomized studies met the inclusion criteria. Five studies had a moderate risk of bias, two serious risks, and one a critical risk. The key findings included four of eight nonrandomized studies reporting a significant association between EMG-confirmed radiculopathy and ESI response and four of eight nonrandomized studies reporting no significant association. Important sources of bias limited interpretation of individual study findings, and multiple sources of clinical heterogeneity limited between-study comparisons. The findings of this systematic review demonstrate that associations existed between EMG-confirmed LS radiculopathy and pain outcomes after ESI in some, but not all studies. These results should be carefully interpreted with full understanding of the risk of bias and very low certainty in evidence that characterize the nonrandomized studies comprising this systematic review.Keywords: electromyography, lumbosacral epidural steroid injection, systematic review

Additional file 1.

Introduction. Some patients with head and neck cancers have pain refractory to aggressive multimodal therapies. Herein, we report the use of an intrathecal targeted drug delivery (TDD) system catheter tip placed at C1 for the treatment of recalcitrant oropharyngeal cancer pain. Case Report. A patient with recurrent metastatic squamous cell tongue cancer reported severe pain not controlled despite high-dose opioids and nonopioid adjuvants. It was elected to proceed with an intrathecal TDD system with the catheter tip placed at the C1 level. After pump placement, we were able to decrease her daily oral morphine equivalents (OME) from nearly 1000 mg to 300 mg over the course of two months while titrating her TDD from 0.3 mg/day to 0.7 mg/day of intrathecal hydromorphone. Unfortunately, her improvement was limited secondary to aggressive cancer-directed treatments likely contributing to device infection and explant. Conclusions. In this patient, high cervical placement of an intrathecal TDD catheter was associated with a decrease in OME. While used in clinical practice on occasion, the use of high cervical TDD placement such as this implantable C1 intrathecal TDD system for cancer-associated pain is underreported in the literature. Further studies on this intervention within this challenging population are warranted.