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Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that, although exceedingly rare, carries a significant burden for the affected patient population. The complex and ambiguous pathophysiology of this condition further complicates clinical management and therapeutic interventions. Furthermore, being a diagnosis of exclusion requires a diligent workup to ensure an accurate diagnosis and subsequent targeted management. The development of the Budapest diagnostic criteria helped to consolidate existing definitions of CRPS but extensive work remains in identifying the underlying pathways. Currently, two distinct types are identified by the presence (CRPS type 1) or absence (CRPS type 2) of neuronal injury. Current management directed at this disease is broad and growing, ranging from non-invasive modalities such as physical and psychological therapy to more invasive techniques such as dorsal root ganglion stimulation and potentially amputation. Ideal therapeutic interventions are multimodal in nature to address the likely multifactorial pathological development of CRPS. Regardless, a significant need remains for continued studies to elucidate the pathways involved in developing CRPS as well as more robust clinical trials for various treatment modalities. [ABSTRACT FROM AUTHOR]

Introduction: Irritable bowel syndrome (IBS) often is treated as a partially diet-responsive functional bowel disorder. Few interventions have been found to be effective in diet-refractory IBS, leading to lifestyle disruptions due to persistent symptoms. The efficacy of low-dose home ketamine therapy suggests others may benefit., Case Presentation: A female patient in her 60s with progressive presumed IBS with diarrhea found diet-based treatments ineffective, resulting in severe lifestyle disruptions. After a hysterectomy, intolerance to opioids for postoperative pain prompted the use of intravenous ketamine. An unexpected and prolonged improvement in IBS symptoms resulted. The patient sought continued treatment with ketamine for IBS symptoms and experienced continued symptomatic relief with 20 mg oral ketamine every 2 weeks at home., Discussion: No other published cases of ketamine for IBS were found., Conclusions: While dietary changes remain the gold standard for IBS, this patient experience highlights ketamine as a potential adjunct therapy., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

The amniotic and chorionic membranes, as well as the stem cell populations contained within them, represent a widely available, versatile, and promising resource for use in numerous regenerative medicine applications. The primary focus of this review is to examine the use of the fetal membranes and/or their resident stem cell populations for regenerating orthopedic tissues. This discussion is prefaced by a brief synopsis of the structure, function, and biological properties of the extracellular matrix; embryological development; and a brief description of the distinct stem cell populations residing within the amniotic and chorionic membranes. Commercially available perinatal tissue allograft products available in the United States are reviewed, and a concise summary regarding the US Food and Drug Administration's current viewpoint on these technologies is provided. Concluding remarks regarding suggested future research directives for evaluating these tissues and stem cell sources in relation to orthopedic regenerative medicine applications also are presented.