Interventional Pain Medicine最新文献

{"title":"Genicular nerve block with corticosteroid for chronic knee Pain: Patient-Reported outcomes across 9-years of practice","authors":"Mingda Chen ,&nbsp;Sercan Tosun ,&nbsp;Nicolas R. Thompson ,&nbsp;Kush K. Goyal","doi":"10.1016/j.inpm.2025.100601","DOIUrl":"10.1016/j.inpm.2025.100601","url":null,"abstract":"<div><h3>Background</h3><div>Genicular nerve blocks (GNB) for knee pain secondary to osteoarthritis (OA) are often performed with an anesthetic only, but corticosteroid can be used as an adjuvant with the goal of extending therapeutic relief. The efficacy of GNB with corticosteroid has been established in small, randomized trials, but its effectiveness in practice remains largely unknown.</div></div><div><h3>Objectives</h3><div>Evaluate the therapeutic effect of GNB with corticosteroid using patient-reported outcomes (PROs) in a large patient sample.</div></div><div><h3>Methods</h3><div>Data from consecutive GNBs with corticosteroid performed at an academic medical center from 2015 to 2024 was collected retrospectively. We included all patients aged ≥18 who received a GNB with corticosteroid for chronic knee pain due to OA, and excluded diagnostic GNBs with anesthetic alone and procedures performed using non-classical/modified techniques. Comparisons between pre-versus post-procedure PROs were by mixed-effect regression models with multiple testing corrections.</div></div><div><h3>Results</h3><div>A total of 123 GNBs (96 patients) with corticosteroid were identified. Post-procedurally, the mean NRS reductions were 3.56 (2–30 days), 2.14 (1–3 months), 1.92 (3–6 months), and 1.23 (6–12 months). 50 % of the patients maintained a pain reduction greater than or equal to the NRS MCID of −2.0 for at least 6.9 months. Post-procedure improvements in PROMIS-GH and PHQ9 were not clinically significant. Mean time to total knee arthroplasty was 16.5 months in 13.5 % of patients (13/96). For active opioid users, opioid usage was significantly decreased from the baseline 28.01 ± 13.20 MME/day to 13.58 ± 16.23 MME/day (p &lt; 0.002) in the first 6 months post-GNB, and this opioid reduction was maintained at 15.59 ± 12.51 MME/day (p &lt; 0.05) after the initial 6-month follow-up period.</div></div><div><h3>Conclusion</h3><div>For the majority of patients who received GNB with corticosteroid, we observed statistically and clinically significant pain reduction for 3 months or more in this cohort. While more comparative studies are required to evaluate its effectiveness, GNB with corticosteroid has promising potential as a safe and effective treatment for chronic knee pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100601"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decrease in opioid use and spinal interventions after basivertebral nerve ablation","authors":"Andrew R. Stephens,&nbsp;Adem F. Aktas,&nbsp;Ramzi El-Hassan","doi":"10.1016/j.inpm.2025.100594","DOIUrl":"10.1016/j.inpm.2025.100594","url":null,"abstract":"<div><h3>Background</h3><div>Basivertebral nerve radiofrequency ablations (BVNRFA) have shown efficacy in improving chronic back pain for indicated patients.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate health care utilization outcomes after BVNRFA in a large cohort utilizing a global database.</div></div><div><h3>Methods</h3><div>TriNetX, a global health research network, was queried from 2022 to 2025 for patients who underwent BVNRFA utilizing CPT codes and 1 year pre-procedure and post-procedure opioid use and spine interventions were recorded. Pre-procedure and post-procedure outcomes were compared using a chi-square test with significance set at p &lt; 0.05. The rate of spine surgery within 1 year after BVNRFA was also reported.</div></div><div><h3>Results</h3><div>A total of 1,118 patients underwent BVNRFA during this time frame at contributing health care systems with appropriate follow-up. Post-procedure opioid use was less than pre-procedure opioid use (57 % vs 51 %, p = 0.006). The number of patients who received spine interventions after BVNRFA were significantly lower compared to patients who received spine interventions prior with lumbar transforaminal epidural steroid injections decreasing from 21 % to 12 % (p &lt; 0.001), lumbar interlaminar steroid injections decreasing from 18 % to 11 % (p &lt; 0.001), and radiofrequency ablations decreasing from 25 % to 13 % (p &lt; 0.001). Only 47 patients had CPT codes related to post-procedure vertebral column spine surgery. Specifically, there were 11 patients who had CPT codes for posterior lumbar fusion (CPT 22630), 10 had lateral lumbar fusion (CPT 22533), and 10 had anterior codes (CPT 22558). There were 0 patients who underwent total disc replacement (CPT 22857).</div></div><div><h3>Conclusions</h3><div>This administrative database study demonstrated significantly less opioid use and spine interventions within 1 year after BVNRFA compared to 1 year prior. This study also demonstrated low rates of spine surgery within 1 year after BVNRFA.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100594"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of epidural amniotic fluid injection for low back pain","authors":"Glenn R. Buttermann ,&nbsp;Matthew Thorson ,&nbsp;Louis C. Saeger","doi":"10.1016/j.inpm.2025.100598","DOIUrl":"10.1016/j.inpm.2025.100598","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Epidural corticosteroid injections have long been used to treat pain and inflammation associated with low back conditions including symptoms due to lumbar herniated disc, HNP; spinal stenosis, SS; and degenerative disc disease, DDD. Amniotic fluid, AF, is rich in the proteins and factors that are believed to contribute to healing by minimizing inflammation. AF injections in non-spinal conditions have been shown to be safe and avoid adverse effects related to steroids.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To investigate the safety and efficacy of a single amniotic fluid injection into the lumbar epidural space for the treatment of low back pain. Specifically, this pilot study was to define indications for future large scale comparative studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This IRB approved prospective clinical study of 3 cohorts included 20 patients each with HNP, SS, and DDD with a 1-year follow-up. Patients were enrolled who had LBP ± leg symptoms for &gt;2 months, with clinical and MRI findings for HNP, SS, or DDD. Inclusion criteria necessitated that study patients had not responded to medications, physical therapy, and/or chiropractic. After obtaining consent, 20 patients in each diagnostic group (HNP, SS, and DDD) had 2 cc′s transforaminal epidural AF injected at the primary symptomatic level using fluoroscopy. Pre- and post-procedure outcomes measurements were obtained at follow-up periods of 2–3 weeks, 6–8 weeks, 3–4 months, 6–8 months and 1 year. Outcome measures were Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Scale (ODI), Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and pain medication usage. Using the VAS and ODI measurements, Minimal Clinical Important Difference (MCID) and Success (50 % improvement) rates were derived.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The average age (years) of HNP, stenosis, and DDD patients was 46, 60, and 46 respectively. There were no complications or other adverse effects. HNP patients had the greatest reduction in symptoms with average LBP VAS improvement from 6.3 to 2.9, leg VAS from 5.9 to 2.2, ODI from 37 to 19, and PROMIS Physical component 13.1 to 14.7. SS patients had LBP VAS improvement from 6.8 to 5.3, leg VAS from 5.8 to 3.1, ODI from 46 to 33 and PROMIS Physical component 10.9 to 13.0. DDD patients had LBP VAS from 7.0 to 4.8, leg VAS from 3.9 to 2.7, ODI from 41 to 37 and PROMIS Physical component 12.0 to 13.1. HNP patients had a significant reduction in pain medication use. Over the one year follow-up, the HNP group had the greatest rate of attaining MCID (65 %–79 %) and Success (47 %–60 %). SS had a similar rate of Success for leg pain. ODI MCDI and Success rates were significantly greater for HNP vs the other 2 groups. Overall, 15 % of patients had additional injections and 20 % went on to surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;AF epidural injections are most effective for patients with lu","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100598"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Herpes zoster prevalence following epidural steroid injections: a retrospective review","authors":"Laura Furtado-Pessoa-de-Mendonca ,&nbsp;Sebastian Encalada ,&nbsp;Alejandro Hallo-Carrasco ,&nbsp;Johanna Mosquera-Moscoso ,&nbsp;Matthew A. Cascio ,&nbsp;Robert Pagan-Rosado ,&nbsp;Michael D. Osborne ,&nbsp;Jason S. Eldrige ,&nbsp;Christine L. Hunt","doi":"10.1016/j.inpm.2025.100597","DOIUrl":"10.1016/j.inpm.2025.100597","url":null,"abstract":"<div><h3>Introduction</h3><div>Herpes Zoster, or shingles, is an infection caused by the reactivation of the latent Varicella zoster virus within a sensory ganglion, leading to painful skin lesions localized along dermatomes. Patients undergoing pain medicine procedures involving steroids may face an elevated risk of shingles, which can significantly impact their quality of life. Though rare, HZ has been reported following minimally invasive procedures, such as epidural steroid injections.</div></div><div><h3>Objectives</h3><div>We evaluated the prevalence of shingles within 31 days after epidural steroid injections within Mayo Enterprise sites.</div></div><div><h3>Methods</h3><div>A retrospective chart review included all patients who reported a new HZ event within 31 days after receiving an epidural steroid injection. Information on patient demographics, procedure details, and potential risk factors for herpes zoster was assessed using qualitative analysis.</div></div><div><h3>Results</h3><div>A total of 50,270 epidural injections were performed during the analyzed period. After initial screening, 149 patients were included for chart review, and 37 individuals met the inclusion criteria. Within this subgroup, the median age was 72, and 21 patients were female (56.76 %). The mean timeframe from the procedure until onset of symptoms of infection as reported in the medical record was 15.9 days. Among the patients in the study, 24 patients (64.86 %) had an identified immunocompromised status, and 28 (75.68 %) had an incomplete vaccination status at the time of infection.</div></div><div><h3>Conclusion</h3><div>The incidence of HZ following ESI is low. Other risk factors linked to HZ were identified in our cohort, confounding a possible causal relationship. Prospective studies are needed to elucidate any relationship between ESI and HZ.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100597"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing ChatGPT responses to patient questions on epidural steroid injections: A comparative study of general vs specific queries","authors":"Timothy Olivier ,&nbsp;Zilin Ma ,&nbsp;Ankit Patel ,&nbsp;Weibin Shi ,&nbsp;Mohammed Murtuza ,&nbsp;Nicole E. Hatchard ,&nbsp;Xiaoyu Norman Pan ,&nbsp;Thiru M. Annaswamy","doi":"10.1016/j.inpm.2025.100592","DOIUrl":"10.1016/j.inpm.2025.100592","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is becoming more integrated into healthcare, with large language models (LLMs) like ChatGPT being widely used by patients to answer medical questions. Given the increasing reliance on AI for health-related information, it's important to evaluate how well these models perform in addressing common patient concerns, especially in procedural medicine. To date, no studies have specifically examined AI's role in addressing patient questions related to epidural steroid injections (ESIs), making this an important area for investigation.</div></div><div><h3>Objective</h3><div>This study examines ChatGPT's ability to answer patient questions about epidural steroid injections (ESIs), focusing on response accuracy, readability, and overall usefulness. Our aim was to evaluate and compare the content, accuracy, and user-friendliness of AI-generated information on common peri-procedural questions and complications associated with ESIs, thereby extending the application of AI as a triage tool into pain management and interventional spine procedures.</div></div><div><h3>Methods</h3><div>We formulated and compiled 29 common patient questions about ESIs and tested ChatGPT's responses in both general and specific formats. Two interventional pain specialists reviewed the AI-generated answers, assessing them for accuracy, clarity, empathy, and directness using a Likert scale. Readability scores were calculated using Flesch-Kincaid Reading Level and Flesch Reading Ease scales. Statistical analyses were performed to compare general versus specific responses.</div></div><div><h3>Results</h3><div>General queries led to longer, more detailed responses, but readability was similar between general and specific formats. Subjective analysis showed that general responses were rated higher for accuracy, clarity, and responsiveness. However, neither format demonstrated strong empathy, and some general queries resulted in off-topic responses, underscoring the importance of precise wording when interacting with AI.</div></div><div><h3>Conclusion</h3><div>ChatGPT can provide clear and largely accurate answers to patient questions about ESIs, with general prompts often producing more complete responses. However, AI-generated content still has limitations, particularly in conveying empathy and avoiding tangential information. These findings highlight the need for thoughtful prompt design and further research into how AI can be integrated into clinical workflows while ensuring accuracy and patient safety.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100592"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of fluoroscopically guided lumbar facet steroid joint injections: A systematic review","authors":"Alexandra E. Fogarty ,&nbsp;Jordan A. Buttner ,&nbsp;Belinda Duszynski ,&nbsp;Michael J. McKenna ,&nbsp;David C. Miller ,&nbsp;Alan Gonzalez-Cota ,&nbsp;Arsenio Avila ,&nbsp;Eduard Vaynberg ,&nbsp;Samir Sheth ,&nbsp;Aaron Conger ,&nbsp;Lisa V. Doan ,&nbsp;Reza Ehsanian","doi":"10.1016/j.inpm.2025.100587","DOIUrl":"10.1016/j.inpm.2025.100587","url":null,"abstract":"<div><h3>Summary of background data</h3><div>Facet joint degeneration is a known source of chronic axial low back pain, and intra-articular steroid injections (IASI) have been used as a treatment.</div></div><div><h3>Objectives</h3><div>To systematically review the evidence of the effectiveness of fluoroscopically guided lumbar IASI for the treatment of lumbar facet joint pain.</div></div><div><h3>Methods</h3><div>The primary outcome was ≥50 % pain reduction at ≥ 1 month, measured by Visual Analog Scale and/or Numeric Rating Scale. Secondary outcomes included ≥30 % functional improvement on a validated functional scale. Studies including group mean improvements in pain/function without categorical reporting were also considered. Two reviewers independently screened Embase, Cochrane, PubMed Medline, Ovid Medline, Web of Knowledge, and Google Scholar. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and evidence quality was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE).</div></div><div><h3>Results</h3><div>Of the 701 publications screened, 21 met the inclusion criteria. Success rates for clinically significant pain reduction (≥50 % pain relief) ranged from 13 to 74 %, and functional improvement (≥30 % improvement) was 29 % at ≥ 1 month, based on only one study. Overall, mean improvement ranged from 11 to 59 % for pain relief and 8–58 % for function at ≥ 1 month. In the seven studies selecting patients with facet or medial branch blocks, success rates for clinically significant pain reduction (≥50 % pain relief) are reported as 13–74 % at ≥ 1 month. In this subgroup, mean pain improvement rates ranged from 23 to 67 % and functional improvement from 15 to 58 % at ≥ 1 month. According to GRADE, the overall quality of the evidence is very low due to the high risk of bias, study heterogeneity, and inconsistent methodologies.</div></div><div><h3>Discussion/conclusion</h3><div>Pragmatic and observational studies suggest IASI may reduce pain and disability, while sham-controlled trials have not demonstrated efficacy. Given the very low quality of evidence, the true effect of IASI is highly uncertain. Further high-quality, placebo-controlled studies using standardized diagnostic criteria are needed.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100587"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericapsular Nerve Group (PENG) Block in Three Simple Steps: A Practical Note for Physiatrists on Interfascial Injection","authors":"Mustafa Turgut Yildizgoren ,&nbsp;Burak Tayyip Dede ,&nbsp;Bulent Alyanak ,&nbsp;Mustafa Huseyin Temel ,&nbsp;Fatih Bagcier","doi":"10.1016/j.inpm.2025.100589","DOIUrl":"10.1016/j.inpm.2025.100589","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100589"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence of non-response bias in patient reported outcome measurement information system surveys","authors":"Andrew R. Stephens,&nbsp;Nicholas R. Bender,&nbsp;Ramzi El-Hassan,&nbsp;Rajeev K. Patel","doi":"10.1016/j.inpm.2025.100588","DOIUrl":"10.1016/j.inpm.2025.100588","url":null,"abstract":"<div><h3>Background</h3><div>Patient-reported outcome measurement instrument surveys (PROMIS) have been increasingly used to assess clinical outcomes following a variety of medical procedures. Despite their value in evaluating patient functional status, response rates to these surveys remain low. Understanding differences in demographics between responders and non-responders to PROMIS may be beneficial to improving generalizability and response rates.</div></div><div><h3>Objective</h3><div>The primary aim of this study was to compare demographic characteristics between patients who respond to PROMIS surveys and those who do not, hypothesizing no significant differences between these groups.</div></div><div><h3>Methods</h3><div>Adult new patient visits from 2018 to 2022 in Department of Physical Medicine &amp; Rehabilitation outpatient clinics at a single academic medical center were analyzed. Patients completed PROMIS surveys (physical function, pain interference, and depression) on iPads at each clinic visit. Demographic variables such as gender, race, BMI, smoking status, employment status, marital status, and Area Deprivation Index (ADI) were collected. Univariate and multivariate analyses were conducted to assess for variables associated with an increased likelihood of responding to PROMIS surveys.</div></div><div><h3>Results</h3><div>A total of 29,830 patients were included in this study. Of the total patient cohort, 8331 (27.9 %) responded to the PROMIS surveys. Significant demographic differences were found between responders and non-responders. Patients in the least deprived ADI quartile were more likely to respond compared to those in the most deprived quartile (33.5 % vs 23.7 %, p &lt; 0.001). Employed patients, white patients, non-smokers and married individuals were more likely to respond. On multivariate analysis, unemployment (OR 0.71, p = 0.006), increased BMI (OR 0.93, p = 0.014), and higher ADI (OR 0.94, p = 0.003) were significantly associated with lower response rates.</div></div><div><h3>Conclusions</h3><div>PROMIS response rates are influenced by patient demographics, with lower response rates observed in unemployed, non-white, and socioeconomically deprived populations. These findings highlight the need for targeted interventions to increase response rates and ensure equitable data collection in PROMIS surveys to enhancing the generalizability of clinical decisions made using PROMIS data.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100588"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar epidural steroid injections for lumbosacral radicular pain in patients with normal imaging: A propensity-matched study","authors":"Steven P. Cohen ,&nbsp;Ariz A. Keshwani ,&nbsp;Dost Khan ,&nbsp;Milan P. Stojanovic","doi":"10.1016/j.inpm.2025.100574","DOIUrl":"10.1016/j.inpm.2025.100574","url":null,"abstract":"<div><h3>Background</h3><div>Epidural steroid injections are indicated for radicular pain, with a pre-injection MRI not mandated in guidelines. There is conflicting evidence that MRI findings correlate with outcomes.</div></div><div><h3>Methods</h3><div>Fourteen patients with near-normal imaging (i.e., no evidence of nerve root compression and minor degenerative changes if present) who underwent ESI for lumbosacral radicular pain and were followed for up to 12 weeks were propensity matched against 14 patients with radicular pain secondary to concordant MRI pathology. The primary outcome measure was mean reduction in average leg pain relief at 4 and 12 weeks. Secondary outcome measures included average back pain, function, analgesic reduction, satisfaction, and a categorical measure of success predesignated as a ≥2-point decrease in average leg pain score coupled with a positive global perceived effect and not requiring any additional intervening interventions.</div></div><div><h3>Results</h3><div>For mean reduction in average leg pain at 4 weeks, there were no significant differences between those with near-normal MRIs and those with abnormal imaging (2.36 (SD 2.55) vs. 2.61 (SD 2.15); P = 0.72). For average back pain reduction at the same time point, the mean reduction was 0.75 (1.73) among cases vs. 1.07 (2.01) in control patients (P = 0.57). There were also no differences observed in pain reduction outcomes at 12 weeks. The average reduction in Oswestry Disability Index at 12 weeks favored the near-normal imaging group (8.64 % (SD 11.36) vs. 0 % (7.69); P = 0.047). A trend was noted wherein more patients with abnormal imaging experienced a positive outcome at 4 weeks (50 % vs. 28.57 %; P = 0.22) but not 12 weeks (28.57 % in both groups).</div></div><div><h3>Conclusions</h3><div>There were no significant differences in pain outcomes compared to control patients, though patients with near-normal imaging fared worse than historical controls and the larger cohort from which propensity-matched patients were selected. The possibility of poorer outcomes should be considered when selecting patients with normal imaging and radiculopathy for ESI.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100574"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tendon modification with percutaneous Ultrasound-Guided Tenotomy using TENEX®: A histological and macroscopic analysis of a bovine cadaveric model","authors":"Suwannika Palee ,&nbsp;Chuanyong Lu ,&nbsp;Adam Betcher ,&nbsp;Ugur Yener ,&nbsp;Jonathan Alerte ,&nbsp;David Howarth ,&nbsp;Luke Cooper ,&nbsp;Asude Nur Hasanoglu ,&nbsp;Alaa Abd-Elsayed ,&nbsp;Sayed Emal Wahezi","doi":"10.1016/j.inpm.2025.100590","DOIUrl":"10.1016/j.inpm.2025.100590","url":null,"abstract":"<div><h3>Background</h3><div>Chronic tendinopathy treatment remains elusive; however, percutaneous Ultrasound-Guided Tenotomy using TENEX® (PUTT) has demonstrated promising clinical outcomes, but the mechanism of action is not clearly defined. This study aims to describe potential mechanisms using an ex-vivo animal model. The objective of the study is to examine the histological effects of PUTT on the bovine soleus tendon across varying treatment durations.</div></div><div><h3>Methods</h3><div>Twelve bovine soleus tendons were allocated to four cohorts to undergo PUTT for 1, 3, 5, and 7 min. Each specimen was treated on one side, the opposite side serving as a control. Macroscopic and microscopic analyses were conducted to assess tendon sheath, fascicle, and perineural disruption. Fascicle penetration was measured using ImageJ software. Statistical analyses were performed using Analysis of Variance (ANOVA), with significance levels set at p &lt; 0.05.</div></div><div><h3>Results</h3><div>Macroscopic and microscopic examination revealed progressive separation of the paratenon, peritendinous nerves, and fascicles, correlating with increased treatment duration. Fascicle penetration depths were 0.1 mm, 2.57 mm, 2.61 mm, and 3.93 mm at 1, 3, 5, and 7 min, respectively. ANOVA confirmed significant differences among groups (F (3, 8) = 620.898, p &lt; 0.001), with a large effect size (η² = 0.996. Tukey's Honest Significant Difference (HSD) test revealed significant differences between most groups (p &lt; 0.001), except between the 3-min and 5-min treatments, which showed no significant difference (p = 0.969).</div></div><div><h3>Conclusion</h3><div>PUTT induces significant structural changes in the paratenon and fascicle layer with longer treatment duration, resulting in more pronounced modifications.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100590"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}