Interventional Pain Medicine最新文献

{"title":"Evaluation of fluoroscopically guided transforaminal epidural steroid injections for cervical radiculopathy utilizing patient reported outcome measurement information system as an outcome measure","authors":"Andrew R. Stephens,&nbsp;Ramzi El-Hassan,&nbsp;Ben L. Laplante,&nbsp;Rajeev K. Patel","doi":"10.1016/j.inpm.2025.100556","DOIUrl":"10.1016/j.inpm.2025.100556","url":null,"abstract":"<div><h3>Background</h3><div>Cervical radiculopathy is a common cause of pain. For patients who fail conservative management, a transforaminal epidural steroid injection (TFESI) is an accepted intervention and alternative to decompression surgery.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate the therapeutic effect of TFESIs for patients with cervical radiculopathy.</div></div><div><h3>Methods</h3><div>Adult patients treated at a multidisciplinary, tertiary academic spine center with cervical radicular pain and MRI evidence of corroborative cervical spondylotic foraminal stenosis and who had failed at least 6 weeks of conservative management consisting of medication and physical rehabilitation were included in this study. Patient Reported Outcome Measurement Information System (PROMIS) domains of Physical Function (PF) v1.2/v2.0 and Pain Interference (PI) v1.1 were collected at baseline and at 3-, 6-, and 12-month follow-up visits. Statistical analysis comparing baseline score with follow-up post-procedural PROMIS scores was performed. The percentage of patients who reported improvement exceeding the minimal clinically important difference was calculated for survey responders and for the worst case scenario.</div></div><div><h3>Results</h3><div>87 patients met inclusion criteria. PROMIS PI at 3-, 6-, and 12-months follow-up statistically improved by 2.2 (95 % confidence interval [CI] 2.1–2.4, p = 0.02), 2.3 (95 % CI 2.1–2.5, p = 0.03), and 2.7 (95 % CI 2.5–3.0, p = 0.03) points, respectively. Follow-up PROMIS PF score did not significantly differ from baseline scores. The percentage of patients that exceeded MCID thresholds of clinical significance was 59 % (95 % CI 47%–70 %) at 3-months, 52 % (95 % CI 41%–63 %) at 6-months, and 60 % (95 % CI 50%–72 %) at 12-months. Worst case scenario analysis demonstrated that 51 % (95 % CI 39%–62 %) of patients exceeded the MCID thresholds at 3-months, 32 % (95 % CI 22%–43 %) at 6-months, and 23 % (95 % CI 13%–33 %) at 12-months.</div></div><div><h3>Conclusions</h3><div>Our study demonstrated that TFESI leads to a long-term improvement up to a year in pain for patients with cervical radiculopathy.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100556"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating prognostic block selection criteria in cervical medial branch radiofrequency neurotomy: A retrospective cohort study","authors":"Allison Glinka Przybysz ,&nbsp;Enrique Galang ,&nbsp;Christian A. Sangio ,&nbsp;Christian Wirawan ,&nbsp;Amanda N. Cooper ,&nbsp;Alycia Amatto ,&nbsp;Brook Martin ,&nbsp;Robert Burnham ,&nbsp;Aaron M. Conger ,&nbsp;Zachary L. McCormick ,&nbsp;Taylor R. Burnham","doi":"10.1016/j.inpm.2025.100559","DOIUrl":"10.1016/j.inpm.2025.100559","url":null,"abstract":"<div><h3>Background</h3><div>Considerable variability exists in the literature record regarding patient selection criteria for cervical medial branch radiofrequency neurotomy (CMBRFN). Few prior studies have assessed the correlation between different prognostic block paradigms and treatment outcomes for this procedure.</div></div><div><h3>Objectives</h3><div>Examine the association between various prognostic block selection criteria and CMBRFN success rates.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of consecutive patients from two Canadian musculoskeletal pain management clinics who underwent first-time CMBRFN between 2016 and 2022 with a three-tined cannula utilizing a perpendicular approach. Patients were categorized according to prognostic block paradigms (single vs. dual), block type (medial branch block [MBB] vs. intraarticular block [IAB]), and percentage pain relief after blocks. Six block criteria were established: 1 = MBB/MBB≥80 %; 2 = MBB/MBB 50–79 %; 3 = IAB/MBB≥80 %; 4 = IAB/MBB 50–79 %; 5 = MBB≥80 %; 6 = MBB 50–79 %. Treatment success was evaluated at 3 months post-CMBRFN as the proportion of participants with (1) ≥50 % NRS pain score reduction (the primary outcome) and (2) ≥17-point score decrease (the minimal clinically important difference [MCID]) on the Pain Disability Quality-of-Life Questionnaire – Spine (PDQQ-S). Logistic regression analyses were used to explore associations between block criteria and CMBRFN treatment success.</div></div><div><h3>Results</h3><div>A total of 171 consecutive patients (58.5 % female; 58.0 ± 12.1 years of age; BMI 28.7 ± 6.0 kg/m²) were included. 60.8 % (95%CI: 53.3–67.8 %) and 61.4 % (95%CI: 53.9–68.7 %) of patients reported ≥50 % NRS and ≥17-point PDQQ-S reduction, respectively. After controlling for demographic factors, there were no statistically significant differences in the odds of treatment success amongst individuals selected by various prognostic block paradigms.</div></div><div><h3>Conclusion</h3><div>Over 60 % of patients who underwent CMBRFN reported clinically significant magnitudes of improvement in pain and disability at three months post-CMBRFN, regardless of prognostic block selection criteria. These findings suggest that multiple block strategies might be employed to determine eligibility for CMBRFN. Larger, prospective studies including long-term outcome assessments are needed to further evaluate these findings.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100559"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PNS for management of intercostal neuralgia: A case report","authors":"Christopher Morris,&nbsp;Kevin Vorenkamp,&nbsp;John Ward","doi":"10.1016/j.inpm.2025.100573","DOIUrl":"10.1016/j.inpm.2025.100573","url":null,"abstract":"<div><div>Intercostal neuralgia is a rare but potentially debilitating condition that manifests as neuropathic pain in any rib space. This pain can typically be treated with typical mainstays of neuropathic pain treatment, such as over-the-counter analgesics, gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and opioids. However, as detailed in this case, patients can have refractor pain despite the use of these mainstays of treatment. In these patients, peripheral nerve stimulator (PNS) placement can be a possible treatment modality. In our case detailing a 75 year old male with refractory intercostal neuralgia, we have shown that PNS placement for this indication can provide analgesia in this debilitating condition.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100573"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe and effective intraosseous basivertebral nerve radiofrequency neurotomy in a patient with a permanent pacemaker","authors":"Thomas S. Lee ,&nbsp;Azeem Ahmad","doi":"10.1016/j.inpm.2025.100565","DOIUrl":"10.1016/j.inpm.2025.100565","url":null,"abstract":"<div><h3>Introduction</h3><div>Intraosseous basivertebral nerve radiofrequency neurotomy is a fairly novel technique which is currently considered contraindicated in patients with an implanted pacemaker. Re-evaluation of this restriction is important given the comorbidity of chronic low back pain and cardiac disease.</div></div><div><h3>Case</h3><div>A 78-year-old male with chronic low back pain (CLBP) that had failed both conservative and operative management with work-up including MRI spine suggestive of vertebrogenic low back pain. Patient agreed to undergo this procedure using a magnet to convert the active pacemaker to asynchronous pacing, resulting in fixed ventricular rate, perioperatively. The procedure was accomplished successfully with sustained improvement of his CLBP at six months follow up.</div></div><div><h3>Conclusion</h3><div>This is the first published case demonstrating successful intraosseous basivertebral nerve radiofrequency neurotomy in a patient with a permanent pacemaker with appropriate precautions.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100565"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"True AP imaging during lumbar medial branch radiofrequency neurotomy: A technical note","authors":"Patrick H. Waring ,&nbsp;Timothy P. Maus","doi":"10.1016/j.inpm.2025.100558","DOIUrl":"10.1016/j.inpm.2025.100558","url":null,"abstract":"<div><h3>Background</h3><div>Optimal outcomes following lumbar medial branch radiofrequency neurotomy (LMBRFN) require close and parallel electrode placement to the targeted medial branch. True segmental fluoroscopic imaging is critical for LMBRFN performance. A true lateral imaging technique for LMBRFN has been described, and its interobserver reliability has been established. However, a similarly detailed technique for true AP imaging has yet to be proposed.</div></div><div><h3>Objective</h3><div>This technical note proposes a clear and concise true AP imaging technique for LMBRFN.</div></div><div><h3>Technique</h3><div>True AP lumbar imaging involves viewing the spinous process in the midline or midway between the pedicles and aligning cortical bone to create a sharp, superior endplate image. Maneuvering the fluoroscope can produce true AP imaging if the initial AP image is untrue. Oblique (axial plane) fluoroscopic rotation allows the spinous process to be positioned appropriately in the midline. Right versus left oblique rotation is informed by the position of the spinous process relative to the midline. Tilt (longitudinal plane) fluoroscopic rotation produces a sharp superior endplate. Cranial versus caudal tilt is informed by the pedicles' position relative to the vertebral body's upper zone.</div></div><div><h3>Conclusions</h3><div>When combined with true lateral imaging, the currently proposed AP imaging technique may yield reliable true segmental imaging during LMBRFN. This true AP segmental imaging process may also be applied to other lumbar spine procedures.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100558"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does radiofrequency ablation type affect global health outcomes in chronic knee pain?","authors":"Bennett Andrassy,&nbsp;Marcus Harris,&nbsp;Taif Mukhdomi","doi":"10.1016/j.inpm.2025.100564","DOIUrl":"10.1016/j.inpm.2025.100564","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100564"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramuscular schwannoma presenting as treatment-resistant lumbar radiculopathy: Case report","authors":"Moshe Spatz ,&nbsp;Madison O'Donnell ,&nbsp;Amir Gamil ,&nbsp;Brett Gerstman","doi":"10.1016/j.inpm.2025.100560","DOIUrl":"10.1016/j.inpm.2025.100560","url":null,"abstract":"<div><div>Intramuscular schwannomas are rare tumors originating from Schwann cells in the peripheral nervous system. These tumors typically occur along small motor nerves deep within the muscle, presenting diagnostic challenges for clinicians due to their rarity and nonspecific symptoms. They can induce pain that is resistant to interventions, and surgical removal is often the only method that provides relief of symptoms. We present a case of a 65-year-old male with low back pain and concurrent right anterior thigh pain and paresthesia. Despite extensive evaluation by numerous specialists and thorough diagnostic testing, including spinal MRIs and electrodiagnostic studies, no clear diagnosis was initially established. His symptoms remained resistant to medical and interventional treatments. Ultimately, MRI imaging of the right thigh revealed a mass measuring approximately 2 cm in the vastus medialis. Following excision of the mass, the patient experienced immediate symptom relief. This case highlights the importance of maintaining a broad differential when evaluating low back pain with associated lower extremity symptoms. We aim to highlight the importance of recognizing this possibility of extra-spinal pain generators.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100560"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143547906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of spinal cord stimulation for phantom limb pain","authors":"Stephen Jaffee ,&nbsp;Rhea Verma ,&nbsp;Mariam Vaezi ,&nbsp;Trent Kite ,&nbsp;Nestor Tomycz","doi":"10.1016/j.inpm.2025.100571","DOIUrl":"10.1016/j.inpm.2025.100571","url":null,"abstract":"<div><h3>Background</h3><div>Phantom limb pain (PLP) is a debilitating condition that affects individuals following limb amputation. While medical management with anticonvulsants and physical therapy is the first-line treatment, spinal cord stimulation (SCS) has emerged as an option for patients with persistent, refractory pain.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the current literature on SCS for PLP, focusing on pain reduction and associated complications.</div></div><div><h3>Methods</h3><div>A systematic review was conducted on reports of adults (≥18 years) with phantom limb pain treated with spinal cord stimulation. Titles and abstracts were screened, followed by a full-text review based on predefined inclusion criteria. Extracted data included sample size, SCS lead placement, pain reduction, visual analog scale (VAS) and brief pain inventory (BPI) scores, and complications. Descriptive statistics were used for analysis.</div></div><div><h3>Results</h3><div>Five reports met inclusion criteria, comprising 33 patients. Of these, 18 % of patients achieved 90–100 % pain reduction, 15 % had ≥80 % reduction, 6 % had ≥60 % reduction, and 15 % experienced ≥50 % reduction. Post-SCS visual analog scores were reported in two studies; one study reported a mean 50 % reduction in visual analog scale scores (VAS), while another found a median brief pain inventory (BPI) reduction of 43.5 %. Complications across all 33 patients included wound infection (6 %), transient weakness (3 %), cerebrospinal fluid leak (3 %), allergic dermatitis (3 %), and electrode site cyst (3 %). Most patients (84.8 %) received epidural lead placement, while 15.2 % had subdural placement.</div></div><div><h3>Conclusions</h3><div>SCS may be effective in reducing pain in some PLP patients.However complications exist, with wound infection being the most common complication. The mechanism of action remains unclear, but PLP likely involves both central and peripheral pathology, which complicates treatment. Historically, SCS has shifted from subdural to epidural lead placement to minimize complications, with recent reports exploring dorsal root ganglion stimulation for more targeted pain relief. Spinal cord stimulation appears to provide meaningful pain reduction for patients with phantom limb pain, with a subset achieving near-complete relief. However, reported outcomes vary and complications remain a concern. Given the limited number of reports and small sample sizes, further research is needed to assess long-term efficacy and to minimize complications.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100571"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allergic reaction to temporary percutaneous peripheral stimulation leads: A case report","authors":"Amir Soheil Tolebeyan,&nbsp;Kimberly Youngren","doi":"10.1016/j.inpm.2025.100562","DOIUrl":"10.1016/j.inpm.2025.100562","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100562"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of thoracic medial branch radiofrequency neurotomy using a three-tined electrode: A single-arm, retrospective cohort study","authors":"Hasan Sen ,&nbsp;Amanda Cooper ,&nbsp;Andrew Stephens ,&nbsp;Brook Martin ,&nbsp;Robert S. Burnham ,&nbsp;Aaron Conger ,&nbsp;Zachary L. McCormick ,&nbsp;Taylor R. Burnham","doi":"10.1016/j.inpm.2025.100563","DOIUrl":"10.1016/j.inpm.2025.100563","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic medial branch radiofrequency neurotomy (TMBRFN) is used to treat chronic thoracic facet joint pain, but research on its technique and effectiveness is still needed. The current International Pain and Spine Intervention Society Practice Guidelines do not describe a technique for TMBRFN.</div></div><div><h3>Objectives</h3><div>Evaluate the effectiveness of TMBRFN in patients with thoracic facet joint pain.</div></div><div><h3>Methods</h3><div>Single-arm, retrospective cohort study of consecutive patients from two Canadian musculoskeletal pain management clinics who underwent first-time TMBRFN between 2016 and 2022. The primary outcome was the proportion of patients with ≥50 % reduction in numerical rating scale (NRS) pain score at 3-months post-procedure. Secondary outcomes included the proportion of patients who achieved a ≥17-point reduction on the Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) at 3-months, as well as mean patient-reported percentage pain relief and duration of relief after a successful index TMBRFN in individuals who reported a return of their index symptoms.</div></div><div><h3>Results</h3><div>18 consecutive patients (50.0 % male; mean age 60.9 ± 15.3 years; mean BMI 30.3 ± 6.9 kg/m²) were analyzed. At 3 months post-procedure, 10 patients (55.6 % [95%CI 33.7–75.4]) reported ≥50 % NRS pain reduction and 9 (50.0 % [95%CI 29.0–71.0]) reported ≥17-point PDQQ-S reduction. Of the 10 patients with successful treatment responses, 4 had a return of symptoms after an average of 9.3 ± 2.2 months with a reported retrospective mean percentage pain relief of 70.0 ± 34.6 %.</div></div><div><h3>Conclusion</h3><div>Within this cohort, approximately 60 % of patients experienced improvement in pain and disability at 3 months following TMBRFN. Among patients whose index symptoms returned after successful treatment, the average reported pain relief was 70 % for close to 9 months. Larger, prospective studies with long-term outcomes are needed to better elucidate the safety and effectiveness of TMBRFN.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100563"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}