Interventional Pain Medicine最新文献

{"title":"Three-year results of the MOTION randomized controlled trial for treatment of lumbar spinal stenosis using the percutaneous mild® Procedure","authors":"Shrif J. Costandi ,&nbsp;Timothy R. Deer ,&nbsp;Timothy B. Chafin ,&nbsp;Christopher Kim","doi":"10.1016/j.inpm.2025.100561","DOIUrl":"10.1016/j.inpm.2025.100561","url":null,"abstract":"<div><h3>Objective</h3><div>The MOTION prospective, multicenter randomized controlled trial compares the outcomes of percutaneous image-guided lumbar decompression in combination with conventional medical management (CMM) to the use of CMM alone for the treatment of lumbar spinal stenosis with neurogenic claudication secondary to hypertrophic ligamentum flavum. The study includes extended follow-up for patients in both the treatment group and for those who crossed over from the control group to the treatment group.</div></div><div><h3>Methods</h3><div>The treatment group received the <em>mild</em>® Procedure (Vertos Medical, Aliso Viejo, CA, USA) in combination with nonsurgical CMM, while the active control group received CMM alone. There were no restrictions for either group regarding access to real-world CMM therapies. Patients reported outcomes using the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and Numeric Pain Rating Scale (NPRS). Objective outcomes were measured using a validated Walking Tolerance Test (WTT), the incidence of subsequent lumbar spine interventions, and the occurrence of adverse events.</div></div><div><h3>Results</h3><div>Forty-eight patients initially receiving <em>mild</em> + CMM consented to extended follow-up and were available for 3-year follow-up. All outcomes for this group were significantly improved over baseline (p-values ranging from &lt;0.0001 to 0.0001). At 3-year, ODI, NPRS back and leg, ZCQ symptom severity, and physical function improved by 16.9, 3.0, 4.3, 0.8, and 0.6, respectively. Walking tolerance test demonstrated 274 % improvement from baseline, and only 4 (5.6 %) patients had received surgical intervention. No device- or procedure-related adverse events were reported.</div></div><div><h3>Conclusions</h3><div>MOTION 3-year follow-up results continue to demonstrate the safety and durability of the <em>mild</em> Procedure combined with CMM for early interventional treatment of symptomatic LSS. The absence of device or procedure-related adverse events further underscores the robust safety profile of the <em>mild</em> Procedure. Significant and substantial improvements in all the outcomes were observed from baseline to follow-up for patients treated with the <em>mild</em> Procedure. These results support the <em>mild</em> Procedure as an effective approach for early intervention in LSS treatment.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100561"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610413","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 effect of hybrid ultrasound/fluoroscopy guidance vs only fluoroscopy guidance on procedure time and radiation exposure in caudal epidural steroid injections","authors":"Serdar Kesikburun ,&nbsp;Şahide Eda Artuç ,&nbsp;Esra Çelik Karbancioğlu ,&nbsp;Bilge Kesikburun ,&nbsp;Emre Adigüzel ,&nbsp;Evren Yaşar","doi":"10.1016/j.inpm.2025.100567","DOIUrl":"10.1016/j.inpm.2025.100567","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasonography guidance have had a rapid increase in its popularity for caudal epidural steroid injections. However, unlike fluoroscopy, ultrasound cannot reliably detect intravascular or intradural distribution of the medication. Therefore, the practitioners cannot be entirely certain about the accuracy of the procedure. A hybrid technique may eliminate these drawbacks. The primary objective of this study is to evaluate the effect of hybrid ultrasound/fluoroscopy guidance on procedure time, fluoroscopy duration, and radiation exposure during caudal epidural injections, compared to the conventional method of fluoroscopy-only guidance.</div></div><div><h3>Methods</h3><div>In this prospective randomized controlled trial, 65 patients who were undergoing caudal epidural steroid injection randomized into two groups: the hybrid ultrasound/fluoroscopy group [Group 1 (n = 32)] and the fluoroscopy-only group [Group 2 (n = 33)]. Kerma area product (KAP), elapsed time of the needle insertion into sacral hiatus, elapsed time of the entire procedure and fluoroscopy time were measured. Numeric Rating Scale (NRS) for pain level and Oswestry Disability Index (ODI) were also assessed before the procedure and two weeks later.</div></div><div><h3>Results</h3><div>Radiation exposure measured using fluoroscopy time (group 1 = 0.06 ± 0.01 min; group 2 = 0.09 ± 0.03 min) and KAP (group 1 = 43.73 ± 16.90 cGy cm²; group 2 = 72.39 ± 32.75 cGy cm²) was significantly lower in group 1 compared to group 2 (p &lt; 0.001 for both). Elapsed time of the needle insertion into sacral hiatus (T1) (group 1 = 2.82 ± 1.07 min; group 2 = 3.73 ± 2.47) was shorter in the group 1 compared to group 2 (p = 0.027). However, there was no significant difference in the entire procedure time (group 1 = 5.14 ± 1.55 min; group 2 = 5.86 ± 2.71 min) between group 1 and group 2 (p = 0.100). A significant improvement in NRS and ODI measurements was shown over time for both groups (p &lt; 0.001 for both). No significant interaction between group and time was identified concerning NRS (p = 0.177) and ODI (p = 0.207) scores. A total of 4 vascular uptake out of 65 procedures (6.1 %) were detected in both groups.</div></div><div><h3>Conclusions</h3><div>The hybrid guidance may offer a potentially safer method minimizing radiation risk compared to fluoroscopy-only guidance for caudal epidural steroid injections.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100567"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143547909","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 balloon kyphoplasty compared to conservative treatment for osteoporotic vertebral compression fractures: A systematic review and meta-analysis","authors":"Sebastian Encalada ,&nbsp;Christine Hunt ,&nbsp;Belinda Duszynski ,&nbsp;Vafi Salmasi ,&nbsp;Paul Scholten ,&nbsp;Zirong Zhao ,&nbsp;George Rappard ,&nbsp;William Evan Rivers ,&nbsp;To-Nhu Vu ,&nbsp;Steven Lobel ,&nbsp;Adrian Popescu ,&nbsp;Larry J. Prokop ,&nbsp;D. Scott Kreiner","doi":"10.1016/j.inpm.2025.100569","DOIUrl":"10.1016/j.inpm.2025.100569","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporotic vertebral compression fractures (OVCFs) are a common and often debilitating condition that significantly impacts quality of life and healthcare costs. While conservative treatment is often pursued initially after fracture, some patients experience severe pain refractory to conservative treatment. In these cases, minimally invasive vertebral augmentation procedures like balloon kyphoplasty (BKP) offer an alternative, but the benefits of BKP compared to conservative treatment remain unclear.</div></div><div><h3>Objectives</h3><div>To evaluate the effectiveness of BKP versus conservative treatment for pain, quality of life, and function in patients with painful OVCFs.</div></div><div><h3>Primary outcome</h3><div>Pain improvement up to 12 months after BKP.</div></div><div><h3>Secondary outcomes</h3><div>Functional improvement, adverse events, and vertebral body height restoration.</div></div><div><h3>Methods</h3><div>This analysis included randomized controlled trials and prospective comparative studies in which at least 100 participants reported pain outcomes following BKP for OVCFs. The risk of bias was assessed using standard tools, and the certainty of the evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.</div></div><div><h3>Results</h3><div>BKP demonstrated superior pain reduction versus conservative treatment at 1 month (mean difference (MD): 2.32 [-3.65;-0.99], P &lt; 0.001), 3 months (MD: 1.19 [-2.14; −0.24], P = 0.014), 6 months (MD: 1.34 [-2.65; −0.04], P = 0.044), and 12 months (MD: 1.11 [-1.96;-0.26], P = 0.029), with the largest effect observed at 1 month. Disability improvements were significant at 1 month (standardized mean difference (SMD): 1.08 [-1.67; −0.48], P &lt; 0.001) and 3 months (SMD: 0.50 [-0.96; −0.04], P = 0.032), but not at 6 or 12 months. No significant differences were found in the risk for new vertebral compression fractures between both groups (odds ratio (OR): 1.36 [0.51; 3.64], P = 0.54). According to the GRADE system, moderate certainty evidence indicates that BKP provides superior pain relief compared to conservative treatment at all time points from 1 to 12 months.</div></div><div><h3>Conclusion</h3><div>BKP showed superior pain reduction compared to conservative treatment from 1 to 12 months and improved disability at 1 and 3 months, with moderate certainty evidence.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100569"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629320","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":"Leukocyte poor platelet rich plasma vs leukocyte rich platelet rich plasma as a treatment for cervical facetogenic pain: A pooled analysis","authors":"David J. Allison ,&nbsp;Eldon Loh ,&nbsp;Robert Burnham ,&nbsp;Taylor Burnham ,&nbsp;Ashley Smith","doi":"10.1016/j.inpm.2025.100566","DOIUrl":"10.1016/j.inpm.2025.100566","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to compare the effectiveness and safety of leukocyte-poor platelet-rich plasma (LP-PRP) and leukocyte-rich platelet-rich plasma (LR-PRP) for the treatment of cervical facetogenic pain through a pooled analysis of two independent studies. The goal was to provide preliminary evidence comparing the effect on pain relief and functional improvement over time to help inform future research.</div></div><div><h3>Methods</h3><div>The pooled analysis integrated data from two studies: a prospective case series of LR-PRP (n = 36) and a randomized controlled trial (RCT) comparing LP-PRP (n = 21) with corticosteroid injections. Participants in both studies had chronic cervical facetogenic pain confirmed through medial branch blocks and were assessed at baseline, 3 months, and 6 months post-injection. Pain intensity was measured using the Numerical Pain Rating Scale (NRS), and functional disability was assessed using the Neck Disability Index (NDI). Linear mixed-effects models evaluated treatment effects over time, controlling for age, sex, and pain duration. Clinically important differences in pain and disability were determined. Adverse events were also recorded.</div></div><div><h3>Results</h3><div>Both PRP groups exhibited significant improvements in pain and functional outcomes. However, LR-PRP demonstrated superior efficacy at 6 months, with a greater reduction in NRS scores (β = −1.68, p &lt; 0.01, Cohen's d = −1.15) and NDI scores (β = −3.66, p = 0.02, Cohen's d = −0.94) compared to LP-PRP. A higher proportion of LR-PRP participants achieved clinically significant pain relief (≥2-point NRS reduction) and functional improvement (≥10 % NDI reduction) at 6-months. No significant differences were observed at 3 months. Adverse events were more common in the LP-PRP group, with 11 documented cases, including increased pain and muscle spasms, whereas the LR-PRP group reported no adverse events.</div></div><div><h3>Conclusion</h3><div>These preliminary findings suggest that LR-PRP appears to provide greater long-term benefits for cervical facetogenic pain compared to LP-PRP, with superior pain reduction, improved function, and a favorable safety profile. These findings suggest the higher leukocyte concentration in LR-PRP may enhance therapeutic outcomes for cervical pain. Further large-scale, randomized trials are necessary to confirm these results and establish standardized PRP preparation protocols.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 1","pages":"Article 100566"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577780","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":"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":"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":"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":"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}