Pain physician最新文献

{"title":"Could the Hanging Drop Technique Be an Alternative Method to Loss of Resistance in Cervical Epidural Injections?","authors":"Shahin Azizov, Mehmet Okcu, Hamit Goksu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cervical interlaminar epidural injections are usually performed with the loss-of-resistance (LOR) technique. Therefore, no studies have evaluated or compared the hanging drop (HD) technique with the LOR technique in the administration of cervical interlaminar epidural injections (ILESIs).</p><p><strong>Objectives: </strong>This study aimed to evaluate the success of the HD technique when used with the LOR technique in cervical ILESIs.</p><p><strong>Study design: </strong>A prospective, randomized trial.</p><p><strong>Setting: </strong>Department of Pain Medicine, Ege Hospital, Baku, Azerbaijan.</p><p><strong>Methods: </strong>After obtaining ethical committee approval and initiating a randomization process, we allocated patients diagnosed with cervical herniated nucleus pulposus (CHNP) into LOR- and HD-method groups. The LOR group comprised 38 patients, and the HD group comprised 41 patients. All patients underwent interlaminar epidural steroid injections under C-arm fluoroscopy in contralateral oblique (CLO) safety view with an initial start angle of approximately 60 degrees. For the LOR group, the procedure was considered successful if there was a loss of pressure after slightly crossing the ventral spinolaminar line (VSLL) and the administered contrast material was in the epidural space. The procedure was considered successful if the saline in the needle's hub fell with negative pressure after slightly passing the VSLL and if the contrast administered was seen in the epidural space with fluoroscopy. In the HD group, there was no sensation of a drop in 3 patients, and the procedure was completed with LOR, so these patients were excluded from the study. Complications and pain scores on the VAS (visual analog scale) were questioned at the time of the procedure and at one hour and 3 weeks after the procedure, and successful injection ratios were recorded.</p><p><strong>Results: </strong>The LOR and HD groups were similar in age, gender, body mass index (BMI), and side of ILESI. The successful injection ratio was higher in the right- and left-sided ILESI group than in the median ILESI group (P < 0.01). Therefore, no differences were found between the right and left ILESI groups. Binary logistic regression analysis found that age, gender, and BMI were not associated with successful injection in the HD group, while medial injection was associated with decreased successful injection risk (OR: 0.068, P = 0.034). The successful injection ratio was higher in the LOR group than in the HD group (P < 0.001).</p><p><strong>Limitations: </strong>The study's limitations include the relatively small number of patients with CHNP  and the lack of mention of the level of CHNP.</p><p><strong>Conclusions: </strong>The LOR technique was superior to the HD for cervical ILESIs. More studies with larger sample sizes may provide more precise and detailed information.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"217-221"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Factors Influencing Medical Treatment Outcomes in Herpes Zoster Patients.","authors":"Wenqin Sun, Zhejia Hu, Lei Peng, Huajing Guo, Quan Zhou, Daobo Pan, Xuefeng Wu, Hao Wang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The routine treatment for herpes zoster (HZ) focuses on symptom control, including the use of antiviral medication, anticonvulsants, and painkillers. However, the analgesic properties of these medical treatments have been reported to be less than highly effective in some HZ patients. The factors influencing the efficacy of medical treatments for HZ patients are not yet fully understood, warranting further investigation.</p><p><strong>Objectives: </strong>This study aims to explore the factors influencing the efficacy of medical treatments in HZ patients and provide insights for clinical management of the condition.</p><p><strong>Study design: </strong>A retrospective study.</p><p><strong>Setting: </strong>This retrospective study included 76 individuals diagnosed with HZ who met specific inclusion criteria and were receiving treatments at Changde Hospital between February 2023 and December 2023.</p><p><strong>Methods: </strong>The patients were divided into 2 groups. Data on age, gender, family history, comorbidities, prior use of antiviral drugs, rash location, skin lesion severity, HZ stage, visual analog scale (VAS) scores at admission and discharge, and responses to questionnaires were collected and statistically analyzed.</p><p><strong>Results: </strong>The study revealed no significant differences in gender, family history, comorbidities, prior use of antiviral medication, rash location, or VAS scores between the 2  groups of patients. However, the results demonstrated a significant correlation between the analgesic effects of medical treatments and age, skin lesion severity, disease duration, and plasma adrenocorticotropic hormone (ACTH) and cortisol levels. Depression, anxiety, and sleep quality also influenced the treatment outcomes.</p><p><strong>Limitations: </strong>The limitations of this study include the relatively small sample size and the lack of long-term follow-up data.</p><p><strong>Conclusion: </strong>Age, skin lesion severity, disease duration, depression, sleep quality, and levels of anxiety and stress hormones are important factors influencing the efficacy of medical treatments for HZ patients.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"223-230"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Predicting Responses to Interventional Pain Management Techniques for Chronic Low Back Pain: A Single-Center Observational Study (PReTi-Back Study)\".","authors":"Santiago Garcia-Hernandez, Francisco de la Gala Garcia, Ignacio Garutti","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"E281-E282"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Focus Involving and Trends in Artificial Intelligence for Spinal Pain: A Bibliometric Analysis.","authors":"Chaobo Feng, Zhuoxi Zhou, Yongen Miao, Sheng Yang, Guoxin Fan, Xiang Liao","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Spinal pain is a pervasive global health issue that poses significant challenges because of the disability and economic burden it causes. Despite the availability of various treatments for the condition, a definitive cure for spinal pain remains elusive, underscoring the need for innovative approaches. Artificial intelligence (AI) is considered a potential method for facilitating relief for patients suffering from spinal pain.</p><p><strong>Objective: </strong>This study utilized a bibliometric analysis to explore the impact of AI on spinal pain research, examining publication trends, collaboration patterns, author contributions, and keyword clusters, to analyze research focus and trends in this field.</p><p><strong>Study design: </strong>Bibliometric analysis.</p><p><strong>Setting: </strong>Data were obtained from the Web of Science Core Collection (WoSCC).</p><p><strong>Methods: </strong>The literature related to AI-assisted techniques in spinal pain treatment was collected from the WoSCC. The CiteSpace and R Bibliometrix software packages were used in the analysis.</p><p><strong>Results: </strong>In total, 310 articles were included, with the number of publications and citations increasing progressively. The greatest number of publications and total citations came from the United States. The University of Washington was the institution associated with the most publications. Mork PJ was the byline that appeared most often in association with both publications and total citations. The European Spine Journal was the journal in which the most publications appeared, while Spine had the greatest number of citations. The literature with the most global citations was published by Jamalusin A in the European Spine Journal, while the literature with the most local citations was by Sandal LF on JMIR Research Protocols. The most frequent key words were \"machine learning,\" \"low back pain,\" \"magnetic resonance imaging, etc. LIMITATIONS: Only the English-language articles in the WoSCC database were included, and proceeding papers, meeting abstracts, and book chapters were excluded. Furthermore, we included no research about wearable sensors, virtual reality, and so on. Additionally, the articles from the other databases were not included.</p><p><strong>Conclusion: </strong>The research of applying AI as a treatment for spinal injury has appealed to interdisciplinary efforts, reflecting the potential for self-management, imaging processing, and clinical decision-making. An overall perspective is shown in our study, which facilitates understanding and provides research focuses and trends in this field.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"167-181"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural Lysis of Adhesions: What Every Interventional Pain Physician Needs to Know.","authors":"Standiford Helm Ii, Carl Noe, Gabor B Racz","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Epidural lysis of adhesions is an effective therapy for treating refractory axial or radicular cervical, thoracic, or lumbar pain. This therapy is an important alternative to surgical interventions. As such, epidural lysis of adhesions is a significant addition to the techniques available to pain management physicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale for lysis of adhesions: &lt;/strong&gt;The underlying rationale for epidural lysis of adhesions is that nerves can become inflamed, either by being entrapped by epidural scarring or being compressed by veins engorged by epidural scarring. Furthermore, the posterior longitudinal ligament can become adhered to the dura. The goal of adhesiolysis, therefore, is to relieve the effects of this scarring. The dural tag is a helpful technique for diagnosing the condition clinically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Mode of action: &lt;/strong&gt;Epidural lysis of adhesions involves placing a spring-wound catheter into the tissue planes that entrap the nerve or vein, executing an injection protocol to expand that tissue plane, and then having the patient implement a self-directed home exercise program of neural flossing. The catheter should be placed in the ventrolateral epidural space, the site of pathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Technique: &lt;/strong&gt;The injection protocol involves the use of contrast dye to confirm appropriate catheter placement. Hyaluronidase is used to enhance the flow of the medications through the tissue plane. Local anesthesia and steroids are given both for the analgesic and anti-inflammatory effects and because of corticosteroid's ability to inhibit fibroblast proliferation after the procedure. Hypertonic saline assists both with helping reduce swelling of the nerve and to provide hydrostatic force as it is diluted from 10% to 0.9% saline. Additionally, hypertonic saline causes an important, transient local anesthetic effect and a prolonged C-fiber blockade. The L5-S1 scarring triangle is an important, specific site of scarring that is now commonly treated, often in conjunction with transforaminal catheters, when performing adhesiolysis. It is imperative that patients meet appropriate discharge criteria before being discharged.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Complications: &lt;/strong&gt;Complications are generally similar to those seen with other interventional procedures. For lysis of adhesions, the potential procedure-specific concern is the risk of subarachnoid spread of hypertonic saline. Although Hitchcock intentionally injected hypertonic saline into cancer patients intrathecally and observed limited adverse effects, epidural lysis of adhesions is specifically designed to minimize this risk by injecting a local anesthetic solution that will not cause motor weakness if injected epidurally but will cause motor weakness if it spreads to the intrathecal space. Perivenous counter spread is a rare complication that can be treated with flexion rotation procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Controversies: &lt;/strong&gt;The technique has eng","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"249-257"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Management in Mild Traumatic Brain Injury: Central Sensitization as a Multispecialty Challenge.","authors":"Christopher File, Remi Nader, Alejandro Villasante-Tezanos, Rowaid Ahmed, Sean Pappolla, Fauwad Ahmed, Ernesto G Miranda-Morales, Yingxin Zhao, Xiang Fang, Alan D Kaye, Miguel A Pappolla","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Several studies indicate that approximately two-thirds of individuals with mild traumatic brain injury (mTBI) will develop chronic pain, which is often debilitating and a primary factor in long-term disability. Patients with mTBI can suffer concurrently from multiple pain types, such as chronic neuropathic (central or peripheral), nociceptive, or nociplastic pain; however, the prevailing pain types in mTBI patients remain undetermined. This knowledge void limits the formulation of effective therapies for mTBI-related pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to identify the predominant pain mechanism in patients who had developed persistent post-concussive syndrome (PPCS) after the onset of their mTBI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a retrospective observational study following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Our study focused on a cohort of mTBI patients with PPCS and chronic pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was conducted at an outpatient neurology clinic from January 2020 to December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study included patients who met the criteria for post-mTBI PPCS. Exclusion criteria consisted of a history of chronic pain before the injury, being in the acute/subacute stage (fewer than 90 days after receiving the injury), or the presence of any other neurological comorbidities. We employed a range of diagnostic instruments, including a clinical research tool to measure the degree of central sensitization. Since patients with mTBI often show normal structural imaging, we used several neurophysiological techniques, including evoked potentials, videonystagmography, and quantitative electroencephalography, to confirm the presence of brain pathology objectively. The severity of the post-concussive symptoms was measured using the Rivermead Post-Concussion Symptoms Questionnaire. Central sensitization was assessed using the Widespread Pain Index and the Symptom Severity Index. The correlation between concussion severity and widespread pain was analyzed statistically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 223 initial mTBI patients, 67 met the study criteria. The main reasons for exclusions included pre-existing chronic pain or other neurological diagnoses. Among the patients, 39 (58%) were male, averaging 45.7 years of age (range: 20-72). Ethnicity distribution was as follows: 26 (39%) Hispanic, 22 (33%) White, 12 (18%) Black or African American, and 7 (10%) Asian or Pacific Islander. We found that patients with PPCS exhibited high levels of central sensitization, highlighting its critical role in the pathophysiology of chronic pain post-mTBI. We observed a significant correlation between the extent of central sensitization and the presence of non-painful symptoms, suggesting shared neuropathological processes between chronic pain and other PPCS manifestations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/stro","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"231-240"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of Liver Function Post Intravenous Ketamine for Treating Complex Regional Pain Syndrome.","authors":"Chanbin Lee, Philip Getson, Neel Mehta, Jay Joshi, Pradeep Chopra","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Complex Regional Pain Syndrome (CRPS) is a severely painful condition with very few effective treatments. One of the treatments used to treat CRPS is intravenous ketamine infusions. There has been one controversial anecdotal report on the effect of ketamine on liver dysfunction.</p><p><strong>Objectives: </strong>This study aimed to determine the effect of ketamine on liver enzymes.</p><p><strong>Study design: </strong>A retrospective study.</p><p><strong>Setting: </strong>Multilocation Pain Management Centers.</p><p><strong>Methods: </strong>During the treatment period from January 2010 through December 2018, the medical records of 52 patients were reviewed and analyzed. All of them had undergone an intravenous ketamine infusion for managing CRPS. As per protocol, a liver function test was performed within 24 hours postinfusion. The Brown University Human Research Protection Program determined that the proposed research did not involve human subjects as defined by 45 CFR Part 46.102.</p><p><strong>Results: </strong>A retrospective chart review was performed as part of ongoing quality assessment. All of the patients had received multiple days of a loading dose of ketamine infusion varying from 7 days to 10 days and received subsequent booster infusions varying from one day to 2 days. All the infusion days were limited to 4 hours each day. All the patients reported at least 50% pain relief lasting for more than 4 weeks to 6 weeks. Out of the 52 patients studied, 36 (69%) had returned to work or resumed attending school. Blood liver function tests were performed within 24 hours of the infusion. The liver function tests performed were serum albumin, total protein, total bilirubin, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase levels. There was no evidence of liver dysfunction in any of the patients following their ketamine infusion.</p><p><strong>Limitations: </strong>This was a retrospective analysis without a control group.</p><p><strong>Conclusions: </strong>Intravenous ketamine infusions performed to achieve adequate pain control for CRPS does not alter liver function tests.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"E255-E261"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Clinical Outcomes Trigeminal Nerve Block With and Without Radiofrequency Thermocoagulation for Trigeminal Neuralgia.","authors":"Ji H Hong, Seung W Lee, Ji H Park","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal neuralgia (TN) is known to be an excruciating disease. It leads to a reduced quality of life and psychological distress, often even to suicide. Patients who are intractable to pharmacotherapy should receive a percutaneous treatment, such as a trigeminal nerve block (TB) or radiofrequency thermocoagulation (RFT) of the trigeminal ganglion.</p><p><strong>Objectives: </strong>The primary endpoint of this study was to compare the clinical outcome of TB alone with TB and RFT of the trigeminal ganglion.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>The pain clinic of a tertiary university hospital.</p><p><strong>Methods: </strong>Patients with TN received an ultrasound-guided supraorbital, infraorbital, or mental nerve block twice depending on the affected division. They were divided into TB only group (n = 42) and TBRF group (n = 60) depending on the result of the nerve block. The TBRF group, which had an unresponsive result to the initial nerve block, then received radiofrequency thermocoagulation (RFT) at the trigeminal ganglion.</p><p><strong>Results: </strong>The Numeric Rating Scale (NRS-11), measured at 2 and 4 weeks post the initial nerve block, was significantly lower in the TB group than the TBRF group (P < 0.001). However, when RFT was performed in the TBRF group, the NRS-11 score became similar between the 2 groups (2.4 vs 2.05). Patients with a Barrow Neurological Institute (BNI) Pain Intensity Scale score of I or II, had a successful outcome: 45 patients in the TBRF group (45/60, 75%). Whereas, patients with a BNI score of IV or V, had an unsuccessful outcome: 6 patients (6/60, 10%) in the TBRF group. The time to recurrence in the TB and TBRF groups was 11.2 ± 1.6 and 19.4 ± 2.8 months, respectively (P = 0.01). The total recurrence rate at the 3-year follow-up in the TB and TBRF groups was 57% (24/42) and 23% (14/60), respectively (P = 0.001).</p><p><strong>Limitation: </strong>Facial hypoesthesia is an important sign of successful destruction of the trigeminal ganglion. However, we did not analyze the BNI score according to the degree of facial hypoesthesia.</p><p><strong>Conclusion: </strong>When patients with TN were unsuccessful with trigeminal nerve block alone, combining RFT at the trigeminal ganglion demonstrated a successful NRS-11 score reduction with a lower recurrence rate and a longer time to recurrence  than trigeminal nerve block alone.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"241-248"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Review of Treatment Approaches to Ilioinguinal Neuralgia.","authors":"Anand S Patil, Mayank Gupta, Nebojsa Nick Knezevic, Whitman Oehlermarx, Sudhir Diwan, Rany T Abdallah, Mahendra Sanapati, Amol Soin, Alaa A Abd-Elsayed","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Ilioinguinal neuralgia is a frequent cause of pain in the lower abdomen, genitals, and upper thighs and is commonly caused iatrogenically. Patients with ilioinguinal neuralgia often have a history of surgical interventions such as hernia repairs, appendectomies, or hysterectomies.</p><p><strong>Objectives: </strong>The objective of this narrative literary review is to catalog and provide an organized level of evidence for the available interventions for treating ilioinguinal neuralgia.</p><p><strong>Methods: </strong>Research databases, including PubMed, CINAHL and Google Scholar, were searched for characterization, diagnosis, and treatment of ilioinguinal neuralgia. The included results comprised case studies, randomized trials, and meta-analyses. Interventions were organized from least to most invasive and sorted into 3levels (A-C). Level A consisted of data derived from multiple randomized clinical trials or meta-analyses. Level B consisted of data derived from single randomized trials or nonrandomized studies. Level C was composed of consensus opinions of experts, case studies, or standards of care.</p><p><strong>Results: </strong>The review finds the greatest level of evidence in support of the conservative management of pain through various classes of medications and topical treatments. Although injection-based interventions and neuromodulation approaches have been developed in the past few years, these techniques lack level A evidence from studies such as multiple randomized clinical trials or meta-analyses. The most invasive treatment discussed is surgical neurectomy, which also lacks level A evidence but has garnered support from retrospective reviews and prospective studies.</p><p><strong>Limitations: </strong>Attempts were made to gather studies from large databases. However, we acknowledge that our efforts do not cover all known publications on the management of ilioinguinal neuralgia.</p><p><strong>Conclusions: </strong>Based on the present literary review, the method of ilioinguinal neuralgia management with the strongest level of evidence in its favor is taking conservative measures, including topical and oral medications. The paper and accompanying original Table 2 provide a good summary of what current literature supports which treatment options.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"197-205"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing the Geographical Trends of Pain Fellowship for Residency to Fellowship and Residency/Fellowship to First Job Location Among Recent Fellows.","authors":"Jimmy Wen, Jared Leapart, Won Jin Choi, Shannon Dwyer, Muhammad Karabala, Ramy Khalil, Daniel Razick, Muzammil Akhtar, Vinay Reddy","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pain medicine has transitioned from its original role as opioid medication management into a multidisciplinary field that plays a critical role in caring for patients with various acute and chronic pain-related conditions. Pain fellowships have traditionally been considered a competitive subspecialty, and the coronavirus disease 2019 (COVID-19) drastically shifted the process in which applications to this field of study have been conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aims to analyze publicly available geographical data on pain fellows from 2017 to 2024 and to ascertain the influence of COVID-19 and primary residency on the distribution of these trainees.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective study analyzing data on Accreditation Council for Graduate Medical Education (ACGME) pain fellows from 2017 to 2024. The data collected consisted of the individuals' fellowship class, residency program, primary residency specialty, and first job location.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Each pain fellow's relative distance and distribution from residency to fellowship, residency to first job, and fellowship to first job were analyzed. These locations were categorized as within 100 miles, the same state, the same region, or a different region. The odds ratio (OR) was calculated for those relative locations, bearing in mind whether the data referred to a pre- or post-COVID-19 time period (2017-2020 and 2021-2024, respectively). An additional OR was also conducted to determine the effect of primary specialty on relative distance. The chi-square test was used to calculate a P-value of 0.05, and confidence intervals were obtained using the Baptista-Pike method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 877 fellows were included, with over half of the fellows (53.6%) staying within the same region as their residency, 51.1% in the same region from residency to first job, and 56.1% in the same region from fellowship to first job. For the residency-to-fellowship period, from pre- to post-COVID-19, fellows were not more likely to stay within 100 miles (OR: 1.16), in the same state (OR: 1.24), or in the same region (OR: 1.08). The residency-to-first-job fellows were not more likely to stay within 100 miles (OR: 0.77) or in the same state (OR: 0.93) or region (CI: 0.89). Similarly, pain fellows did not show more likelihood of staying within 100 miles (OR: 1.02) or the same state (OR: 1.08) or region (OR: 1.01) as they progressed to their first jobs. Anesthesiology trainees demonstrated a higher likelihood of staying within 100 miles from residency to fellowship (OR: 1.47) and in the same state for the fellowship-to-first-job period (OR: 1.50).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;We were unable to obtain information from all the ACGME programs because some trainees declined to respond or participate. Additionally, the subjective factors that might have influenced trainees' ranking lists, such as family and","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 3","pages":"E243-E254"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}