Pain physician最新文献

{"title":"Comment on \"Predicting Responses to Interventional Pain Management Techniques for Chronic Low Back Pain: A Single-Center Observational Study (PReTi-Back Study).","authors":"Natasha C Pocovi, Stephen A Sharp, Mark J Hancock","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E230"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764640","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":"Effect of Tattoos on Spinal or Epidural Anesthesia: A Narrative Review.","authors":"Haixia Yang, Yali Ji","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The popularity of tattoos has increased significantly, particularly among younger demographics. However, the implications of tattoos on medical procedures, such as spinal or epidural anesthesia, are not well established. There is a need to understand the potential risks and complications associated with administering anesthesia through tattooed skin.</p><p><strong>Objectives: </strong>This narrative review aims to explore the principles of tattooing, the composition of tattoo pigments, the immune response to tattoos, the complications arising from tattoos, and the impact of tattoos on spinal or epidural anesthesia.</p><p><strong>Study design: </strong>A comprehensive literature review was conducted to gather information on the interaction between tattoos and anesthesia. The review included studies that examined the effects of tattoos on anesthesia outcomes and patient safety.</p><p><strong>Setting: </strong>The review spans both clinical and research environments, focusing on the interactions of tattooed skin and anesthesia administration, particularly in regions where tattoos are prevalent.</p><p><strong>Methods: </strong>Relevant databases were searched for studies discussing the relationship between tattoos and anesthesia. The analysis included examination of tattoo pigments, immune responses, and the potential for complications during the administration of anesthesia through tattooed skin.</p><p><strong>Results: </strong>The review found that tattoos could lead to various complications, including infections, allergic reactions, and skin lesions. The presence of tattoos does not preclude the use of spinal or epidural anesthesia but may necessitate modifications in anesthetic technique. The pigments used in tattoos, especially organic compounds, can potentially cause neurotoxic reactions if introduced into the spinal canal. Additionally, tattoos may interfere with the body's immune response, leading to localized inflammation and potential nerve injury.</p><p><strong>Limitations: </strong>The review is limited by the scarcity of studies specifically addressing the interactions between tattoos and anesthesia. The variability in tattoo pigments and individual patient responses further complicates the establishment of standardized guidelines.</p><p><strong>Conclusions: </strong>While tattoos present potential risks when considering spinal or epidural anesthesia, they do not absolutely contraindicate these procedures. Anesthesia providers should be aware of the possible complications and adapt their practices accordingly. These adjustments may include selecting alternative puncture sites, using caution with MRI and high-frequency electrosurgery, and obtaining detailed information about the tattoo's pigment composition. Further research is needed to establish clear guidelines and to better understand the long-term implications of tattoos on anesthesia safety and efficacy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E129-E135"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764573","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":"Patient Experience with Open-Loop Spinal Cord Stimulation Devices Across Manufacturers and Waveforms: Results of a Double-Blind Survey.","authors":"Scott G Pritzlaff, Mehul Desai, Sean Li, Melissa Z Murphy, Vwaire Orhurhu, David A Provenzano, Henry E Vucetic, Kate Robertson, Louis Archila, Lisa M Johanek, Abi Franke, Ashish Gulve","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Spinal cord stimulation (SCS) is an established, efficacious therapy for chronic neuropathic pain. SCS therapy has the unique challenge of variability in the amount of applied stimulation that reaches the cord as it moves within the spinal canal during the patient's activities of daily living (ADLs). This variability is experienced by the patient as transient instances of overly strong (i.e., overstimulation) or overly weak (i.e., understimulation) therapy when the person changes their posture. While patients report a high degree of satisfaction with the pain reduction and quality-of-life improvement from this therapy, they make manual adjustments to the programmed settings, including turning the amplitude up, down or off, to avoid these events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study was undertaken to understand patients' experiences with the current generation of open-loop (OL) SCS devices and what innovations would be meaningful to those patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;The study was a prospective, double-blind survey of a representative sample of SCS patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was executed by a third-party vendor as a 20-minute electronic survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients were recruited from the database of another market research vendor and screened via email or phone. Eligibility was determined based on screening questions, including location of implant, manufacturer, time since implant, and location of pain. Consent was obtained prior to participation, and patients were compensated for their time. The questions were tested prior to being administered to the patients in a separate cohort for ease of understanding and adequacy of choices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred patients representative of the SCS population provided responses to this survey; the patients were implanted with devices manufactured by Medtronic (33%), Nevro (28%), Boston Scientific (24%), and Abbott (15%). Over 80% of patients were being treated for low-back pain with or without leg pain. Regardless of whether the patient was programmed to receive sub- or supra-perception therapy, 58% reported experiencing overstimulation, and 46% reported understimulation as they engaged in ADLs. Most of the patients (85%) reported avoiding one or more ADLs, and 70% reported increasing or decreasing the level of therapy proactively to avoid those side effects, resulting in a significant burden of device management. Over 80% of patients expressed being satisfied or very satisfied with the pain relief provided by the devices and technology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study has the inherent limitations of a direct-to-patient survey design, including subjective interpretation of the questions without a complete understanding of the relative merits of different waveforms or devices (e.g., MRI conditionality).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients report a high degree of ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E205-E214"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764669","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":"Efficacy of Nerve Blocks for Managing Refractory Posttraumatic Headaches.","authors":"Christopher File, Xiang Fang, Rowaid Ahmad, Ahmed Harazeen, John Jung, Fauwad Ahmed, Naveed Ahmad, Sean Pappolla, Remi Nader, Miguel A Pappolla","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Nerve blocks (greater occipital, lesser occipital, others) are commonly used, singly or in combination, to treat various forms of refractory headaches, including migraine and cervicogenic headaches. Their efficacy in treating posttraumatic headaches, however, particularly those unresponsive to medications or severely disabling, is not well documented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To characterize the efficacy of nerve blocks in the treatment of posttraumatic headaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective chart review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A single-specialty outpatient neurology clinic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients from January 2022 through July 2023 who fulfilled International Headache Society criteria for posttraumatic headache (i.e., new onset headache developing within the first week following head trauma) were included. A rigorous, comprehensive, and unbiased selection process was followed via Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Headaches were refractory to various treatments, including analgesic agents or headache prophylactic medications. The treatments the study patients received were a combination of nerve blocks, including greater, lesser, and third occipital nerve blocks, and supraorbital and supratrochlear nerve blocks. We used the percentage of pain improvement in order to assess the response to the blocks: minimal improvement (&lt; 50%), moderate improvement (50-75%), and significant improvement (&gt; 75%) pain relief.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-four patients met the inclusion criteria; 15 were women (44%). The mean (SD) age was 43.11 ± 14 years. Of these 34, 28 stated a significant improvement in headache pain immediately following their injection. Twenty-one patients (75%) rated their response to nerve blocks as a &gt;= 90% improvement in headaches. Six patients reported complete resolution of their headache pain. Expressed as percentage headache pain improvement, average pain improvement was 88%. Six patients reported moderate improvement of their headaches.Thirty-one patients reported an average headache improvement of 73% on Postprocedure Day One. Nineteen of these 31 patients had significant pain improvement from baseline, with 12 of them reaching a &gt;= 90% pain improvement. Eight patients reported moderate improvement, while 4 had minimal headache pain improvement. Twenty-seven patients were available for a 3-month follow-up; they reported an average headache improvement of 73%. Thirteen of these patients reported significant improvement in their headache pain, with 12 of them having a &gt;= 90% improvement in their headaches. Twelve patients reported moderate pain improvement, and 2 had minimal or no pain improvement. Nineteen patients returned for a 6-month follow-up; they reported an average pain improvement of 78%. Twelve patients reported significant pain improvement, with 11 having an improvemen","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"137-145"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764577","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":"In Memoriam: Dr. Jorge Antonia (\"Tony\") Aldrete 1937-2025.","authors":"Kenneth D Candido, Ricardo Plancarte Sanchez","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E219-E225"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764664","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":"Sedatives and Opioids Best Practices: An Approach to the Use of Technological Tools.","authors":"Cinthya Galindo, Rosa-Helena Bustos, Marisol Porra, Marta-Ximena Leon, Diego Becerra, Peter Vergara, Fernando Rios, Diego Jaimes, Laura Bravo, Jose-Manuel Quintero, Monica Maria Diaz-Lopez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The formulation of opioid medications is becoming increasingly common among hospitalized patients, due to the need for pain control or sedation during procedures. This phenomenon represents the possibility of an increase in adverse events, as demonstrated by monitoring through the Adverse Event Reporting System (FAERS). The importance of tools that unify information search and provide easy access for physicians is becoming more evident. Thus, it is essential to assess the medical needs for information when using technological tools that can support clinical practice.</p><p><strong>Objective: </strong>To characterize the main pharmacological and pharmaceutical needs of critical care physicians for the management of adult patients when administering sedative and/or opioid analgesic medications.</p><p><strong>Study design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>A tertiary care setting in Bogotá and Chía, Colombia from October 1 through December 31, 2022.</p><p><strong>Methods: </strong>Surveys were collected through Google Forms. The surveys were directed to physicians from Clinica Universidad de La Sabana and Clínia Nueva de Bogotá. These physicians perform sedation and analgesia procedures on adult patients in critical care services, including emergency departments, hospitalization units, surgical rooms, and adult intensive care units.</p><p><strong>Results: </strong>Ninety-five percent of the respondents considered the use of technological tools necessary for support during their workday. Most respondents reported that these tools were helpful for information searches regarding dose adjustments of sedatives and opioid analgesics, especially in cases of renal disease, dose calculations for rotation, and titration of opioids.</p><p><strong>Limitations: </strong>Designed for academic purposes, the survey identified 4 key areas requiring improvement: pharmacological knowledge, patient safety monitoring, specialized administration techniques, and practical application of knowledge during the administration of medication. The survey was conducted under the constraints of time and resources, limiting the sample to 2 institutions based on accessibility and feasibility.</p><p><strong>Conclusions: </strong>The study highlights the need for the development of technological tools to support medical services in the safe use of sedative and opioid analgesic medications. The evaluation of specific pharmacological and pharmaceutical knowledge related to this group of medications is crucial.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E165-E172"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764671","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":"Technical Modification of Cervical Facet Joint Radiofrequency Ablation: A Novel Approach.","authors":"Boqing Chen, Daniel H Cho, Kevin W Tang, Malaka Badri, Patrick M Foye, Todd P Stitik","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Current standards of practice recommend performing the cervical medial branch block (MBB) and applying the subsequent radiofrequency ablation (RFA) electrode via anterior-posterior (AP) and lateral fluoroscopic views. The lateral views of the lower cervical segment are frequently hindered by patients' anatomical factors and prevent the accurate and safe placement of the RFA needle.</p><p><strong>Objective: </strong>The goal of this technical modification is to introduce and standardize an oblique angle view using fluoroscopy to enable more accurate placement of the MBB needle and RFA needle electrode in the cervical facet joint.</p><p><strong>Study design: </strong>The technical modification was developed using a cadaveric skeletal model. Then, in an actual patient, this additional oblique view was tested in an RFA procedure for a cervical facet joint.</p><p><strong>Setting: </strong>This protocol was produced at a single musculoskeletal and interventional spine center.</p><p><strong>Methods: </strong>A team of interventional pain specialists developed a step-by-step technique that utilized a 50-degree ipsilateral fluoroscopic view, in addition to AP and lateral views, by simulating a cervical facet joint RFA in a cadaveric skeletal model. The technique was then tested in an actual patient's cervical facet joint RFA procedure.</p><p><strong>Results: </strong>The team successfully developed a technique to confirm placement of the RFA needle electrode at the articular pillar to denervate the medial branch for treating pain in the cervical facet joint. This technique allows for the clear visualization of the needle RFA electrode to overcome patient factors that can obscure the electrode, including physiological aspects such as short neck and shoulder musculature.</p><p><strong>Limitations: </strong>A potential disadvantage of this technical modification is the additional radiation exposure, which is caused by the addition of an oblique view.</p><p><strong>Conclusions: </strong>Our technical modification of an oblique angle view enables clear visualization, thus increasing the accuracy and potentially the safety of RFA needle electrode placement in lower cervical facet joint RFA over those of the conventional approach.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E199-E203"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764672","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":"Greater Occipital Nerve Block at Two Levels Spares the Need for an Epidural Blood Patch for Managing Postdural Puncture Headache: A Randomized Comparative Trial.","authors":"Enas Wageh Mahdy, Asmaa Mohamed A Elsaid, Yehya Shahin Dabour, Samar A Salman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Anesthesia through neuroaxial approaches is an effective option for lower abdominal surgeries, but postdural puncture headache (PDPH) is often an adverse effect of this procedure.</p><p><strong>Objectives: </strong>Evaluation of the effect of bilateral bi-level greater occipital nerve blocks (GONB) on the severity of PDPH and its effect on patients' quality of life.</p><p><strong>Study design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>Department of Anesthesia, ICU and Pain, Faculty of Medicine, Benha University in conjunction with multiple private centers, Cairo, Arab Republic of Egypt.</p><p><strong>Methods: </strong>A total of 180 patients with PDHP were evaluated using the Numeric Rating Scale (NRS-11) to assess pain in an upright position and the 36-Item Short-form Survey Instrument (SF-36) was used to assess the effect of PDPH on quality of life. Patients were randomly divided into an intramuscular group and received an intramuscular injection. Other injection location groups were distal (DG), proximal (PG), and bilevel (BG). All groups received bilateral GONB using 2 mL of lidocaine 2% mixed with 2 mL of dexamethasone. Pain scores were evaluated at 24 hours postprocedure. At one month pain and SF-36 scores were recorded. The success rate was defined as the frequency of pain-free (NRS-11 < 4) among the trial patients. Recurrent cases received bilevel GONB and nonresponsive patients received an epidural blood patch.</p><p><strong>Results: </strong>At 24 hours postprocedure, 82.8% of the total patients and all BG patients were pain-free. NRS-11 pain scores were significantly lower in BG patients than patients in other groups; 7 patients required an epidural blood patch. At one month, 114 total patients (63.3%) had a zero pain score and 95.6% of BG patients were pain-free; the BG patients had significantly lower pain scores than the other groups. Also, SF-36 scores were improved in all patients with significantly higher scores in the BG and PG groups compared to the other groups. Twenty-seven total patients had recurrent PDPH; intramuscular  injection patients had a significantly higher frequency of recurrent PDPH and shorter pain-free duration. The success rate of bilevel GONB management for recurrent PDPH was 81.5%.</p><p><strong>Limitations: </strong>The limitations of this trial are two-fold: missing of blocking the other occipital nerves and omission of blocking at the recently defined area of the three main occipital nerves communicate.</p><p><strong>Conclusion: </strong>Bilevel GONB provided was superior to single level blocks and intramuscular injection with no 24 hour postprocedure failure, a low recurrence rate, and totally negated the need for an epidural blood patch; it also significantly improved patients' quality of life. Bilevel GONB is an efficient first-line therapy for recurrent PDPH.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E137-E146"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764663","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":"Nerve Block Efficacy and Safety for Acute Thoracic Herpes Zoster: A Systematic Review and Meta-analysis.","authors":"Chiao-Ming Chuang, Chung-Ren Lin, Yu-Lien Hsieh","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute zoster-related pain affects more than 90% of patients with acute herpes zoster. While nerve blocks with local anesthetics and steroids are commonly used to manage acute postoperative and chronic pain, their efficacy and safety in treating acute herpes zoster remain underexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our systematic review and meta-analysis aimed to evaluate the efficacy and safety of various nerve blocks for managing acute herpes zoster.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify studies of patients with acute herpes zoster who received nerve blocks. Study quality was assessed using risk-of-bias tools for randomized and nonrandomized studies. The primary outcome was analgesic efficacy; secondary outcomes included postherpetic neuralgia (PHN) incidences, analgesic consumption, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirteen studies (9 RCTs, n = 815; 4 observational studies, n = 253) were included. Nerve blocks administered were  paravertebral blocks (PVB), erector spinae plane (ESP) blocks, epidural blocks, and intercostal nerve blocks. The meta-analysis, which included 6 RCTs, indicated that at 4 weeks postprocedure, nerve blocks significantly reduced Visual Analog Scale pain scores. The blocks also reduced the need for acetaminophen and pregabalin compared with the control group. However, no differences in Visual Analog Scale pain scores were observed at 12 weeks. Both PVB and ESP blocks significantly decreased the PHN incidences at 3 and 6 months postprocedure. Five studies demonstrated that ultrasound-guided ESP blocks significantly reduced pain severity, duration, and the incidence of PHN without notable adverse events. Eight studies found PVBs to be effective in reducing pain scores and PHN incidences, though adverse events such as dizziness, drowsiness, and pain at the injection site were reported. Four observational studies comparing epidural or intercostal nerve blocks with other techniques provided weak evidence for their use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our study's limitations include its small sample size with only 6 RCTs, significant heterogeneity in study designs, and variations in the interventions. Subjectivity in measuring pain and the lack of blinding introduces potential bias. Additionally, limited evidence on intercostal and epidural blocks for acute herpes zoster highlights the need for more high-quality RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In conclusion, nerve blocks with local anesthetics and steroids provide effective analgesia, reduce analgesic consumption, and lower PHN incidences in ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"83-96"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764667","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":"Evaluation of Genicular Nerve Blocks Durations With and Without Corticosteroid: A Single-blind, Randomized Controlled Trial.","authors":"Suzanna Shermon, Terence Hillery, Mi Mi Kim, Gustaf Van Acker, Chong H Kim","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Genicular nerve blocks (GNBs) are commonly performed prior to performing  radiofrequency ablation (RFA) to assess RFA's potential efficacy. Typically, GNBs are commonly performed with local anesthetic only. The duration of efficacy of GNBs has not been investigated much in the literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The primary goals of this study were to evaluate for any differences in response to GNBs between using local anesthetic only versus local anesthetic and corticosteroid, and assess for the potential therapeutic benefit of GNBs by examining pain relief percentage, pain relief duration, and change in pain scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Randomized prospective trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Fluoroscopy suite at an urban academic teaching hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Fifty patients with chronic knee osteoarthritis were randomly assigned to undergo a GNB done under fluoroscopic guidance with either bupivacaine only (n = 24, the control group) or bupivacaine and triamcinolone (n = 26, the experimental group). Baseline and postprocedure pain scores were collected on the day of the procedure. Patients were then called at postprocedure 24 hours, 2 weeks, and 6 weeks and asked their maximum percentage of pain relief, duration of pain relief, and Numeric Rating Scale (NRS-11) scores, which were compared between the 2 groups. Associations between these factors and Kellgren-Lawrence Classification of Osteoarthritis scores, body mass index, age, gender, race, and baseline pain scores were also assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean duration of pain relief was significantly higher in the group administered a corticosteroid (0.87; SD, 0.29 days) compared to the group not administered a corticosteroid (0.64; SD, 0.43 days) at 24 hours postprocedure. No significant differences were found between the 2 groups in pain relief percent, pain relief duration, or NRS-11 scores at any of the 3 time points. No significant difference in changes from baseline NRS-11 scores over time were found between the 2 groups. No significant associations were found between pain relief percent, pain relief duration, and NRS-11 scores regarding age, gender, body mass index, race, Kellgren-Lawrence scores, and baseline pain scores at postprocedure days one, 14, and 42.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This was a single-blind, single-center study. It lacked a follow-up at 6 weeks postprocedure, lacked a placebo group, and had a small sample size.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The addition of a corticosteroid to local anesthetic for GNB may prolong initial analgesic effects within the first postprocedure 24 hours. However, there is no analgesic difference in the weeks following a GNB between procedures done with local anesthetic only or local anesthetic and corticosteroid. These findings suggest that there is a lack of therapeutic benefit and effect on relief duration with using  corticost","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"127-135"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764595","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}