Pain physician最新文献

{"title":"Predictive Value of Preoperative Antioxidant Levels in Postherpetic Neuralgia: A Retrospective Study.","authors":"JiaYu Yue, Ming Yao","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Herpes zoster (HZ) presents as painful blisters caused by the reactivation of the varicella-zoster virus. Postherpetic neuralgia (PHN) is a challenging complication of HZ. Oxidative stress, implicated in various skin diseases, may play a role in PHN, motivating the investigation of blood antioxidants as potential predictors of the complication. Only a limited amount of research has explored the connection between serum antioxidants and HZ outcomes.</p><p><strong>Objectives: </strong>To examine the impact of specific serum antioxidants on the development of PHN.</p><p><strong>Study design: </strong>A retrospective, observational study.</p><p><strong>Setting: </strong>The study was carried out in the Pain Department of the First Hospital Affiliated to Jiaxing College in Jiaxing, China.</p><p><strong>Methods: </strong>A total of 305 patients were included in the study, with 149 classified into the PHN group and 156 into the non-PHN group. Demographic information such as gender, age, disease duration, hospitalization, affected site, number of segments involved, complications, and treatment details were gathered. Moreover, common hematological data, including patients' levels of albumin (ALB), total bilirubin (TBIL), uric acid (UA), homocysteine (Hcy), and C-reactive protein (CRP) upon admission were recorded. Factors influencing prognosis were analyzed through both univariate and multivariate logistic regression analyses. Furthermore, a receiver operating characteristic (ROC) curve was constructed to evaluate the predictive potential of ALB and TBIL for prognosis.</p><p><strong>Results: </strong>In the univariate analysis, age (odds ratio [OR] = 2.386, P = 0.000), disease duration (OR = 2.182, P = 0.001) and levels of albumin (OR = 0.284, P = 0.000), and TBIL (OR= 0.224, P = 0.000) were found to be correlated with PHN. Multifactorial logistic regression analysis revealed that an age exceeding 60 years (OR = 1.979, P = 0.012), ALB levels >= 44 g/L (OR = 0.278, P = 0.000), and TBIL levels >= 9.2 mu-mol/L (OR = 0.302, P = 0.000) were independent factors associated with PHN. The ROC curve demonstrated high predictive values for PHN with ALB and TBIL.</p><p><strong>Conclusions: </strong>This study highlights the significant association between serum antioxidants, specifically ALB and TBIL, and the prognosis of PHN in patients with HZ.</p><p><strong>Limitations: </strong>The nonrandomized, single-center, and retrospective design are major limitations of this study.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"431-438"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131582","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":"Nonlinear Association Between Serum Lutein and Zeaxanthin Levels and Low Back Pain in US Adults: Results from the National Health and Nutrition Examination Survey.","authors":"Shuai Qing, Shiming Huang, Jiang Feng Wang, Min Xiao, Qishan Yi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Oxidative stress plays a critical role in the pathogenesis of low back pain. Higher serum levels of lutein and zeaxanthin are associated with reduced susceptibility to this disease due to their potent antioxidant properties.</p><p><strong>Objectives: </strong>Our study aimed to assess the correlation between serum lutein and zeaxanthin levels and low back pain.</p><p><strong>Study design: </strong>This is a cross-sectional study based on publicly available data from the National Health and Nutrition Examination Survey.</p><p><strong>Setting: </strong>The National Health and Nutrition Examination Survey employs a complex, multistage probability sampling design in order to select a nationally representative sample.</p><p><strong>Methods: </strong>In our study, information was gathered from individuals who were 20 years old or older who took part in the National Health and Nutrition Examination Survey from 2001 through 2004. Detailed information was collected on low back pain, serum lutein and zeaxanthin levels, and various other crucial factors. Multivariable logistic regression and restricted cubic spline regression analyses were performed in order to investigate the relationship between serum lutein and zeaxanthin levels and the occurrence of low back pain.</p><p><strong>Results: </strong>In our study 7,026 participants were included, of whom 38.21% (2,685 of 7,026) had low back pain. There was a nonlinear relationship (P < 0.001) between serum lutein and zeaxanthin levels and low back pain, depicted as a U-shaped curve in the restricted cubic spline. The occurrence rate for individuals with serum lutein and zeaxanthin levels below 25.3 nmol/dL was 0.975 (95% CI, 0.960-0.990; P < 0.001). In comparison, the occurrence rate for individuals with serum lutein and zeaxanthin levels exceeding 25.3 nmol/dL was 1.006 (95% CI, 1.000-1.013; P = 0.043).</p><p><strong>Limitations: </strong>This is a cross-sectional study; therefore causality cannot be established.</p><p><strong>Conclusion: </strong>A nonlinear association between serum lutein and zeaxanthin levels and the risk of low back pain was observed in US adults. The ideal serum lutein and zeaxanthin level that corresponds to the lowest risk of low back pain is approximately 25.3 nmol/dL.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"439-448"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131592","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":"The Past, Present, and Future of the Biopsychosocial Approach to Nonspecific Chronic Low Back Pain in Research and Clinical Practice Based on a Bibliometric Analysis.","authors":"Aybuke Fanuscu, Iris Meuwissen, Mira Meeus","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Recent studies show increasing evidence for the implication of a multimodal treatment approach for CLBP, including education, exercise therapy, and physical activity.</p><p><strong>Objective: </strong>This study aimed to analyze the trends in the biopsychosocial approach to CLBP through bibliometric analysis and to explore the main topics and provide recommendations for researchers and clinicians.</p><p><strong>Study design: </strong>In this bibliometric analysis, a 2-phase literature screening was performed to generate clusters and thus explore the main topics of the years 2012-2023.</p><p><strong>Methods: </strong>Literature was derived from Web of Science for the years 2012-2023. Two researchers independently conducted double-blind title and abstract screening in accordance with PRISMA guidelines. VOSViewer and CiteSpace software were used to analyze authors, countries, institutions, journals, keywords, and references. The clusters of co-cited references generated by the CiteSpace software were analyzed, and the largest clusters related to the biopsychosocial approach were narratively reviewed in detail.</p><p><strong>Results: </strong>A total of 2,070 studies were included in the analysis. The most influential country, institution, and author were the United States of America, the University of Sydney, and Leonardo Oliveira Pena Costa, respectively. BMC Musculoskeletal Disorders was the journal with the greatest number of publications. Exercise therapy, cognitive-functional therapy, pain neuroscience education, manual therapy, mobile applications, and psychologically informed physical therapy stood out in the reference analysis.</p><p><strong>Limitations: </strong>This study has several limitations, such as the restriction to studies indexed in the WOS database. Only English-language studies were included, and to maintain focus, we chose to discuss only those relevant to the biopsychosocial approach within the top 10 clusters.</p><p><strong>Conclusions: </strong>This bibliometric analysis highlighted the evolving trends and main contributors in this field. The study mapped the complex knowledge network in the field, highlighting various interventions as focal points of scientific interest, particularly exercise therapy, cognitive-functional therapy, pain neuroscience education, manual therapy, mobile application, and psychologically informed physical therapy. Standardization in research methodologies and more high-quality studies are needed to solidify the efficacy of these interventions and inform clinical practice more effectively.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"397-416"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131645","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":"Optimizing Pain Relief in Refractory Thoracic Outlet Syndrome: The Role of Ultrasound-Guided Injections.","authors":"Helen Gharaei, Negin Gholampoor","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Thoracic outlet syndrome (TOS) encompasses a range of symptoms originating from the compression of neurovascular structures, often leading to significant morbidity. Neurogenic thoracic outlet syndrome (N-TOS) frequently manifests as brachial plexus neuropathy, with a subset of patients experiencing refractory pain that does not respond to conservative treatments.</p><p><strong>Objectives: </strong>This review aims to consolidate current evidence to evaluate the efficacy of available ultrasound (US)-guided injection techniques, including muscle injections, hydrodissection, regenerative therapies, and nerve blocks, in managing refractory pain associated with N-TOS. Additionally, this study aims to provide clinical guidance for pain management in refractory TOS through current treatment strategies, offering structured guides that physicians can use as practical tools.</p><p><strong>Methods: </strong>A literature search was conducted across various academic databases to identify studies addressing US-guided interventions for refractory N-TOS. Relevant data regarding treatment efficacy, patient outcomes, and procedural details were extracted and synthesized narratively, as well as using structured tables and frameworks to aid in clinical decision-making.</p><p><strong>Results: </strong>US-guided injection techniques have demonstrated effectiveness in managing refractory pain that occurs after TOS surgery. Muscle injections, particularly botulinum toxin and local anesthetics, target muscle spasms, while hydrodissection alleviates nerve entrapment. Additionally, nerve blocks, such as epidurals and stellate ganglion blocks, provide targeted pain relief by addressing specific nerve pathways. However, although regenerative therapies, including dextrose prolotherapy and platelet-rich plasma (PRP), show great potential for tissue healing, they remain under research and available data on them are limited.</p><p><strong>Limitations: </strong>The effectiveness of these interventions may vary based on individual patient factors, practitioner experience, and the complexity of TOS presentations. Furthermore, while US-guided injections are well-established, the role of regenerative therapies requires further investigation due to a lack of standardized protocols and robust clinical trials, calling for future research.</p><p><strong>Conclusion: </strong>US-guided injection techniques represent a promising approach for managing refractory pain in N-TOS, offering tailored pain relief strategies. However, ongoing research is essential to clarify the efficacy of regenerative therapies and to optimize treatment protocols, ultimately enhancing patient outcomes and quality of life.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"E509-E523"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131595","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 Errata.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"449"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131608","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":"Escalating Growth of Spending on Medicare Advantage Plans: Save Medicare from Insolvency and Balance the Budget.","authors":"Laxmaiah Manchikanti, Mahendra Sanapati, Paul J Hubbell Iii, Ann Conn, Mayank Gupta, Ramarao Pasupuleti, Alaa Abd-Elsayed, Alan D Kaye","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The U.S. health care system faces escalating costs and inefficiencies, with Medicare projected to reach insolvency by 2036. Despite this, Medicare Advantage (MA) plans continue to receive preferential funding, resulting in overpayments, rising patient out-of-pocket expenses and limited accountability, instead of being a tool to achieve lower spending and increase quality. Physicians endure payment cuts, sequestration, and denied services, threatening access to care.</p><p><strong>Objective: </strong>To analyze MA plans' growth, costs, and policy implications and assess their impact on Medicare solvency, physician reimbursement, and patient care quality.</p><p><strong>Study design: </strong>A comprehensive policy and financial analysis using data from Medicare Payment Advisory Commission, Centers for Medicare and Medicaid Services, Congressional Budget Office, peer-reviewed literature, and federal reports from 1997-2025.</p><p><strong>Methods: </strong>We reviewed legislative history, financial trends, and quality metrics of Medicare and MA programs. Specific focus was placed on benchmarks, rebates, risk adjustments, favorable selection, coding intensity, and patient access barriers. Data on enrollment trends, geographic variation, and out-of-pocket costs were analyzed.</p><p><strong>Results: </strong>MA enrollment grew from 6.9 million (16% of Medicare beneficiaries) in 2014 to 33.6 million (54%) in 2024. Payments to MA plans exceed fee-for-service (FFS) Medicare by 22%, translating to $84 billion annually, plus $15 billion in quality bonuses. Out-of-pocket maximums surged 859% since 1999, and inappropriate care denials affect 13%-18% of cases. Risk adjustment and coding practices inflate payments, undermining program sustainability.</p><p><strong>Limitations: </strong>The present investigation relies on secondary data from government agencies and published literature; real-time administrative and clinical data from MA plans were unavailable due to reporting gaps.</p><p><strong>Conclusion: </strong>Originally intended to reduce costs, MA plans have driven higher expenditures, limited access, and increased patient burdens. Policy reforms-including alignment of MA payments with FFS Medicare, elimination of favorable selection and upcoding incentives, and enforcement of coverage requirements-are critical to preserving Medicare solvency and ensuring equitable patient care.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"359-376"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131652","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":"Physician Payment Reform in Interventional Pain Management: Balancing Cost, Quality, Access, and Survival of Independent Practices.","authors":"Laxmaiah Manchikanti, Mahendra Sanapati, Vidyasagar Pampati, Paul J Hubbell Iii, Ann Conn, Ramarao Pasupuleti, Mayank Gupta, Alan D Kaye, Alaa Abd-Elsayed, Annu Navani, Miles Day, Devi Nampiaparampil, Christopher G Gharibo, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;On July 14, 2025, the Centers for Medicare and Medicaid Services (CMS) released the 2026 Physician Proposed Payment Rule aimed at reducing wasteful spending, enhancing quality measures, improving chronic disease management, and protecting independent practices from systemic financial pressures that have favored large healthcare systems and plagued independent practices. The goals are admirable, but the proposed measures with uniform reductions of 2.5% in physician payments based on efficiency adjustments apply across the board to all physicians. Further, practice expense (PE) reductions of 4% to 6%, meant to apply for hospital-based physicians will inadvertently apply to independent physicians constituting 43% of the physician workforce providing services in ambulatory surgery centers (ASCs), as well as hospitals. Thus, reductions of work relative value unit (wRVU) based on efficiency adjustment of 2.5% and PE reductions of 4% to 6%, with total reductions of 7% to 9%, compromise and limit patient care by putting additional pressure on independent physicians. Further, CMS' proposal to start Ambulatory Specialty Model (ASM) for low back pain with specialties of interventional pain management (IPM) and pain management involved. These specialties have no control over costs incurred as an overwhelming majority of patients are chronic pain patients and managed by family physicians, chiropractors, physical therapists, neurosurgeons, and others, resulting in 9% reductions, or increase in reimbursement over a period of 3 years with recurring changes of 3% each year.The proposal includes a 3.8% conversion factor (CF) payment update and increased reimbursement for office-based services, including evaluation, management, and procedures. The changes will increase reimbursement by 8% to 10% for office-based services, but they also decrease reimbursement for all procedures performed outside offices by 7% to 9%. These proposals arrive at a time when non-physician health care providers are striking for wage increase tied to inflation, and ironically, physicians have experienced repeated cuts in reimbursement with occasional stagnation, leading to 33% reduction from 2001 to 2025 in general, and 41% reductions in reimbursement for interventional pain physicians. In addition, there is an additional 2% sequester cut each year from 2011 to last until 2031, and there is a potential for 4% PAYGO cuts starting next year. Further, supply costs have increased 56% to 80% during these years. Further, despite technological advancements such as EMRs and AI, administrative burdens have intensified rather than improved. Independent physicians contend with complex prior authorizations, evolving Medicare coverage policies, growing audit risk with increased documentation and compliance demands from all payers' sources, 30% of interventional pain physicians under audit at any time. Our data on interventional pain physicians and published data on other physicians shows that eff","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"377-396"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131642","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":"BMJ Publications on Interventional Techniques Do Not Meet Appropriateness Criteria of Conducting a Rapid Review: A Comprehensive Review.","authors":"Laxmaiah Manchikanti, Mahendra Sanapati, Amol Soin, Alan D Kaye, Alaa Abd-Elsayed, Christopher G Gharibo, Allen Dennis, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>A recent surge of publications on interventional techniques has questioned their effectiveness, based on a rapid review and network meta-analysis of randomized trials. This was followed by releasing a clinical practice guideline recommending a global ban on these techniques. Understandably, such recommendations have raised significant concern worldwide. Interventional techniques are widely used in chronic pain management, yet their effectiveness has been debated, with longstanding concerns about overuse, misuse, fraud, and abuse.</p><p><strong>Objectives: </strong>To provide a comprehensive review and critical analysis of the BMJ rapid reviews and associated guidelines, with particular attention to the application-or absence-of basic appropriateness criteria published in the same journal, and the improper incorporation of such evidence into guideline recommendations.</p><p><strong>Methods: </strong>A review of the available literature was conducted to assess the appropriate criteria for rapid reviews and guideline development.</p><p><strong>Results: </strong>The absence of established appropriateness criteria led to an inadequately conducted rapid review and poorly developed guidelines. These, in turn, resulted in sweeping, globally applicable recommendations that lack a sound evidentiary basis.</p><p><strong>Conclusion: </strong>A thorough examination of BMJ publications and related literature demonstrates that the BMJ's rapid reviews and subsequent guidelines on interventional techniques fail to meet recognized appropriateness criteria for conducting rapid reviews and developing consequential clinical guidelines based on such reviews.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"E467-E479"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131654","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 Comparative Analysis of Single versus Double Intravertebral Reduction Device Implantation for Single-Level Osteoporotic Vertebral Fractures: Radiological and Clinical Outcomes.","authors":"Yuan-Fu Liu, Hao-Jun Chuang, Yu-Chia Hsu, Fu-Yao Fan, Chao-Jui Chang, Cheng-Li Lin","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intravertebral reduction devices have been used for treating osteoporotic vertebral fractures (OVFs), with the advantage of fracture reduction before cement injection and the potential to prevent the secondary loss of vertebral height. While double devices via bipedicle insertion are commonly recommended, there is currently no report on the safety and efficacy of using a single device to treat OVFs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to compare the radiological and clinical outcomes of single intravertebral reduction device implantation to those of double intravertebral reduction device implantation in the treatment of single-level OVFs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was conducted at a tertiary medical center. Data were collected by reviewing the electronic medical records of a consecutive series of individuals from January 2015 to December 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with single-level OVFs between T8 and L4 who underwent single (n = 27) or double (n = 56) intravertebral device implantation were included in the study and analyzed. Outcome measures included radiographic assessments and the evaluation of clinical outcomes. Multiple linear regression analysis was used to examine the associations among the number of implants, body mass index (BMI), bone mineral density, and presence of radiographic vacuum clefts on vertebral height correction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both the single- and double-device groups demonstrated significant improvements in fracture reduction and functional outcomes. The single-device group had a shorter operating time (36.0 ± 2.82 min vs. 62.92 ± 16.49 min, P = 0.012) and lower cement volume usage (3.60 ± 0.00 mL vs. 5.04 ± 1.56 mL, P = 0.032).However, the double-device group showed greater improvement in anterior vertebral height (7.02 ± 3.34 mm, 95% CI: 6.13-7.91 vs. 5.24 ± 3.94 mm, 95% CI: 3.68-6.80, p = 0.034) and regional kyphotic angle correction (6.79 ± 6.50°, 95% CI: 4.83-8.75 vs. 2.79 ± 6.79°, 95% CI: 0.10-5.48, P = 0.011). Despite these radiological differences, long-term functional outcomes at the last follow-up were comparable between groups. There were no significant differences in complication rates between the 2 groups. Higher BMI and the presence of an intravertebral vacuum cleft appeared as potential risk factors for the re-collapse of vertebral body height.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study is retrospective and has inherent limitations related to sample size and variability. Some measurements showed a high degree of variability, which could have led to overlapping confidence intervals and a potential risk of Type II errors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Single intravertebral reduction device implantation is an effective and safe treatment option for OVFs, yielding clinical outcomes comparable to those of double device implantation. Additiona","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"E535-E546"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131633","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":"Effectiveness of Peripheral Nerve Stimulation in Managing Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Laxmaiah Manchikanti, Massab Bashir Khaira, Amol Soin, Alan D Kaye, Nebojsa Nick Knezevic, Alaa Abd-Elsayed, Mahendra Sanapati, Vivekanand A Manocha, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve stimulation (PNS) has been used for over 50 years to treat chronic pain. Since 2015, the Food and Drug Administration (FDA) has approved percutaneously implanted PNS leads and neurostimulators, offering a minimally invasive, non-opioid alternative for managing persistent and refractory chronic pain.</p><p><strong>Objective: </strong>To evaluate the current evidence on PNS through a systematic review and meta-analysis.</p><p><strong>Study design: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) on PNS for chronic pain management, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.</p><p><strong>Methods: </strong>Quality was assessed using Cochrane review criteria for risk of bias and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials.A comprehensive literature search was conducted across multiple databases (1966-February 2025), supplemented by manual searches of bibliographies from relevant review articles. Included studies underwent quality assessment, best evidence synthesis, and grading using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Evidence levels were classified from Level I to Level V.</p><p><strong>Outcome measures: </strong>The primary outcome was the proportion of patients achieving significant pain relief and functional improvement (>= 50%) sustained for at least 12 months.</p><p><strong>Results: </strong>The present investigation identified 7 high-quality and 2 moderate-quality RCTs based on Cochrane criteria and 9 moderate-quality trials based on IPM-QRB criteria. Utilizing GRADE criteria, 7 of 9 studies demonstrated moderate evidence and clinical applicability, and 2 of 9 showed low evidence and applicability.Overall, the combined qualitative and quantitative analysis supported a fair (Level III) evidence level, with moderate certainty and moderate strength of recommendation for:Implantable PNS systems following a trial or selective lumbar medial branch stimulation without a trialTemporary PNS therapy for 60 days.</p><p><strong>Limitations: </strong>A key limitation remains the scarcity of high-quality studies.</p><p><strong>Conclusion: </strong>The evidence supports a fair (Level III) level of evidence with moderate certainty and recommendation strength, based on qualitative and quantitative analyses and GRADE assessment.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"E481-E507"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131589","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}