Pain physician最新文献

{"title":"Spinal Cord Stimulation for the Treatment of Phantom Limb Pain: A Narrative Review.","authors":"Rayan Fawaz, Laura Boutevillain, Audrey Thomas, Muriel Curtet, Anne-Marie Giner, Marion Lapenderie, Sarah Sulpis, Emmanuelle Chaleat-Valayer, Manon Duraffourg","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The annual number of amputations is estimated to be between 200 and 500 million worldwide. The different etiologies of these amputations can be sorted into the following categories: traumatic, vascular, infectious, and tumoral. Since the twentieth century, progress has been made in stump management, surgical techniques to treat amputation, and rehabilitation, with improvements made in the prostheses designed for amputees. Among amputees, 10-79% will suffer from stump pain and phantom limb pain (PLP). Several studies have highlighted the various neuromodulation techniques available for the management of PLP, including spinal cord stimulation (SCS).</p><p><strong>Objectives: </strong>To provide a review of the literature about the impact of SCS on PLP.</p><p><strong>Study design: </strong>A narrative review about the use of SCS as a PLP treatment, conducted in accordance with relevant elements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.</p><p><strong>Setting: </strong>An academic medical center.</p><p><strong>Methods: </strong>In the review, we included case reports and case series about patients with PLP. The literature search identified 206 articles. After the removal of duplicates, 13 articles were excluded, as were 17 articles published before January 1980. One hundred sixty articles were reviewed by 2 authors. Of those articles, 9 met our criteria and were therefore included within the review.</p><p><strong>Results: </strong>The patients' median age at the time that surgery was indicated was 56.6 ± 14.4 years. Three patients presented with an upper-limb amputation, and 24 presented with a lower-limb amputation. Of 27 patients who suffered from amputation-related pain and were treated with SCS, the total reduction in pain, found by combining all the scores, had a mean (SD) value of 60.1% (27.6). Among all the studies reviewed, one included the performance of a functional evaluation before and after surgery, using an improvement of the functional scale.</p><p><strong>Limitations: </strong>The review contained no prospective controlled trials, and only a small number of articles could be included in the analysis.</p><p><strong>Conclusions: </strong>Based on our review of the literature concerning the effectiveness of SCS as a PLP treatment, the procedure seems to be a favorable option. Stimulation also appears to have a role to play in somatosensory feedback.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"483-491"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075302","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 Escalating Growth of Spending on Medicare Advantage Plans: A 2026 Update on Controlling Costs, Preserving Medicare Solvency, and Balancing the Federal Budget.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Vidyasagar Pampati, Allen Dennis, Kenneth D Candido, Alan D Kaye, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In September/October 2025, Manchikanti et al. published an analysis showing that Medicare Advantage (MA) spending growth was outpacing traditional fee-for-service (FFS) Medicare, driven by favorable selection, risk-adjustment coding intensity, and quality bonus payments, and warned that this trajectory threatened both Medicare's Hospital Insurance (HI) trust fund solvency and physician payment stability. Frantz et al. also published a leadership perspective describing promises and challenges of Medicare Advantage. In the year since, MA now covers more than half of all Medicare beneficiaries, Centers for Medicare & Medicaid Services (CMS) has undertaken the largest Risk Adjustment Data Validation (RADV) audit expansion in program history, a federal court has struck down CMS's ability to extrapolate audit findings across whole contracts, and a separate court has found CMS exceeded its statutory authority in administering the Quality Bonus Program (QBP). Despite these changes, MA plans continue to be rewarded by both parties, with corresponding, rather devastating cuts to physician payments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To update 2025 analysis with developments through mid-2026, quantify the current scale of MA overpayment using the most recent Medicare Payment Advisory Commission (MedPAC) and Medicare Trustees data, summarize the regulatory and legal actions taken to control MA spending since publication of the original article, examine quality of care, access, out-of-pocket costs, and prior authorization/non-coverage practices including specific implications for interventional pain management and provide updated, actionable recommendations to control MA cost growth, preserve Medicare solvency, and contribute to balancing the federal budget.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Narrative update drawing on the 2025 and 2026 Medicare Trustees Reports, MedPAC's March 2025 and subsequent 2026 status reports, CMS rate announcements and audit policy releases, and contemporaneous legal and policy analyses from the Committee for a Responsible Federal Budget (CRFB), Kaiser Family Foundation (KFF), the Center on Budget and Policy Priorities, and Health Affairs Forefront, current through August 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;MA now enrolls over half of Medicare beneficiaries and is projected to cost $615 billion in 2026, approximately 14% ($76 billion) more than equivalent FFS spending, with MedPAC's coding-intensity estimate revised to 10.3% above FFS following full phase-in of the 2024 CMS-Hierarchal Condition Category (HCC) (V28) risk-adjustment model. The QBP will pay plans $13.4 billion in 2026 despite MedPAC's finding that star ratings do not reliably reflect care quality, a conclusion reinforced by a May 2026 federal court ruling that CMS exceeded its statutory authority in setting 20 star-rating measures. CMS's May 2025 expansion of RADV audits to all approximately 550 eligible MA contracts was substantially unde","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E481-E492"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075359","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 Effect of Unilateral Subcostal Transversus Abdominis Plane Block Applied as Single or Multiple Injections on Pain in Laparoscopic Cholecystectomy.","authors":"Ozden Medure Gul Nihan, Girgin Dinc Ebru","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Effective postoperative pain management in cases of laparoscopic cholecystectomy is essential for recovery and patient satisfaction. The subcostal transversus abdominis plane (TAP) block is a regional analgesic technique used for upper-abdominal pain. While the single-injection TAP has shown benefits in reducing perioperative opioid consumption, the comparative efficacy of the multi-injection version of this block remains insufficiently studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to compare the analgesic efficacy of unilateral single-injection versus multi-injection subcostal TAP blocks in patients undergoing laparoscopic cholecystectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A prospective, randomized, single-center, parallel-group clinical trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A tertiary referral center where patients underwent elective laparoscopic cholecystectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ninety adult patients (ASA I-III) scheduled for laparoscopic cholecystectomy were randomized into 3 groups: Group S received a single-injection unilateral subcostal TAP block, Group T received a multi-injection unilateral subcostal TAP block, and Group C received no block. Blocks were performed under ultrasound guidance with standardized anesthetic management. The primary endpoint was 24-hour tramadol consumption. Secondary endpoints included postoperative pain scores on the Visual Analog Scale (VAS), intraoperative remifentanil use, postoperative nausea and vomiting (PONV), rescue analgesic requirement, and patient satisfaction. Pain and adverse effects were assessed at 30 minutes and at one, 3, 6, and 24 hours after the procedure. Statistical comparisons were made using analysis of variance (ANOVA), Bonferroni correction, and logistic regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eighty-nine patients completed the trial. Both TAP groups demonstrated significantly reduced intraoperative remifentanil consumption compared with controls. At 24 hours, tramadol use was lowest in the multi-injection group, which also showed significantly lower VAS scores at one, 6, and 24 hours than did the single-injection and control groups (P &lt; 0.05). Rescue analgesic requirements were markedly reduced in the multi-injection group, in which PONV incidence was also lowest (92% without PONV vs. 64% in the single-injection group and 52% in the control group; P = 0.007). Patient satisfaction was significantly higher in the multi-injection group, with a greater proportion reporting \"very satisfied\" (P &lt; 0.001). No major complications were reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The study's single-center design limited external generalizability. Dermatomal mapping of block spread was not performed, and long-term outcomes beyond 24 hours were not evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both single- and multi-injection subcostal TAP blocks provided effective perioperative analgesia in laparoscopic cholecystectomy. The m","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E615-E626"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075405","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":"Comparative Outcomes of Posterior and Lateral Sacroiliac Joint Fusions from a Single Academic Pain Center.","authors":"Christopher J Mallard, Michael E Harned, Jay S Grider, Preston C Rippe, Aric Schadler","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sacroiliac (SI) joint dysfunction is a common source of chronic low back pain. Minimally invasive SI joint fusion techniques, including posterior interpositional and lateral transiliac approaches, have emerged as treatment options for patients who fail conservative management; however, comparative real-world outcome data, particularly from procedures performed by interventional pain physicians, are limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to evaluate short-term outcomes, complication rates, and revision rates of posterior interpositional vs lateral transiliac SI joint fusion performed by interventional pain physicians at a single academic medical center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Patients were treated at a pain management clinic within an academic medical center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review was performed of patients' records who underwent SI joint fusion from January 1, 2020 through May 23, 2025. Patients were identified using Current Procedural Terminology codes 27278 and 27279. Demographic data, procedural characteristics, perioperative outcomes, pain scores, and revision surgeries data were collected. Outcomes included preoperative and postoperative month one Visual Analog Scale scores, percentage of pain relief, estimated blood loss, complications, and need for revision surgery. Comparative analyses between posterior and lateral approaches were performed using appropriate statistical tests with statistical significance set at P &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eighty patients were included; 33 had posterior interpositional fusion and 47 had lateral transiliac fusion. There were no statistically significant differences in baseline demographics between groups. Both approaches resulted in clinically meaningful short-term pain improvement, with mean Visual Analog Scale scores improving from a preoperative score of 6.6 cm to 3.4 cm at postoperative month one. The posterior interpositional group demonstrated a statistically significant higher revision rate due to loss of efficacy compared with the lateral transiliac group (18.2% vs 0%, P = 0.003). Estimated blood loss and complication rates were low for both approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our study is limited by its retrospective design, small sample size, and variable follow-up duration. Standardized pain scores and percentage pain relief beyond the one-month postoperative visit were not consistently documented and therefore could not be reliably analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Both posterior interpositional and lateral transiliac SI joint fusion performed by interventional pain physicians provided meaningful short-term pain relief in appropriately selected patients. A higher revision rate was observed in the posterior interpositional group, suggesting potential differences in procedural durability. Prospective, adequatel","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"521-527"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075623","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":"Asipp","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"529"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075631","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":"An Updated Systematic Review and Meta-Analysis of Fluoroscopic Caudal, Interlaminar, and Transforaminal Epidural Injections in Lumbar Disc Herniation.","authors":"Laxmaiah Manchikanti, Emilija Knezevic, Nebojsa Nick Knezevic, Rajesh Naidu Janapala, Mahendra R Sanapati, Alexander Bautista, Vidyasagar Pampati, Alan D Kaye, Amol Soin, Alaa A Abd-Elsayed, Mittal Prajapati, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Epidural injections are among the most frequently used interventions for management of low back and lower extremity pain. These injections are administered through caudal, interlaminar, and transforaminal approaches. Despite widespread use, controversy persists regarding effectiveness, appropriateness, medical necessity, and clinical indications. Although numerous studies have evaluated efficacy, there has been limited advancement in high-quality randomized evidence. In addition, multiple systematic reviews have repeatedly analyzed the same clinical trials, resulting in an evidence base that remains limited, inconsistent, and, at times, contradictory.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To synthesize the latest clinical evidence evaluating the efficacy of the 3 epidural injection approaches: caudal, interlaminar, and transforaminal for the management of lumbar disc herniation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating transforaminal, interlaminar, and caudal epidural injections for management of chronic low back and lower extremity pain associated with lumbar disc herniation and radiculitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Randomized controlled trials with either placebo-controlled or active-controlled designs, performed under fluoroscopic guidance and including a minimum follow-up of 6 months, were identified and reviewed. Methodological quality was assessed using the Cochrane risk of-bias criteria and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Levels of evidence were determined using best-evidence synthesis with modified qualitative grading ranging from Level I to Level V. A comprehensive literature search was conducted across multiple databases to identify publications from 2020 through March 2026. Additional studies were identified through manual searches of the bibliographies of relevant review articles, systematic reviews, and clinical guidelines. Eligible trials underwent quality assessment and were incorporated into both qualitative and quantitative evidence synthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome measure was proportion of patients achieving significant pain relief and functional improvement, defined as at least a 50% improvement sustained for at least 3 months. Duration of benefit was categorized as short-term relief (&lt; 6 months) or long-term relief (&gt; 6 months).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 21 trials met the inclusion criteria. Among these, 7 evaluated caudal epidural injections, 12 evaluated transforaminal epidural injections, and 10 evaluated lumbar interlaminar epidural injections. Qualitative and quantitative analyses included c","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E553-E590"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075626","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 CY 2027 Medicare Physician Fee Schedule and the Continuing Struggle to Balance Cost, Quality, Access, and the Survival of Interventional Pain Management.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Vidyasagar Pampati, John T Ruxer, Ramarao Pasupuleti, Amol Soin, Alan D Kaye, Annu Navani, Miles Day, Devi Nampiaparampil, Deborah H Tracy, Alexander Bautista, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;On July 16, 2026, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (PFS) Proposed Rule (CMS-1848-P). The rule arrives one year after the CY 2026 final rule institutionalized two structural changes of unusual consequence for procedural specialties: a recurring efficiency adjustment that reduces work relative value units (RVUs) for non-time-based services, and a redesign of the indirect practice expense (PE) methodology that shifts payment away from facility-based procedural care toward office-based evaluation and management (E/M). CY 2027 also marks the first performance year of the mandatory Ambulatory Specialty Model (ASM), which places interventional pain management (IPM) physicians at direct financial risk for the longitudinal management of low back pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To analyze the CY 2027 PFS Proposed Rule and its implications for the cost, quality, access, and financial sustainability of independent interventional pain practices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We reviewed the CY 2027 Proposed Rule, the CY 2026 final rule, American Society of Interventional Pain Physicians (ASIPP's) 2026-2027 CPT-level payment comparison and independent-physician modifier proposal, Medicare Trustees and MedPAC reports, CBO and OIG analyses, and relevant peer-reviewed literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The CY 2027 qualifying-APM conversion factor (CF) is projected at $33.1693, a decrease of $0.42 (-1.19%) from CY 2026, and the non-qualifying CF at $32.8409 (-1.68%), driven largely by expiration of the temporary 2.5% statutory increase that applied only during CY 2026. Because the -2.5% efficiency adjustment and the PE redesign were embedded in the CY 2026 baseline, most IPM procedures face additional year-over-year reductions of approximately 2% to 6% in CY 2027, with selected codes-sacroiliac joint arthrodesis (-14.9%), trigeminal and occipital nerve blocks (-17% to -20%), and percutaneous neurostimulator implantation (-6% to -7.5%) declining substantially more. A representative independent practice is projected to lose roughly 2% of Medicare-allowed revenue year-over-year, compounding a cumulative inflation-adjusted decline of approximately 47% for IPM services from 2001 to 2026. Independent physicians remain disproportionately exposed because more than 40% practice in ASCs and hospitals, where the PE redesign concentrates its reductions and inappropriately applies to independent physicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The CY 2027 Proposed Rule perpetuates a structural mismatch between rising practice costs and declining procedural reimbursement, now amplified by a mandatory specialty model imposed on physicians who do not control upstream utilization. Without permanent, inflation-indexed CF updates, reconsideration of the efficiency adjustment and PE redesign, a distinct payment identifier for independent physicia","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"411-428"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075296","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":"Reduction of Serum Substance P and Beta Endorphin in Herpes Zoster After Erector Spinae Plane Block.","authors":"Jae Y Lee, Ji Hoon Park, Joon Beom Park, Ji Hee Hong","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Acute herpes zoster (AHZ) is caused by the reactivation of varicella-zoster virus. This reactivation results in peripheral nerve fiber damage and triggers an immune reaction, which leads to the production of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha). In the skin of patients affected with postherpetic neuralgia (PHN), high levels of calcitonin gene-related peptide (CGRP) have been found.</p><p><strong>Objectives: </strong>The primary goal of this study was to compare changes in serum inflammatory cytokines (IL-6, IL-8) and pain neurotransmitters (substance P, CGRP) with those of a control group, and before and after fascial plane blocks.</p><p><strong>Study design: </strong>A prospective, nonrandomized, and case-control study.</p><p><strong>Methods: </strong>The diagnosis of AHZ (< 2 months) and PHN (> 6 months) were determined based on the duration of each patient's pain since the onset of skin eruption. Healthy age- and gender-matched volunteers were included as the control group. For the sake of the enzyme-linked immunosorbent assay (ELISA), blood sampling was performed 2 or 3 times before and after the block. An ultrasound-guided erector spinae plane block (ESPB) was performed 2 or 3 times at an affected dermatome.</p><p><strong>Results: </strong>The levels of IL-6 and pain neurotransmitters (substance P, CGRP) in HZ patients did not show any significant differences from those in the control group. However, the serum substance P (median, 24.0; IQR, 7.2-49.5) and beta-endorphin levels following the ESPBs (median, 237.8; IQR, 177.4-414.5) were significantly lower than they were prior to the ESPBs (median, 30.6; IQR, 13.3-71.6; P = 0.009).</p><p><strong>Limitations: </strong>The AHZ patients in this study did not experience a very acute phase. Since the matter of whether or not the levels of serum inflammatory cytokines in AHZ patients can demonstrate a significant reduction or increase is uncertain, further study is required.</p><p><strong>Conclusions: </strong>Between the HZ patients and the control group, the levels of inflammatory cytokines (IL-6) and pain neurotransmitters (substance P, CGRP) did not show any significant differences. However, a significant reduction of substance P and beta-endorphin following the ESPBs was observed.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E725-E732"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075341","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":"Prediction of Therapeutic Outcome after Transforaminal Epidural Steroid Injection in Patients with Radiculopathy following Lumbar Spinal Stenosis Using Machine Learning.","authors":"Jeoung Kun Kim, Jung Hwan Park, Min Cheol Chang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Transforaminal epidural steroid injections are widely used to manage radicular pain caused by lumbar spinal stenosis; however, therapeutic outcomes vary among patients. Accurately predicting a transforaminal epidural steroid injection's response may help clinicians optimize treatment planning.</p><p><strong>Objectives: </strong>Our study aimed to develop and validate machine learning models, particularly a deep learning neural network, to predict therapeutic outcomes post transforaminal epidural steroid injections using both clinical and magnetic resonance imaging data.</p><p><strong>Study design: </strong>A study using machine learning analysis.</p><p><strong>Setting: </strong>The spine center of a university hospital.</p><p><strong>Methods: </strong>A retrospective dataset of 188 patients with lumbar spinal stenosis who underwent a single-level transforaminal epidural steroid injection was analyzed. Nine input variables were included: age, gender, injection side, injection level, pain duration, pretreatment Numeric Rating Scale pain score, predominant stenotic location, and the degrees of central and foraminal stenosis. A positive therapeutic outcome was defined as a ≥ 50% reduction in the Numeric Rating Scale score at one month postprocedure. Deep learning neural network, XGBoost, and CatBoost algorithms were used to develop the models. Model performance was evaluated using receiver operating characteristic analysis and standard classification metrics.</p><p><strong>Results: </strong>The deep learning neural network model, configured with 5 fully connected layers, had the best performance among the 3 models, achieving a validation accuracy of 0.868 and an area under the curve (AUC) of 0.882 (95% CI, 0.733-0.994). CatBoost had an intermediate performance with an accuracy of 0.789 and an AUC of 0.765 (95% CI, 0.593-0.906), whereas XGBoost had the lowest accuracy of 0.763 and an AUC of 0.662 (95% CI, 0.458-0.853). In addition, the deep learning neural network model achieved balanced precision and recall across both favorable and poor outcome classes, with a weighted F1 score of 0.869.</p><p><strong>Limitations: </strong>This was a single-center retrospective study with a small sample size.</p><p><strong>Conclusions: </strong>Deep learning demonstrated superior predictive performance compared with conventional machine learning algorithms in forecasting transforaminal epidural steroid injection outcomes among patients with lumbar spinal stenosis. Integrating clinical and magnetic resonance imaging-derived features through a deep learning neural network may facilitate individualized treatment decisions and enhance therapeutic planning for lumbosacral radiculopathy. Future multicenter studies with larger datasets are warranted for external validation and clinical implementation.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E663-E670"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075727","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":"Local Coverage Determinations for Peripheral Nerve Injections and Procedures for Chronic Pain: Policy Changes, Clinical Limitations, and Health-Equity Implications.","authors":"Amol Soin, Mahendra R Sanapati, Annu Navani, Laxmaiah Manchikanti","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Five Medicare Administrative Contractors (MACs)-CGS, Palmetto GBA, Wellpoint Federal (formerly National Government Services), Wisconsin Physicians Service, and Noridian-participated in a collaborative policy-development process addressing peripheral nerve injections and related procedures for chronic pain. Novitas Solutions and First Coast Service Options did not participate. The September 2025 draft policies would have limited coverage principally to radiofrequency neurolysis for trigeminal neuralgia and corticosteroid injections for carpal tunnel syndrome and Morton neuroma, with lifetime caps on the latter procedures. After public comment and further evidence review, four contractors published materially identical final LCDs, with a notice period from September 10 through October 24, 2026, and an effective date of October 25, 2026. The final policies restored limited, criteria-based coverage for sympathetic blocks in complex regional pain syndrome, genicular nerve blocks and ablation for selected patients with knee osteoarthritis, greater occipital nerve blocks for occipital neuralgia, and selected suprascapular nerve blocks. They also removed the lifetime caps on median-nerve and Morton-neuroma injections. Pudendal, intercostal, ganglion impar, ulnar, and unspecified other peripheral-nerve procedures remain noncovered when performed for chronic pain. This health-policy analysis compares the draft and final policies, distinguishes Noridian's participation in the collaborative process from publication of a final LCD, summarizes coding and documentation requirements, and examines the access and health-equity implications of geographically discordant Medicare coverage.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"403-409"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075744","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}