Pain physician最新文献

{"title":"Assessing the Efficacy of Dexmedetomidine in Postoperative Pain Management: A Trial Sequence Analysis Approach.","authors":"I-Wen Chen, Wei-Ting Wang, Kuo-Chuan Hung","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175926","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":"Chronic Low Back Pain and Sleep Disturbance in Adults in the US: The NHANES 2009-2010 Study.","authors":"Ye Tong, Xiao-Qing Zhang, Hao-Yuan Zhou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain (CLBP) is a significant health challenge with a high prevalence rate. Sleep disorders, which are prevalent among adults, have been linked with CLBP. However, the intricate relationship between sleep and pain adds complexity to our understanding of CLBP.</p><p><strong>Objectives: </strong>To investigate the association between CLBP and sleep disorders, with a focus on the potential role of sleep disorders as a risk factor for CLBP.</p><p><strong>Study design: </strong>Cross-sectional study based on publicly available data from the National Health and Nutrition Examination Survey (NHANES) for one cycle (2009-2010).</p><p><strong>Setting: </strong>The NHANES employs a complex, multistage probability sampling design to select a nationally representative sample.</p><p><strong>Methods: </strong>In this study, we included patients aged 20 to 69 years from the NHANES 2009-2010 cycle. After eliminating cases with missing data, a total of 863 patients remained. Baseline characteristics were analyzed by stratifying patients based on their CLBP status to assess initial inter-group disparities. Due to age imbalances between groups, we employed a 1:1 propensity score matching (PSM) method, reducing the sample to 508 patients. The association between CLBP and trouble sleeping was investigated following this calibration using a multivariate logistic regression analysis.</p><p><strong>Results: </strong>Upon categorizing the baseline characteristics of 863 patients based on CLBP, we identified that those within the CLBP group tended to be older and had a greater prevalence of health conditions, including cancer, hypertension, and cardiovascular disease (CVD). Notably, the prevalence of sleep disorders was higher in the CLBP group than in the non-CLBP group (P < 0.001). After implementing an age-based PSM for the 2 groups, 508 patients were selected from the initial 863 patients. After adjusting for various confounders using multivariate logistic regression, our analysis revealed a strong association between sleep disorders and an increased risk of CLBP.</p><p><strong>Limitations: </strong>This is a cross-sectional study, and therefore causality cannot be established.</p><p><strong>Conclusions: </strong>This study underscores the significant association between sleep disorders and an elevated risk of CLBP, highlighting the need for comprehensive management strategies that consider the role of sleep disorders in CLBP.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703067","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":"Three-Dimensional Lumbosacral Reconstruction by An Artificial Intelligence-Based Automated MR Image Segmentation for Selecting the Approach of Percutaneous Endoscopic Lumbar Discectomy.","authors":"Zhaoyin Zhu, Enqing Liu, Zhihai Su, Weijian Chen, Zheng Liu, Tao Chen, Hai Lu, Jin Zhou, Qingchu Li, Shumao Pang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Assessing the 3-dimensional (3D) relationship between critical anatomical structures and the surgical channel can help select percutaneous endoscopic lumbar discectomy (PELD) approaches, especially at the L5/S1 level. However, previous evaluation methods for PELD were mainly assessed using 2-dimensional (2D) medical images, making the understanding of the 3D relationship of lumbosacral structures difficult. Artificial intelligence based on automated magnetic resonance (MR) image segmentation has the benefit of 3D reconstruction of medical images.</p><p><strong>Objectives: </strong>We developed and validated an artificial intelligence-based MR image segmentation method for constructing a 3D model of lumbosacral structures for selecting the appropriate approach of percutaneous endoscopic lumbar discectomy at the L5/S1 level.</p><p><strong>Study design: </strong>Three-dimensional reconstruction study using artificial intelligence based on MR image segmentation.</p><p><strong>Setting: </strong>Spine and radiology center of a university hospital.</p><p><strong>Methods: </strong>Fifty MR data samples were used to develop an artificial intelligence algorithm for automatic segmentation. Manual segmentation and labeling of vertebrae bone (L5 and S1 vertebrae bone), disc, lumbosacral nerve, iliac bone, and skin at the L5/S1 level by 3 experts were used as ground truth. Five-fold cross-validation was performed, and quantitative segmentation metrics were used to evaluate the performance of artificial intelligence based on the MR image segmentation method. The comparison analysis of quantitative measurements between the artificial intelligence-derived 3D (AI-3D) models and the ground truth-derived 3D (GT-3D) models was used to validate the feasibility of 3D lumbosacral structures reconstruction and preoperative assessment of PELD approaches.</p><p><strong>Results: </strong>Artificial intelligence-based automated MR image segmentation achieved high mean Dice Scores of 0.921, 0.924, 0.885, 0.808, 0.886, and 0.816 for L5 vertebrae bone, S1 vertebrae bone, disc, lumbosacral nerves, iliac bone, and skin, respectively. There were no significant differences between AI-3D and GT-3D models in quantitative measurements. Comparative analysis of quantitative measures showed a high correlation and consistency.</p><p><strong>Limitations: </strong>Our method did not involve vessel segmentation in automated MR image segmentation. Our study's sample size was small, and the findings need to be validated in a prospective study with a large sample size.</p><p><strong>Conclusion: </strong>We developed an artificial intelligence-based automated MR image segmentation method, which effectively segmented lumbosacral structures (e.g., L5 vertebrae bone, S1 vertebrae bone, disc, lumbosacral nerve, iliac bone, and skin) simultaneously on MR images, and could be used to construct a 3D model of lumbosacral structures for choosing an appropriate approach of ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703023","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":"Electronic Cigarette (E-Cig) Use in the Chronic Pain Population.","authors":"John Maclean, Skylar Remick, Jin Woo Shim, Anil Chakravorty, Chong Kim","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Since electronic cigarettes (E-Cigs) were introduced to the United States (US) in 2007 its use has increased. Like other tobacco products, E-Cigs too pose health risks. Studies have shown a correlation between pain and tobacco use, with the association being bidirectional. However, there is limited data on the effect of E-Cig use on chronic pain, as well as its association with opioid use.</p><p><strong>Objectives: </strong>To evaluate the use of tobacco products, including E-Cigs in a chronic pain population.</p><p><strong>Study design: </strong>This study was designed as a cross sectional survey.</p><p><strong>Setting: </strong>This study was set in an urban academic teaching center.</p><p><strong>Methods: </strong>After IRB approval, surveys of established chronic pain patients were conducted over 4 months. The survey and results were anonymous, without the collection of any identifiable information. The adult patients who had been treated in the pain practice for over 3 months were included in this study. The survey collected the patients' age, gender, history of tobacco usage, cigarette smoking, E-Cig and opioid use.</p><p><strong>Results: </strong>A total of 312 patients were surveyed. 198 women (63.5%) and 114 men (36.5%). The average age was 58.2; ~59 years for men and ~58 years for women. Eighty-four patients (26.9%) were managing pain using chronic opioids; 46 women and 38 men. Nine women (4.5%) had tried E-Cigs in the past, but none (0%) were active users. Eighteen men (15.8%) had tried E-Cigs in the past with 9 (7.8%) being active users. Among the opioid managed patients, 6 (9.1%) had and were active users of E-Cigs and all 6 were men (20%).</p><p><strong>Limitations: </strong>The anonymous results collected through the survey may not be accurate as they cannot be validated. In addition to the small sample size, the entire study population is from an urban academic center which may not be generalizable to all chronic pain patients. Finally, the study does not evaluate the impact of tobacco or E-Cig use on pain level or functional status.</p><p><strong>Conclusion: </strong>In this study of chronic pain patients, cigarette smoking and E-Cig use was similar to the reported use in the general adult population in the US. The study showed a strong correlation between tobacco use, especially cigarettes and E-Cigs, and opioid use. As the use of E-Cigs becomes more mainstream, the association between E-Cig use, chronic pain, and opioid use should be monitored.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Selective Nerve Root Pulsed Radiofrequency Vs Paramedian Interlaminar Epidural Steroid Injection for the Treatment of Painful Cervical Radiculopathy.","authors":"Gokhan Yildiz, Gevher Rabia Genc Perdecioglu, Omer Taylan Akkaya, Ezgi Can, Damla Yuruk","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Although there are studies evaluating ultrasound-guided selective nerve root pulsed radiofrequency (ULSD-SNRPRF) and fluoroscopy-guided paramedian cervical interlaminar epidural steroid injection (FL-CIESI) for the treatment of chronic cervical radicular pain, no study has compared the efficacy of these 2 methods.</p><p><strong>Objectives: </strong>This study aimed to compare the efficacy of these 2 methods, their superiority to each other, and the incidence of adverse events.</p><p><strong>Study design: </strong>A prospective, randomized controlled trial.</p><p><strong>Setting: </strong>Outpatient department of a single-center pain clinic.</p><p><strong>Methods: </strong>Sixty patients who did not respond to conservative treatments for lower cervical radicular pain were randomly divided into 2 groups. One group underwent ULSD-SNRPRF (Group U), and the other underwent paramedian FL-CIESI (Group F). Patients were evaluated pretreatment, and 3 and 6 months posttreatment. The Numeric Rating Scale (NRS-11) was used to assess clinical improvement, The Neck Disability Index (NDI) to assess improvement in functional disability, and the Self-Leeds Assessment of Neuropathic Symptoms and Signs Pain Score (S-LANSS) to assess the treatment's effect on neuropathic pain. Clinically significant pain relief was defined as a 50% or more pain reduction in the NRS-11. The posttreatment reduction in medication consumption was assessed using the Medication Quantification Scale Version III (MQS III). We also evaluated whether there was a difference in treatment-related characteristics, such as procedure time and adverse events.</p><p><strong>Results: </strong>The procedure time was significantly longer in Group U. Blood aspiration was observed in 2 patients in Group U and vascular spread in one patient in Group F, with no significant difference. At 3 and 6 months posttreatment, NRS-11 and NDI scores showed a significant decrease compared to the pretreatment scores in both groups; there was no difference between the groups. Both treatments effectively improved neuropathic pain, with no significant difference between the S-LANSS scores. There was no difference in the reduction of medication consumption between the groups.</p><p><strong>Limitations: </strong>There was no sham or control group, and the follow-up period was limited to 6 months.</p><p><strong>Conclusions: </strong>Pain relief, functional improvement, and safety were similar between groups. ULSD-SNRPRF and paramedian FL-CIESI are 2 different effective techniques for chronic cervical radicular pain. The choice of method should depend on various factors, such as patient preference, operator experience, and availability of resources. An advantage of ULSD over fluoroscopy is that patients and physicians are not exposed to radiation.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703069","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":"Cytokine Expression in Cancer Survivors Suffering From Chronic Pain: A Systematic Review.","authors":"Amber De Groote, Thijs Vande Vyvere, Wiebren Tjalma, Wim Vanden Berghe, Samir Kumar-Singh, An De Groef, Mira Meeus","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic cancer-related pain remains underdiagnosed and undertreated, although it affects 40% of cancer survivors. Recent insights suggest that cytokine signaling between immune, neuro, and glial cells contributes to chronic pain.</p><p><strong>Objectives: </strong>This study systematically reviewed cytokine levels and their relation to chronic cancer-related pain and, additionally, investigated differences in cytokine levels between cancer survivors with and without chronic pain.</p><p><strong>Study design: </strong>Systematic review.</p><p><strong>Methods: </strong>This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). The study conducted a systematic literature search in the databases PubMed, Web of Science, and Embase for articles examining cytokine levels and pain experience at a time point of a minimum of 3 months post-cancer diagnosis. Pain experience was categorized into a total pain score, pain intensity, and pain interference. The risk of bias was assessed using the Newcastle Ottawa Scale.</p><p><strong>Results: </strong>Eight articles were included, investigating 6 cancer types and 30 cytokines. Moderate evidence was found for pro-inflammatory cytokine IL-6 to be correlated with pain intensity, of which higher levels are observed in cancer survivors experiencing chronic pain compared to pain-free survivors. Moderate evidence was found for TNF-alpha to be not correlated with any pain experience, which is similar for anti-inflammatory cytokines IL-8 and IL-10 with pain intensity. For the remaining 26 cytokines and pain outcomes, only limited evidence was found for an association or alteration.</p><p><strong>Limitations: </strong>The number of included studies was small. Overall, studies showed a moderate risk of bias, except one indicated a high risk of bias.</p><p><strong>Conclusion: </strong>More standardized post-cancer treatment studies are warranted to confirm these results and explore associations and alterations of other cytokines. Nonetheless, moderate evidence suggests that elevated levels of IL-6, in contrast with TNF-alpha levels, are correlated with pain intensity in cancer survivors experiencing chronic pain compared to pain-free survivors.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703070","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":"Stellate Ganglion Destruction With Alcohol Versus Thermal Ablation for Chronic Post-Mastectomy Pain: A Randomized Trial.","authors":"Taher Saed Thabet, Suzan Adlan Khedr","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Post-mastectomy pain syndrome (PMPS) is a persistent post-surgical neuropathic pain. Stellate ganglion (SG) block is used for diagnosis, prognosis, and treatment of pain syndrome.</p><p><strong>Objectives: </strong>We aimed to evaluate the efficacy of SG destruction with alcohol versus thermal ablation for PMPS management.</p><p><strong>Study design: </strong>Randomized, double-blind clinical trial.</p><p><strong>Setting: </strong>National Cancer Institute, Cairo University, Egypt.</p><p><strong>Methods: </strong>Female patients aged 20-65 years who underwent breast cancer surgery and suffered moderate to severe pain for more than 6 months were categorized equally into 2 groups. SG destruction was with ultrasound (US) guidance and C7 level confirmation by fluoroscopy either by alcohol injection in Group A or thermal ablation with a time of 60 seconds at 80ºC repeated twice in Group B. Follow-up was at 1, 4, 8, and 12 weeks.</p><p><strong>Results: </strong>Visual analog scale (VAS) measurements after 1, 4, 8, and 12 weeks were significantly lower than pre-procedure measurements in both groups (P value < 0.001). There was a significant reduction in VAS score after 4 and 8 weeks in Group A than in Group B (P value = 0.003 and 0.018). Oxycodone and pregabalin consumption after 4 and 8 weeks were significantly lower in Group A than in Group B. Physical health, mental health, and satisfaction scores were comparable. There were no significant complications in both groups.</p><p><strong>Limitations: </strong>The relatively small sample size and short follow-up period are limitations to our study.</p><p><strong>Conclusion: </strong>US-guided SG destruction with alcohol was more effective than thermal radiofrequency for managing acute postoperative pain by decreasing pain score, oxycodone, and pregabalin consumption, which were consumed before the block.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703074","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":"Use of Bilateral Rectus Sheath Blocks in Open Umbilical Hernia Repair.","authors":"Yuanyuan Wang, Mingying Li, Zhenyuan Wang, Wei Liu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the rectus sheath block (RSB) has become increasingly prevalent in laparoscopic surgery. However, there is currently no definitive research on its use in the open repair of umbilical hernias with cirrhotic ascites.</p><p><strong>Objective: </strong>In this study, we assessed the safety and clinical efficacy of ultrasound-guided (US-guided) bilateral RSBs in open umbilical hernia repair for patients diagnosed with cirrhotic ascites.</p><p><strong>Study design: </strong>Seventy-two patients diagnosed with umbilical hernias that presented with cirrhotic ascites and who were admitted to our hospital were randomly divided into 2 groups. These categories were labeled the RSB group (Group R) and the local infiltration group (Group L); we used US-guided RSBs in Group R and local infiltration in Group L.</p><p><strong>Setting: </strong>The clinical outcomes of the patients in each group were compared to one another. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded at various time points in both groups.</p><p><strong>Methods: </strong>Measurements of the patients' outcomes were taken before anesthesia (T0), at the beginning of surgery (T1), at the time of the separation of the hernia sac (T2), at the end of surgery (T3), 6 hours postoperatively (T4), and 24 hours postoperatively (T5). On the Visual Analog Scale (VAS), pain scores at rest (T1-T3) and during activity (T4-T5) were recorded, as were the incidence of perioperative remedial analgesia and adverse effects.</p><p><strong>Results: </strong>Compared to T0, both groups' HR was significantly higher at T1-T3 (P < 0.05). The SBP and DBP were also significantly higher (P < 0.05). At T1-T3, the HR of Group R was significantly slower than that of Group L (P < 0.05), and at T4-T5, the VAS score for activity in Group R was significantly lower than that of Group L (P < 0.05). Group R had a significantly lower incidence of intraoperative remedial analgesia and postoperative nausea and vomiting than did Group L (P < 0.05). Neither group required postoperative remedial analgesia, and no patient experienced adverse reactions during the perioperative period.</p><p><strong>Limitations: </strong>This study has limitations in its sample size, lack of blood ammonia levels, and absence of data on patient satisfaction, necessitating future studies to address these issues.</p><p><strong>Conclusion: </strong>US-guided RSBs are an efficient method of anesthesia for open umbilical hernia repair in patients diagnosed with cirrhosis. This technique not only provides precise anesthesia and appropriate analgesia but also results in a low incidence of postoperative nausea and vomiting.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703024","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 Facet Joint Nerve Blocks in Managing Chronic Axial Spinal Pain of Facet Joint Origin: A Systematic Review and Meta-Analysis.","authors":"Laxmaiah Manchikanti, Emilija Knezevic, Nebojsa Nick Knezevic, Mahendra R Sanapati, Alan D Kaye, Salahadin Abdi, Amol Soin, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic axial spinal pain is one of the major causes of disability. Literature shows that spending on low back and neck pain and musculoskeletal disorders continues to escalate, not only with disability, but also with increasing costs, accounting for the highest amount of various disease categories. Based on the current literature utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been shown as potential sources of spinal pain. Therapeutic facet joint interventional modalities of axial spinal pain include radiofrequency neurotomy, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections.</p><p><strong>Objective: </strong>The objective of this systematic review and meta-analysis is to evaluate the effectiveness of facet joint nerve blocks as a therapeutic modality in managing chronic axial spinal pain of facet joint origin.</p><p><strong>Study design: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.</p><p><strong>Methods: </strong>The available literature on facet joint nerve blocks in axial spinal pain was reviewed. The quality assessment criteria utilized were the Cochrane review criteria to assess risk of bias, the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials, and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for nonrandomized studies. The evidence was graded according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment criteria. The level of evidence was based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. A comprehensive literature search of multiple databases from 1966 to July 2023, including manual searches of the bibliography of known review articles was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into qualitative and quantitative evidence synthesis.</p><p><strong>Outcome measures: </strong>The primary outcome measure was the proportion of patients with significant relief and functional improvement of greater than 50% of at least 3 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months).</p><p><strong>Results: </strong>This assessment identified 8 high-quality and one moderate quality RCTs and 8 high quality and 4 moderate quality non-randomized studies with application of spinal facet joint nerve blocks as therapeutic modalities. However, based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment, only 3 of the 21 studies showed high l","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Radiation Doses of Contralateral Oblique and Lateral View for Fluoroscopy-Guided Lumbar Interlaminar Epidural Steroid Injection.","authors":"Yucel Olgun, Rekib Sacaklidir, Serdar Kokar, Savas Sencan, Osman Hakan Gunduz","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite newly developing technologies and techniques, the use of fluoroscopic guidance in spinal interventional treatments remains popular. Therefore, it is essential to set reference standards and techniques for reducing radiation exposure in fluoroscopy-guided procedures.</p><p><strong>Objective: </strong>The aim of this study was is to compare the radiation doses and procedure time of the contralateral oblique (CLO) view to  lateral view imaging during fluoroscopy-guided spinal procedures.</p><p><strong>Study design: </strong>A retrospective study.</p><p><strong>Setting: </strong>Pain management unit of a tertiary care center.</p><p><strong>Methods: </strong>An evaluation of patients who received epidural steroid injections between May 2021 and May 2023 in a university hospital interventional pain management center was performed. This observational study was conducted with 248 patients aged 18 and older who underwent lumbar interlaminar epidural injections (ILESI) confirmed by CLO or lateral oblique imaging. The primary outcomes were the comparison of radiation dose and procedure time between the 2 groups. The secondary outcome was the comparison of complication rates.</p><p><strong>Results: </strong>There were no significant differences between the two groups in terms of age, gender, diagnosis, body mass index, procedure level, Numeric Rating Scale, and procedure time. Although the radiation dose was lower in the CLO group, there was no significant difference between the 2 groups. However, there was a significant difference between the 2 groups in terms of complications (P < 0.001).</p><p><strong>Limitations: </strong>The study was designed in a single center and performing all the procedures with the same fluoroscopy device makes it difficult to generalize our results.</p><p><strong>Conclusions: </strong>Although there was no difference in terms of radiation dose and duration of procedure between lumbar ILESI conducting using the CLO or lateral view fluoroscopy imaging, there was a significant difference in terms of complications. Therefore, conducting lumbar ILESI using a CLO view minimizes the complication rate.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703068","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}