Pain physician最新文献

{"title":"A Prospective, Randomized, Controlled Clinical Trial of High-Frequency Electromagnetic Coupling Powered Permanent Peripheral Nerve Stimulator for the Treatment of Chronic Craniofacial Pain.","authors":"Salim M Hayek, Nameer Haider, Ashwin Viswanathan, Mehul Desai, Jeffrey Rosenberg, Niek E Vanquathem","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Craniofacial pain is one of the most common chronic pain conditions, affecting more than one-fifth of the US population. While various medications and conservative treatment modalities are available for this condition, many patients have refractory symptoms. These patients suffer from social impairment, reduced quality of life, and increased financial burdens.</p><p><strong>Objective: </strong>The objective of this study was to examine the clinical outcomes of patients receiving a permanent, high-frequency electromagnetic coupling (HF-EMC) powered peripheral nerve stimulator (PNS) system for the treatment of chronic craniofacial neuropathic pain.</p><p><strong>Study design: </strong>This study was a multicenter, randomized, controlled clinical trial conducted under an investigational device exemption (IDE).</p><p><strong>Setting: </strong>This study was conducted in 7 clinical sites in the US.</p><p><strong>Methods: </strong>All patients in this randomized controlled trial (RCT) were permanently implanted with the Freedom® Peripheral Nerve Stimulator (PNS) System (Curonix LLC). All patients completed an initial 7-day therapy assessment period following the permanent implantation. The patients who successfully completed the initial 7-day therapy assessment period (>= 50% pain relief) were randomly assigned to either a patient group that received continued stimulation (the \"active\" arm) or a patient group whose treatment was discontinued for 3 months after the initial positive 7-day therapy assessment period (the \"deactivated\" stimulation arm). After the 3-month follow-up visit, the deactivated patients were reactivated. The primary efficacy outcome included the proportion of patients who experienced significant pain relief (>= 50%) 3 months after the permanent implant procedure. The visual analog scale (VAS), Brief Pain Inventory Facial (BPIF) questionnaire, and Short-Form McGill Pain Questionnaire 2 (MPQ-SF-2) were used to measure changes in pain. Additional functional outcome measures included the Patient Global Impression of Change (PGIC) and the 36-Item Short-Form Survey (SF-36).</p><p><strong>Results: </strong>During the 7-day therapy assessment period, 56 out of 60 patients reported significant pain relief (>= 50%), representing a 93% responder rate. At 3 months, 69% of the active stimulation group experienced significant pain relief, while only 11% of the deactivated group reported significant pain relief. The mean VAS scores were reduced by 62% and 8.5% in the active and deactivated stimulation groups. When patients within the deactivated group were reactivated after 3 months, the reactivated patients reported similar reduction in pain scores to those reported by the active arm patients. Similar results were found for the functional outcome measures. After the reactivation, significant pain relief was maintained through the 12-month follow-up period. No SAEs were reported throughout the study for any of the ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"417-429"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131570","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":"Full Endoscopic Decompression Surgery for Far-Out Syndrome Via Pseudoarthrosis Formed by L5 Transverse Process and Sacral Ala: A Preliminary Outcome.","authors":"Hao Hu, Fu-Kuan Zhu, Lei Shi, Rui Deng, Xi-Zi Miao, Ya-Feng Wen, Zhen-Yong Ke, Xiao-Min Sheng, Lei Chu, Zhong-Liang Deng","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Far-out syndrome (FOS) refers to the compression of the L5 nerve root in the extraforaminal region by a pseudoarthrosis formed between the L5 transverse process and the sacral ala. If conservative treatment for this condition fails, surgical intervention should be considered.</p><p><strong>Objectives: </strong>This study aims to introduce a minimally invasive endoscopic technique for treating FOS via the pseudoarthrosis approach.</p><p><strong>Study design: </strong>A technical note and preliminary outcome.</p><p><strong>Methods: </strong>We retrospectively analyzed the medical history, physical examination, auxiliary examinations, and imaging data as well as the visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab scores of 5 FOS patients treated with minimally invasive endoscopic surgery at our hospital from April 2024 to July 2024. The implementation process of this surgical technique is illustrated through typical cases.</p><p><strong>Results: </strong>We performed decompression surgery via the L5 transverse process-sacral ala pseudoarthrosis approach using full endoscopy, which successfully relieved the clinical symptoms in the 5 patients. The patients' postoperative VAS scores were significantly lower than the preoperative scores (P = 0.041). Similarly, the postoperative ODI scores were markedly decreased (P = 0.043), and the last follow-up showed a 100% excellent rate (Macnab score). Imaging examination indicated a sufficiently expanded extraforaminal outlet, and the nerve roots were adequately decompressed.</p><p><strong>Limitations: </strong>The study involved a relatively small number of samples and a short follow-up period.</p><p><strong>Conclusions: </strong>The full endoscopic decompression surgery via the L5 transverse process-sacral ala pseudoarthrosis approach can address the extraforaminal compression in FOS. This procedure is a feasible endoscopic surgical option that serves as a valuable supplement to the minimally invasive treatment for FOS.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"E525-E533"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131579","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":"Minimally Invasive Sacroiliac Joint Fusion: Posterior Graft Implant vs. Lateral Arthrodesis with Compression Screw Hardware at a Pain Management Center.","authors":"Ramis Gheith, Mindy Wortmann, Michel Najjar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The sacroiliac joint (SIJ) is a frequently overlooked source of lower back pain (LBP), contributing to 15-30% of cases. Nonoperative treatments such as NSAIDs, physical therapy, and SIJ injections have limited effectiveness on LBP. When conservative measures fail, SIJ fusion is recommended, with minimally invasive techniques showing better outcomes than traditional open surgery. However, there is no clear agreement on the optimal approach for SIJ fusion.</p><p><strong>Objectives: </strong>This study aims to evaluate the outcomes of minimally invasive SIJ fusion performed by a single surgeon, comparing the lateral and posterior approaches to another in terms of pain relief, functional improvement, and procedure durability.</p><p><strong>Study design: </strong>A retrospective comparative study.</p><p><strong>Setting: </strong>A single pain management center at the Interventional Pain Institute, where patients underwent SIJ fusion between April 2020 and May 2024.</p><p><strong>Methods: </strong>A total of 115 patients who underwent minimally invasive SIJ fusion and met the inclusion criteria were included in the study. Patients were assessed before and after the procedure for pain using the Visual Analog Scale (VAS), functional outcomes using the Oswestry Disability Index (ODI), opioid consumption, sleep quality, and procedure durability. Statistical comparisons between the lateral and posterior approaches were performed using the chi-square (c²), Fisher's exact test, and t-test as appropriate, while durability was analyzed with the Kaplan-Meier curve and log-rank test.</p><p><strong>Results: </strong>The average follow-up duration was 11.3 ± 5.8 months. Lateral SIJ fusion demonstrated longer procedural durability compared to the posterior approach, with greater improvements in VAS pain scores (66.3% vs. 53.8%, P = 0.017), ODI functional outcomes (45.0% vs. 30.7%, P = 0.002), higher rates of sleep improvement (83.9% vs. 61.0%, P = 0.006), and lower recurrence rates (12.5% vs. 28.8%, P = 0.031). At the last follow-up, most patients (79.1%) maintained their improvements.</p><p><strong>Limitations: </strong>This study is limited by its retrospective design, its single-center setting, and the lack of randomization between the lateral and posterior approaches.</p><p><strong>Conclusion: </strong>Both the lateral and posterior approaches to minimally invasive SIJ fusion were beneficial. However, the lateral approach used in our study demonstrated superior outcomes in the areas of pain relief, functional improvement, and procedure durability. Further multicenter prospective studies with larger patient populations are recommended to confirm these findings.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"E555-E566"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131650","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":"HbA1c is Associated with Hyperglycemia After Local Dexamethasone Injection in Diabetes Mellitus Patients: A Cohort Study.","authors":"Kumiko Tanabe, Takuma Ishihara, Yoshimi Nakamura, Hiroki Iida","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Glucocorticoids (GCs) are often administered locally to inhibit the synthesis and release of pro-inflammatory cytokines, thereby alleviating local pain. While GCs are known to exacerbate hyperglycemia, we previously reported changes in glucose levels following a single-dose dexamethasone injection in patients who did not have diabetes mellitus (DM). In patients without DM, blood glucose levels increased on the first day but were generally not critical. However, the exact changes in blood glucose levels due to GCs and the risk factors for blood glucose elevation in DM patients remain unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To measure changes in glucose levels following a single-dose dexamethasone injection in patients with DM and identify the risk factors for hyperglycemia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Gifu University Hospital, Japan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Fifty DM patients undergoing elective pulsed radiofrequency of the lumbar or sacral nerve root or radiofrequency of the lumbar medial branch of the posterior primary ramus were analyzed. Each patient received 0.1 mg/kg of dexamethasone and was subjected to interstitial glucose monitoring using a continuous glucose monitoring system. Hyperglycemia was defined as a blood glucose level &gt;= 200 mg/dL. The area under the curve (AUC) for glucose levels &gt;= 200 mg/dL was calculated. Risk factors for hyperglycemia were analyzed using an ordinal regression model, with AUC as the objective variable and 4 factors (glycosylated hemoglobin [HbA1c], age, body mass index, and pre-procedure glucose levels) as explanatory variables. Nonlinear regression models were used to predict the blood glucose trends.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Blood glucose levels increased immediately after the dexamethasone injections. The median (interquartile range) maximum glucose level was 328 (250-386) mg/dL, with a median time to peak of 592 (400-700) min. Among the 4 factors, age and HbA1c level were significant predictors of hyperglycemia (P = 0.035 and 0.023, respectively). Patients treated with insulin were predicted to have significantly higher blood glucose levels than those treated for DM with non-insulin medications or no pharmacological medications (P &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Firstly, GCs are metabolized by cytochrome p450 3A4, and medications that affect this pathway may alter the clearance of GCs. Some of our patients were taking medications that influenced the cytochrome pathway. Secondly, preoperative insulin management details (dosing, timing, and types) were not fully documented. Thirdly, stress-induced hyperglycemia could not be ruled out. Finally, patients' meal timing and caloric intake were not recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients with DM experienced significant hyperglycemia even after a single dose of dexamethasone. Age and HbA1c levels were risk factors for hyperglycemia. ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 5","pages":"E547-E554"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131658","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 the Efficacy of Ultrasound-Guided Repeated Greater Occipital Nerve Blocks and Greater Occipital Nerve Pulsed Radiofrequency in Migraine Treatment.","authors":"Sukriye Dadali, Gulcin Babaoglu, Ulku Akarirmak, Erkan Yavus Akcaboy","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Greater occipital nerve (GON) blocks and pulsed radiofrequency (PRF) are commonly used in migraine management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study compares the clinical outcomes of migraine patients who underwent repeated GON blocks (GONBs) and pulsed radiofrequency of the greater occipital nerve (GONPRF), both of which were performed using a proximal technique with ultrasound (US)-guidance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Single-center, prospective, comparative, observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Tertiary referral center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who were diagnosed with migraines based on the criteria from the International Classification of Headache Disorders III, experienced migraine attacks at least once a week or 5 times per month, did not respond to preventive migraine medications, and had a positive response to diagnostic GONB treatment (2-4 mL of 0.25% bupivacaine) were included in the study.The first group (the GONBs group) consisted of patients who could visit the clinic regularly. In this group, a GONB was administered at the C2 level using a proximal technique under US-guidance once a week for 4 weeks. The second group (the GONPRF group) included patients who, for various reasons, had only a limited ability to attend weekly treatments. In this group, GONPRF was performed at the C2 level using a proximal technique under US-guidance.For both groups, the following outcomes were evaluated at the first, second, and third months after treatment: headache attack duration, monthly frequency of headache attacks, number of headache days, and average monthly headache visual analog scale (VAS) scores. All side effects and adverse events related to the treatments were recorded, as were those effects' and events' duration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 68 patients were included in the study, with 35 in the GONPRF group and 33 in the GONBs group. No significant differences were observed between the 2 groups in terms of baseline demographic and clinical characteristics. Over the study period, the duration of headache attacks showed much greater improvement in the GONPRF group than in the GONBs group. In the first month, headache duration decreased in both groups, but the difference between them was not significant. However, in the second month, the GONPRF group exhibited a significantly shorter median headache duration. As for attack frequency, no significant differences were noted at baseline. By the first month, the GONPRF group showed a significantly lower median attack frequency than did the GONBs group. This trend continued into the second and third months. The mean number of headache days also showed more significant reductions in the GONPRF group than in the GONBs group, and this difference remained significant at both the second and third months. VAS pain scores were comparable at baseline. By the second month, the GONPRF group had significant","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"337-346"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799806","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 Role of the Subcutaneous Fat Index in Predicting Transforaminal Epidural Steroid Injection Treatment Success: An Observational Prospective Study.","authors":"Ahmet Sac, Erhan Biyikli, Savas Sencan, Serdar Kokar, Osman Hakan Gunduz, Umit Suleyman Sehirli","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Obesity is thought to be one factor that contributes to low back pain (LBP). Classifying obesity according to body mass index (BMI) and its use in general health-related predictions is often considered inadequate. For this reason, a new parameter known as the subcutaneous fat index (SFI) has been defined to provide insight into spine health. SFI is the thickness of subcutaneous fat tissue (SFTT) at the L1-L2 level.</p><p><strong>Objectives: </strong>This study aimed to investigate the answer to the question \"Is this new index, which has been shown to be successful in predicting spinal degeneration and morphological changes, effective in predicting the success of transforaminal epidural steroid injection (TFESI) treatment?\"</p><p><strong>Study design: </strong>An observational prospective clinical study.</p><p><strong>Setting: </strong>A university hospital's interventional pain management center.</p><p><strong>Methods: </strong>Patients with spinal radicular pain due to intervertebral disc herniation, for whom TFESI was planned, were categorized into two groups according to SFI (was measured as the vertical distance from the tip of the spinous process of the L1 vertebra to the skin on axial T2-weighted lumbar spine magnetic resonance images cut-off values (9.4 mm in men and 8.45 mm in women) and were followed up for 3 months after the procedure. During patient follow-up, evaluations were performed with the Numeric Rating Scale, Oswetry Disability Index, and 12-Item Short-Form Health Survey. Additionally, intervertebral disc degeneration (IVDD) related to injection level and nerve compression grading were evaluated radiologically.</p><p><strong>Results: </strong>A total of 50 patients' IVDD as related to injection level was significantly higher in the SFI > 9.4/8.45 mm group. According to the 3rd month's follow-up results, significant treatment success was observed in all parameters in both groups. However, no significant difference was found in predicting treatment success between the SFI < 9.4/8.45 mm and SFI > 9.4/8.45 mm groups.</p><p><strong>Limitations: </strong>Our sample sizes were asymmetric, and a single radiologist performed the evaluation.</p><p><strong>Conclusion: </strong>The newly defined SFI parameter was not effective enough to provide a significant difference in nerve compression grading or in predicting treatment success.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E421-E430"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799879","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":"Diagnostic Guidance for Chronic Complex Regional Pain Syndrome Type I and Type II from The American Society of Interventional Physicians (ASIPP).","authors":"Christopher Gharibo, Miles Day, Steve M Aydin, Alan D Kaye, Salahadin Abdi, Sudhir Diwan, Lisa V Doan, Danielle Feng, Kris Ferguson, Kirolos Georges, Andrew Kaufman, Nebojsa Nick Knezevic, Sean Li, Franzes A Liongson, Devi Nampiaparampil, Annu Navani, Mahendra Sanapati, Michael E Schatman, Amol Soin, Peter S Staats, Giustino Varrassi, Jing Wang, Laxmaiah Manchikanti","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Complex Regional Pain Syndrome (CRPS) is a challenging and often disabling condition marked by persistent pain, most commonly in a limb following injury or surgery. It presents with a wide array of symptoms, including intense pain, swelling, alterations in skin color and temperature, motor dysfunction, and trophic changes such as skin and tissue atrophy. While the precise cause of CRPS is not fully understood, it is thought to stem from abnormal nervous system activity, leading to heightened pain sensitivity and inflammatory responses. A thorough understanding of CRPS is essential for accurate diagnosis, effective treatment, and enhancing patients' quality of life.Although attempts have been made to distinguish between acute and chronic CRPS, there are currently no established diagnostic criteria specific to chronic CRPS in medical literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This ASIPP guidance document offers updated, evidence-based recommendations for the diagnosis and management of Chronic Complex Regional Pain Syndrome (CRPS), with a primary focus on introducing novel, time-based diagnostic criteria specific to the chronic phase. These proposed criteria address significant gaps in the current literature, where existing standards, such as the Budapest Criteria, do not sufficiently differentiate between the acute and chronic stages of the condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An expert panel convened by the American Society of Interventional Pain Physicians (ASIPP) conducted a comprehensive literature review and employed a structured consensus process to develop recommendations. Acknowledging that the clinical and pathological characteristics of CRPS change significantly beyond 12 months, the panel proposed chronic-specific diagnostic criteria based on disease duration, clinical history, physical examination findings, and optional diagnostic tests. These draft criteria were refined through multidisciplinary input and expert consensus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The diagnostic framework for chronic CRPS consists of four key components:General Criteria - Require fulfillment of the Budapest Criteria for at least 12 months, continued recognition of CRPS as a diagnosis of exclusion, and differentiation from generalized nociplastic pain syndromes.History-Based Criteria - Mandate the presence of at least three out of five specific historical features.Physical Examination Criteria - Include asymmetric limb findings, sensory disturbances, and musculoskeletal changes.Optional Diagnostic Testing - May involve assessments such as intraepidermal nerve fiber density (IENFD) and imaging evidence of regional bone demineralization.This framework builds upon the Budapest Criteria by incorporating time-dependent features of chronic CRPS, including musculoskeletal dystrophy, neurogenic inflammation, and sympathetic dysfunction. Emerging objective tools-such as quantitative sensory testing (QST), skin biopsy for IENFD, fu","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E287-E327"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799807","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":"Ozone and Hyaluronic Acid, Alone and in Combination: Exploring Temporal Dynamics and Synergies in Intraarticular Therapy for Knee Osteoarthritis.","authors":"Eleonora Latini, Sveva Maria Nusca, Enrico Roberto Curci, Alessandra Lacopo, Valerio Di Stasi, Flavia Santoboni, Donatella Trischitta, Mario Vetrano, Maria Chiara Vulpiani","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Knee Osteoarthritis (KOA) is the most common chronic joint disease in old age. Treatment for KOA focuses on symptom relief and improvement of function. Intraarticular hyaluronic acid (HA) is a well-documented treatment for KOA; it provides pain relief and enhances joint function by increasing lubrication and synovial fluid viscosity. Recently, there has been a growing interest toward the medical effects of oxygen-ozone (O3) treatment, especially for musculoskeletal disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We investigated whether a combination of intraarticular O3 and HA could reduce pain and improve functional and clinical outcomes compared with the same treatments administered separately in patients with KOA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This is a retrospective, comparative, observational study approved by the institutional review board of the \"Sapienza\" University of Rome [RS 6599/2021].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Physical Medicine and Rehabilitation Unit of Sant'Andrea University Hospital, Rome, Italian Republic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 106 patients with KOA were examined. Of these, 84 patients met the eligibility criteria and were divided into one of 3 treatment groups: intraarticular O3 therapy (n = 28), intraarticular HA injections (n = 26), or a combination of both (n = 30). Outcome measures were assessed using the Numeric Rating Scale (NRS-11) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for functional disability, Knee Society Scores (KSS) for knee assessment, and the 12-item Short-Form Health Survey (SF-12) for quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Significant differences occured between groups at various evaluation points. At the end of treatment (T1), O3 alone and O3 combined with HA showed superior pain relief compared to HA alone; HA alone and O3 combined with HA demonstrated better stiffness alleviation compared to O3 alone. The combination therapy showed advantages in the WOMAC physical function score, total WOMAC score, KSS knee score, KSS functional score, 12-item Physical Component Summary (PCS-12) score and 12-item Mental Component Summary (MCS-12) score compared to O3 alone and HA alone treatments (P &lt; 0.05). At the one-month follow-up (T2), O3 combined with HA showed significant differences in NRS-11 and WOMAC physical function scores compared to O3 alone (P = 0.026 and P = 0.011, respectively). The KSS knee score, KSS functional score, PCS-12 score, and MCS-12 score all showed differences between the O3 combined with HA and both the O3 and HA alone groups (P &lt; 0.05). At the 3-month follow-up (T3), HA alone demonstrated superiority in the WOMAC pain and physical function scores over O3 alone (P &lt; 0.001 and P = 0.023, respectively). Compared to O3 alone, O3 combined with HA showed advantages in WOMAC stiffness, WOMAC physical function, and total WOMAC scores, as well as the KSS knee score, KSS functional score, PC","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"347-357"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799875","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":"Spinal Cord Stimulation for Chronic Neuropathic Pain: Research Progress in Molecular and Circuit Mechanisms.","authors":"Yi Kang, Yidan Tang, Jun Gao, Yong Qiu, Weishuang Kong, Tao Zhu, Guo Chen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) is an effective surgical intervention for treating chronic neuropathic pain conditions that are refractory to other management options, such as opioids, physical therapy, nerve blocks, or radiofrequency ablation. It is currently clinically approved as the main therapeutic procedure for persistent low back pain. As we understand these mechanisms better, SCS could have novel clinical applications. For this reason, an accurate understanding of research progress into the molecular and circuit mechanisms of SCS is indispensable for enhancing its effectiveness, safety, and future applications.</p><p><strong>Objectives: </strong>This review aims to systematically discuss the molecular mechanisms of spinal cord electrical stimulation, from its action sites and transmitter interactions to the supraspinal circuit, to reveal the biological basis behind these mechanisms further and provide a more solid theoretical foundation and scientific basis for the clinical application of SCS.</p><p><strong>Study design: </strong>Narrative review.</p><p><strong>Methods: </strong>Our research was conducted in PubMed, Ovid MEDLINE, and Embase. Boolean operators were used to combine MeSH (Medical Subject Headings) terms and keywords such as \"spinal cord stimulation,\" \"chronic neuropathic pain,\" \"electric stimulation therapy,\" \"analgesic mechanism,\" \"spinal cord dorsal horn,\" \"central sensitization,\" \"neural circuits,\" and \"neurotransmitter function\".</p><p><strong>Results: </strong>Numerous retrospective clinical studies and randomized controlled trials have yielded results supporting the remarkable efficacy and broad development prospects of SCS. However, the effectiveness and safety of SCS in certain diseases are still insufficiently studied, and the related molecular mechanisms are not well developed. We present a comprehensive, up-to-date overview and elaboration of the neurophysiological, biochemical, anti-inflammatory, and neurocirculatory mechanisms that have been associated with the use of spinal cord electrical stimulation for treating chronic pain.</p><p><strong>Limitations: </strong>There exists an inconsistency in SCS animal experimental models.</p><p><strong>Conclusions: </strong>Our findings from available studies include the molecular mechanisms involved in SCS on chronic pain, new paradigms for spinal cord electrical stimulation therapy, and explain their underlying biological processes, as well as the pros and cons of SCS in terms of its effectiveness in clinical use. With a better understanding of SCS's mechanisms, we may gain a more in-depth understanding of the current insights about the analgesic mechanisms of action underlying SCS for chronic neuropathic pain treatment.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E371-E384"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799878","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 Different Spinal Level Approaches in Splanchnic Sympathetic Neurolysis for Intractable Upper Abdominal Cancer Pain: A Retrospective Review.","authors":"Dhanalakshmi Koyyalagunta, Steven Mach, Matthew Chung","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Celiac plexus or splanchnic nerve neurolysis is a treatment modality commonly offered for cancer-related upper abdominal pain. The optimal spinal level for performing celiac/splanchnic sympathetic neurolysis remains unclear.</p><p><strong>Objective: </strong>We aimed to assess the outcome, effectiveness, and complications associated with undergoing splanchnic sympathetic neurolysis at various spinal levels for treating intractable upper abdominal cancer pain.</p><p><strong>Study design: </strong>This is an analysis of a retrospective cohort.</p><p><strong>Setting: </strong>Pain management clinic at a large quaternary comprehensive cancer center.</p><p><strong>Methods: </strong>A retrospective chart review of patients with unremitting cancer-related upper abdominal pain refractory to medical management was performed. Data were collected on pertinent demographic, clinical characteristics, cancer diagnosis and staging, location of abdominal pain, pain Numeric Rating Scale (NRS-11) scores, prior cancer treatments, level/laterality of splanchnic neurolysis, agents and volumes used for neurolysis, adverse events, pre- and postprocedure daily morphine milligram equivalents (MME), and symptom burden/quality-of-life outcomes.</p><p><strong>Results: </strong>A total of 254 patients treated with splanchnic sympathetic neurolysis for intractable upper abdominal cancer pain from July 2014 through June 2017 were included. Of the splanchnic sympathetic neurolysis procedures performed, most were done at T12 (44%) and L1 (54%)., The vast majority were bilateral (96%) using absolute alcohol (98%). There was no significant difference in MME requirements at postprocedure 6-months. Additionally, while NRS-11 scores improved at postprocedure one month and 6 months compared to baseline, there was no significant difference in NRS-11 scores based on the level at which the procedure was performed. A subgroup analysis of patients (n = 201 observations) with cancer pain related to intraabdominal viscera innervated by the splanchnic nerves (i.e., pancreatic, hepatobiliary, renal/adrenal, and gastrointestinal tract) also revealed that block level was not significantly associated with pain score. Time was a significant factor associated with NRS-11 score; patients had a significantly decreased pain score at postprocedure one month and 6 months. For patients with abdominal cancers of predominately splanchnic innervation, splanchnic sympathetic neurolysis also improved quality of life measures such as nausea, feeling of wellbeing, and mental clarity.</p><p><strong>Limitations: </strong>One-third of the patients in our study were lost to follow-up at 3 months, likely due to the patient population with end-stage cancer, the natural history of cancer disease progression, or death.</p><p><strong>Conclusion: </strong>The majority of splanchnic sympathetic neurolysis were performed at L1 and T12. Improved pain scores were comparable between block levels","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E403-E410"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799805","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}