Pain physician最新文献

{"title":"Minimally Invasive Office-Based Protocol Yields Preliminary Improvements in Pelvic Pain and Function.","authors":"Allyson Shirkhande, Emory Ship, Theodora Berry, Jasmine Roass, Kimberlee Leishear, Sandra Sandhu-Restaino, Monica Zirolli, Myesha Banks, Laura Kemp, Lauren Capurata, Amanda Kinder, Jennifer Ezavin, Ximena Rossato-Bennett, Michael Dieciuc, Nairi Brown","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic pelvic pain (CPP) is difficult to treat, with many patients who have the condition continuing to live in pain despite numerous interventions. Patients frequently report opioid use, visits to emergency departments and urgent care clinics, and pain associated with working and functional everyday activities such as walking, sleeping, and sitting, reflecting a reduced quality of life overall. Patients with CPP have been known to spend over 15 years in pain prior to finding a suitable treatment option, often spending thousands of dollars on care. This situation presents a need for additional CPP treatment options that provide enduring relief across the multiple dimensions impacted by the condition.</p><p><strong>Objectives: </strong>To evaluate a minimally invasive, nonsurgical, office-based protocol involving a series of 6 ultrasound-guided pelvic peripheral nerve blocks and trigger point injections. This procedure is well tolerated, with patients able to resume normal activity following each appointment.</p><p><strong>Study design: </strong>A retrospective cohort study was conducted in 2660 male and female patients with CPP.</p><p><strong>Setting: </strong>Patients completed the full treatment protocol at Pelvic Rehabilitation Medicine centers across the United States.</p><p><strong>Methods: </strong>Patients who reported data during a new patient visit and a visit approximately 3 months after the initiation of the protocol were included in the analysis. Patients with missing or incomplete data on overall pain, emergency department and urgent care visits, opioid use, functional ability, and work productivity were excluded from analysis. Impact was assessed across these domains.</p><p><strong>Results: </strong>Patients reported a 48.6% reduction in pain at the 3-month follow-up visit (P < 0.001). Fifty-five percent of the patients achieved at least 50% improvement in pain. Functional scores improved by 32.6%, with significant improvement observed across all functional gains analyzed (P < 0.001). Notably, patients exhibited a 43.1% reduction in pain associated with sleeping (P < 0.001). Emergency department and urgent care visits decreased by 89.4%, and opioid use decreased by 45.4% (P < 0.001). At 3 months, reports of 0 workdays missed due to pain increased by 36.9%, and reports of 0 hours of impaired productivity increased by 93.4% (P < 0.001).</p><p><strong>Limitations: </strong>Due to the retrospective nature of analysis, this study lacks a control group. However, prior research conducted by the organization demonstrated that the protocol led to greater improvement in all domains tested in this analysis, as opposed to a control group.</p><p><strong>Conclusions: </strong>This series of nerve block and injection procedures is associated with significant improvements in pain, emergency department and urgent care visits, opioid use, functional activities, and work productivity in patients with CPP. Notably, more","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E705-E715"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075749","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 Effectiveness of Nucleoplasty and Intradiscal Ozone Therapy for Lumbar Disc Herniation: A Double-Blind, Randomized, Controlled Trial.","authors":"Mustafa Kilic, Mustafa Sahin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation (LDH) is responsible for more than 60% of chronic low back and leg pain. Although some patients respond to conservative treatment, a considerable proportion require surgical or minimally invasive interventions. The demand for minimally invasive procedures has increased; these procedures have high success rates in appropriately selected patients.</p><p><strong>Objective: </strong>To compare the clinical outcomes of intradiscal ozone therapy and percutaneous lumbar nucleoplasty in patients with LDH.</p><p><strong>Study design: </strong>Prospective, double-blind, randomized controlled trial.</p><p><strong>Setting: </strong>A tertiary care center.</p><p><strong>Methods: </strong>Ninety patients with low back pain due to lumbar disc herniation were assigned to intradiscal ozone therapy (Group I) or percutaneous lumbar nucleoplasty (Group II). Pain was assessed using the Visual Analog Scale (VAS), disability using the Oswestry Disability Index (ODI), and quality of life using the Short Form-36 (SF-36) at baseline, and at postprocedure months one and 12. All procedures were performed under sterile conditions with C-arm fluoroscopy.</p><p><strong>Results: </strong>Significant postprocedure improvements in pain, disability, and quality of life were observed in both groups. Both groups had statistically significant decreases in VAS and ODI scores at the postprocedure one-month and 12-month follow-ups (P < 0.001). However, when the postprocedure one-month scores were compared, it was evident that Group II had lower VAS and ODI scores than Group I; this difference is statistically significant (P < 0.001). This difference was maintained at 12 months and became more pronounced, with a greater improvement favoring Group II, particularly in the VAS scores (P < 0.001). While both methods are effective in the short term, nucleoplasty yields better long-term results than intradiscal ozone therapy (12 months). This finding supports the idea that nucleoplasty may have a longer-lasting effect on pain control and functional improvement.</p><p><strong>Limitations: </strong>The main limitations of our study are the limited number of patients and the short follow-up time.</p><p><strong>Conclusion: </strong>Our study compared the efficacy of percutaneous lumbar nucleoplasty and intradiscal ozone therapy. Both procedures were efficacious in reducing patients' pain and improving their quality of life. However, percutaneous lumbar nucleoplasty had superior long-term outcomes compared to intradiscal ozone therapy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E655-E662"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075584","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 Effectiveness of Intra-Articular Nanofat and Platelet-Rich Plasma Injections in Pain Relief and Functional Improvement for Unilateral Knee Osteoarthritis: A Retrospective Cohort Study.","authors":"Anuj Jain, Gaurav Chaturvedi, Sonali Ahuja, Supriya Agrawal, Suruchi Jain, Kanika Suhag","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (OA) is a leading cause of chronic pain and disability. Regenerative therapies such as intra-articular injections of platelet-rich plasma (PRP) and nanofat (and adipose-derived stromal vascular fraction) have emerged as promising treatment options, but comparative evidence on their effectiveness remains limited.</p><p><strong>Objective: </strong>To compare the efficacy of intra-articular PRP injections to that of nanofat injections for pain relief and functional improvement in patients with predominantly unilateral knee OA over a 6-month follow-up.</p><p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Methods: </strong>In this retrospective cohort study, data from 149 patients treated between July 2023 and August 2025 at a tertiary pain clinic in India were analyzed. Ninety-two patients received intra-articular PRP injections, and 57 received intra-articular nanofat injections. The patients' pain was assessed on the Numeric Pain Rating Scale (NPRS) and their functioning with the 6-minute walk test (6MWT) via the Accupedo mobile app. Group differences were adjusted for baseline pain and varus deformity using a repeated measures ANCOVA. Logistic regression identified predictors of ≥ 50% pain relief.</p><p><strong>Results: </strong>Both treatments reduced pain over 6 months, but the 6MWD scores showed that nanofat was associated with greater and more sustained pain relief (P < 0.01) and functional improvement than was PRP (P = 0.006). The odds of achieving ≥ 50% pain relief were higher in the nanofat group (adjusted OR 2.05, 95% CI 0.92 to 4.58, P = 0.078), though this finding did not reach statistical significance. Varus deformity ≥ 5° lowered the odds of significant pain relief (adjusted OR 0.44, 95% CI 0.19 to 1.02, P = 0.056).</p><p><strong>Limitations: </strong>The retrospective design, lack of randomization, attrition in the PRP group, use of baseline observation carried forward (BOCF), and relatively short follow-up period limit causal inference and long-term generalizability.</p><p><strong>Conclusions: </strong>Nanofat injections provide greater, longer-lasting pain relief and functional benefits for unilateral knee OA than PRP injections do, although larger randomized studies are needed to confirm these findings. Baseline varus deformity may influence treatment outcomes.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"513-519"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075651","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":"Ambulatory Surgery Centers and Medicare Payment Policy for Calendar Year 2027: Impact on Interventional Pain Management.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Vidyasagar Pampati, Ramarao Pasupuleti, Alexander Bautista, Amol Soin, Annu Navani, Alan D Kaye, Rajesh Naidu Janapala, Mayank Gupta, Alaa A Abd-Elsayed, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ambulatory surgery centers (ASCs) have become a common site of service for interventional pain management (IPM) procedures over the past three decades, driven by lower costs, physician ownership incentives, and a permissive regulatory environment. Medicare payment policy for ASCs has evolved through repeated rulemaking cycles since the original 1982 ASC payment system, with each cycle reshaping which procedures may be performed in the ASC setting and their relative payment. On July 2, 2026, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System proposed rule (CMS-1850-P), representing the latest development in this continuum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To review the historical evolution of ASC payment policy relevant to interventional pain management and provide a detailed analysis of the CY 2027 OPPS/ASC proposed rule, its projected impact on IPM procedure reimbursement, and its implications for the survival of independent interventional pain practices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A narrative policy review was conducted using the CY 2027 OPPS/ASC proposed rule (CMS-1850-P; Federal Register, July 2026), CMS fact sheets and impact tables, and prior peer-reviewed analyses of ASC payment policy published in Pain Physician.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 2.4% ASC payment update, reflecting a 3.2% market basket update less a 0.8-percentage-point productivity adjustment, is offset for some services by changes in relative payment weights, resulting in substantial variation in payment changes across individual procedures. CMS also proposes continuing, for an additional year, the use of the more favorable hospital market basket rather than the consumer price index as the ASC update factor. Device-intensive, neuromodulation-related codes central to interventional pain practice, including SCS generator insertion (+14.8%), peripheral nerve stimulator electrode implantation (+9.8%), and sacral neuromodulation (+8.0%), receive substantial proposed increases; however, these increases are muted by unfavorable changes incorporating multiple procedure discounts, ultimately resulting in payment reductions when multiple procedures are performed. Minimally invasive sacroiliac joint fusion (+7.1%) and basivertebral nerve ablation (+6.5%) also receive substantial proposed increases. In contrast, core injection-based procedures, including interlaminar and transforaminal epidural steroid injections, facet joint injections, and facet joint radiofrequency ablation, are proposed to decrease by 3.8% to 4.3%. Prior authorization requirements continue to apply to selected procedures in hospital outpatient departments but not in ASCs, and CMS proposes expanding prior authorization requirements for HOPDs to additional botulinum toxin codes, effective July 2027.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This analysis is based on a","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E469-E480"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075460","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":"Comment on \"Cervical Erector Spinae Plane Block vs. Epidural Steroid Injection for Cervical Radicular Pain: A Clinical Trial\".","authors":"Gonca Yazici Sacaklidir, Rekib Sacaklidir","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E751"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075602","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 Effects of Normal Saline, Hypertonic Saline, and Hyaluronidase on Patients with Postoperative Relapse of Carpal Tunnel Syndrome: A Randomized Controlled Trial.","authors":"Mostafa Shahrezaee, Amirsaleh Abdollahi, Yazdan Yahaghi, Ali Abbaskhani Davanloo, Hossein Meskar, Mohsen Chamanara","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recurrent carpal tunnel syndrome affects up to 25% of patients following surgical decompression, causing significant therapeutic challenges. Hydrodissection, a minimally invasive technique that alleviates perineural adhesions, has shown promise for symptom relief. However, optimal injectable agents for hydrodissection in postoperative relapse of carpal tunnel syndrome remain under investigation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our study aimed to compare the clinical efficacy of 3 injectable treatments-normal saline, hypertonic saline, and hyaluronidase-in ultrasound-guided hydrodissection for patients with postoperative relapse of carpal tunnel syndrome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A randomized controlled trial with a 12-month follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Our study was conducted at Imam Hospital Center in Sari, Islamic Republic of Iran.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ninety patients aged 18-60 years, experiencing carpal tunnel syndrome relapse within 6 months postsurgery, were randomly assigned to 3 equal groups (n = 30) to receive ultrasound-guided hydrodissection with either hyaluronidase (300 IU) combined with methylprednisolone, bupivacaine, and normal saline; hypertonic saline (5%) with methylprednisolone and bupivacaine; or normal saline with methylprednisolone and bupivacaine. Patients were followed at postinjection months 3, 6, and 12. Assessed outcomes included the Visual Analog Scale (VAS) for pain, Symptom Severity Scale, patient satisfaction, and the number of required reinjections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 3 groups had statistically significant improvements in pain and function (P &lt; 0.05). However, the hyaluronidase group had statistically significant greater reductions in VAS and Symptom Severity Scale scores at all follow-up points compared to the other 2 groups (P &lt; 0.01). Additionally, this group required fewer reinjections and reported the highest satisfaction rates throughout the study period. There were no statistically significant differences between the hypertonic and normal saline groups in terms of pain, function, satisfaction, or reinjection frequency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Including methylprednisolone in all injection treatments may have confounded the independent effects of the tested agents. The single-center design limits generalizability, and objective imaging or electrophysiological evaluations were not used. The follow-up period was limited to 12 months, leaving long-term outcomes unexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Ultrasound-guided hydrodissection using hyaluronidase statistically significantly improves pain, symptom severity, and patient satisfaction in cases of postoperative relapse of carpal tunnel syndrome and reduces the need for reinjections compared to hypertonic or normal saline. Hyaluronidase appears to be a superior adjunct in hydrodissection procedures and may offer a cost-effective and clinically advantageo","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"505-512"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075610","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":"Prolozone M Therapy's Analgesic Efficacy for Managing Moderate-to-Severe Knee Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"G Niraj, N Charan, M Prabhu, Paul Bassett","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis is one of the most common disabling joint diseases in India. Nonsurgical management remains the only option for patients who are unwilling to undergo or unable to afford total knee arthroplasty.</p><p><strong>Objective: </strong>Our study's primary objective was to compare the analgesic efficacy of intraarticular injection of either a combined hypertonic dextrose, ozone, and magnesium injectate with an injectate of corticosteroid only in patients with moderate-to-severe knee osteoarthritis. A third group received an intraarticular saline injection.</p><p><strong>Study design: </strong>Prospective, randomized, double-blind, placebo-controlled study.</p><p><strong>Setting: </strong>Pain medicine clinic at Sri Madhusudan Sai Institute of Medical Sciences and Research, a tertiary care medical college in the Republic of India.</p><p><strong>Methods: </strong>Patients were randomly assigned to one of 3 groups (combined hypertonic dextrose, ozone, and magnesium; corticosteroid; or saline). Patients and the clinicians performing the injections were blinded to the treatment allocation. All study patients had moderate-to-severe primary osteoarthritis of the knee (a Kellgren Lawrence Grading Scale score of 3 or 4). They received a total of 3 intraarticular treatments-one every 3 weeks. Patients and follow-up assessors were both blinded. Follow-ups were conducted at 3, 6, 12, and 24 weeks post the first injection. The primary outcome criterion was the change from baseline to 24 weeks post the first injection in the Western Ontario and McMaster Universities Osteoarthritis Index A (pain) subscore.</p><p><strong>Results: </strong>A total of 180 patients with a Kellgren Lawrence Grading Scale score of 3 or 4 were randomly assigned. Baseline characteristics were similar. When compared to corticosteroids, patients in the Prolotherapy M Group had statistically significant greater improvements in their Western Ontario and McMaster Universities Osteoarthritis Index A (pain) subscore at 24 weeks post the first injection (mean, -2.3 [98.3% CI, -3.8 to -0.8], P < 0.001, d 0.88). Radiological images showed improvement at 24 weeks in the Prolotherapy M Group when compared to baseline.</p><p><strong>Limitation: </strong>This was a single-center study with a limited follow-up period.</p><p><strong>Conclusion: </strong>Our placebo-controlled study showed that 3 injections of combined hypertonic dextrose, ozone, and magnesium is safe and efficacious in providing statistically significant, clinically relevant analgesia at 24 weeks post the first injection, with a significant difference vs corticosteroid only injections. There were early signs of chondroprotection with Prolozone M therapy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E635-E644"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075692","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 Response to Comment on \"Comparison of Local Anesthetic Concentration in Pericapsular Nerve Group (PENG) Block for Total Hip Arthroplasty Under Spinal Anesthesia: A Randomized Controlled Trial\".","authors":"Ilke Akay Akgul, Nur Canbolat, Mehmet I Buget, Demet Altun, Cengiz Sen, Kemalettin Koltka","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E747-E748"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075724","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":"Evolution and Emerging Trends in Liposomal Bupivacaine Research: A Comprehensive Bibliometric Study (1993-2024).","authors":"Xinhong Wan, Jiangang Hu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Liposomal bupivacaine has become a significant advancement in postsurgical pain management.</p><p><strong>Objectives: </strong>Our study aimed to describe liposomal bupivacaine's current research landscape and its evolution from 1993 through 2024.</p><p><strong>Study design: </strong>Bibliometric analysis.</p><p><strong>Methods: </strong>Publications related to liposomal bupivacaine were sourced from the Web of Science Core Collection. The analysis employed VOSviewer, CiteSpace, and R4.3.3 to examine publication trends, collaborations, and emerging research themes.</p><p><strong>Results: </strong>A total of 580 publications were identified, showing an annual growth rate of 13.59%. The United States led the field with 457 publications and 8,880 citations, followed by the People's Republic of China and the State of Israel. The Mayo Clinic, Harvard University, and the University of Texas System were the top institutions. The Journal of Arthroplasty published the most articles-33-and garnered the highest citations-957. Key authors such as Daniel S. Kohane and Michael A. Mont were prominent. A cluster analysis highlighted 5 major research hotspots: pain management and recovery; regional anesthesia techniques; surgical innovation and drug delivery; pharmacological safety; and clinical/regulatory issues. Notably, citation bursts around terms like \"placebo controlled trial,\" \"total knee arthroplasty,\" and \"enhanced recovery after surgery\" indicate shifting research priorities toward optimizing perioperative protocols.</p><p><strong>Limitations: </strong>Our analysis was limited to publications indexed in the Web of Science Core Collection, potentially excluding relevant studies from other databases or non-English publications; this limitation may have introduced language and database biases.</p><p><strong>Conclusion: </strong>Our bibliometric study highlights 5 major hotspots in liposomal bupivacaine research and reveals a temporal shift from basic pharmaceutical development to clinical integration within enhanced recovery protocols. These findings underscore the need for future investigations focusing on comparative effectiveness, cost-benefit evaluation, and protocol standardization across surgical specialties.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E691-E703"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075569","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":"Peripheral Nerve Stimulation for Intractable Chronic Pain: Real-World Clinical Outcomes, Utilization, and Economic Impact (PNS IMPACT Study).","authors":"Robert Moghim, Hemant Kalia, Dennis Scotti, David Gregory, Keith Needham, Niek E Vanquathem","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain imposes a substantial clinical and economic burden, as many patients undergo repeated procedures and high-risk opioids without durable relief, driving persistent health care costs and resource utilization.</p><p><strong>Objectives: </strong>To evaluate whether established clinical outcomes can be replicated in real-world practice and to assess health care utilization and payer costs in a large cohort of patients treated with peripheral nerve stimulation (PNS).</p><p><strong>Study design: </strong>Hybrid single-center retrospective study (n = 175) combined with national claims analysis (n = 953). A site coordinator collected data independently of the treating physician.</p><p><strong>Setting: </strong>Single US center supplemented by national claims data.</p><p><strong>Methods: </strong>One hundred and seventy-five adults with chronic neuropathic pain underwent a PNS trial. Those achieving ³ 50% pain relief were eligible for permanent implantation. Pain intensity was assessed with the Numeric Rating Scale (NRS-11) at baseline and up to 36 months post implant. Health care utilization and payer costs were derived from CPT-coded encounters one year pre- to two years post-implant, supported by national claims data, with appropriate statistical testing applied.</p><p><strong>Results: </strong>Of 175 patients, 163 (93%) achieved ≥ 50% pain relief during the trial, and 132 received permanent implants. Mean NRS-11 scores decreased from 7.2 ± 1.7 at baseline to approximately 1.7 ± 1.6 through 12 months, 1.4 ± 1.3 at 24 months, and 2.2 ± 1.8 at 36 months (all P < 0.001). No serious adverse events were reported. Pain center office visits decreased from 19.4 to 8.9 (54.1%) during months 0-12 (n = 103) and from 21.4 to 8.8 (58.9%) during months 13-24 (n = 50), with corresponding reductions in office-visit and pain management intervention costs (Wilcoxon z ≈ 2.8-7.6; all P < 0.001). National claims analyses showed similar facility-use trends. Cost reductions totaled $10,271 over 2 years, with projected 3-year savings of $17,110-$18,586. Of 103 patients with 12-month data, 91% reported high pain scores at baseline despite use of opioids. Ninety percent subsequently discontinued, reduced, or maintained stable medication use.</p><p><strong>Limitations: </strong>This analysis may be limited by coding variability, and differences between the EMR and claims datasets. Year-3 economic outcomes were projected from year-2 trends, though comparable patient characteristics support the relevance of the findings.</p><p><strong>Conclusions: </strong>Permanent receiver-based PNS was associated with sustained pain reduction, no serious adverse events, and reduced health care utilization and costs in patients with chronic, intractable neuropathic pain of peripheral nerve origin. These findings support its clinical utility and potential economic value.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"429-443"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075658","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}