Pain physician最新文献

{"title":"Erector Spinae Plane Block Provided Comparable Analgesia as Thoracic Paravertebral Block Post Pediatric Nuss Procedure for Pectus Excavatum: A Randomized Controlled Trial.","authors":"Min Xu, Guangchao Zhang, Rui Wang, Yong Liu, Bin Du, Jing Yang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Thoracic paravertebral block (TPVB) is frequently used to treat pain following a pediatric Nuss procedure but is associated with various undesirable risks. The erector spinae plane block (ESPB) also provides postoperative analgesia, which is purported to be easier to administer and has a favorable safety profile. However, it remains unknown whether ESPB provides analgesia comparable to the TPVB technique post  pediatric Nuss procedure.</p><p><strong>Objective: </strong>This study aimed to compare the analgesic effects of ultrasound-guided ESPB and TPVB in children undergoing the Nuss procedure.</p><p><strong>Study design: </strong>A prospective, randomized, noninferiority trial.</p><p><strong>Setting: </strong>A university hospital in the People's Republic of China.</p><p><strong>Methods: </strong>A total of 68 children aged 4 to 18 scheduled for the Nuss procedure were enrolled in the study. They were randomly assigned to receive a single-injection ultrasound-guided bilateral T5-level ESPB or TPVB with 0.5 mL/kg of 0.25% ropivacaine post anesthesia induction. All patients received postprocedure multimodal analgesia. The primary outcomes were pain scores at rest and 24 hours postprocedure. The secondary outcomes included total rescue morphine milligram equivalents, emergence agitation, chronic postprocedure pain, and side effects.</p><p><strong>Results: </strong>The median difference in pain scores at rest 24 hours postprocedure  was 0 (95% CI, 0 to 1), demonstrating the noninferiority of ESPB to TPVB. In addition, the difference in oral morphine milligram equivalents at 24 hours postprocedure was -4.9 (95% CI, -16.7 to 7.9) with the ESPB group consuming median (interquartile range) 37.7 mg (12-53.2) vs 36.9 mg (23.9-58.1) for the TPVB group. We concluded that the non-inferiority of ESPB with regard to opioid consumption as the 95% CI upper limit of 7.9, which was within the predefined margin of 10. We found no significant differences in pain scores at rest or during coughing, incidences of chronic postoperative pain, emergence agitation, or side effects.</p><p><strong>Limitations: </strong>We did not evaluate the effect of analgesic protocols on patient-centric outcomes, such as resuming functional status and emotional wellbeing. Also, the sample size is small to some extent.</p><p><strong>Conclusions: </strong>Preoperative ESPB, when combined with multimodal analgesia, was noninferior in analgesic effect compared with TPVB in terms of pain scores and opioid consumption in pediatric patients undergoing the Nuss procedure.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366109","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":"Prevalence, Risk Factors and Pain Subtypes of Post-COVID Pain in Nonhospitalized Older Adults: A Cross-Sectional Study.","authors":"Chenhui Wang, Mengwei Yan, Yuru Li, Hongqian Wang, Lei Han, Yang Liu, Fan Wu, Baoguo Wang","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Post-COVID pain (PCP) is a condition that ensues from an infection of coronavirus disease 2019 (COVID-19). Some researchers have explored the prevalence of PCP and its characteristics in the individuals who experience it. However, most individuals involved in the previous studies were middle-aged, and those studies focused mainly on hospital patients and musculoskeletal PCP. Existing data on PCP and its subtypes among older adults and outpatients are scanty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our study aims to identify PCP's prevalence and associated risk factors and to compare the quality of life (QoL), sleep quality, and anxiety and depression levels in nonhospitalized elderly COVID-19 survivors with different PCP subtypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was conducted from April 2023 to June 2023 after the first outbreak of the Omicron variant of SARS-CoV-2 in the Taikang Yanyuan Continuing Care Retirement Community (CCRC) in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Eligible participants were surveyed using the Numeric Rating Scale (NRS), Douleur Neuropathique-4 questionnaire (DN4), EuroQol 5D-5L questionnaire (EQ-5D-5L), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale. COVID-19 symptoms and laboratory parameters were obtained through an electronic healthcare system. Descriptive analysis was performed based on the presence of PCP and PCP subtypes. Multivariable logistic regression analysis and multiple linear regression were used for risk-factor analysis and adjustment of confounding factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 668 individuals (female: 59.3%, median age: 84 years) who had been infected with COVID-19 for a median duration of 145 (126-168) days were enrolled in our study. PCP was observed in 9.4% (63/668) of elderly COVID-19 survivors. Number of COVID-19 symptoms (aOR 1.31, 95%CI 1.05-1.64, P = 0.018) and previous chronic pain (aOR 4.24, 95%CI 1.59-11.27, P = 0.004) were risk factors associated with PCP. Individuals with neuropathic PCP exhibited higher NRS scores (5 [5-6] vs. 3 [3-4], P &lt; 0.001) and more use of analgesic drugs (70.0%, 7/10 vs. 20.8%, 11/53, P = 0.005) for pain management. Neuropathic PCP was associated with lower scores on the EQ-5D index (B = -0.210, 95% CI -0.369 to -0.051, P = 0.011) and EQ-VAS (B = -10.808, 95% CI -21.149 to -0.468, P = 0.041) and higher PHQ-9 scores (B = 3.154, 95% CI 0.674-5.634, P = 0.014).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;It is difficult to establish a strong causality between PCP and SARS-CoV-2 infection due to the study's cross-sectional nature. Selection bias could not be eliminated, since our study relied on volunteer participation. Due to neuropathic PCP's lower prevalence than nonneuropathic PCP, larger sample sizes and multicenter studies are crucial for a comprehensive understanding of","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366132","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 \"A Comprehensive Overview of the Stellate Ganglion Block Throughout the Past Three Decades: A Bibliometric Analysis\".","authors":"Hao Kong","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366113","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 Analysis of Awake Computed Tomography-Guided Double-Needle Percutaneous Radiofrequency Thermocoagulation for the Treatment of Glossopharyngeal Neuralgia.","authors":"Zuying Liu, Lijun Fu, Jiaming Fan, Letian Ma, Huilian Bu, Qingying Liu, Xinxin Li, Jian Wang, Jingjing Yuan, Xiaochong Fan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous radiofrequency thermocoagulation (PRT) is an established treatment for glossopharyngeal neuralgia (GPN). However, the effectiveness of conventional single-needle PRT is limited due to the glossopharyngeal nerve's unique anatomical location.</p><p><strong>Objectives: </strong>A major objective of our study was to evaluate the effectiveness and long-term outcomes of computed-tomography (CT)-guided double-needle PRT for patients with GPN.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Department of Pain Medicine, the First Affiliated Hospital of Zhengzhou University.</p><p><strong>Methods: </strong>Clinical data from 38 postoperative GPN patients who underwent CT-guided double-needle PRT between October 2019 and September 2022 were retrospectively reviewed and analyzed. Pain severity was assessed using the Barrow Neurological Institute Pain Intensity Scale (BNI-P) score, and anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS).</p><p><strong>Results: </strong>Thirty-eight GPN patients were treated with CT-guided double-needle PRT, and 28 patients could be contacted for follow-up. Pain was relieved in 23 patients (82.14%) immediately after the PRT procedure. The percentage of patients who experienced persistent pain relief was 85.71% at T2, 85.71% at T3, 89.28% at T4 and 89.28% at T5. Post-procedure complications included dysesthesia in the throat, dysphagia, choking on drinking water, and hoarseness. No mortality was observed during or after PRT procedures. Twelve patients (42.9%) suffered from anxiety, and 16 patients (57.1%) had depression. Postoperative HADS scores showed notable improvements over the preoperative scores.</p><p><strong>Limitations: </strong>Because this study was observational and retrospective, there was no detailed evaluation of the patients. Additionally, the study's small sample size and single-center nature may have further contributed to the bias of the results. A multicenter, prospective study with a large sample size should be performed to further investigate the effectiveness of CT-guided double-needle PRT as a GPN treatment.</p><p><strong>Conclusion: </strong>This study's findings suggest that CT-guided double-needle PRT is a safe and effective alternative treatment for GPN.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366107","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 Suprascapular Nerve Blocks and Intraarticular Corticosteroid Injections for Frozen Shoulder: A Randomized Controlled Trial.","authors":"Yu-Ting Lin, Ying-Chen Kuo, Xin-Ni Wu, Ya-Fang Liu, Lin-Fen Hsieh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The current mainstream treatment for frozen shoulder is a combination of physiotherapy and intraarticular corticosteroid injections (IACIs). Recently, the ultrasound-guided suprascapular nerve block (SSNB) has developed as a notable alternative option to the mainstream treatment.</p><p><strong>Objective: </strong>We aimed to compare ultrasound-guided SSNBs' effectiveness to IACIs' as treatments for frozen shoulder.</p><p><strong>Study design: </strong>This study was conducted as a prospective single-blind, randomized controlled trial.</p><p><strong>Setting: </strong>Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, a medical center in Taipei, Taiwan.</p><p><strong>Methods: </strong>Patients with frozen shoulder (n = 76) were enrolled as participants and allocated to either an SSNB group (n = 38) or an IACI group (n = 38). Both groups received 2 injections of 20 mg of triamcinolone and 3 mL of 1% lidocaine at 2-week intervals and underwent the same physiotherapy protocol for 3 months. The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). The secondary outcome measures were the Shoulder Disability Questionnaire (SDQ), the active and passive range of motion (ROM) of each patient's affected shoulder, and the 36-item Short Form Health Survey (SF-36). Evaluations were performed at baseline and at 4 and 12 weeks after starting treatment.</p><p><strong>Results: </strong>Both groups achieved significant improvements in all outcome measures, except the general health subscale of the SF-36 at 4 and 12 weeks after starting treatment. For time and group interaction, the results for the SDQ (P = .047) and SF-36 (bodily pain, P = .025) indicated significant differences that favored IACIs. Additionally, the IACI group achieved more favorable outcomes than did the SSNB group on the SPADI (P = .094) and in ROM (i.e., abduction [P = .190] and external rotation [P = .081]) as well as on 2 subscales of the SF-36: bodily pain (P = .059) and role-emotional (P = .072).</p><p><strong>Limitations: </strong>Our study is limited by the lack of participant stratification based on the stages of frozen shoulder and the 12-week follow-up period.</p><p><strong>Conclusions: </strong>A combination of ultrasound-guided IACIs and physiotherapy should be attempted first as a frozen shoulder treatment.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366126","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 Analgesic Effectiveness of Genicular Nerve-targeted Cooled and Pulsed Radiofrequency Ablation for Osteoarthritis Knee Pain: A Systematic Review and Meta-analysis.","authors":"Bintang Soetjahjo, Denny Adriansyah, Mochammadsyah Beizar Yudistira, Alif Noeriyanto Rahman, Herry Herman, Sudhir Diwan","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Radiofrequency ablation (RFA) is a form of therapy for knee osteoarthritis (OA) pain that has become more popular in recent years. In addition to standard RF approaches, there are cooled and pulsed options. RFA could be used to treat the superolateral, superomedial, and inferomedial branches of the genicular nerves. Pulsed and cooled RF ablation on the genicular nerve to treat knee OA pain, however, has not yet been shown to be effective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We conducted a meta-analysis to assess nonconventional, pulsed or cooled, RFA on the genicular nerve to treat knee OA pain; intended our study to provide useful information in deciding whether to use nonconventional RFA because of its effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Meta-analysis study of nonconventional, pulsed or cooled, RFA on the genicular nerve to treat knee OA pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, Ovid MEDLINE, Scopus, and Cochrane Central were searched for eligible papers. In our literature review, procedures, posttreatment outcomes, follow-up data, and adverse events were compiled and analyzed from the selected studies. The National Heart, Lung, and Blood Institute Quality Assessment tool was used to assess therapeutic relevance and evidence strength. Our meta-analysis analyzed pre- and posttreatment pain and physical function scores. The primary outcome was pain measured with either the Visual Analog Scale  or the Numeric Rating Scale. The secondary outcome was physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our systematic review and meta-analysis includes 11 eligible publications (604 patients). Both cooled and pulsed RFA procedures targeting the genicular nerve resulted in considerable pain reduction at post one, 3, 6, and 12 months (P &lt; 0.005). There was no significant improvement in physical function outcome for the cooled RFA technique in all follow-up visits. There was a significant improvement in physical function outcome for the pulsed RFA technique at the one-month and 3-month follow-up visits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Limitations include that there are a limited number of randomized controlled trials available, the methodology utilized for comparison is based on the change in outcome between baseline and follow-up visits. There are only a few papers that have reported physical function outcomes in complete WOMAC rating data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;At the 6-month follow-up, both cooled and pulsed RFA targeting the genicular nerve provided significant osteoarthritic pain alleviation. There is no different in pain relief between cooled and pulsed RFA targeting the genicular nerve for treating knee osteoarthritis. There was no significant functional improvement of cooled RFA in all follow-ups, but there was a significant functional improvement of pulsed RFA up to 3-month follow-up. Acc","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366135","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":"Yoga as an Adjunctive Treatment for Chronic Low Back Pain: A Narrative Review.","authors":"Andrea Nikolis, Louis Nikolis, Adele Meron","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Yoga has been recognized for its many mental and physical health benefits. A growing body of literature supports yoga's indication in chronic low back pain (CLBP) management. CLBP is a major public health concern, given its high rates of associated disabilities and large healthcare costs. A biopsychosocial approach has been deemed the most effective and appropriate management strategy for this condition. When alternative and comprehensive approaches for managing the complexity of CLBP are considered, yoga poses a safe, accessible adjunctive treatment option.</p><p><strong>Objectives: </strong>The goal of this review is to demonstrate, by highlighting yoga's benefits on mental and physical health and the pathophysiology associated with CLBP, that yoga is an effective form of CLBP management. Our other goal is to establish that yoga encompasses a biopsychosocial approach to managing CLBP.</p><p><strong>Study design and methods: </strong>After thorough examination of the available published literature, this narrative review evaluated 24 articles examining yoga's benefits to CLBP patients.</p><p><strong>Results: </strong>CLBP is associated with high rates of anxiety, depression, chronic stress, and pain catastrophizing. Numerous studies support yoga as an effective intervention for depression, anxiety, chronic stress, and pain catastrophizing, given yoga's effects on the sympathetic nervous system, endocrine system, and various neurotransmitters and brain regions, and improvements in these areas may ameliorate the clinical symptoms experienced by CLBP patients. Physically, symptoms experienced by those with CLBP include pain, impaired function and mobility, disability, fatigue, and medication dependence, all of which, according to the literature, yoga has been shown to improve. Additionally, the chronicity and persistence of low back pain are related to central and peripheral sensitization, and yoga may intervene in these pathways to minimize symptom propagation.</p><p><strong>Limitations: </strong>This review is not without limitations. The current literature lacks standardization regarding which yoga poses are safe, appropriate, and effective for CLBP patients, which limits the generalizability of yoga therapy. Additionally, few existing prospective trials study yoga in the management of CLBP. Though numerous randomized controlled trials (RCTs) are included in this review, most of the current literature details other reviews or analyses of RCTs, includes smaller sample sizes, and lacks long-term follow-up data. Furthermore, many of these studies include patients who have volunteered or self-selected to trial yoga therapy for their back pain, indicating inherent selection bias.</p><p><strong>Conclusion: </strong>Overall, the current management strategies for CLBP do not encompass an effective biopsychosocial approach, and an intervention such as yoga is a promising adjunctive treatment for the condition.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Sequential Percutaneous Radiofrequency Treatment Strategy for Drug-refractory Trigeminal Neuralgia: A Propensity Score-matched Study.","authors":"Hao Ren, Yang Wang, Zheng Chen, Yan Zhang, Guo Feng Ma, Fang Luo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Gasserian ganglion-targeted conventional and pulsed radiofrequency treatments are percutaneous procedures performed for drug-refractory trigeminal neuralgia. However, ideal outcomes are not always achieved with these procedures; frequent postprocedural complications and therapeutic ineffectiveness are also of major concern.</p><p><strong>Objectives: </strong>This study was conducted to investigate a novel strategy for effective, uncomplicated pain relief in patients with drug-refractory trigeminal neuralgia.</p><p><strong>Study design: </strong>A multicenter, retrospective, observational study.</p><p><strong>Setting: </strong>Participating centers were Beijing Tiantan Hospital and Sanbo Brain Hospital.</p><p><strong>Methods: </strong>From January 2010 through December 2019, a total of 2,087 patients with drug-refractory trigeminal neuralgia were included in the current study. Of them, 143 underwent sequential conventional radiofrequency treatment and 1,944 underwent conventional radiofrequency treatment only. The primary outcome was being pain free at 24 months postprocedure; multiple secondary outcomes were compared between treatments before and after propensity score matching.</p><p><strong>Results: </strong>At the 24-month follow-up, sequential radiofrequency treatment provided a higher pain-free outcome than conventional radiofrequency treatment (0.93 [95% CI, 0.92-0.94]) vs 0.89, (95% CI, 0.84-0.94; P = 0.04); hazard ratio, 1.703 (95% CI, 1.01-2.86). For the 124 propensity score-matched pairs, there was no significant difference between groups, although pain-free outcomes were numerically higher in the sequential radiofrequency treatment group (0.93 [95% CI, 0.89-0.98]) vs 0.90 (95% CI, 0.85-0.96; P = 0.3); hazard ratio, 0.653 (95% CI, 0.27-1.60). Notably, sequential radiofrequency treatment correlated with fewer overall postprocedural complications than conventional radiofrequency treatment, despite propensity score matching analysis (14/143 vs 723/1944, relative risk, 0.69 (95% CI, 0.65-0.74; P < 0.001); 11/124 vs 45/124, relative risk 0.69 (95% CI, 0.60-0.80; P < 0.001).</p><p><strong>Limitations: </strong>Procedural parameters and quality of life evaluation by treatment were not analyzed and cost data were not collected.</p><p><strong>Conclusion: </strong>Sequential radiofrequency treatment has the potential to provide effective, uncomplicated, pain-free outcomes.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366120","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":"Treatment Gaps and Emerging Therapies in Lumbar Disc Herniation.","authors":"Douglas P Beall, Kee D Kim, Kevin Macadaeg, Kianoush Donboli, Kinsuk Chauhan, Mohan Sowlay, Amy Guo, Alexander Vaccaro","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation (LDH) occurs when the central disc material, primarily the nucleus pulposus, is displaced beyond the outer annulus, compressing the spinal nerve roots. LDH symptoms, including radicular leg pain, radiculopathy, and low back pain, are associated with considerable disease burden and the significant utilization of health care resources.</p><p><strong>Objectives: </strong>Provide overview of the current treatment landscape for LDH, identify unmet needs, and describe emerging treatments.</p><p><strong>Study design: </strong>Narrative literature review.</p><p><strong>Methods: </strong>A review of literature concerning available LDH treatments and associated outcomes was conducted in PubMed to identify areas of unmet need. Some key words included \"lumbar disc herniation,\" \"radicular leg pain,\" \"sciatica,\" \"treatment,\" \"therapy,\" and \"burden.\"</p><p><strong>Results: </strong>For patients who do not respond to conservative therapy, epidural steroid injections (ESIs) are widely used for persistent LDH symptoms. While ESIs provide short-term improvements in radicular pain, evidence that ESIs bestow sustained benefits is limited. ESIs are not approved by the US Food and Drug Administration (FDA) and, in rare cases, carry risks of infection and neurological injury, as well as the potential for long-term systemic effects of glucocorticoids. In cases when nonsurgical treatment fails to relieve symptoms, lumbar discectomy can provide rapid pain relief; however, in addition to the risk of intraoperative complications, the long-term consequences of lumbar discectomy may include recurrent pain or herniation, revision discectomy, loss of disc height, and Modic changes. Treatments for LDH in late-stage clinical development include sustained-release ESI formulations and a novel agent for chemonucleolysis, a nonsurgical method of minimizing the volume of the displaced nucleus pulposus. Emerging minimally invasive therapies that address the underlying pathophysiology of the disease have the potential to bridge the gap between symptomatic treatments and surgery.</p><p><strong>Limitations: </strong>Because this paper was a narrative review, literature search and selection processes were not systematic in nature. The evidence regarding the long-term efficacy of some treatments, such as discectomy, was limited by the high rates of crossover between the treatment groups.</p><p><strong>Conclusions: </strong>The lack of sustained benefits associated with ESIs and the risks associated with surgery underscore the unmet need for novel, minimally invasive interventional therapies able to address the underlying nerve root compression in LDH.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366137","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":"Percutaneous Intradiscal Radiofrequency Thermocoagulation Combined with Sinuvertebral Nerve Ablation for the Treatment of Discogenic Low Back Pain.","authors":"Qingda Li, Junsong Yang, Tuanjiang Liu, Botao Liu, Datong Li, Wangli Huang, Bin Geng, Yayi Xia, Dingjun Hao, Baorong He","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Percutaneous intervertebral radiofrequency thermocoagulation (PIRFT) and sinuvertebral nerve ablation (SVNA) are commonly used clinical treatments for discogenic low back pain (DLBP). However, they have been reported to have low efficacy rates of approximately 16.5%-26.5%, especially in the medium to long term.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate whether PIRFT combined with SVNA can reduce pain and improve clinical outcomes in patients with DLBP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This is a prospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;All data were from Honghui Hospital in Xi'an.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following the inclusion and exclusion criteria, 195 patients were enrolled in this study and randomly divided into 3 groups of 65 patients each and treated with PIRFT+SVNA, PIRFT, or SVNA. Postoperative follow-ups were done at one week, one month, 3 months, 6 months, and 12 months. The demographic characteristics, relevant surgical information, and observed complications of all groups were recorded. The efficacy of the surgeries was evaluated using the visual analog scale (VAS), Oswestry disability index (ODI), and modified Macnab criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 167 patients, comprising 81 men and 86 women (aged 28-75 years), were included in this study and completed postoperative follow-ups. There were 54 patients in the combined PIRFT and SVNA (PIRFT+SVNA) group, 58 patients in the PIRFT group, and 55 patients in the SVNA group. All groups were comparable because there were no significant differences in gender, age, disease duration, follow-up time, surgical segments and presence of high-intensity zones of the groups (P &gt; 0.05). In addition, the efficacy of the PIRFT+SVNA group was significantly higher than that of the PIRFT and SVNA groups as assessed by the modified Macnab criteria (P = 0.032). Surgery was successfully completed in all 3 groups, and VAS and ODI improved at all postoperative time points in all 3 groups compared to the preoperative scores. The differences between the VAS and ODI scores preoperation and 12 months postoperation were not statistically significant between all 3 groups. However, at one week, one month, 3 months, and 6 months after surgery, the VAS and ODI scores were lower in the PIRFT+SVNA group compared to the PIRFT and SVNA groups. The difference in VAS scores among the 3 groups was most significant at one week postoperation, and the difference in ODI scores was most significant at one month postoperation. The VAS and ODI improvement rates of the 3 groups showed significant improvement at one week, one month, 3 months, and 6 months postoperation (P &lt; 0.05). There was no significant difference among the 3 groups at 12 months postoperation (P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study was limited by its small sample size in a single-center study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In DLBP, the sinuvertebral nerve (SVN) is","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366130","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}