Pain physician最新文献

{"title":"Intradiscal Saline as Sham Control: A Methodological Note.","authors":"Chunbo Li, Ding Li","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E743"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075729","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":"Ultrasound- and Fluoroscopy-Guided Curved Needle Lumbar Sympathetic Radiofrequency Ablation for Diabetic Peripheral Neuropathy Pain: A Randomized Trial.","authors":"Meirong Wang, Jing Li, Chuiliang Liu, Xiao Wu, Jingquan Wang, Yaya Li","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Lumbar sympathetic ganglion radiofrequency ablation (LSGRF) is an effective pain relief technique for patients with diabetic peripheral neuropathic pain (DPNP). Fluoroscopy, when combined with ultrasound, can guide the needle tip to locate the lumbar sympathetic ganglion (LSG) accurately, but the vertebrae pose an obstruction.</p><p><strong>Objectives: </strong>The purpose of this study is to compare the technical efficacy and clinical outcomes between curved-needle and straight-needle techniques for LSGRF in DPNP patients.</p><p><strong>Study design: </strong>A prospective, randomized design.</p><p><strong>Setting: </strong>The study was carried out in the anesthesiology department of Foshan Fosun Chancheng Hospital, Foshan, China.</p><p><strong>Methods: </strong>This study included 60 DPNP patients aged 18 to 80 years, with ASA grade II to III and BMI 18 to 30 kg/m2, who underwent combinations of LSGRF and anhydrous ethanol under ultrasound and fluoroscopy guidance. The patients were divided randomly into the curved-needle group (Group C, n = 30) and the straight-needle group (Group S, n = 30). The primary endpoint was the duration of the procedure. Secondary outcomes included ablation success rate, fluoroscopic imaging time, number of needle redirections, frequency of needle-bone contacts, serial pain scores on the visual analog scale (VAS), and surgical complications.</p><p><strong>Results: </strong>Group C demonstrated statistically significant advantages in procedural efficiency, including shorter operation time (10.6 ± 3.1 min vs. 15.2 ± 2.3 min, P < 0.001), fewer needle redirections (0.5 vs. 4.5, P < 0.001), and reduced bone contacts (1.0 vs. 4.0, P < 0.001), over Group S. While the ablation success rate was numerically higher in Group C (96.7% vs 90.0%), this difference did not reach statistical significance (P = 0.611). Both groups showed a significant reduction in VAS scores from their preoperative counterparts at all postoperative assessment time points (P < 0.05), but there was no significant difference in VAS scores between the groups. The complication rate was lower in Group C (3.33% vs. 13.33%, P = 0.357), but that result had no statistical significance.</p><p><strong>Limitations: </strong>The analgesic effect of LSGRF and the temperature of the affected limb were evaluated based only on short-term outcomes.</p><p><strong>Conclusions: </strong>Compared to the traditional straight needle, the curved needle can reduce the operation time and the number of needle redirections in LSGRF for treating DPNP. Satisfaction of both patients and anesthesiologists also increased when using the curved needle. However, no statistically significant differences were observed between the 2 types of needles in terms of success rate or post-procedural analgesic efficacy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E645-E653"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075384","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":"Hormonal and Mental Health Influences on Musculoskeletal Pain and Mastalgia in Physically Active Women.","authors":"Saba Yazdekhasti, Rebekah M Maddux, Kemly M Philip, Emily C LaVoy, Stacey L Gorniak","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The inflammatory response mediates the primary pain pathway in animals assigned female at birth, whereas sex hormones are cited as the primary mediator of the pain pathway in animals assigned male at birth. It is unclear if these sex-based pain mediators are also present within humans in cases of musculoskeletal pain.</p><p><strong>Objectives: </strong>This study investigates the association of self-reported pain in the neck, back, arms, and breasts in physically active, full-busted women with their hormonal levels, anthropometry measures, and indicators of overall mental health.</p><p><strong>Study design: </strong>Twenty (20) healthy, full-busted women who were assigned female at birth and performed regular physical activity were recruited to participate in this cross-sectional observational study.</p><p><strong>Setting: </strong>University-research center in Houston, TX, USA.</p><p><strong>Methods: </strong>Patients completed a series of surveys and questionnaires regarding their medical health history, physical activity, and history of pain-including neck, back, and arm pain as well as mastalgia. The patients also underwent anthropomorphic measurements and a blood draw.</p><p><strong>Results: </strong>Patients demonstrated significant musculoskeletal pain, anxiety, and depression (P < 0.005). Estradiol, progesterone, and glycated hemoglobin levels were significantly associated with self-reported musculoskeletal pain in the neck, back, and arms, as was mastalgia. Additional covariates, including anxiety, number of children borne, and trunk anthropometry, were found to clarify hormonal and metabolic contributions to the patients' pain presentation.</p><p><strong>Limitations: </strong>Limitations of this initial project include the small sample size (n = 20) of physically active women without current metabolic health complications (glycated hemoglobin values of less than 5.7%).</p><p><strong>Conclusions: </strong>These data indicate significant influences of hormonal levels and metabolic health on musculoskeletal pain and mastalgia perceived in physically active women. The data also suggest that several control covariates, including self-reported anxiety, should be considered to clarify potential mechanistic pathways in pain presentation in women who were assigned female at birth.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E733-E739"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075571","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":"Analgesic Efficacy of Mirogabalin in Patients With Herpes Zoster: Protocol for a Prospective Multicenter Randomized Open-Label Blinded-Endpoint (PROBE) Study.","authors":"Yan Xing, Minying Liu, Yu'e Ren, Jianxin Yang, Fang Luo","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Herpes zoster (HZ) is a debilitating condition characterized by acute dermatomal pain and a high risk of developing postherpetic neuralgia (PHN). Although early antiviral therapy is essential, its analgesic efficacy is often insufficient, particularly in patients with moderate to severe pain. While gabapentinoids are recommended as adjunctive analgesics, current options like gabapentin and pregabalin are often limited by inconsistent efficacy and dose-dependent adverse events. Mirogabalin, a novel gabapentinoid with higher affinity and selective dissociation for the a2d subunit, may offer superior pain relief with a wider safety margin. However, although mirogabalin has demonstrated efficacy in PHN, its analgesic efficacy and safety in patients with acute HZ-associated pain have not been adequately established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To test the hypothesis that conventional treatment combined with mirogabalin provides superior pain relief compared to conventional treatment alone in patients with HZ.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Multicenter, prospective, randomized, open-label, blinded-endpoint trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Beijing Tiantan Hospital, Second Hospital of Hebei Medical University, and Second Hospital of Shanxi Medical University.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 750 adult patients experiencing moderate to severe pain with rash onset within the last 30 days will be enrolled. Patients will be randomly assigned in a 1:1 ratio to either mirogabalin group or control group. The mirogabalin group will receive oral mirogabalin in addition to conventional treatment, while the control group will receive conventional treatment alone. Mirogabalin will be titrated from 5 mg twice daily to a maximum of 15 mg twice daily according to individual tolerability and will be used during the prespecified treatment period up to 90 days after rash onset. After 90 days following rash onset, treatment will be identical in both groups, and patients with persistent pain meeting the definition of PHN will receive standardized guideline-based PHN management. The study duration will be 52 weeks. Patients and treating physicians will be aware of treatment allocation, whereas outcome assessors will remain blinded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The primary outcome is the average pain intensity at week 4. Secondary outcomes include the worst pain intensity, proportions of patients achieving ≥ 30% and ≥ 50% pain reduction, proportion of patients developing postherpetic neuralgia, type of analgesics and average weekly consumption per analgesics, the Herpes Zoster Severity of Illness Index, quality of life assessed by the 12-item Short Form Health Survey, sleep quality assessed by the Medical Outcomes Study Sleep Scale, the Neuropathic Pain Scale, and adverse events. These outcomes will be assessed at prespecified time points from baseline through week 52, according to the assessment schedule for eac","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E627-E634"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075599","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":"Implications of the CMS Ambulatory Specialty Model for Low Back Pain for Interventional Pain Management: The Good, The Bad, And The Ugly.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Amol Soin, John T Ruxer, Vidyasagar Pampati, Annu Navani, Alan D Kaye, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Since the enactment of the Affordable Care Act (ACA) in 2010, the Centers for Medicare & Medicaid Services (CMS) have embraced value-based care as the organizing principle of national payment reforms. Yet, after more than a decade, the value-based movement has, at best, generated modest returns and at worst increased costs on patients and negatively impacted access. Pursuant to its authority under the ACA, CMS proposed the Ambulatory Specialty Model (ASM) in the CY 2026 Physician Fee Schedule rulemaking and subsequently finalized the model, establishing the agency's first mandatory alternative payment model focused on ambulatory specialty care. ASM targets 2 high-cost, high-prevalence chronic conditions, heart failure, and low back pain (LBP) and will require eligible physicians in selected geographic regions to accept 2-sided financial risk beginning with performance year 1 in January 2027.This article summarizes the design of ASM, details how physicians are selected into the model and how payment adjustments are calculated (including how procedure mix and site of service, office versus ambulatory surgery center or hospital outpatient, affect episode-based cost scoring), enumerates the required quality measures and patient-reported outcome measures (PROMs), describes the Collaborative Care Arrangement requirements, compares ASM against traditional Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM) such as Accountable Care Organizations (ACOs), weighs whether ASM functions as a carrot-and-stick or aversion-based policy and whether it represents innovation or limitation, and addresses whether performance is compared across specialty types (e.g., neurosurgery versus pain medicine). It then examines specific implications for interventional pain management (IPM) practices, situates IPM within the broader multispecialty landscape of LBP care, and closes with a practical action list and CMS reference links for IPM groups preparing for mandatory participation.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"445-460"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075612","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":"Perioperative Management of Antiplatelet and Anticoagulant Therapy in Patients Undergoing Interventional Techniques: A Critical and Analytical Summary of the 2024 Guidelines of the American Society of Interventional Pain Physicians (ASIPP).","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Devi Nampiaparampil, Nebojsa Nick Knezevic, Alan D Kaye, Alexander Bautista, Kenneth D Candido, Paul Christo","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The frequency of performance of interventional techniques in chronic pain patients receiving anticoagulant and antiplatelet therapy continues to increase. Understanding the importance of continuing chronic anticoagulant therapy, the need for interventional techniques, and determining the duration and discontinuation or temporary suspension of anticoagulation also when bridging therapy is appropriate is crucial to avoiding devastating complications, primarily when neuraxial procedures are performed. In 2024, the American Society of Interventional Pain Physicians (ASIPP) published updated guidelines for the perioperative management of antiplatelet and anticoagulant therapy in patients undergoing interventional techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A critical and analytical review and structured synthesis of a consensus clinical practice guideline developed by review of the literature, best evidence synthesis, and modified Delphi consensus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The present investigation summarizes the 2024 updated guidelines of the American Society of Interventional Pain Physicians (ASIPP) on the perioperative management of antiplatelet and anticoagulant therapy in patients undergoing interventional techniques. The summary is organized around the recommendations, presenting for each the underlying evidence, the assigned evidence level and strength of recommendation, and the practical consequences for risk stratification, drug cessation, bridging, resumption, and documentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multidisciplinary panel convened by ASIPP reviewed the literature on bleeding risk during interventional pain procedures, practice patterns, thrombotic risk, and perioperative management of antithrombotic therapy. Relevant literature was identified through searches of PubMed, the Cochrane Library, and Google Scholar from 1966 through 2023, supplemented by review of contemporary guidelines. Evidence and recommendations were graded using the modified ASIPP approach, Grading of Recommendations, Assessment, Development and Evaluation (GRADE), considerations of clinical relevance and pragmatism, and the Agency for Healthcare Research and Quality (AHRQ) strength-of-recommendation methods, with the rating scheme derived from the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) instrument. Institute of Medicine (IOM) standards were followed. Consensus required at least 80% agreement among eligible panelists without a primary conflict of interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-four authors participated, and 29 voted. Twenty recommendations were initially developed, of which 16 achieved 100% acceptance; the set was consolidated to 18 through second and third rounds of voting, with 16 of 18 achieving unanimous acceptance and the remaining two reaching 94% and 89%. The dissent concerned the risk classification of transforaminal epidural injections and is re","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E591-E613"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075666","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 \"High-Voltage Fluoroscopic Guided Pulsed Radiofrequency Compared to Standard-Voltage Pulsed Radiofrequency on the Dorsal Root Ganglion for Chronic Lumbosacral Radicular Pain\".","authors":"Meiyi Long, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E749-E750"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075563","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":"Real-World Safety Profile of Intrathecal Morphine Monotherapy vs Morphine-Bupivacaine Combination: A 10-Year MAUDE Database Analysis.","authors":"Andres F Mantilla-Santamaria, Sebastian Vallejo, David L Cedeno, Michelle M Boyd, Tony L Yaksh, Ricardo Vallejo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic intrathecal morphine infusion is a standard US Food and Drug Administration (FDA)-approved therapy for severe refractory pain. However, long-term morphine monotherapy is associated with opioid tolerance and complications like catheter-tip granulomas. Coadministration with bupivacaine is widely used off-label to mitigate these risks, yet comparative real-world safety data remain scarce.</p><p><strong>Objectives: </strong>To systematically compare the real-world adverse event (AE) profiles of intrathecal (IT) morphine monotherapy versus binary morphine-bupivacaine therapy.</p><p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Setting: </strong>FDA's Manufacturer and User Facility Device Experience (MAUDE) database.</p><p><strong>Methods: </strong>The MAUDE database was queried for reports related to the SynchroMed® and Prometra® infusion pump systems from 2016 through 2025. Reports specifying the exclusive use of morphine monotherapy or a binary morphine-bupivacaine mixture were extracted. Data on drug dosing and device- and medication-related AEs were analyzed with the Mann-Whitney U test and Fisher's exact test. This study was exempt from IRB approval.</p><p><strong>Results: </strong>Out of 41,495 total reports for the SynchroMed and Prometra pumps during the 2016 through 2025 period, 5,423 involved morphine monotherapy and 1,072 involved the binary mixture. The median morphine dose was significantly higher in the binary group (2.20 mg/day) compared to monotherapy (1.50 mg/day) (P < 0.05). Despite higher opioid doses, the binary group had a significantly lower incidence of cognitive impairment (0.56% vs 1.48%, P < 0.05). Inflammatory granulomas trended lower in the binary group (0.65% (n = 7) vs 1.33% (n = 72), P = 0.068). Opioid withdrawal was the most common medication-related AE in both regimens (17.33% mono vs 15.30% binary, P > 0.05). Significantly different bupivacaine-specific AEs in the binary group included numbness (1.77%) and paresis (1.49%).</p><p><strong>Limitations: </strong>As a passive surveillance system, MAUDE lacks denominator data (i.e., total devices in service), precluding the calculation of true incidence rates. Unverified reporting and lack of specific patient comorbidities are inherent limitations.</p><p><strong>Conclusions: </strong>The addition of bupivacaine to IT morphine is associated with a safety profile similar to morphine monotherapy, although with a significantly smaller frequency of cognitive impairment, and a trend toward fewer granulomas, despite higher median morphine doses. These real-world findings are consistent with the safety profile of this consensus-backed off-label practice.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E457-E467"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075328","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":"Translating Evidence to Practice: A Critical and Analytical Summary of the Evidence-Based Guidelines of Facet Joint Interventions in Management of Chronic Spinal Pain.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Alan D Kaye, Paul Christo, Sujeivan Mahendram, Nebojsa Nick Knezevic, Kenneth D Candido, Annu Navani, Devi Nampiaparampil, Amol Soin, Rajesh Naidu Janapala, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic axial spinal pain is a major contributor to disability and healthcare expenditures, with facet joints recognized as one of the established sources of pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Summary and structured synthesis of a comprehensive, multidisciplinary, evidence-based clinical practice guideline developed by systematic review of the literature, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) appraisal, and modified Delphi consensus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This article summarizes the recommendations of the 2026 comprehensive evidence-based guidelines for facet joint interventions in the management of chronic spinal pain, published by the American Society of Interventional Pain Physicians (ASIPP). The summary is organized around the recommendations themselves, presenting for each the underlying evidence, the assigned level of evidence, the strength of recommendation, and the practical implications for clinical practice, documentation, and coverage policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Literature was searched from 1966 through October 2025. Methodologic quality was assessed using multiple instruments for diagnostic and therapeutic studies. Evidence was graded on a 5-level modified ASIPP scale (Level I, strong, through Level V, consensus-based) supplemented by GRADE certainty ratings, and the strength of each recommendation was rated as strong, moderate, or weak using a scheme adapted from the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) instrument. Institute of Medicine (IOM) standards for trustworthy guidelines were followed. Consensus required at least 80% agreement among eligible panelists without a primary conflict of interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For non-interventional diagnosis, the level of evidence ranged from I to V, with strong recommendations for structured physical examination and for mandatory fluoroscopic or computed tomography (CT) guidance, and weak recommendations for advanced imaging. For interventional diagnosis, the evidence was Level I to II in the lumbar spine and Level II in the cervical and thoracic spine, with moderate to strong recommendations for controlled diagnostic medial branch blocks using an 80% pain-relief threshold. For therapeutic interventions, the evidence was Level II with moderate recommendations for cervical and lumbar radiofrequency ablation (RFA) and for therapeutic facet joint nerve blocks in all three spinal regions; Level III with weak to moderate recommendations for thoracic RFA; and Level III to V with weak recommendations for intraarticular injections. For special considerations, evidence ranged from Level II to Level V, addressing repeat interventions, lesion parameters, electrode selection and position, stimulation testing, metallic and electronic implants, antithrombotic therapy, and sedation. Cost-utility analyses demonstrated costs of $4,664 to $5,446 per q","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E493-E530"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075423","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":"Practice Expense, Site of Service, and the Survival of the Independent Interventional Pain Practices: With Medicare Policies Leading the Way.","authors":"Laxmaiah Manchikanti, Sheri L Albers, Vidyasagar Pampati, Mahendra R Sanapati","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Practice expense (PE) accounts for approximately 45% of relative value units (RVUs) under the Medicare Physician Fee Schedule (PFS), yet it receives substantially less analytic attention than physician work. For interventional pain management (IPM), a specialty in which physicians frequently own the procedural suite, imaging equipment, and clinical infrastructure and employ the clinical and administrative staff, or perform surgical interventions in an Ambulatory Surgery Center (ASC) or hospital setting, PE is not merely an accounting abstraction but a major determinant of practice viability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine how Medicare values practice expense, how the calendar year (CY) 2026 PFS final rule and CY 2027 proposed rule alter that valuation, and why the resulting site-of-service payment architecture produces outcomes for independent interventional pain physicians that are inconsistent with the stated policy rationale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Narrative health policy review with descriptive quantitative synthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;United States Medicare program; traditional fee-for-service Part B.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We reviewed the CY 2026 PFS final rule, the CY 2027 PFS proposed rule, published specialty-society analyses, peer-reviewed utilization studies of interventional techniques in the Medicare population, national practice-cost and physician-employment data, and relevant local coverage determinations. Payment, cost, and utilization trends were assembled and compared descriptively. No patient-level data were used, and no statistical inference was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between 2001 and 2025, practice costs measured by the Medicare Economic Index (MEI) increased 59%, while inflation-adjusted Medicare physician payment declined approximately 33% across all specialties and approximately 41% in interventional pain management. Sequestration, applied to Medicare's share of each claim rather than to the fee schedule, further reduced realized revenue by approximately 1.6% for 13 of those 25 years. The CY 2026 final rule reduced indirect PE allocated per work relative value unit for facility services to 50% of the non-facility amount, producing an estimated 7% to 10% increase for office-based services and an estimated 8% to 11% decrease for services furnished in hospital outpatient departments (HOPDs) and ASCs, along with a 2.5% efficiency adjustment applied to non-time-based codes. Because ASCs and hospital outpatient facilities do not provide practice management support to independent physicians, this reallocation penalizes a substantial proportion of the independent physicians the policy rationale was intended to protect. Utilization of interventional techniques per 100,000 beneficiaries declined 16.8% between 2019 and 2024. Nationally, the proportion of physicians practicing in physician-owned practices declined to 18% by January 2","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"461-481"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075690","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}