Pain physician最新文献

{"title":"Prevalence and Risk Factors for Persistent Spinal Pain Syndrome Type II Following Spinal Surgery: A Nationwide Retrospective Cohort Study.","authors":"Tak Kyu Oh, In-Ae Song","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Persistent Spinal Pain Syndrome Type II (PSPS II) is a major health concern in patients undergoing spinal surgery. However, there are little data on the prevalence and risk factors of PSPS II post spinal surgery.</p><p><strong>Objectives: </strong>We examined the prevalence and factors associated with diagnosing PSPS II post spinal surgery using a nationwide database in the Republic of Korea.</p><p><strong>Study design: </strong>A retrospective, population-based cohort study.</p><p><strong>Setting: </strong>Nationwide cohort study in the Republic of Korea.</p><p><strong>Methods: </strong>Adult patients who underwent spinal surgery under general anesthesia from January 1, 2016 through December 31, 2020 were included. Patients previously diagnosed with PSPS II were excluded from the study in order to focus only on patients who were newly diagnosed post spinal surgery. We determined that a PSPS II diagnosis must be made within  one year of the date of spinal surgery, with an additional evaluation for diagnoses occurring within 2 years to capture longer-term cases. A multivariate logistic regression model was developed to identify the factors associated with diagnosing PSPS II post spinal surgery.</p><p><strong>Results: </strong>In total, 530,644 patients who underwent spinal surgery were included. Of these, 25.6% and 31.5% were diagnosed with PSPS II within one and 2 years post spinal surgery, respectively. The multivariate logistic regression model indicated that being a woman, old age, being a member of a medical aid program group, an increased Charlson Comorbidity Index score, discectomy, laminectomy, and lumbar level surgery were associated with an increased prevalence of PSPS II within one year post spinal surgery. Similar results were observed in the multivariate logistic regression model for PSPS II within 2 years post spinal surgery.</p><p><strong>Limitation: </strong>Our study's retrospective cohort design is a limitation.</p><p><strong>Conclusions: </strong>This population-based cohort analysis found a 25.6% prevalence of PSPS II within one year post spinal surgery and 31.5% within two years post spinal surgery. Identified risk factors include old age, being a woman, economic poverty, comorbid status, underlying disability, type of surgery, and lumbar-level surgery. A large dataset was used to document the prevalence and risk factors for PSPS II post spinal surgery.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"555-563"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771311","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":"Regional Analgesia Techniques Following Thoracic Surgery: A Systematic Review and Network Meta-analysis.","authors":"Meijuan Yang, Xiaomei Zhang, Gang Liu, Xingwang Zhang, Wenjun Yan, Dong Zhang","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Regional analgesia techniques have become the basis of multimodal analgesia for acute and chronic pain. They are widely used in thoracic surgery, but the best treatment is still uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to compare and rank the effectiveness of regional analgesia techniques for thoracic surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A systematic review and network meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, MEDLINE, Embase, Cochrane Library, Science-Direct, and Web of Science were searched for articles published from inception through the end of January 2023. The network meta-analysis was conducted using Stata 15.1 software (StataCorp, LLC). The certainty of evidence was assessed by using Confidence in Network Meta-analysis (CINeMA https://cinema.ispm.unibe.ch/ A (unibe.ch). The primary outcome was cumulative opioid consumption within postoperative 24 hours. The secondary outcomes included pain scores at postoperative 6 hours, 12 hours, and 24 hours.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 32 trials with 1,996 patients and 11 techniques were included. No major network inconsistency or heterogeneity were found. Postoperative opioid consumption within postoperative 24 hours was decreased most by continuous extrapleural block (cEPB) (standardized mean difference [SMD] = 0.00; 95% CI,: 0.00-0.00), followed by continuous thoracic epidural analgesia (cTEA) and continuous serratus plane block (cSAPB). In the postoperative 6 hour analysis, pain scores were  decreased most by cTEA (SMD = 0.16; 95% CI,: 0.05-0.49), followed by thoracic paravertebral block (TPVB) and ESPB (erector spinae plane block). In the postoperative 12 hour analysis, pain scores were decreased most by cSAPB (SMD = 0.12; 95% CI, 0.011.84), followed by TPVB and cTEA. In the postoperative 24 hour analysis, pain scores were decreased most by ESPB (SMD = 0.09; 95% CI, 0.030.32), followed by cSAPB and continuous thoracic paravertebral block (cTPVB).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our study has several limitations. First, 4 enrolled studies had a sample size of less than 40 patients. Second, the different regimens were potential factors contributing to heterogeneity, such as local anesthetic dose and volume, infusion time, infusion mode, adding adjuncts, and rescue analgesic regimens. Third, the number of primary and secondary outcomes is limited. Fourth, the number of randomized controlled trials for cEPB is limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The cTEA and cSAPB techniques are more likely to reduce the cumulative opioid consumption within 24 hours. The cTEA, cSAPB, ESPB techniques were more likely to improve pain at postoperative 6, 12, and 24 hours. Therefore, cTEA, cSAPB, and ESPB are the first choices for pain relief post thoracic surgery, whereas wound infiltration, intercostal block, continuous wound infiltration, and continuous intercostal block were less likely to be effective. We need more high-q","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E803-E818"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771313","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 Robot-Assisted and Fluoroscopy-Assisted Percutaneous Kyphoplasty for Bone Cement Distribution and Clinical Efficacy.","authors":"Hui Tao, Zhiwei Huang, Shanzhong Shao, Ruoyu Yang, Kun Yang, Yinshun Zhang, Wei Li, Fulong Dong, Jun Qian, Cailiang Shen","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The distribution of bone cement after percutaneous kyphoplasty (PKP) affects its clinical efficacy in patients with osteoporosis. Robotic and traditional treatment of osteoporotic vertebral compression fractures (OVCFs) have both been established as effective, but no studies have compared these 2 modalities in terms of bone cement distribution and clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the bone cement distribution and clinical efficacy of robot-assisted percutaneous kyphoplasty to those of fluoroscopy-assisted percutaneous kyphoplasty for the treatment of OVCFs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Department of Orthopedics and Spine Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A single-center, retrospective observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data from 151 patients with OVCFs who underwent PKP between January 2020 and July 2022 were analyzed retrospectively. The patients were divided into 3 groups: robot-assisted unipedicular percutaneous kyphoplasty (RAUPK), fluoroscopy-assisted unipedicular percutaneous kyphoplasty (FAUPK), and fluoroscopy-assisted bipedicular percutaneous kyphoplasty (FABPK). The operation time, intraoperative blood loss, bone cement injection volume, bone cement distribution, and complications (vascular and nerve injury, bone cement leakage, and re-fracture) of each procedure were recorded. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, Cobb angle, and anterior height of the injured vertebrae were compared among the 3 groups preoperatively, one day postoperatively, and at the final follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;No puncture failures occurred in any of the 3 groups. The mean follow-up period was 20.0 ± 5.2 months. The postoperative VAS scores, ODI, anterior vertebral heights, and Cobb angles of all patients were significantly improved compared to the preoperative values (P &lt; 0.05). There were no significant differences in the VAS score, ODI score, Cobb angle, anterior vertebral height ratio preoperatively or one day postoperatively among the 3 groups (P &gt; 0.05). The groups' comparative rates of intraoperative blood loss and complications also showed no significant differences (P &gt; 0.05). At the last follow-up, the VAS and ODI scores of the RAUPK group were lower than those of the FAUPK group (P &lt; 0.05), as were the anterior height of the injured vertebra and Cobb angle of the RAUPK group (P &lt; 0.05). The operation time, bone cement injection volume, and bone cement distribution in the RAUPK group were superior to those in the FAUPK group (P &lt; 0.05). Nevertheless, there were no significant differences in the VAS, ODI, Cobb angle, or anterior vertebral height at the last follow-up between the FABPK group and the RAUPK group (P &gt; 0.05). Those 2 groups also showed no significant difference in operation time, intraoperative blood loss, bone cement distrib","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E953-E963"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771196","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 Using High-Frequency Electromagnetic Coupling Technology to Power an Implanted Neurostimulator with a Separate Receiver at the Superior Cluneal Nerve for Treatment of Chronic Back Pain Due to Neuralgia: A Retrospective Study.","authors":"David Lindley, Adrianna Anders","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Low back pain is a highly prevalent condition with substantial costs. Superior cluneal neuralgia is present in up to 14% of low back pain cases. This etiology of back pain is often overlooked because the symptoms of superior cluneal neuralgia manifest similarly to those of other conditions, such as radiculopathy and sacroiliac joint pain. Peripheral nerve stimulation (PNS) is an emerging pain management modality used to treat various chronic pain conditions. This retrospective study will examine the outcomes of patients who have back pain caused by neuralgia and are treated with the permanent Freedom® PNS System (Curonix LLC) at the superior cluneal nerve.</p><p><strong>Objectives: </strong>The primary objective was to examine the responder rate (proportion of patients who experienced greater than 50% relief) and changes in pain scores after the trial procedure. Secondary objectives included changes in pain scores from at least one month after permanent implantation, adverse event occurrences, changes in function and quality of life, and reductions in medication usage.</p><p><strong>Setting: </strong>This was a retrospective single-site study. All procedures were performed by the same interventional pain physician.</p><p><strong>Methods: </strong>A retrospective chart review was conducted to assess baseline and follow-up parameters. Inclusion criteria consisted of requirements that patients be 18 years or older and have a confirmed superior cluneal neuralgia diagnosis responsible for their pain presentation. Exclusion criteria included the presence of another active implanted device for pain management. The 11-point verbal rating scale (VRS) was used to assess pain scores.</p><p><strong>Results: </strong>Twenty-one patients were included in this study. All 21 responded to the trial procedure with a 77% average reduction in VRS scores. At the follow-up (mean = 11 months), 20 patients reported an average 57% reduction in pain scores with the verbal rating scale. The same proportion of patients reported improved function and quality of life. Five patients reported reduced medication usage, including one who stopped taking pain medication altogether. No complications were reported.</p><p><strong>Limitations: </strong>We were limited to the data available in the patient charts since this was a retrospective study investigating the efficacy and safety of the Freedom® PNS System for patients with refractory chronic back pain.</p><p><strong>Conclusion: </strong>When used to target the superior cluneal nerve, the Curonix Freedom® PNS System is an effective and safe treatment for neuralgia-caused chronic lower back pain resistant to conservative therapy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E937-E942"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771309","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 Ultrasonographic Method to Quickly and Accurately Access the C2 Dorsal Root Ganglion.","authors":"Liangliang He, Wenxing Zhao, Po-Yi Paul Su, Xu Liao, Jie Zhao, Zhi Dou, Hongyan Wang, Liqiang Yang, Zhonghui Guan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Occipital neuralgia manifests as pain in the cutaneous distribution of occipital nerves, with the greater occipital nerve stemming from the C2 spinal nerve and the lesser occipital nerve originating from the C2 and C3 spinal nerves. While pulsed radiofrequency ablation of the C2 dorsal root ganglion (DRG) is an effective treatment for refractory occipital neuralgia, accessing the C2 DRG remains a clinical challenge even under fluoroscopic guidance.</p><p><strong>Objective: </strong>We aimed to develop an ultrasonographic method for quickly and accurately accessing the C2 DRG.</p><p><strong>Study design: </strong>This is a prospective, observational cohort study.</p><p><strong>Setting: </strong>Our study was conducted in the Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China.</p><p><strong>Methods: </strong>Unlike the C3-C8 foramina, which are ventral to the corresponding facet joints, the C2 foramen is positioned more posteriorly, dorsal to the C1-C2 atlantoaxial joint and longitudinally aligns with the cervical facet joints of C2-C3 and C3-C4. This unique anatomical feature allowed us to rapidly identify the C2 foramen in the sonographic longitudinal-axis view, what we call the \"Stage-light Sign.\" Further exposure of the C2 DRG in the oblique-axis view we call the \"Turtle Sign.\" The following procedural parameters were prospectively obtained: the time required to identify the C2 DRG target, the time needed to reach the target from the point of skin puncture, the number of puncture attempts required to reach the target, and the minimum sensory testing voltage to evoke paresthesia responses in the cutaneous occipital nerve distributions. Clinical outcomes were assessed by serial pain severity using the Numeric Rating Scale at baseline and up to 3 months post the C2 DRG pulsed radiofrequency ablation procedure.</p><p><strong>Results: </strong>The correct placement of the needle tip was initially confirmed with fluoroscopy, with the injected contrast medium distributed along the C2 spinal nerve. Importantly, electrical sensory stimulation elicited paresthesia in the headache area in all patients, with the required voltage being 0.35 ± 0.02 V. Furthermore, treatment outcomes supported the correct needle tip position, as pulsed radiofrequency ablation treatment led to sustained pain reduction. It took 36.2 ± 2.2 seconds to obtain the final \"TurtleSign\" view of the C2 DRG. Once the target was identified, it required a single puncture attempt to reach it, with a duration of 36.3 ± 2.5 seconds from puncturing the skin to reaching the target.</p><p><strong>Limitation: </strong>We only followed patients for up to 3 months postprocedure.</p><p><strong>Conclusion: </strong>We have developed an ultrasonographic method to quickly and accurately access the C2 DRG, which has the potential to greatly facilitate treating the C2 DRG for managing occipital neuralgia.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E927-E935"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770996","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":"Computed Tomography-guided Percutaneous Bilateral Neurolytic Celiac Plexus Block with Alcohol for Upper Abdominal Visceral Cancer Pain.","authors":"Bing Huang, Dan Wu, YaJing Chen, Yingjie Hua, Zhongwei Zhao, Xufang Huang, Qiaoying Rao, Lu Liu, Jianliang Sun","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The neurolytic celiac plexus block (NCPB) can be introduced through the posterior para-aortic, anterior para-aortic, posterior transaortic, or endoscopic anterior para-aortic puncture approach, as well as the posterior approach via the intervertebral disc. To reduce the complications of puncture, this block's original manual blind puncture technique can be improved upon by using a C-arm fluoroscope, computed tomography (CT), or an ultrasound, the last of which may be endoscopic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To observe the distribution of absolute alcohol and its analgesic effect on cancer-induced upper abdominal visceral pain during percutaneous NCPB through the anterior and posterior diaphragmatic crura under CT guidance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Clinical research study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Thirty-eight patients (19 men and 19 women) with advanced carcinomatous epigastric pain were enrolled in this study. The patients were 47-88 (mean, SD: 64.9 ± 8.8) years old, weighed 37-62 kg (mean, SD: 51.6 ± 12.3), and had a grade III or IV physical status on the classification system established by the American Society of Anesthesiologists. The left and right punctures were made through the T12-L1 intervertebral space under CT guidance. The left side was punctured through the paravertebral and diaphragmatic crura to the anterolateral side of the anterior abdominal aorta of the diaphragmatic crus; and the right side was punctured via the posterior approach through the intervertebral disc to the posterior abdominal aorta of the diaphragmatic crus and then to the exterior. A solution consisting of 8 mL of 1% lidocaine and 1 mL of 30% iohexol was injected. If this injectate wholly or partly surrounded the abdominal aorta, then injecting anhydrous alcohol was deemed practicable. Fifteen mL of absolute alcohol containing 10 mL iohexol were injected into the left and right sides 15 minutes later. The alcohol diffusion was observed by CT. The pain Visual Analog Scale was used to evaluate the analgesic effect before NCPB and one hour, one week, one month, 3 months, and 6 months after the treatment. Any treatment-related complications were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All patients were punctured at the predetermined position under CT guidance. Among the 23 patients whose injection of absolute alcohol surrounded the abdominal aorta completely, 19 (82.6%) stopped taking analgesic drugs altogether; of the 8 patients whose injection of absolute alcohol surrounded 75% of the abdominal aorta, 6 (75%) stopped taking oxycodone. In the 7 patients whose injection of absolute alcohol surrounded only 50% of the abdominal aorta, the pain was alleviated to varying degrees, but only 2 (28.6%) stopped taking oxycodone completely, and the other 5 patients still needed oral oxycodone. No ab","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E919-E926"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771199","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":"L5-S3 Compared to L5-S2 Full-Endoscopic Rhizotomy and Ablation Under a Navigation System for Sacroiliac Joint Pain: A Comparative Study.","authors":"Jae Hwan Lee, Kuo-Tai Chen, Ying-Chieh Chen, Chien-Min Chen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain (CLBP) with sacroiliac joint (SIJ) involvement is a prevalent issue in health care. Surgical intervention, employing an endoscopic technique with a navigation system, targets and ablates nociceptive nerve fibers associated with SIJ pain, although the clinical effect of omitting rhizotomy of the lateral sacral branch of S3 remains uncertain.</p><p><strong>Objectives: </strong>This study aimed to compare the clinical outcomes of 2 full-endoscopic rhizotomy and ablation (FERA) techniques for SIJ pain and to determine the effect of omitting rhizotomy of the lateral sacral branch of S3 on patient outcomes.</p><p><strong>Study design: </strong>This study adopted a retrospective cohort study design.</p><p><strong>Setting: </strong>This study was conducted at a single medical institution by a neurosurgeon.</p><p><strong>Methods: </strong>From January 2018 through March 2021, the records of 73 patients undergoing L5-S3 or L5-S2 FERA for SIJ pain associated with CLBP were retrospectively reviewed. The patients were evaluated using the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI) for functional disability, and MacNab criteria for satisfaction. The procedures were guided by 3-D robotic C-arm navigation. The L5-S3 FERA group underwent rhizotomy and ablation of the L5-S3 lateral branches, whereas the L5-S2 FERA group did not undergo rhizotomy of the S3 lateral sacral branch.</p><p><strong>Results: </strong>Both groups showed significant  improvements at one year in VAS and ODI scores with similar trends. The L5-S2 FERA group had a shorter operative time, particularly bilaterally, without complications. Although the L5-S3 FERA group initially presented a slightly higher recurrence rate at 6 months, their recurrence rate was equal with that of the L5-S2 FERA group at one year. Furthermore, the MacNab criteria showed comparable satisfaction rates in both groups.</p><p><strong>Limitation: </strong>This was a small retrospective study.</p><p><strong>Conclusion: </strong>L5-S2 FERA demonstrated clinical outcomes similar to those of L5-S3 FERA for pain relief, functional improvement, and satisfaction. Omitting S3 lateral branch rhizotomy did not adversely affect the outcomes. Surgeons may consider omitting S3 lateral branch rhizotomy for SIJ pain treatment, thereby reducing operative time while maintaining patient benefits.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E943-E951"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771231","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":"Mindfulness Meditation for Fibromyalgia Syndrome: A Systematic Review and Meta-analysis.","authors":"Shuo Meng, Chunfeng Cao, Minghua Zhang, Jing Dong, Minpeng Lu","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The effectiveness of mindfulness meditation (MM) for the treatment of fibromyalgia syndrome (FMS) is unknown and needs to be updated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed at investigating the effectiveness of MM for the treatment of FMS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search of relevant studies published from the databases' inception through April 12, 2023 was conducted within the following databases: Cochrane Library, Embase, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO. We included randomized controlled trials that reported at least one of the following outcome indicators: the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburg Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI), and the Perceived Stress Scale (PSS). Results are presented in terms of mean difference (MD), supplemented by 95% CIs The I2 statistic assessed heterogeneity across 3 distinct observational time frames. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to appraise the robustness of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ten randomized controlled trials were selected from 1,377 citations (n = 818). Various MM regimens were reported (type of mindfulness, duration, schemes, and ingredients). Among 818 patients, very low to moderate evidence indicated that MM could reduce FIQ in the short-term (MD = -6.20; 95% CI,-8.51 to -3.89; P &lt; 0.05; GRADE: moderate); a lower PSQI score (MD = -1.84; 95% CI, -3.35 to -0.33; P &lt; 0.05; GRADE: very low); a reduce BDI score (MD = -3.26; 95% CI, -5.77 to -0.76; P &lt; 0.05; GRADE: moderate); and a decreased PSS score (MD = -4.85; 95% CI, -8.22 to -1.49; P &lt; 0.05; GRADE: very low). At medium-term follow-up, MM consistently reduced the BDI score (MD = -2.88; 95% CI, -4.98 to -0.79; P &lt; 0.05; GRADE: moderate) and decreased the PSS score (MD = -2.76; 95% CI, -4.82 to -0.70; P &lt; 0.05; GRADE: moderate) but there was no significant difference in FIQ scores (MD = -2.78; 95% CI, -6.32 to 0.76; P &gt; 0.05; GRADE: low) and PSQI scores (MD = -1.28; 95% CI, -3.35 to -0.80; P &gt; 0.05; GRADE: very low). However, at long-term follow-up, MM still reduced FIQ scores (MD = -6.09; 95% CI, -9.01 to -3.16; P &lt; 0.05; GRADE: moderate).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The relatively small sample size and the average quality of the included studies may have introduced biases. The time and method of meditation in the included studies were not completely unified, and there were confounding factors. Additionally, the limited amount of available literature is a challenge. Despite focusing on randomized controlled trials, there is heterogeneity among these studies. Future research should aim for larger, higher-quality studies to address these limitations and provide a more comprehensive understanding of MM's effectiveness in fibromyalgia management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"479-494"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771249","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":"Predicting Responses to Interventional Pain Management Techniques for Chronic Low Back Pain: A Single-Center Observational Study (PReTi-Back Study).","authors":"Santiago Garcia-Hernandez, Fernando Higuero-Cantonero, Francisco de la Gala Garcia, Ángel Alonso Chico, Javier Blanco Aceituno, Sara Zapatero Garcia, José Laureano Aguilar Godoy, Javier Hortal Iglesias, Ana Esther Lopez Perez, Ignacio Garutti","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Exploring factors linked to the outcomes of certain interventional pain management techniques may optimize the selection of candidates for those procedures. Our hypothesis is that factors that influence responses to interventional therapies for chronic low back pain (CLBP) can be identified by analyzing a prospective cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our main aim is to identify the factors that may be associated with adult patients' responses to interventional therapies for the treatment of CLBP after 4 weeks of follow-up. Secondary objectives include the development of a predictive model and the establishment of a predictive score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;The PReTi-Back (Predicting REsponse to interventional Therapies In chronic BACK pain) study is an observational prospective single-center study, employing a nonprobability-sampling method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Our population consists of adult outpatients with CLBP in a chronic pain unit of a tertiary hospital. The procedures we evaluated included epidural steroid injections, medial branch blocks and denervations, dorsal root ganglion blocks, and pulsed radiofrequency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ratings on the Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) were measured at the baseline and after 4 weeks of follow-up. The primary outcome of the study was composite and was evaluated at 4 weeks. A positive response to an intervention was defined as the simultaneous occurrence of a decrease of at least 2 points in the NPRS score and a decrease of at least 20% in the ODI score. A predictive model was constructed using logistic regression analysis, which incorporated 14 variables selected in advance. A predictive score was developed based on the odds ratios of the model variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Four hundred patients were recruited. Of these patients, 368 completed follow-up, 49 were excluded, and 319 were included in the analysis. The interventional therapies provided a positive response to 85 patients (26.6%) at 4 weeks. Listhesis, radicular compression, and satisfaction with previous interventional therapies were positively associated with the positive response, and their ORs were close to 2. Meanwhile, obesity and persistent spinal pain syndrome type 2 (PSPS-2) had negative associations with the outcome, presenting ORs close to 0.5. The models were statistically significant and exhibited satisfactory goodness of fit. The area under the curve was 0.67 (95% CI, 0.60-0.74). Both models exhibited low sensitivity but high specificity. The synthesis of the prediction score had little impact on its discriminatory capacity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The subgroup analysis revealed that both listhesis and radicular compression were associated with the response to epidural therapies but not with the response to medial branch therapies. The score was efficient in ruling out those who would no","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E851-E863"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771310","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 Review of Etiological Biomarkers for Fibromyalgia and Their Therapeutic Implications.","authors":"Marc Russo, Danielle Santarelli, Peter Georgius, Paul J Austin","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fibromyalgia is a complex condition that has long puzzled the medical community. Hypotheses to explain the chronic widespread pain associated with the disease have evolved significantly over the years. However, research efforts to identify disease-specific biomarkers and develop effective treatments have been largely unsuccessful.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The goals of this study were to review potential etiological biomarkers for fibromyalgia, focusing on micro-inflammation and metabolic syndrome, and to discuss the clinical implications of the review findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A narrative review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Relevant literature was obtained via Medline/PubMed, using the following search terms: fibromyalgia[ti] (\"metabolic syndrome\" OR \"metabolic disease\" OR biomarker*[ti] OR micro-inflammation OR sub-inflammation OR \"low-level inflammation\" OR \"low-grade inflammation\"). Results were filtered for the English language and screened for inclusion in the review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Articles included in the review covered the topics of pain, immune response/inflammation, micro-inflammation, metabolic syndrome, gut dysbiosis, oxidative stress, and stress response. Various molecules have been proposed as pain biomarkers for fibromyalgia, including neurotransmitters, neuropeptides, growth factors, and cytokines with possible etiological relevance. Recent genome-wide expression profiling suggests connections among low-level inflammation, termed \"micro-inflammation,\" and the upregulation of genes involved in antibacterial and innate immune system response as well as those involved in clinical features, including high body mass index (BMI) and comorbid depression, in a subgroup of fibromyalgia patients. A set of 5 differentially expressed inflammatory genes have been identified as potential biomarkers of a micro-inflammation fibromyalgia subtype. Proposed triggers of micro-inflammation include bacterial disease and gut dysbiosis. Metabolic syndrome may be causative or consequential, while comorbid depression may be associated with dysbiosis and/or micro-inflammation through the gut-immune-brain axis. A potential new treatment approach based on this information has been proposed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;External validation of potential etiological biomarkers is needed. Further investigations to ascertain the involvement of metabolic syndrome and gut dysbiosis and support the proposed treatment paradigm are warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Fibromyalgia is likely the result of multiple causative factors, genetic and environmental. To date, no clear, reliable etiological biomarker for fibromyalgia has been identified. The considerable variability among patients suggests the presence of multiple disease subtypes with different pathophysiological mechanisms. Effective treatment therefore requires a multimodal, multidisciplinary approach that targ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"495-506"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771003","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}