Pain physician最新文献

{"title":"Atelocollagen vs. Prolotherapy in Partial-Thickness Supraspinatus Tears: A Prospective Randomized Controlled Trial with MRI-Confirmed Outcomes.","authors":"Eun Joo Choi, Joon Hee Lee, Dongsik Lim, Minhye Chang, Pyung Bok Lee","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Partial-thickness rotator cuff tears (PTRCTs) are a common cause of shoulder pain. The treatment options for this condition vary by tear characteristics and patient needs. Prolotherapy using a hypertonic dextrose solution promotes tissue regeneration by triggering an inflammatory response but may yield variable results. Recently, atelocollagen injections have emerged as a novel treatment for PTRCTs, offering pain relief and functional improvement by serving as a scaffold for tissue repair without causing additional tissue damage.</p><p><strong>Objectives: </strong>This study aims to compare the efficacy of prolotherapy with hypertonic dextrose to that of atelocollagen injections for managing pain, improving shoulder functionality, and enhancing structural healing at the tear site in patients with PTRCTs. The efficacy of these methods will be evaluated by follow-up magnetic resonance imaging (MRI).</p><p><strong>Study design: </strong>A prospective, randomized, observational study.</p><p><strong>Setting: </strong>Interventional pain management center at a university-affiliated hospital.</p><p><strong>Methods: </strong>Thirty-four patients with partial-thickness supraspinatus tears (PTSTs) were enrolled and randomly assigned to 2 groups: Group P received prolotherapy, and Group C received atelocollagen injections. The treatments (ultrasound-guided injections) were administered in 3 sessions at one-week intervals. The primary outcome was pain reduction, measured immediately after treatment and at 2 weeks, one month, and 3 months. Secondary outcomes were functional improvements measured with the Korean Shoulder Pain and Disability Index (K-SPADI) and the Shoulder Constant-Murley Scoring System (SCSS) at one and 3 months, as well as comparative MRI evaluations of the supraspinatus tear between the baseline and the 3-month marks.</p><p><strong>Results: </strong>Of the 34 patients, 28 completed the study. Group C (n = 15) showed significant pain relief from the baseline at both one and 3 months (P = 0.04 and P < 0.01) post-injection, whereas Group P (n = 13) showed significant pain reduction only at 2 weeks after the injection. MRI findings indicated better healing outcomes in Group C, in which improvements were observed in 4 patients as opposed to 0 patients in Group P. Similarly, 10 patients in Group P exhibited aggravated tear signs in follow-up MRI scans, while only 2 patients in Group C showed such aggravations. Functional scores improved in both groups (P < 0.01); however, no significant differences were observed.</p><p><strong>Limitations: </strong>The 3-month follow-up period was relatively short.</p><p><strong>Conclusions: </strong>In patients with PTSTs, atelocollagen injections provided more efficient pain relief and demonstrated greater structural improvements than did prolotherapy, as confirmed by MRI. While both treatments were associated with improved shoulder function, atelocollagen seemed to offer the add","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"299-306"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799798","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 \"Technique Considerations to Improve Efficacy in Sacroiliac Radiofrequency Ablation\".","authors":"Victor M Silva-Ortiz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E459-E460"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799802","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":"Promising Outcomes of Ultrasound-Guided Pulsed Radiofrequency for the Treatment of Morton's Neuromas - A Prospective Study.","authors":"Lucas Furtado da Fonseca, Fernando Gonzalez Correa, Jonathas Teixeira Salles, Rodrigo Cortes Vicente, Eduardo Souza Maciel, Tania Szejnfeld Mann, Jose Fabio Lana, Raffael Marum Bachir, Leonardo Fernandez Maringolo, Vinicius Felipe Pereira, Nacime Salomao Mansur, Madhan Jeyaraman, Swaminathan Ramasubramanian","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Morton's neuroma is a compressive neuropathy of the common plantar digital nerve, causing significant pain and limiting patients' activities.</p><p><strong>Objectives: </strong>This study aimed to investigate the effect of pulsed radiofrequency (PRF) on the pain, functionality, and quality of life experienced by patients with Morton's neuroma.</p><p><strong>Study design: </strong>This was a prospective study with pre- and post-intervention assessments after one, 3, and 6 months of treatment.</p><p><strong>Setting: </strong>The orthopedics department of an affiliated hospital.</p><p><strong>Methods: </strong>Patients with Morton's neuroma underwent treatment with ultrasound-guided PRF in 2 sites around the neuroma for 8 minutes. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire for assessing foot function, and the Short Form-36 (SF-36) for quality of life.</p><p><strong>Results: </strong>A total of 20 patients (29 feet) completed the 6-month minimum follow-up period. The VAS and face scale values at follow-up were statistically lower than the pre-procedure VAS scores (P < 0.05). The AOFAS and SF-36 values at follow-up were statistically higher than the pre-procedure values (P < 0.05). No significant adverse events were recorded during the follow-up.</p><p><strong>Limitations: </strong>The prospective research features a limited follow-up duration and lacks an additional group, whether control or treatment, for result comparisons.</p><p><strong>Conclusion: </strong>Applications of PRF decreased the pain and the improved functionality and quality of life experienced by patients with Morton's neuroma for a 6-month follow-up at minimum.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E385-E391"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799877","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 Safety and Outcome of Erector Spinae Plane Block in Patients Using Antiplatelets, Anticoagulants, or Peripheral Vasodilators.","authors":"Jae Y Lee, Ji H Hong, Ji H Park, Seung W Lee","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The erector spinae plane block (ESPB) is used in various clinical situations with good to excellent analgesic effectiveness. The ESPB can be performed safely even in patients with altered hemostasis. However, the safety of ESPB in patients being treated with antiplatelets and anticoagulants is based on limited clinical data, mostly from single case series.</p><p><strong>Objectives: </strong>The primary endpoint of this study was to identify any complications related to a thoracic or lumbar ESPB in patients using an antiplatelet, an anticoagulant, or a peripheral vasodilator without any preprocedure or postprocedure time interval. The secondary endpoint was to compare the clinical efficacy of ESPB in ischemic and nonischemic groups.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>The pain clinic of a tertiary university hospital.</p><p><strong>Methods: </strong>After careful reviewing of medical records, if patients were taking medications with antiplatelet, anticoagulant, or peripheral vasodilator properties, or combinations of these medications due to ischemic disease, they were assigned to the ischemic group. If patients were taking only a peripheral vasodilator due to cervical or lumbar spinal stenosis but did not have any ischemic disease, they were assigned to the nonischemic group. Right- or left-sided unilateral ultrasound-guided ESPB was performed depending on the patient's pain location.</p><p><strong>Results: </strong>There were only 2 patients who developed an adverse event: one each in the ischemic (1/103, 0.9%) and the nonischemic groups (1/149, 0.7%). These complications were irrespective to hematoma or bleeding. The post-ESPB Numeric Rating Scale scores for pain were significantly higher in the ischemic group than the nonischemic group at all measured time points (P < 0.001). However, there were no significant differences between the groups in the number of patients who experienced a >= 50% reduction in Numeric Rating Scale scores or in those who required spinal surgery due to inadequate ESPB efficacy.</p><p><strong>Limitation: </strong>The actual incidence of complications might be underestimated since this study did not include any unreported complications due to its retrospective data collection.</p><p><strong>Conclusion: </strong>In our study, ESPB had a complication rate less than 1% which was irrespective of bleeding. Hematoma or bleeding did not occur in either group. The ischemic group demonstrated lower clinical efficacy with ESPB than the nonischemic group.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"321-327"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799810","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":"Preemptive Acetaminophen for Postoperative Analgesia in Children Undergoing Surgery: A Systematic Review and Meta-Analysis.","authors":"Xin-Yi Hua, Ru-Yi Zhang, Hua Xie, Zhong-Xian Zhu, Wei-Bing Tang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Preemptive analgesia is an antinociceptive intervention aimed at inhibiting hyperexcitability in both the peripheral and central nervous systems, diminishing the intensity of postoperative pain. Pre-analgesic acetaminophen has been employed extensively in diverse surgical procedures among adult individuals; however, its efficacy in pediatric patients remains controversial.</p><p><strong>Objectives: </strong>This review aimed to evaluate the impact of preemptive acetaminophen on postoperative pain, rescue analgesia, and nausea and vomiting in children.</p><p><strong>Study design: </strong>A meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Setting: </strong>The electronic databases of PubMed, EMBASE, Cochrane Library, Web of Science, and Sino-Med were searched. The protocol was previously registered in the PROSPERO database under the registration number CRD 42023469972.</p><p><strong>Methods: </strong>We adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Thirteen RCTs examining the effects of preemptive APAP in pediatrics were incorporated. The risk of bias for each included study was independently assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. A systematic review and meta-analysis were performed using Review Manager Software version 5.4.</p><p><strong>Results: </strong>A total of 13 studies, observing 718 patients, were included. Our research found that children who received preoperative acetaminophen had a reduction in pain scores within one-2 hours (standardized mean difference [SMD], -2.83; 95% confidence interval [CI], -3.69 to -1.96; P < 0.001), and 6-8 hours (SMD,-2.23; 95% CI, -2.84 to -1.61; P < 0.001) postoperatively on the VAS scale and a lower incidence of rescue analgesia (odds ratio [OR], 0.50; 95% CI, 0.3-0.82; P = 0.006).</p><p><strong>Limitations: </strong>The main limitation of this meta-analysis is the potential bias in the few studies included.</p><p><strong>Conclusion: </strong>Preemptive acetaminophen in pediatric patients could effectively alleviate postoperative pain and decrease the need for additional rescue analgesic interventions.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E359-E369"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799876","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 \"A Nomogram Model for Predicting Postherpetic Neuralgia in Patients with Herpes Zoster: A Prospective Study\".","authors":"Tugba Yagan, Ridvan Isik, Ayhan Kamanli","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E461"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799800","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":"Applying a Preoperative Planning Method Based on 3D Artificial Intelligence-generated Lumbar Models in Transforaminal Puncture: A Phantoms Study.","authors":"Zhihai Su, Chengjie Huang, Zhifei Cui, Yunfei Wang, Wencong Zhang, Lei Zhao, Shumao Pang, Naiwen Zhang, Libin Liang, Zhen Yuan, Qianjin Feng, Xiang Liu, Tao Chen, Hai Lu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Transforaminal puncture is a critical element of lumbar transforaminal epidural steroid injections used to manage lumbar radicular pain. Numerous challenges persist, owing to the intricate 3-dimensional (3D) anatomy of the spine and the delicate nature of the neurovascular structures involved. Consequently, performing the puncture expeditiously, precisely, and safely is imperative. Although numerous scholars have explored methods for reconstructing 3D lumbar models from patient data, the practical application of these models in puncture path planning for transpedicular procedures remains limited. Approaches based on artificial intelligence offer promising advantages for constructing patient-specific 3D models to facilitate puncture pathways planning.</p><p><strong>Objective: </strong>In this experimental study, we proposed a preoperative planning method utilizing 3D artificial intelligence-generated lumbar models to improve the accuracy and efficiency of the transforaminal puncture process.</p><p><strong>Study design: </strong>A phantoms study.</p><p><strong>Setting: </strong>The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, P.R. China.</p><p><strong>Methods: </strong>A total of 24 puncture trials utilizing 12 phantom models were independently conducted by 2 surgeons, employing our developed preoperative planning method and conventional fluoroscopy. After one month, one of the surgeons repeated the procedure. Puncture error, characterized by the discrepancy between the preoperative planning puncture target and the actual postoperative needle puncture point (measured in millimeters), as well as puncture procedure duration (measured in minutes), were evaluated by comparing the newly developed preoperative planning method with the traditional fluoroscopy method employed in the transforaminal puncture process.</p><p><strong>Results: </strong>The average puncture error associated with the preoperative planning method was significantly lower than the conventional fluoroscopy method (3.33 ± 0.73 mm vs 5.25 ± 0.92 mm, P < 0.001). Additionally, the average puncture time of the preoperative planning method was significantly shorter than the conventional fluoroscopy method (7.29 ± 0.95 minutes vs 11.48 ± 1.27 minutes, P < 0.001).</p><p><strong>Limitations: </strong>Our study used a small number of models; additional clinical trials are required to validate our preoperative planning methods.</p><p><strong>Conclusion: </strong>The preoperative planning method utilizing 3D artificial intelligence-generated lumbar models for transforaminal puncture demonstrated superior accuracy and efficiency in phantom trials over the traditional fluoroscopic method. This newly developed preoperative planning technique has the potential to significantly improve the accuracy and efficiency of the transforaminal puncture process.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E347-E357"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799841","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":"Application of Glucocorticoids in Minimally Invasive Interventional Pain Management: Chinese Expert Panel-Based Guideline: Expert Panel of Special Training Project on Pain Management of National Health Commission Capacity Building and Continuing Education Center.","authors":"Ke Ma, Zhiying Feng, Yongjin He, Deshou Luo, Jinfeng Liu, Shibao Lu, Xiaoguang Liu, Xuewu Lin, Longxi Ren, Guangyun Sun, Tao Song, Hongpei Wang, Jianshe Yu, Zhigang Zhuang, Yanqing Liu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Glucocorticoids (GCs) are widely used in clinical practice. Through minimally invasive intervention technology, GCs act on lesions accurately. This route of administration is superior to others. However, GCs are often applied irrationally, and serious adverse reactions frequently ensue.</p><p><strong>Objectives: </strong>The aim of this review is to provide an expert consensus for the application of GCs in minimally invasive interventional-administration routes and thereby develop a consistent philosophy among the many diverse groups interested in the use of GCs.</p><p><strong>Setting: </strong>The Expert Panel of Special Training Project on Pain Management of National Health Commission Capacity Building and Continuing Education Center.</p><p><strong>Methods: </strong>We set up the Expert Panel of Special Training Project on Pain Management of National Health Commission Capacity Building and Continuing Education Center from various specialties and groups and performed the study of GC-related objectives and vital issues. The center reviewed the literature on the use, effectiveness, and adverse outcomes of GCs in accordance with evidence-based medicine principles, evaluated the quality of evidence by synthesizing existing literature, and utilized grading for recommendation.</p><p><strong>Results: </strong>The grading recommendations for the application of GCs were formed to standardize said application. The center recommended that the principles of minimally invasive intervention of GCs be as follows: 1) Suspending GCs is not recommended for the cervical and thoracic epidural block or the radicular block if imaging monitoring is unavailable; 2) For drug compatibility, drugs other than normal saline, local anesthetics, and GCs are not recommended; 3) For treatment of epidural and selective radicular blocks within 6 months, intermediate- and long-acting GCs should not be used more than 3 times, while short-acting GCs should not be used more than 5 times; 4) GCs can be injected intraarticularly once every 3 months for up to 2 consecutive years. The frequency of intraarticular GC injections should be determined based on the severity of the patient's conditions and symptoms, as well as the preferences of the medical staff and patient; 5)GCs are not recommended for sympathetic blocks. In addition, the expert team made detailed grading recommendations for the indications, contraindications, minimally invasive interventional-administration routes, and specific operations of GCs.</p><p><strong>Limitations: </strong>Lack of high-quality RCTs.</p><p><strong>Conclusions: </strong>The expert consensus was established on the basis of comprehensive review of the literature and consensus among the panelists. Consequently, different minimally invasive routes of GC administration recommend different doses and courses to standard the use of GCs.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E411-E420"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799840","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":"Innervation Patterns of the Anterior and Posterior Ligamentous Region of the Sacroiliac Joint: Insights from a Cadaveric Study.","authors":"Yubo Sun, Nizhou Jiang, Zhijin Wang, Yu Liu, Jian Jiang","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In addition to the sacroiliac joint (SIJ) itself, the anterior and posterior ligaments of the SIJ are also sources of pain in the SIJ complex. Nevertheless, detailed descriptions of the nerves that supply the anterior and posterior ligamentous areas of the SIJ are lacking in the literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The purpose of this study was to examine the anatomical characteristics of the lumbar and sacral nerve branches, which are primarily responsible for the pain signal pathway in the SIJ complex and are distributed within the anterior and posterior ligaments of the SIJ.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A dissection-based study of 10 embalmed human cadavers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The research took place at Central Hospital of Dalian University of Technology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 20 SIJs were examined in this study. The research focused on measuring the angles formed by the lateral branches of the ventral ramus of L4-L5 and the vertical axis, as well as the angles formed by the lateral branches of the posterior ramus of S1-S4 and the vertical axis. The distance from the lateral branches of the sacral posterior ramus to the posterior median line, specifically at a point 8 mm away from the edge of the posterior sacral foramen (PSFs), was also measured.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The angles formed by the lateral branches of the ventral ramus of L4-L5 and the vertical axis were measured to be 43° ± 6° and 25° ± 2°, respectively. Similarly, the angles formed by the lateral branches of the posterior ramus of S1-S4 and the vertical axis were found to be approximately 39° ± 6°, 48° ± 12°, 43° ± 12°, and 44° ± 6°, respectively. At a distance of 8 mm from the PSFs, the distances from the lateral branches of the sacral posterior ramus to the posterior median line were approximately 20-30 mm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The study is subject to certain constraints, including the utilization of preserved specimens that may have resulted inadvertently in damage to the lateral branches of the sacral ventral ramus during anatomical dissections. Furthermore, the study was limited by a small sample size and difficulties in controlling the movement of nerve fibers during data collection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In the event that the lateral branch capture rate of the perioral bipolar leapfrog technique attains 100%, it is imperative to delineate bipolar lesions in the superolateral and inferolateral quadrants of each PSF. Moreover, when employing the lateral pathway of the PSFs for lateral branch radiofrequency ablation (RFA), it is recommended that the radiofrequency (RF) needles be positioned at a minimum distance of 30 mm from the posterior midline to mitigate the risk of inadvertent thermal injury to the spinal nerves. The lateral branches of the lumbar posterior ramus should also be denervated during the RFA. If the patient's pain symptoms are still not ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"E393-E402"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799873","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 Systematic Review And Meta-Analysis Of Randomized Trials Of Therapeutic Intraarticular Facet Joint Injections In Chronic Axial Spinal Pain.","authors":"Laxmaiah Manchikanti, Emilija Knezevic, Aleksandar Sic, Nebojsa Nick Knezevic, Alan D Kaye, Mahendra Sanapati, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic axial spinal pain remains a leading cause of disability. Therapeutic interventional modalities for managing axial spinal pain of facet joint origin include intraarticular injections, facet joint nerve blocks, and radiofrequency neurotomy.Based on multiple randomized controlled trials (RCTs), systematic reviews, and clinical guidelines, the evidence supporting intraarticular facet joint injections is rated as Level III, with a weak to moderate recommendation for managing spinal facet joint pain.</p><p><strong>Objective: </strong>To evaluate intraarticular facet joint injections as a therapeutic option for managing chronic axial spinal pain of facet joint origin.</p><p><strong>Study design: </strong>A systematic review and meta-analysis of RCTs involving intraarticular facet joint injections, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across multiple databases from 1966 through February 2025, including manual searches of bibliographies from known review articles. The methodological quality and risk of bias for the included studies were assessed.Evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. The level of evidence was classified using a modified best evidence synthesis, ranging from Level I to Level V.</p><p><strong>Outcome measures: </strong>The primary outcome measure was the proportion of patients achieving significant pain relief and functional improvement of more than 50% for a minimum of 3 months. Duration of relief was categorized as short-term (< 6 months) and long-term (> 6 months).</p><p><strong>Results: </strong>This analysis identified 12 high-quality and 2 moderate-quality RCTs based on Cochrane review criteria, and 11 high-quality and 3 moderate-quality RCTs based on Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) criteria. Based on grade assessment, there were no high quality trials.Evidence synthesis using both qualitative and quantitative analyses, along with GRADE assessment, indicated Level IV (limited evidence), with low certainty and a low level of recommendation.</p><p><strong>Limitations: </strong>The primary limitation is the continued paucity of high-quality literature.</p><p><strong>Conclusion: </strong>Based on qualitative analysis and GRADE assessment, intraarticular facet joint injections are supported by Level IV evidence, with limited quality, low certainty, and a low strength of recommendation.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 4","pages":"261-286"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799839","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}