Pain physician最新文献

{"title":"Macrophages of CNS and DRG in Postherpetic Neuralgia: From Pathobiology to Therapeutic Frontiers.","authors":"Ting Luo, Jinhua Zhang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Postherpetic neuralgia (PHN), the most common complication of herpes zoster (HZ), is a type of neuropathic pain. Described as the presence of chronic, persistent, debilitating pain, PHN impairs patients' quality of life significantly. Currently, numerous clinical interventions for PHN have been developed, each demonstrating various curative effects. However, these interventions are often accompanied by limitations such as high recurrence rates and inconsistent therapeutic outcomes. Further efforts are still needed to explore effective treatments for PHN.</p><p><strong>Objective: </strong>Our aim was to provide a comprehensive review of the latest research findings on the mechanism of the macrophages of the central nervous system (CNS) and dorsal root ganglion (DRG) in PHN. We focused on the symptomatic and etiological treatments of PHN.</p><p><strong>Study design: </strong>A narrative review.</p><p><strong>Methods: </strong>We searched PubMed for all articles on macrophage-related mechanisms in the CNS and DRG in cases of PHN, as well as all literature on PHN treatment strategies, with a focus on therapeutic measures that targeted neural inflammation and injury.</p><p><strong>Results: </strong>Microglial activation in the spinal dorsal horn (SDH) and macrophage expansion in the DRG are major mechanisms underlying PHN. The therapeutic strategies for managing PHN include symptomatic and etiological treatments. The former involve medications, nerve blocks, and neuromodulation. The latter, meanwhile, focus on autologous biomaterials, such as autologous fat, bone-marrow aspirate concentrate (BMAC), autologous plasma, and serum, which specifically target neural inflammation and injury.</p><p><strong>Limitations: </strong>Therapeutic interventions for PHN, especially those employing autologous biomaterials, are still lacking multicenter, large-sample, high-quality studies to provide robust evidence and guide clinical application of the treatments.</p><p><strong>Conclusion: </strong>Patients with PHN, especially those with refractory pain, endure profound and unremitting suffering. Therefore, the quest for interventions that can achieve stable and substantial improvements in patients' conditions is both urgent and of critical clinical importance.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"493-503"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075673","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":"Optimizing the Interpretation of Genicular Nerve Radiofrequency Ablation Outcomes.","authors":"Timur Ekiz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 6","pages":"E759"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075721","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":"Response to \"Methodological Notes on a Placebo-Controlled Trial of GCSB-5 in Lumbar Disc Herniation\".","authors":"Min Cheol Chang","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"E441"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670375","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":"Impact of Serum Magnesium Levels on Outcomes After Transforaminal Epidural Steroid Injections for Lumbar Radicular Pain: A Retrospective Study.","authors":"Salim Taner Gozukizil, Halil Ibrahim Altun, Fatma Aysen Eren","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Transforaminal epidural steroid injections (TFESIs) are a commonly used intervention for the management of lumbar radicular pain. While anatomical predictors of pain conditions like nerve compression severity, are well-known, the role of patient-specific metabolic factors has received comparatively less attention. Meanwhile, magnesium (Mg), a natural N-methyl-D-aspartate (NMDA) receptor antagonist, plays a major role in pain modulation and the prevention of central sensitization.</p><p><strong>Objectives: </strong>To investigate the association between pre-procedural serum magnesium levels and the clinical success of TFESIs.</p><p><strong>Study design: </strong>A retrospective observational cohort study.</p><p><strong>Setting: </strong>A tertiary referral center, Istanbul, Türkiye.</p><p><strong>Methods: </strong>Data from 121 patients undergoing single-level TFESIs were analyzed. The severity of each patient's radiological nerve root compression was graded using magnetic resonance imaging (MRI)-based criteria. With the use of an evidence-based cutoff value of 0.85 mmol/L to identify subclinical deficiency, the patients were categorized into groups labeled Low-Mg (< 0.85 mmol/L, n = 29) and Normal-Mg (≥ 0.85 mmol/L, n = 92). Clinical progress was tracked using the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) at baseline, one month, and 3 months. Treatment success was defined as ≥ 50% pain relief and ≥ 40% functional improvement.</p><p><strong>Results: </strong>Despite comparable radiological nerve compression grades, patients in the low-Mg group reported significantly higher baseline pain intensity than did those in the normal-Mg group (9.65 vs. 8.15, P < 0.001). Post-procedural outcomes were significantly better in patients with normal Mg levels. Success rates differed significantly between the groups: 71.7% vs. 20.7% at one month (P < 0.001), and 66.3% vs. 34.5% at 3 months (P = 0.002). Correlation analysis suggested a possible threshold effect, with outcomes deteriorating below the defined Mg cutoff rather than following a linear dose-response relationship.</p><p><strong>Limitations: </strong>Limitations include the study's retrospective design, the lack of dietary intake data, and the reliance on serum rather than ionized Mg measurements.</p><p><strong>Conclusion: </strong>Low serum Mg levels (< 0.85 mmol/L) are associated with higher baseline pain intensity and a poor therapeutic response to TFESIs. Screening patients for their Mg levels represents a simple and potentially modifiable factor that may help improve injection outcomes, warranting consideration for supplementation in borderline cases.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"369-375"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670210","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":"Sphenopalatine Ganglion Block's Effect on Pain Control in Septorhinoplasty Surgeries.","authors":"Suheda Akbulut, Mesure Gul Nihan Ozden","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Postsurgical pain and discomfort from septorhinoplasty have been shown to exert a detrimental effect on patients, including their functional recovery, satisfaction levels, and overall quality of life. Although the sphenopalatine ganglion block (SPGB) has been shown to provide effective pain control for rhinoplasty, different application techniques are available. The application of local anesthesia into the sphenopalatine fossa in the form of a drip is a simple technique that is easier and faster to apply than other techniques.</p><p><strong>Objectives: </strong>Our study investigated the effect of a sphenopalatine ganglion block applied presurgically as a noninvasive pain management method for septorhinoplasty.</p><p><strong>Study design: </strong>A retrospective nonrandomized trial.</p><p><strong>Setting: </strong>Our retrospective study included 100 patients who had a septorhinoplasty who also met specific inclusion criteria.</p><p><strong>Methods: </strong>The data of patients who had septorhinoplasty were examined. One group of patients had a presurgical SPGB administered via transnasal catheter- an18G intravenous branula-with 2 mL of 0.5% bupivacaine as well as submucosal anesthesia infiltration. The other group only had submucosal anesthesia infiltration. The intrasurgical consumption of remifentanil, hemodynamic parameters, postsurgical pain levels, additional analgesic use, and patient and surgeon satisfaction were compared.</p><p><strong>Results: </strong>The consumption of remifentanil was found to be lower in the SPGB Group. There was a lower requirement for analgesia and a higher level of patient satisfaction in the SPGB Group. Pain scores in the first 2 postsurgical hours were lower in the SPGB Group, but no differences were observed in later hours.</p><p><strong>Limitations: </strong>The limitations of this study include the relatively small sample size and the lack of long-term follow-up to evaluate the long-term benefits of an SPGB and its effect on chronic pain developing.</p><p><strong>Conclusion: </strong>Our study shows the safety and efficacy of a presurgical SPGB administered via transnasal dripping without needle injections in septorhinoplasty surgery. The block had positive results in terms of intrasurgical opioid consumption reduction and beneficial effects on postsurgical pain. It can thus be considered a beneficial adjunct in clinical practice for patients undergoing septorhinoplasty.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"E429-E435"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670361","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":"Cervical Erector Spinae Plane Block vs. Epidural Steroid Injection for Cervical Radicular Pain: A Clinical Trial.","authors":"Mahmoud Reza Alebouyeh, Farnad Imani, Saeid Reza Entezary, Poupak Rahimzadeh, Masood Mohseni, Sajede Salehi, Sara Saadat, Payam Hoshyar Azar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cervical radicular pain is a common chronic pain syndrome, typically managed with conservative treatments. In patients unresponsive to conservative management, minimally invasive interventions, such as an interlaminar cervical epidural steroid injection (ICESI), are employed. The cervical erector spinae plane block (ESPB), initially utilized at the upper thoracic level, has shown promise for managing cervical radicular pain and may serve as an alternative to an ICESI.</p><p><strong>Objective: </strong>Our study compared the efficacy of ICESIs and cervical ESPBs in patients with cervical radicular pain that was refractory to conservative treatment.</p><p><strong>Study design: </strong>A randomized, double-blind, controlled trial.</p><p><strong>Setting: </strong>Rasool Akram Hospital, pain clinic and pain operating room, Department of Anesthesia and Pain Medicine, Iran University of Medical Science, Tehran, Islamic Republic of Iran.</p><p><strong>Methods: </strong>In this randomized clinical trial, 30 patients with cervical radicular pain that was unresponsive to conservative therapy were randomized into 2 groups: ICESI Group and ESPB Group. Outcomes were assessed at baseline, and at the 2- and 8 weeks postprocedure follow-ups using the Neck Disability Index (NDI) and the Numeric Rating Scale (NRS-11).</p><p><strong>Results: </strong>Both groups demonstrated significant reductions in pain intensity and improvements in functional status (P < 0.05). No significant differences in mean (SD) NRS-11 scores were recorded between the groups at 2 weeks (ICESI: 3.93 [1.87] vs. ESPB: 3.73 [1.98], P = 0.778) and 8 weeks (ICESI: 3.53 [2.92] vs. ESPB: 4.93 [3.06], P = 0.211). However, the ICESI group showed significantly greater improvement in mean (SD) NDI scores at both follow-up intervals (11.870 [6.812] vs 19.670 [7.715], P = 0.007, at 2 weeks; 10.070 [8.216] vs 19.000 [9.577], P = 0.011, at 8 weeks follow-up).</p><p><strong>Limitations: </strong>The limitations of this study are its short follow-up times and small sample size.</p><p><strong>Conclusion: </strong>Cervical ESPBs are as effective as ICESIs in reducing pain and improving function in patients with cervical radicular pain. Given its comparable efficacy and potentially fewer adverse effects, ESPBs may be considered a suitable alternative to ICESIs in this patient population.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"E375-E381"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of Dexmedetomidine and Esketamine on Postoperative Sleep Disturbances and Analgesia: A Systematic Review and Network Meta-Analysis.","authors":"Ting Jiang, Rui Zhao, Yingli Zhang, Rui Zhang, Xiuqing Wu, Lina Jin, Yukun Huang, Yiwei Zhang, Wojciech Czyzewski, Grzegorz Staskiewicz, Karol Pruszynski, Changshun Huang, Binbin Zhu","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postoperative sleep disturbance (PSD) is a complication that often follows surgery. The condition is closely associated with impaired recovery, heightened pain sensitivity, and increased risk of chronic postsurgical pain. While pharmacological interventions like dexmedetomidine and esketamine have been reported to improve perioperative sleep quality, their comparative efficacy-particularly in the realm of analgesia-remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This review aimed to evaluate the efficacy of dexmedetomidine and esketamine in treating PSDs and providing analgesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs) that compared the effects of dexmedetomidine, esketamine, and control interventions on adult surgical patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Comprehensive literature searches were performed in 4 electronic databases from their inception to August 1st, 2025. The protocol was previously registered in the PROSPERO database under the registration number CRD420251126227.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The primary outcomes were postoperative pain scores assessed using the Visual Analog Scale (VAS) at 24 and 48 hours. Secondary outcomes included the incidence of PSD, Athens Insomnia Scale (AIS) scores, and sleep quality measured on the Numerical Rating Scale (NRS). Subjective sleep outcomes were synthesized using a Bayesian network meta-analysis. Additionally, a supplementary traditional meta-analysis was performed on studies that used polysomnography (PSG) to evaluate objective sleep architecture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ten RCTs involving 645 patients were included in the study. Esketamine demonstrated significantly superior analgesic efficacy, substantially reducing VAS pain scores both at rest and during movement at 24 and 48 hours postoperatively. Compared to the control, both esketamine and dexmedetomidine showed a tendency to reduce the incidence of PSD on the first postoperative day (esketamine: risk ratio [RR] = 0.655, 95% credible interval [CrI]: 0.517-0.798; dexmedetomidine: RR = 0.773, 95% CrI: 0.434-1.23) and improved AIS and NRS scores. A supplementary meta-analysis of 4 PSG studies (n = 182 patients) indicated that dexmedetomidine increased the percentage of stage N2 sleep (mean difference [MD] = 13.0%, 95% confidence interval [CI]: -5.2 to 31.2) and the odds of experiencing stage N3 sleep, although the latter finding was not statistically significant (odds ratio [OR] = 2.99, 95% CI: 0.61 to 14.66).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The primary limitation on this study is that the trials included were all conducted in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Both dexmedetomidine and esketamine improve postoperative sleep quality effectively. Esketamine demonstrates superior analgesic efficacy and has the higher probability being the optimal treatment for reducing early PSD incid","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"E325-E336"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670066","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":"Osteogenic Pain: A \"Novel\" Concept Based on Rodent and Human Studies.","authors":"Ricard Plancarte, Sudhir A Diwan, Alaa A Abd-Elsayed, Mojdeh Sarzaeim, B Carolina Hernandez-Porras, Juan Miguel Jimenez-Andrade","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The chronic bone pain associated with various skeletal conditions poses significant challenges to clinical management. Current treatments, which often rely on systemic opioids, come with adverse effects, emphasizing the need for safer alternatives. Understanding the neurobiology of bone pain and exploring novel therapeutic avenues for the condition are critical for improving patient outcomes.</p><p><strong>Objectives: </strong>This review aims to examine recent preclinical studies elucidating the mechanisms underlying bone pain and to propose an innovative concept, known herein as osteogenic pain, to aid in relieving it.</p><p><strong>Study design: </strong>A comprehensive review of preclinical studies investigating bone pain mechanisms and treatment approaches was conducted. Literature focusing on the interaction between neurons and bone microenvironment cells was examined, as was literature concerning the development of nonopioid analgesics targeting peripheral processes.</p><p><strong>Results: </strong>This review highlights the intricate interactions among neurons, immune cells, osteoclasts, and osteoblasts within the bone microenvironment that contribute to the pathophysiology of bone pain. The study identifies the increased excitability of primary afferent neurons as a crucial factor in bone pain development, and a new concept of osteogenic pain is proposed.</p><p><strong>Limitations: </strong>The translation of preclinical findings to clinical settings requires further validation, highlighting the need for more clinically relevant animal models and experimental methods.</p><p><strong>Conclusion: </strong>The proposal of \"osteogenic pain\" as a new concept underscores the need for improved clinical methods of treating bone pain and validated tools for the assessment and diagnosis thereof. The future of bone pain management lies in exploration, including targeting peripheral processes and leveraging innovative therapies, interventional techniques, and inclusive integration of artificial intelligence into them. Through new tools for assessment and monitoring, these efforts may provide patients who have bone disorders with better pain relief and improved quality of life.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"E363-E374"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670299","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":"Dual Stellate Ganglion Blocks for Managing Treatment-Resistant Anxiety Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"G Niraj, Varsha Karanth, N Charan, Shruti Niraj, A Aiswarya, Paul Bassett","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Anxiety disorders are associated with a high burden of illness. In patients with treatment-resistant anxiety disorder, management options can be limited. Stellate ganglion block has been reported to reduce anxiety symptoms in Posttraumatic Stress Disorder.</p><p><strong>Objectives: </strong>We aimed to determine dual stellate ganglion block's effectiveness for reducing anxiety symptoms in moderate to severe treatment-resistant anxiety disorder.</p><p><strong>Study design: </strong>This double blinded, sham procedure, randomized controlled trial used a 2:1 active treatment to sham (control) treatment ratio.</p><p><strong>Setting: </strong>Pain Medicine clinic at Sri Madhusudan Sai Institute of Medical Sciences & Research, a tertiary care medical college in the Republic of India.</p><p><strong>Methods: </strong>Study patients were screened by an interdisciplinary team comprising a pain medicine physician, a psychiatrist, and a clinical psychologist. Participants and assessors were blinded. Adult patients with treatment-resistant moderate to severe anxiety disorder (a Generalized Anxiety Disorder-7 [GAD-7] scale score of ≥ 10) were included in the study. Patients with Posttraumatic Stress Disorder were excluded. Patients received either dual ultrasound-guided stellate ganglion blocks or a sham treatment.</p><p><strong>Results: </strong>The primary outcome measure was the GAD-7 scale score at postintervention week 4. Of 87 screened individuals, 63 were eligible (72.4%); 20 were men and 43 were women; mean (SD) age, 38.4 (10.3) years. They were randomized (42 to the Stellate Ganglion Blocks Group and 21 to the Control (Sham) Group; 62 (98.4%) completed the study. In an intent-to-treat analysis, the mean total GAD-7 score change at postintervention week 4 was -9.6 points for the Stellate Ganglion Blocks Group, compared with -3.6 points for those receiving the sham/control treatment (mean difference -6.2; 95% CI,-9.3 to -3.2; P < 0.001).</p><p><strong>Limitations: </strong>This was a single-center study with a limited follow-up period.</p><p><strong>Conclusion: </strong>In this trial of patients with treatment-resistant anxiety disorder, dual stellate ganglion blocks were effective in reducing GAD-7 scores for 12 weeks postintervention. Further studies are recommended to assess the durability beyond 12 weeks and elucidate the mechanism of action of stellate ganglion block.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"327-334"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670182","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":"Safety and Effectiveness of Different Approaches for Epidural Steroid Injections in Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis.","authors":"Igor Wilderman, Francesca Sarzetto, Tina Didari, Rotem Frish Manor, Seyed Kourosh Ghavami Riabi","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Lumbar canal stenosis is a common degenerative disorder that causes pain and functional alterations. Epidural steroid injections (ESIs) are often used to treat the symptoms of this condition; however, treatment protocols can vary significantly, and no standardized practice for the management of lumbar canal stenosis has been established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To identify the optimal method of administration for maximizing the effectiveness and duration of pain relief and functionality improvements provided by ESIs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched PubMed, Google Scholar, ScienceDirect, CINAHL, EMBASE, and OVID for clinical trials published from January 2000 to December 2025 that examined the effectiveness of different ESI protocols to ameliorate pain and functionality in spinal stenosis patients. The search terms included (\"lumbar spinal stenosis\" OR \"lumbar canal stenosis\" or \"lumbar foraminal stenosis\") AND \"epidural steroid/corticosteroid injection(s)\" AND (\"interlaminar\" OR \"caudal\" OR \"transforaminal\" OR \"route\"). Studies that met exclusion criteria were those that did not use human patients, that were not focused on lumbar stenosis, that had no consistent protocol, or did not express their outcomes as decreases in pain intensity. The risk of bias was assessed with the Cochrane RoB2 tool. We conducted a meta-analysis on the data from individual groups extracted from different studies, including sub-group and meta-regression analyses, to identify variables with significant effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 33 groups (comprising 1,350 patients) were extracted from 24 studies, with results from one week to 12 months after the injection. Most studies reported significant pain relief up to 3 months from the injections, and some reported that such pain relief persisted even after a year. Of all the factors that influenced the results, the type of steroid used had the greatest effect, with betamethasone providing the greatest and more prolonged relief. Triamcinolone and methylprednisolone offered similar initial levels of pain relief, though it decreased more rapidly, whereas dexamethasone showed the lowest level of benefits. Moreover, the pain relief effect was significantly weaker in patients with severe stenosis, and functionality improvements were also limited in patients with moderate/severe stenosis. In contrast, route of administration (transforaminal, interlaminar, or caudal), dose size, and other parameters showed no significant differences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Most groups included in the analysis were small, with 22 of the 33 (66.7%) having fewer than 50 patients, and only one group including more than 100. Furthermore, the results overall were significantly heterogeneous, and the follow-up times varied, meaning that some subgroups had only one result or none whatsoever at certa","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"E337-E361"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670363","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}