Pain physician最新文献

{"title":"Toward A Naturalistic Neuroethics of Pain Care.","authors":"James Giordano, John R Shook","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1123-E1127"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838688","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":"Escalating Growth to Rapid Decline of Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain in the Medicare Population: Updated Analysis of the Effect of Multiple Factors from 2000 To 2022.","authors":"Laxmaiah Manchikanti, Alaa Abd-Elsayed, Alan D Kaye, Vidyasagar Pampati, Mahendra R Sanapati, Devi E Nampiaparampil, Nebojsa Nick Knezevic, Amol Soin, Christopher G Gharibo, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The use of facet joint interventions for spinal pain management experienced rapid growth between 2000 and 2010, with an annual increase of 14.2%. However, this trend slowed significantly from 2010 to 2019, with a reduced growth rate of just 2.9% annually. A more recent analysis highlighted a steep decline in facet joint interventions and sacroiliac joint injections, with an overall decrease of 33.2% and an annual decline rate of 12% per 100,000 Medicare beneficiaries between 2019 and 2022.</p><p><strong>Objective: </strong>This study aims to update and analyze utilization patterns of facet joint interventions for chronic pain management in the U.S. Medicare population over three periods: 2000-2010, 2010-2019, and 2019-2022.</p><p><strong>Study design: </strong>A retrospective cohort study analyzing utilization trends and influencing factors for facet joint interventions in the FFS Medicare population in the United States from 2000 to 2022.</p><p><strong>Methods: </strong>Data were obtained from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary database (2000-2022). Utilization rates were calculated based on Medicare beneficiaries for each year and expressed as procedures per 100,000 beneficiaries. Episodes or procedural visits included only primary codes, while services encompassed all procedure levels, including add-on codes.</p><p><strong>Results: </strong>Utilization patterns showed substantial fluctuations. From 2000 to 2010, facet joint intervention rates grew at 14.4% annually, slowing to 2.2% from 2010 to 2019. The COVID-19 pandemic led to a 19.3% decline in episodes. From 2019 to 2022, episodes of facet joint interventions decreased by 21.2% per 100,000 beneficiaries, while the rate of services dropped by 37%, with an annual decrease of 14.3%. Specific declines included lumbar and cervical facet joint injections (38.8% and 40.2%, respectively) and lumbosacral and cervicothoracic facet joint neurolysis (33.6% and 30.8%, respectively). The reduction in facet joint injections and nerve blocks was greater than that observed for neurolytic procedures.</p><p><strong>Limitations: </strong>Data were limited to the FFS Medicare population and were available only through 2022, excluding patterns for Medicare Advantage Plans, which covered nearly half of Medicare enrollees in 2022. Additionally, this study shares the common limitations of retrospective claims-based reviews.</p><p><strong>Conclusion: </strong>This retrospective analysis reveals a substantial decline in facet joint intervention episodes, with an overall decrease of 21.2% per 100,000 Medicare beneficiaries and an annual decline rate of 7.6% for episodes from 2019 to 2022.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E979-E982"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838697","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 Study Between the Analgesic Effect of Prednisolone and Pregabalin in Managing Post Dural Puncture Headache After Lower Limb Surgeries.","authors":"Dina Abdelhameed Elsadek Salem, Mahmoud M Elnady, Sherif A Alagamy, Sherif M Mowafy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Post dural puncture headache (PDPH) is a major challenging complication and may be a cause of morbidity after spinal anesthesia. Currently there is no definitive management for PDPH, so the search for effective treatment continues.</p><p><strong>Objectives: </strong>Our aim was to investigate the analgesic effectiveness of oral prednisolone vs oral pregabalin for managing PDPH subsequent to spinal anesthesia for lower limb surgeries.</p><p><strong>Study design: </strong>A prospective controlled double-blind randomized study.</p><p><strong>Setting: </strong>Academic University Hospitals.</p><p><strong>Methods: </strong>A total of 63 patients who had lower limb surgeries and suffered PDPH after spinal anesthesia were randomly allocated into one of 3 groups. Group C patients received conservative treatment and to maintain blinding, a tablet of vitamins was given to them twice per day for 3 days; Group P patients received conservative treatment and oral prednisolone 20 mg once daily plus one tablet of vitamins (in order to ensure blinding) for 3 days; Group G patients received oral pregabalin 150 mg twice daily for 3 days in addition to conservative treatment. The primary outcomes we measured were the Visual Analog Scale (VAS) score and modified Lybecker score. The secondary outcomes we measured were the total dose of rescue analgesia, the need for an epidural blood patch (EBP), and adverse effects from the study drugs.</p><p><strong>Results: </strong>When comparing the intensity of headaches assessed through both the VAS and the modified Lybecker score, no statistically significant disparities were observed in relation to baseline measurements. While after starting treatment by 12 hours and 24 hours, the headache intensity was statistically significantly lower in Group G compared to Group P and Group C, but there was no significant difference between Group C and Group P at 12 hours. The headache intensity was statistically significantly higher in Group C compared to Group P and Group G, but there was no significant difference between Group P and Group G at 48 hours and 72 hours. Ketorolac consumption was statistically significantly higher in group C than the other groups. However, it was statistically significantly lower in group G than group P. Only 2 patients in group C were indicated for EBP while no patients in either Groups P or G required an EBP.</p><p><strong>Limitations: </strong>Our study's limitations include the paucity of literature studying prednisolone and pregabalin use in PDPH, our study's small sample size, and the lack of sufficient studies for comparing results may limit the generalization of our findings.</p><p><strong>Conclusion: </strong>Both oral prednisolone and pregabalin were effective in reducing PDPH severity; oral pregabalin is superior to prednisolone.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1045-E1054"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838579","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":"2024 Indices.","authors":"Asipp","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1129-E1167"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838571","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":"Association Between Chronotype and Chronic Neuropathic Pain Sensitivity: A Pilot Prospective, Observational, Single-Center, Cross-Sectional Study.","authors":"Michael Kim, Yuri C Martins, Kishan Patel, Chiu-Hsieh Hsu, Mohab Ibrahim, Vasudha Goel, Amol M Patwardhan, Sejal Jain","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronotype defines an organism's biological preference for timing of activity and sleep. Being a morning chronotype (i.e., tending to wake up early and go to bed earlier at night) is associated with protection against chronic musculoskeletal pain and headaches, but the relationship between chronotype and neuropathic pain sensitivity remains unclear.</p><p><strong>Objectives: </strong>The aim of this pilot study was to explore the relationship among chronotype, neuropathic pain sensitivity, and pain interference in patients with chronic neuropathic pain disorders.</p><p><strong>Study design: </strong>This was a prospective, observational, single-center, cross-sectional study.</p><p><strong>Setting: </strong>Patients were recruited from pain management clinics.</p><p><strong>Methods: </strong>The Morningness-Eveningness Questionnaire (MEQ) was used to evaluate circadian typology. Linear mixed-effects models, principal component analysis, and principal component regression were used to determine the predictors of pain intensity and pain interference evaluated by the Numeric Rating Scale (NRS) and Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI) scores, respectively.</p><p><strong>Results: </strong>We analyzed 38 adults who had at least one documented chronic neuropathic pain diagnosis. Morning-chronotype patients reported higher NRS scores over time and lower PROMIS-PI t-scores than did intermediate chronotypes. MEQ, depression, risk of sleep apnea, sleep quality, and body mass index (BMI) were all significant independent predictors of average NRS scores and PROMIS-PI t-scores.</p><p><strong>Limitations: </strong>The population was small and homogeneously white, with an average age of 57 years. However, this population was representative of our pain clinic.</p><p><strong>Conclusions: </strong>Morning chronotypes are more sensitive to chronic neuropathic pain, reporting higher pain scores than do intermediate chronotypes. However, in this study, morning chronotypes were more resistant to neuropathic pain interference, suggesting that they may experience less disturbance of their physical, mental, and social activities than intermediate chronotypes. Further, larger studies are needed.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1097-E1104"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838575","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":"Clinical Response to Joint Infiltration With Bone Marrow Aspirate in Hip Osteoarthritis: A Systematic Review and Single-arm Meta-analysis.","authors":"Michael Silveira Santiago, Fernanda Valeriano Zamora, Elcio Machinski, Andre Richard da Silva Oliveira Filho, Mariana Taina Oliveira de Freitas, Deivyd Vieira Silva Cavalcante, Felipe da Fonseca Delmondes, Rosana Cipolotti","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Hip osteoarthritis is a joint disease that causes  worsening pain and inhibits activities of daily living. Due to poor pain control and the function of usual clinical treatment, joint infiltration with orthobiologics is a therapeutic alternative. Among these, bone marrow aspirate (BMA) represents a cellular therapy with promising clinical results.</p><p><strong>Objective: </strong>Our study aimed to assess the clinical response of joint infiltration with BMA for hip osteoarthritis.</p><p><strong>Study design: </strong>We conducted a systematic review and meta-analysis of the main outcomes in hip osteoarthritis after infiltration with BMA and bone marrow concentrate (BMC).</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Cochrane, and Science Direct for studies evaluating patients with hip osteoarthritis who received joint infiltration with BMA or BMC. In the absence of studies with a control group, we performed a pairwise meta-analysis comparing results of a single group at follow-up vs baseline.</p><p><strong>Results: </strong>We included 4 studies with improvement in Numeric Rating Scale pain scores associated with BMA or BMC therapy at 3 months (mean difference [MD], -3.48 points; 95% CI, -5.81 to -1.15), 6 months (MD, -3.25 points; 95% CI, -4.07 to -2.42), and 12 months (MD, -2.79 points; 95% CI, -3.83 to -1.74). There was also  a significant improvement in measurable quality of life through validated questionnaires at 3 months (standardized mean difference [SMD], -0.91; 95%, CI -1.59 to -0.23), 6 months (SMD, -1.38; 95% CI, -1.79 to -0.98), and 12 months (SMD, -1.30; 95% CI, -2.44 to -0.16).</p><p><strong>Limitations: </strong>Among our study's limitations is the lack of a randomized controlled trial in the meta-analysis.  Also, since there was no comparator, we could not conduct a pairwise meta-analysis. Finally, the small sample size  limits the generalization of the findings.</p><p><strong>Conclusion: </strong>In this meta-analysis, joint infiltration with BMA or BMC was associated with an improvement in pain and quality of life in patients with hip osteoarthritis. Further randomized studies are needed to improve the quality of evidence.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1033-E1044"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838577","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":"Prognostic Effect of Trigeminal Neuralgia Treated With Percutaneous Balloon Compression by Machine Learning-based Modeling of Radiomic Morphological Features.","authors":"Ji Wu, Keyu Chen, Hao Mei, Yuankun Cai, Lei Shen, Jingyi Yang, Dongyuan Xu, Songshan Chai, Nanxiang Xiong","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Trigeminal neuralgia (TN) is defined as spontaneous pain in the region of the trigeminal nerve that seriously affects a patient's quality of life. Percutaneous balloon compression of the trigeminal ganglion is a simple and reproducible surgical procedure that reduces the incidence of TN, but the postoperative outcome is poor in some patients, with it being ineffective or TN recurring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To establish a machine learning-based clinical imaging nomogram to predict the recurrence of trigeminal neuralgia in patients treated with percutaneous balloon compression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The clinical data of 209 patients with TN treated with percutaneous balloon compression at Zhongnan Hospital of Wuhan University from January 2017 through August 2023 were retrospectively collected and randomized into training and validation cohorts. All imaging histologic morphological features were extracted from the intraoperative x-ray balloon region using 3D slicer software. The relationship among clinical factors, least absolute shrinkage and selection operator, and 4 machine learning predictions of the patient's TN prognosis were analyzed using a one-way analysis of clinical factors. A prediction model was constructed using receiver operating characteristics curve analysis. The performance of the clinical imaging histogram of patients' TN prognoses was evaluated using a receiver operating characteristics curve and decision curve analysis. The model was finally validated using a validation cohort and a receiver operating characteristics curve.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The training group included 149 patients; 16 morphology-related imaging histological features were extracted for analysis. After one-way logistic regression analysis, least absolute shrinkage and selection operator analysis incorporated original_shape_Elongation, original_shape_MajorAxisLength, original_shape_flatness morphology-related imaging histologic features, gender, and affected side to give a total of 6 predictors. The final results were obtained for gender, affected side, and MajorAxisLength. Finally, 4 machine learning receiver operating characteristics curves for random forest tree, support vector machine, generalized linear model, and extreme gradient boosting models were obtained for the clinical and imaging features of gender, affected side, drug, original_shape_MajorAxisLength, and original_shape_flatness. The areas under the receiver operating characteristics curves were 0.990, 0.993, 0.990, and 0.986, respectively. Finally, predictive column maps of affected side, gender, original_shape_flatness, and MajorAxisLength were constructed using the support vector machine method, and the area under the receiver operating characteristics curve of the model was 0.99, which suggests that the model had good predictive ability. Decision curve analysis  and cali","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1105-E1116"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838685","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":"Effect of Epidural Volume Extension Using Low-Dose Sufentanil Combined with Low-Concentration Ropivacaine on Visceral Pain During Cesarean Sections: A Randomized Trial.","authors":"Jin Wang, Feng Xia, Li-Ying Wang, Li-Zhong Wang, Xiang-Yang Chang, Zhi-Yu Meng, Chang-Na Wei","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Visceral pain is common in cesarean sections conducted under combined spinal-epidural anesthesia (CSE). Epidural volume extension (EVE) is a technique for enhancing the effect of intrathecal blocks by inducing epidural fluid boluses in the CSE. Whether EVE that uses different drugs can reduce visceral pain during cesarean sections is rarely studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;In this study, we compared the effect of EVE that used low-dose sufentanil, either alone or combined with low-concentration ropivacaine, on visceral pain during cesarean sections under CSE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A prospective, randomized controlled study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was performed in the Jiaxing University Affiliated Women and Children Hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We randomly allocated 100 healthy patients to 4 groups to receive spinal hyperbaric bupivacaine followed by EVE with 10 mL of 0.9% saline (Group NS), 10 mL of 0.15% ropivacaine (Group R), 10 mL of 10 mu-g sufentanil (Group S), or a combination of 10 mL of 0.15% ropivacaine and 10 mu-g sufentanil (Group RS) through the epidural catheter 15 minutes thereafter. The primary outcome was the incidence of visceral pain. Each occurrence of visceral pain during the procedure was recorded. Every patient's pain level was evaluated on the visual analog scale (VAS). The consumption of sufentanil during patient-controlled intravenous analgesia (PCIA) and patient satisfaction scores under anesthesia were recorded within 48 hours after surgery. Maximum sensory block levels, segmental increases after EVE, time for sensory regression to the tenth thoracic dermatome (T10), and time for motor recovery to modified Bromage 0 were compared among each group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Visceral pain occurred in 60% (15/25), 56% (14/25), 24% (6/25) and 12% (3/25) of patients in the NS, R, S, and RS groups, respectively. The incidence of visceral pain was significantly lower in the RS group than in the NS or R groups (P &lt; 0.05) but not significantly different from the S group. The S and RS groups have significantly lower VAS scores compared to the NS and R groups (P &lt; 0.05). Sufentanil consumption during PCIA in the R and RS groups was significantly lower than in the NS group. Patients' overall intraoperative satisfaction scores were significantly higher in the S and RS groups than in the NS or R groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study has limitations in its sample size, time point of EVE implementation, absence of laboratory indicators, and lack of assessment of postoperative visceral pain, necessitating future studies to address these issues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;EVE at 15 minutes after spinal anesthesia with a 10 mL combination of low-dose sufentanil (10 mu-g) and low-concentration (0.15%) ropivacaine can effectively reduce the incidence and severity of visceral pain in cesarean sections under CSE. At the sa","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1065-E1071"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838641","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 24% Decline in the Utilization of Epidural Procedure Visits for Chronic Spinal Pain Management in the Medicare Population from 2019 to 2022: Updated Analysis of the Effect of Multiple Factors.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Vidyasagar Pampati, Alan D Kaye, Alaa Abd-Elsayed, Amol Soin, Devi E Nampiaparampil, Nebojsa Nick Knezevic, Christopher G Gharibo, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The analysis of epidural procedure utilization has revealed several notable trends over recent years. Utilization increased significantly until 2004, then rose minimally until 2011, followed by gradual declines up to 2019 in the Medicare population. The COVID-19 pandemic led to a marked 19% decline in usage from 2019 to 2020. Additionally, recent studies of interventional pain management techniques showed a 28.9% reduction in use from 2019 to 2022, leading to an average annual decline of 10.9%.</p><p><strong>Objective: </strong>The present investigation aims to provide an updated evaluation of epidural procedure usage for chronic pain management in the U.S. Medicare population.</p><p><strong>Study design: </strong>A retrospective cohort study examining utilization patterns and variables for epidural injections in the fee-for-service (FFS) Medicare population in the U.S. from 2000 to 2022.</p><p><strong>Methods: </strong>Data was obtained from the Centers for Medicare & Medicaid Services (CMS) master database, specifically using the physician/supplier procedure summary for 2000-2022. Episodes or procedure visits were defined as one per region using primary codes only, while services included all procedure levels and any add-on codes.</p><p><strong>Results: </strong>Between 2000 and 2010, epidural episodes rose by 6.7% annually but then declined by 3% each year from 2010 to 2019. The COVID-19 pandemic led to a 19.3% reduction in procedures from 2019 to 2020, followed by a partial recovery of 5.5% in 2021, then another 10.9% drop in 2022. During 2019-2022, lumbar interlaminar and caudal procedures decreased by 26.9%, while cervical/thoracic interlaminar procedures declined by 24.2%. By 2022, transforaminal procedures surpassed interlaminar procedures, reversing the trend from 2000.</p><p><strong>Limitations: </strong>This analysis includes data only through 2022 and is limited to the FFS Medicare population; it does not account for Medicare Advantage Plan enrollees, who made up nearly half of Medicare participants by 2022. Additionally, the study is subject to limitations inherent in retrospective claims data analysis.</p><p><strong>Conclusion: </strong>This two-decade analysis indicates significant shifts in epidural procedure utilization, with steady increases until 2010, followed by a general decline affected by COVID-19 and other contributing factors. An approximate 24% decline in epidural procedure visits for chronic spinal pain management was noted from 2019 to 2022.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E983-E994"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838573","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":"Pectoralis I and Serratus Anterior Plane Block Analgesia for Bilateral Mastectomy: A Case Series.","authors":"Kinjal M Patel, Kiana D de Guzman, Keri Cronin, Noud van Helmond, Sandeep Krishnan, Ludmil Mitrev, Keyur C Trivedi, Ronak G Desai","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Poorly controlled acute breast surgery postoperative pain is associated with delayed recovery, increased morbidity, impaired quality of life, and prolonged opioid use during and after hospitalization. Recently, ultrasound-guided pectoralis nerve (PECS) I block and serratus anterior plane (SAP) block, together or individually, have emerged as a potential method to relieve pain, decrease opioid requirements, and improve patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to assess if the addition of a PECS I/SAP block in patients undergoing bilateral mastectomies provides more effective perioperative analgesia compared to standard analgesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective case series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Tertiary academic medical center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For patients undergoing breast cancer surgery, different approaches to analgesia by anesthesiologists at our institution provided an opportunity to compare patients who received a PECS I/SAP block to patients who received standard peri- and postoperative pain control from May 1, 2019 through November 30, 2020. Adult women who had bilateral mastectomy and reconstruction with tissue expanders for breast cancer were included. Bilateral PECS I/SAP blocks were performed with 60 mL 0.25% bupivacaine and 266 mg liposomal bupivacaine. The standard analgesia group had a balanced general anesthetic with volatile anesthetic, opioids (fentanyl or hydromorphone), and muscle relaxant. The postoperative analgesic regimen was similar in both groups. Pain scores (Numeric rating Scale) and opioid consumption (converted to oral morphine milligram equivalent [MME]) intraoperatively, and on postop day (POD) 0 up to POD 3 were collected. Length of stay data were collected as a secondary outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty patients were included (n = 17 PECS I/SAP block; n = 23 standard analgesia). Baseline characteristics were similar between groups; most patients in the PECS I/SAP block (93%) and standard analgesia (96%) groups were discharged on POD 1 or 2. Intra-operative opioid requirements were lower in the PECS I/SAP block vs the standard analgesia group (median 56 MME, interquartile range [IQR] 44-62 vs median 65 MME, IQR 63-83, respectively, P = 0.002). Opioid requirements were similar in the block group compared to the standard analgesia group from POD 0 to POD 2. Pain scores from POD 0 to POD2, postanesthesia care unit length of stay, and hospital length of stay were also similar between the PECS I/SAP block and standard analgesia group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The retrospective nature of this study and its reliance on medical records are limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The PECS I/SAP block may potentially reduce pain in patients having breast surgery for cancer by providing analgesia to the lateral and anterior chest wall. While this analysis showed a reduction in int","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 10","pages":"E1117-E1122"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838682","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}