Pain physician最新文献

{"title":"Sedatives and Opioids Best Practices: An Approach to the Use of Technological Tools.","authors":"Cinthya Galindo, Rosa-Helena Bustos, Marisol Porra, Marta-Ximena Leon, Diego Becerra, Peter Vergara, Fernando Rios, Diego Jaimes, Laura Bravo, Jose-Manuel Quintero, Monica Maria Diaz-Lopez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The formulation of opioid medications is becoming increasingly common among hospitalized patients, due to the need for pain control or sedation during procedures. This phenomenon represents the possibility of an increase in adverse events, as demonstrated by monitoring through the Adverse Event Reporting System (FAERS). The importance of tools that unify information search and provide easy access for physicians is becoming more evident. Thus, it is essential to assess the medical needs for information when using technological tools that can support clinical practice.</p><p><strong>Objective: </strong>To characterize the main pharmacological and pharmaceutical needs of critical care physicians for the management of adult patients when administering sedative and/or opioid analgesic medications.</p><p><strong>Study design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>A tertiary care setting in Bogotá and Chía, Colombia from October 1 through December 31, 2022.</p><p><strong>Methods: </strong>Surveys were collected through Google Forms. The surveys were directed to physicians from Clinica Universidad de La Sabana and Clínia Nueva de Bogotá. These physicians perform sedation and analgesia procedures on adult patients in critical care services, including emergency departments, hospitalization units, surgical rooms, and adult intensive care units.</p><p><strong>Results: </strong>Ninety-five percent of the respondents considered the use of technological tools necessary for support during their workday. Most respondents reported that these tools were helpful for information searches regarding dose adjustments of sedatives and opioid analgesics, especially in cases of renal disease, dose calculations for rotation, and titration of opioids.</p><p><strong>Limitations: </strong>Designed for academic purposes, the survey identified 4 key areas requiring improvement: pharmacological knowledge, patient safety monitoring, specialized administration techniques, and practical application of knowledge during the administration of medication. The survey was conducted under the constraints of time and resources, limiting the sample to 2 institutions based on accessibility and feasibility.</p><p><strong>Conclusions: </strong>The study highlights the need for the development of technological tools to support medical services in the safe use of sedative and opioid analgesic medications. The evaluation of specific pharmacological and pharmaceutical knowledge related to this group of medications is crucial.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E165-E172"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764671","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":"Technical Modification of Cervical Facet Joint Radiofrequency Ablation: A Novel Approach.","authors":"Boqing Chen, Daniel H Cho, Kevin W Tang, Malaka Badri, Patrick M Foye, Todd P Stitik","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Current standards of practice recommend performing the cervical medial branch block (MBB) and applying the subsequent radiofrequency ablation (RFA) electrode via anterior-posterior (AP) and lateral fluoroscopic views. The lateral views of the lower cervical segment are frequently hindered by patients' anatomical factors and prevent the accurate and safe placement of the RFA needle.</p><p><strong>Objective: </strong>The goal of this technical modification is to introduce and standardize an oblique angle view using fluoroscopy to enable more accurate placement of the MBB needle and RFA needle electrode in the cervical facet joint.</p><p><strong>Study design: </strong>The technical modification was developed using a cadaveric skeletal model. Then, in an actual patient, this additional oblique view was tested in an RFA procedure for a cervical facet joint.</p><p><strong>Setting: </strong>This protocol was produced at a single musculoskeletal and interventional spine center.</p><p><strong>Methods: </strong>A team of interventional pain specialists developed a step-by-step technique that utilized a 50-degree ipsilateral fluoroscopic view, in addition to AP and lateral views, by simulating a cervical facet joint RFA in a cadaveric skeletal model. The technique was then tested in an actual patient's cervical facet joint RFA procedure.</p><p><strong>Results: </strong>The team successfully developed a technique to confirm placement of the RFA needle electrode at the articular pillar to denervate the medial branch for treating pain in the cervical facet joint. This technique allows for the clear visualization of the needle RFA electrode to overcome patient factors that can obscure the electrode, including physiological aspects such as short neck and shoulder musculature.</p><p><strong>Limitations: </strong>A potential disadvantage of this technical modification is the additional radiation exposure, which is caused by the addition of an oblique view.</p><p><strong>Conclusions: </strong>Our technical modification of an oblique angle view enables clear visualization, thus increasing the accuracy and potentially the safety of RFA needle electrode placement in lower cervical facet joint RFA over those of the conventional approach.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E199-E203"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764672","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":"Chronic Pain in Neurofibromatosis 1, Neurofibromatosis 2, and Schwannomatosis: A Review on Epidemiology, Pathophysiology, Symptomatology and Treatment.","authors":"Barlas Benkli, Peter D Vu, Alaa Abd-Elsayed, John M Slopis, Yimin Geng, Matthew Chung","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Neurofibromatosis (NF) is a group of neurogenetic disorders (including neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis) known for their tendency to induce the development of numerous nerve sheath tumors. Pain is a common symptom associated with NF, and the incidence of this pain can vary significantly, severely affecting the quality of life for many patients.</p><p><strong>Objective: </strong>This narrative review aims to compile recent epidemiological data on NF1, NF2 and schwannomatosis, covering prevalence, incidence, and distribution across populations. It explores the disease's pathophysiology, highlighting the molecular mechanisms behind its development, and examines the diverse clinical manifestations and their impacts on patients. Additionally, the review evaluates current treatment approaches, synthesizing recent advancements to provide a comprehensive understanding. This review aims to offer researchers and health care professionals an updated perspective on managing NF effectively.</p><p><strong>Study design: </strong>A narrative review of peer-reviewed literature for NF, the management of its associated pain, and quality of life for patients who have the condition.</p><p><strong>Methods: </strong>The MEDLINE and Embase databases were reviewed to identify peer-reviewed research that discussed factors relevant to NF-related pain and its management.</p><p><strong>Limitations: </strong>This narrative review is not systematic and focuses primarily on existing literature without presenting new data.</p><p><strong>Conclusions: </strong>While advances have been made in understanding pain associated with NF, particularly for NF1, NF2, and schwannomatosis, significant gaps in treatment and understanding remain. Future research should prioritize targeted therapies and improved pain management strategies to enhance the quality of life for NF patients.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"105-115"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132729","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":"Evaluation of Genicular Nerve Blocks Durations With and Without Corticosteroid: A Single-blind, Randomized Controlled Trial.","authors":"Suzanna Shermon, Terence Hillery, Mi Mi Kim, Gustaf Van Acker, Chong H Kim","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Genicular nerve blocks (GNBs) are commonly performed prior to performing  radiofrequency ablation (RFA) to assess RFA's potential efficacy. Typically, GNBs are commonly performed with local anesthetic only. The duration of efficacy of GNBs has not been investigated much in the literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The primary goals of this study were to evaluate for any differences in response to GNBs between using local anesthetic only versus local anesthetic and corticosteroid, and assess for the potential therapeutic benefit of GNBs by examining pain relief percentage, pain relief duration, and change in pain scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Randomized prospective trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Fluoroscopy suite at an urban academic teaching hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Fifty patients with chronic knee osteoarthritis were randomly assigned to undergo a GNB done under fluoroscopic guidance with either bupivacaine only (n = 24, the control group) or bupivacaine and triamcinolone (n = 26, the experimental group). Baseline and postprocedure pain scores were collected on the day of the procedure. Patients were then called at postprocedure 24 hours, 2 weeks, and 6 weeks and asked their maximum percentage of pain relief, duration of pain relief, and Numeric Rating Scale (NRS-11) scores, which were compared between the 2 groups. Associations between these factors and Kellgren-Lawrence Classification of Osteoarthritis scores, body mass index, age, gender, race, and baseline pain scores were also assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean duration of pain relief was significantly higher in the group administered a corticosteroid (0.87; SD, 0.29 days) compared to the group not administered a corticosteroid (0.64; SD, 0.43 days) at 24 hours postprocedure. No significant differences were found between the 2 groups in pain relief percent, pain relief duration, or NRS-11 scores at any of the 3 time points. No significant difference in changes from baseline NRS-11 scores over time were found between the 2 groups. No significant associations were found between pain relief percent, pain relief duration, and NRS-11 scores regarding age, gender, body mass index, race, Kellgren-Lawrence scores, and baseline pain scores at postprocedure days one, 14, and 42.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This was a single-blind, single-center study. It lacked a follow-up at 6 weeks postprocedure, lacked a placebo group, and had a small sample size.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The addition of a corticosteroid to local anesthetic for GNB may prolong initial analgesic effects within the first postprocedure 24 hours. However, there is no analgesic difference in the weeks following a GNB between procedures done with local anesthetic only or local anesthetic and corticosteroid. These findings suggest that there is a lack of therapeutic benefit and effect on relief duration with using  corticost","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"127-135"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764595","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":"Greater Occipital Nerve Block at Two Levels Spares the Need for an Epidural Blood Patch for Managing Postdural Puncture Headache: A Randomized Comparative Trial.","authors":"Enas Wageh Mahdy, Asmaa Mohamed A Elsaid, Yehya Shahin Dabour, Samar A Salman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Anesthesia through neuroaxial approaches is an effective option for lower abdominal surgeries, but postdural puncture headache (PDPH) is often an adverse effect of this procedure.</p><p><strong>Objectives: </strong>Evaluation of the effect of bilateral bi-level greater occipital nerve blocks (GONB) on the severity of PDPH and its effect on patients' quality of life.</p><p><strong>Study design: </strong>Randomized controlled trial.</p><p><strong>Setting: </strong>Department of Anesthesia, ICU and Pain, Faculty of Medicine, Benha University in conjunction with multiple private centers, Cairo, Arab Republic of Egypt.</p><p><strong>Methods: </strong>A total of 180 patients with PDHP were evaluated using the Numeric Rating Scale (NRS-11) to assess pain in an upright position and the 36-Item Short-form Survey Instrument (SF-36) was used to assess the effect of PDPH on quality of life. Patients were randomly divided into an intramuscular group and received an intramuscular injection. Other injection location groups were distal (DG), proximal (PG), and bilevel (BG). All groups received bilateral GONB using 2 mL of lidocaine 2% mixed with 2 mL of dexamethasone. Pain scores were evaluated at 24 hours postprocedure. At one month pain and SF-36 scores were recorded. The success rate was defined as the frequency of pain-free (NRS-11 < 4) among the trial patients. Recurrent cases received bilevel GONB and nonresponsive patients received an epidural blood patch.</p><p><strong>Results: </strong>At 24 hours postprocedure, 82.8% of the total patients and all BG patients were pain-free. NRS-11 pain scores were significantly lower in BG patients than patients in other groups; 7 patients required an epidural blood patch. At one month, 114 total patients (63.3%) had a zero pain score and 95.6% of BG patients were pain-free; the BG patients had significantly lower pain scores than the other groups. Also, SF-36 scores were improved in all patients with significantly higher scores in the BG and PG groups compared to the other groups. Twenty-seven total patients had recurrent PDPH; intramuscular  injection patients had a significantly higher frequency of recurrent PDPH and shorter pain-free duration. The success rate of bilevel GONB management for recurrent PDPH was 81.5%.</p><p><strong>Limitations: </strong>The limitations of this trial are two-fold: missing of blocking the other occipital nerves and omission of blocking at the recently defined area of the three main occipital nerves communicate.</p><p><strong>Conclusion: </strong>Bilevel GONB provided was superior to single level blocks and intramuscular injection with no 24 hour postprocedure failure, a low recurrence rate, and totally negated the need for an epidural blood patch; it also significantly improved patients' quality of life. Bilevel GONB is an efficient first-line therapy for recurrent PDPH.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E137-E146"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764663","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":"Nerve Block Efficacy and Safety for Acute Thoracic Herpes Zoster: A Systematic Review and Meta-analysis.","authors":"Chiao-Ming Chuang, Chung-Ren Lin, Yu-Lien Hsieh","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute zoster-related pain affects more than 90% of patients with acute herpes zoster. While nerve blocks with local anesthetics and steroids are commonly used to manage acute postoperative and chronic pain, their efficacy and safety in treating acute herpes zoster remain underexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our systematic review and meta-analysis aimed to evaluate the efficacy and safety of various nerve blocks for managing acute herpes zoster.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify studies of patients with acute herpes zoster who received nerve blocks. Study quality was assessed using risk-of-bias tools for randomized and nonrandomized studies. The primary outcome was analgesic efficacy; secondary outcomes included postherpetic neuralgia (PHN) incidences, analgesic consumption, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirteen studies (9 RCTs, n = 815; 4 observational studies, n = 253) were included. Nerve blocks administered were  paravertebral blocks (PVB), erector spinae plane (ESP) blocks, epidural blocks, and intercostal nerve blocks. The meta-analysis, which included 6 RCTs, indicated that at 4 weeks postprocedure, nerve blocks significantly reduced Visual Analog Scale pain scores. The blocks also reduced the need for acetaminophen and pregabalin compared with the control group. However, no differences in Visual Analog Scale pain scores were observed at 12 weeks. Both PVB and ESP blocks significantly decreased the PHN incidences at 3 and 6 months postprocedure. Five studies demonstrated that ultrasound-guided ESP blocks significantly reduced pain severity, duration, and the incidence of PHN without notable adverse events. Eight studies found PVBs to be effective in reducing pain scores and PHN incidences, though adverse events such as dizziness, drowsiness, and pain at the injection site were reported. Four observational studies comparing epidural or intercostal nerve blocks with other techniques provided weak evidence for their use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our study's limitations include its small sample size with only 6 RCTs, significant heterogeneity in study designs, and variations in the interventions. Subjectivity in measuring pain and the lack of blinding introduces potential bias. Additionally, limited evidence on intercostal and epidural blocks for acute herpes zoster highlights the need for more high-quality RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In conclusion, nerve blocks with local anesthetics and steroids provide effective analgesia, reduce analgesic consumption, and lower PHN incidences in ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"83-96"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764667","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":"Correlation Between Meckel's Cave Size and lohexol Dosage in Percutaneous Microballoon Compression for Trigeminal Neuralgia of Aged Patients.","authors":"Yong Yu, Jing Wang, Chuanxi Peng, Chengxing Qian, Renbo Shen, Yanqing Zuo, Weibang Liang, Jie Chen, Yulong Chong","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Percutaneous microballoon compression (PMC) is a safe and effective method (1) for treating trigeminal neuralgia (TN). Though many surgeons have carried out this kind of surgery, practitioners who lack sufficient surgical experience may be unaware of this method of improving the clinical effectiveness of PMC for aged patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the relationship among the success of the PMC method, the size of a patient's Meckel's cave (MC), and the iohexol dosage in a pear-shaped balloon and form a mathematical model for the effectiveness of the treatment.&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;Setting: &lt;/strong&gt;Neurosurgery Department of Tongling People's Hospital, China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;One hundred eighteen patients (34 men and 84 women) undergoing PMC, aged 72.07 ± 7.10 years old, were collected retrospectively in the study. Fifteen of the patients were in Tongling People's Hospital from September 2022 to March 2024, and 103 were in Nanjing Drum Tower Hospital from January 2023 to October 2023, The sizes of all the patients' MCs were measured by 3D-Slicer software with preoperative cranial magnetic resonance imaging (MRI); all balloons were of the standardized pear shape, and intraoperative iohexol dosages were recorded. The patient's score on the Barrow Neurological Institute pain scale (BNI-P) was recorded at 3 time points: before the surgery (Pre_BNI), the first day after the surgery (BNI_1), and the seventh day after the surgery (BNI_7). Correlation analysis was carried out to determine the association between the intraoperative iohexol dosage and MC size.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall effective rate of PMC was 97.46% (115/118). During the first postoperative day, 3 patients reported feeling pain scores of V on the BNI-P scale. None of the other patients reported an experience of pain. At the 7th day of post-operation, those 3 patients still felt no pain relief, whereas the others continue not to experience pain. There was a significant correlation between iohexol dosage (unit: mL) and MC size (expressed as MC volume, unit: mm3): iohexol dosage (mL) = 0.54336 + 0.00060286 x MC Volume (mm3) - 0.05654 x BNI_1*. ( *The scores from 1 to 5 are equivalent to I to V on the BNI-P.).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The study was retrospective, so we could not validate the accuracy of the model by analyzing the iohexol dosage used in the operation; additionally, the duration of the follow-up was short, and the sample size was relatively small.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The equation (iohexol dosage = 0.54336 + 0.00060286 x MC Volume - 0.05654 x BNI_1) yields a value at which operations have a very high success rate, regardless of whether the patients have received previous TN treatment. The equation can be used to guide the intraoperative usage of iohexol and to help surgeons without sufficient surgical experienc","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E191-E198"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764644","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":"Accuracy of Imaging in Dynamic Spondylolisthesis: Emerging Strategies and Understanding for Pain Physicians: A Systematic Review.","authors":"Mihir Jani, Eli Dayon, Nimesha Mehta, Kunal Aggarwal, Joseph D Fortin, Karoline Zektser, Joshua Lewis, Marco Lawandy, Ricky Ju, Ugur Yener, Jonathan D Krystal, Reza Yassari, Alan D Kaye, Sayed E Wahezi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain (CLBP) is prevalent, with lumbar spondylolisthesis a common cause of the condition. Spondylolisthesis, the displacement of one vertebra over another, can have various causes. Isthmic and degenerative forms are the most common. Clinicians need to evaluate whether the condition is fixed or dynamic, since dynamic cases may cause vertebral instability and nerve compression, necessitating surgery. Traditional flexion-extension x-rays have been the standard diagnostic tool, but recent studies suggest that alternative imaging methods, such as magnetic resonance imaging or computed tomography, may offer more accurate detection.</p><p><strong>Objective: </strong>Spondylolisthesis, often described as the slipping forward of one of the vertebrae, is a common etiology for CLBP. Generally, spondylolisthesis can be categorized as either stable or unstable. Unstable or dynamic spondylolisthesis is usually diagnosed based on the visualization of sagittal translation of the vertebral body on flexion-extension x-rays. However, it has been reported that flexion-extension x-rays may not be the most reliable method for determining the presence of an unstable spondylolisthesis. The present investigation aimed to identify the extent of the literature that discussed alternative imaging techniques for diagnosing dynamic spondylolisthesis.</p><p><strong>Study design: </strong>A retrospective systematic review of original research done on spondylolisthesis from 2000 to 2023.</p><p><strong>Methods: </strong>A review protocol was followed based on PRISMA guidelines and conducted across 3 databases for relevant articles published between the years 2000 and 2023. Two reviewers screened and characterized the articles independently, and 3 additional reviewers performed full-text analysis and data extraction.</p><p><strong>Results: </strong>The search yielded 13 articles with differences in origin, study design, sample size, and outcomes. Most of the articles were retrospective studies. Of the 13 articles, 11 showed promising results in utilizing alternative imaging to diagnose dynamic spondylolisthesis.</p><p><strong>Limitations: </strong>The lack of a formally registered protocol and potential publication bias were the limitations for this review.</p><p><strong>Conclusion: </strong>The present investigation analyzed the current literature and determined that alternative imaging techniques could adequately diagnose the dynamic instability of the spine. Further research is warranted to establish an in-depth analysis that elucidates the most reliable and sensitive imaging sequence for diagnosing dynamic spondylolisthesis.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"97-103"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764550","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":"Neuropathic Pain Management in France: A Comparison of French Recommendations Using Case-Vignette Surveys.","authors":"Paul Elhomsy, Stephane Sanchez, Catherine Doussot, Philippe Rault","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of clinical practice guidelines, suboptimal adherence among general practitioners (GPs) in pain management remains a concern. The French Pain Society issued revised guidelines for pain management in 2020.</p><p><strong>Objectives: </strong>This study aimed to evaluate the current adherence of French doctors to the updated guidelines for pain management.</p><p><strong>Study design: </strong>A non-interventional, cross-sectional study.</p><p><strong>Setting: </strong>  A panel of doctors from France, participated in an online questionnaire.</p><p><strong>Methods: </strong>Two selected vignettes describing patients with chronic neuropathic pain (central and peripheral) were completed. The ability to correctly prescribe appropriate first- and second-line treatments according to the 2020 French Pain Society guidelines was assessed.</p><p><strong>Results: </strong>A total of 191 physicians were recruited from a database of 3,380, representing a response rate of 5.7%. Of the participants, 182 (95.3%) completed the survey correctly and were included in the final analysis. Among those participants, 64% were general practitioners (GPs). Adherence to the guidelines for the management of l ocalized peripheral neuropathic pain was reported by 15.38% of participants, while 21% reported adherence for central neuropathic pain. A significant disparity was observed in the prescription of medications, with pregabalin being prescribed by 32.9% of participants and gabapentin by 22.5% for localized neuropathic pain. For central neuropathic pain, pregabalin use was reported by 30.7% of respondents and gabapentin by 26.3%. Following the failure of a second-line therapy, 66% of participants considered reorientation to be a viable treatment option for localized peripheral neuropathic pain, compared to 45% for central neuropathic pain.</p><p><strong>Limitations: </strong>The number of participants is one of the main limitations in this study.</p><p><strong>Conclusions: </strong>Despite the participants' low adherence to guidelines, substantial variation in medication use, and limited support for reorientation after failed treatment, this study offers insight into management practices for neuropathic pain among French GPs in Burgundy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E157-E164"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764668","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 Effect of Local Skin Precooling on Alleviating Injection Site Pain in Patients With Androgenetic Alopecia Receiving a Scalp Nerve Block.","authors":"Rashid M Rashid, Kenneth D Candido, Shariq Ibrahim, Bangda Chai, Ling Gao, Yanling Song, Yue Wang, Xiaowen Pan, Wenjun Le, Weiting Liu, Zhongmin Liu","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Scalp platelet-rich plasma (PRP) mesotherapy is commonly used to increase hair density and improve scalp health in patients with androgenetic alopecia. While PRP therapy is favored for its lower risk of adverse effects and reduced treatment frequency compared to other methods, the potential for injection site pain remains a significant challenge, potentially reducing patient compliance and treatment continuation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the effectiveness of local skin precooling in reducing injection site pain during scalp PRP mesotherapy in patients with androgenetic alopecia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A single-center retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was conducted at the Precision Health Management Center of the Shanghai East Hospital, Tongji University School of Medicine, People's Republic of China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were collected from 100 patients (82 men, 18 women) aged 18-50 years who underwent scalp PRP mesotherapy from August 2020 through July 2024. Patients were divided into 2 groups: Group A (n = 50) received local skin precooling administered using sterile gloves by way of soft ice packs for 2 minutes pre scalp nerve block; Group B (n = 50) did not receive local skin precooling pre scalp nerve block. All patients received scalp PRP mesotherapy. Pain perception was measured using a 100-mm Visual Analog Scale (VAS) at multiple time points: 30 seconds post scalp nerve block at 2 nerve points, at immediate posttreatment, and at one- and 24-hours posttreatment. Demographic data and Positive and Negative Affect Schedule scores were also collected. Safety outcomes included the incidence of adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VAS scores were significantly lower in Group A compared to Group B at all measured time points. At 30 seconds post scalp nerve block, Group A showed a 34.08% pain reduction at the supraorbital nerve and the supratrochlear nerve and an 18.86% pain reduction at the greater occipital nerve compared to Group B. VAS scores for Group A at immediate posttreatment, and one and 24 hours posttreatment were significantly lower than those for Group B (P &lt; 0.05). The primary adverse reactions reported were mild. They included headache, injection site pain, and scalp sensitivity, all of which resolved quickly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The retrospective nature of the study, limited data collection, small sample size, and short follow-up period are notable limitations. Larger-scale prospective studies with extended follow-up periods are recommended for future research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;local skin precooling is a simple and effective technique for reducing injection site pain during a scalp nerve block. PRP mesotherapy, thereby enhancing patient comfort and compliance. Our study is the first to analyze the analgesic effects of local skin precooling on scalp nerve block injection site p","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"155-165"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764674","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}