Pain physician最新文献

{"title":"Comprehensive Evidence-Based Guidelines for Implantable Peripheral Nerve Stimulation (PNS) in the Management of Chronic Pain: From the American Society Of Interventional Pain Physicians (ASIPP).","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Amol Soin, Alan D Kaye, Adam M Kaye, Daneshvari R Solanki, Grant H Chen, Devi Nampiaparampil, Nebojsa Nick Knezevic, Paul Christo, Alexander Bautista, Jay Karri, Shalini Shah, Standiford Helm Ii, Annu Navani, Bradley W Wargo, Christopher G Gharibo, David Rosenblum, Komal Luthra, Kunj G Patel, Saba Javed, Warren Reuland, Mayank Gupta, Alaa Abd-Elsayed, Gerard Limerick, Ramarao Pasupuleti, Gary Schwartz, Matthew Chung, Konstantin V Slavin, Vidyasagar Pampati, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve stimulation (PNS) has been used for over 50 years to treat chronic pain by delivering electrical pulses through small electrodes placed near targeted peripheral nerves those outside the brain and spinal cord. Early PNS systems often required invasive neurosurgical procedures. However, since 2015, the Food and Drug Administration (FDA) approved percutaneously implanted PNS leads and neurostimulators  offering a much less invasive, non-opioid option for managing recalcitrant chronic pain. The following FDA-cleared PNS systems are commercially available in the United States for the management of chronic, intractable pain:•    Freedom® Peripheral Nerve Stimulator (PNS) System (Curonix LLC, 2017) •    StimRouter® Neuromodulation System (Bioness, now Bioventus, 2015)•    SPRINT® PNS System (SPR® Therapeutics, Inc., 2016) •    Nalu™ Neurostimulation System (Nalu Medical Inc., 2019)•    ReActiv8® Implantable Neurostimulation System (Mainstay Medical Limited, 2020) The American Society of Interventional Pain Physicians (ASIPP) has published evidence-based consensus guidelines for the application of PNS systems in managing chronic pain.</p><p><strong>Objective: </strong>The guidelines aim to provide evidence-based recommendations for the utilization of peripheral nerve stimulation (PNS) in the management of moderate to severe chronic pain. These guidelines exclude field stimulation, or sacral nerve stimulation.</p><p><strong>Methods: </strong>A multidisciplinary panel of experts in various medical and pharmaceutical fields, convened by ASIPP, reviewed the evidence, considered patient perspectives, and formulated recommendations for implantable peripheral nerve stimulation in chronic pain management. The methodology included developing key questions with evidence-based statements and recommendations. The grading of evidence and recommendations followed a modified approach described by ASIPP, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method, and the Agency for Healthcare Research and Quality (AHRQ) strength of recommendations methods. The evidence review includes existing guidelines, systematic reviews, comprehensive reviews, randomized controlled trials (RCTs), and observational studies on the effectiveness and safety of implantable peripheral nerve stimulation in managing chronic pain. The quality of published studies was assessed using appropriate instruments for systematic reviews, RCTs, and observational studies.In the development of consensus statements and guidelines, we used a modified Delphi technique, which has been described to minimize bias related to group interactions. Panelists without a primary conflict of interest voted to approve specific guideline statements. Each panelist could suggest edits to the guideline statement wording and could suggest additional qualifying remarks or comments as to the implementation of the guideline in clinical practice to achie","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 S9","pages":"S115-S191"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676637","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 Nomogram Model for Predicting Postherpetic Neuralgia in Patients with Herpes Zoster: A Prospective Study.","authors":"Hui-Min Hu, Peng Mao, Xing Liu, Yuan-Jing Zhang, Chen Li, Yi Zhang, Yi-Fan Li, Bi-Fa Fan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Herpes zoster (HZ) and postherpetic neuralgia (PHN) have a negative effect on patients. A simple and practical PHN prediction model is lacking.</p><p><strong>Objective: </strong>We aimed to investigate risk factors associated with PHN in patients with HZ and develop a predictive model.</p><p><strong>Study design: </strong>A prospective observational study.</p><p><strong>Setting: </strong>This study was conducted at the Department of Pain Management, China-Japan Friendship Hospital in Beijing, People's Republic of China, spanning from August 2020 through March 2022.</p><p><strong>Methods: </strong>Clinical data of 174 patients with HZ were recorded using a case report form. The patients underwent a 3-month follow-up, which included both in-person visits and telephone follow-ups. Patients were categorized into either a PHN or non-PHN group based on the diagnosis  of PHN. Multiple logistic regression analysis was used to identify the predictors of PHN occuring in patients with HZ. Subsequently, a nomogram model was developed to estimate the likelihood of PHN. To validate the prediction model's accuracy, calibration curves, the C-index, and receiver operating characteristic (ROC) curves were utilized.</p><p><strong>Results: </strong>In this study, a total of 174 patients were divided into 2 groups: the PHN Group, consisting of 52 patients, and the non-PHN Group, consisting of 122 patients based on the follow-up results. Multiple logistic regression analysis revealed 5 significant risk factors for PHN, including being a woman, being more than 50 years old, having prodromal phase pain, having a large rash area, and having great pain severity during the acute phase. The model's performance was excellent, with an area under the ROC curve of 0.81 and a close alignment between the calibration curve and the actual data, signifying high accuracy. The model's accuracy and net benefit were maximized when predicting a prevalence between 6% and 92%.</p><p><strong>Limitations: </strong>Our study was conducted at a single center and had a limited sample size.</p><p><strong>Conclusions: </strong>The incidence of PHN is influenced by factors such as being a woman, being more than 50 years old, having prodromal phase pain, having a large rash area, and having great pain severity during the acute stage. The prediction model developed in this study effectively forecasts the occurrence of PHN using these 5 risk factors, making it a valuable tool for clinical practice.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E843-E850"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770982","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":"Effectiveness and Safety of Hydromorphone Compared to Morphine for Postoperative Analgesia: A Systematic Review and Meta-analysis.","authors":"Yihang Li, Xinying Yue, Shuang Liang, Fei Ren, Qulian Guo, Wangyuan Zou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Because of its side effects, a morphine replacement has been searched for in the field of postoperative analgesia. Hydromorphone is a derivative of morphine with no active metabolites.</p><p><strong>Objectives: </strong>We conducted a meta-analysis of hydromorphone and morphine to compare their clinical effects in postoperative analgesia.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>The methodological quality of the studies included in this meta-analysis was assessed according to the Cochrane risk-of-bias tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were used to evaluate the quality of evidence and recommendation grade for inclusion of randomized controlled trials. The primary outcome was postoperative pain score. Secondary outcomes were severe sedation, nausea, vomiting, and pruritus. The meta-analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre for The Cochrane Collaboration).</p><p><strong>Results: </strong>Eight randomized controlled trials comprising 833 patients were found. There was no significant difference in pain scores between the hydromorphone and morphine groups at any measured postoperative time point: 8 hours (mean difference [MD] = -0.42; 95%CI, -2.08 to 1.24; P = 0.62); 12 hours (MD = -0.19; 95%CI, -0.62 to 0.24; P = 0.39); 24 hours (MD = -0.22; 95%CI, -0.54 to 0.09; P = 0.17); 36 hours (MD = 0.01; 95%CI, -0.67 to 0.69; P = 0.98) and 48 hours (MD = -0.14; 95%CI, -1.25 to 0.96; P = 0.80). There was no significant difference in the incidence of nausea and vomiting at 24 hours postoperative. The incidence of pruritus at 24 hours postoperative was lower in the hydromorphone group (relative risk = 0.24; 95%CI, 0.09 to 0.66; P = 0.005).</p><p><strong>Limitations: </strong>The perioperative multimodal analgesia measures were varying in the included studies, such as different medication doses. The sample size was small for some outcomes and high heterogeneity was observed.</p><p><strong>Conclusions: </strong>There was no significant statistical difference in postoperative analgesic effect between hydromorphone and morphine, as well as side effects, including severe sedation, nausea, and vomiting at 24 hours postoperative. However, the incidence of pruritus was lower in the hydromorphone group at 24 hours postoperative.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"469-478"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771206","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 Randomized Double-blind Trial of 5% Dextrose Versus Corticosteroid Hydrodissection for Meralgia Paresthetica.","authors":"Xiaochen Shi, Hailin Xu, Jiaan Zhu, Guicheng Li, Ling Bai","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided 5% dextrose (D5W) hydrodissection provides  favorable outcomes for treating peripheral entrapment neuropathies; its safety is well recognized. However, clinical evidence regarding the use of D5W hydrodissection for meralgia paresthetica (MP) is limited. Although corticosteroids are the most common injectates, the possible adverse effects are a big concern.</p><p><strong>Objective: </strong>To compare the efficacy and safety of ultrasound-guided D5W hydrodissection compared to corticosteroid hydrodissection in patients with MP during a 6-month follow-up period.</p><p><strong>Study design: </strong>A prospective, randomized double-blind, controlled trial.</p><p><strong>Setting: </strong>Outpatient clinic at a university hospital.</p><p><strong>Methods: </strong>A total of 56 patients with MP were randomly allocated to either a D5W or steroid group in a 1:1 ratio. The patients received one session of ultrasound-guided perineural injection therapy of 10 mL D5W or a corticosteroid solution (1 mL compound betamethasone [1 mL: betamethasone sodium phosphate 5 mg and betamethasone dipropionate 2 mg] mixed with 5 mL 2% lidocaine and 4 mL 0.9% saline).The primary outcomes were Visual Analog Scale (VAS) scores for MP (pain and paresthesia) and global quality of life. The secondary outcomes included self-reported successful clinical response and injection adverse effects. Evaluations were conducted at pretreatment and at one, 3, 4 and 6 months posttreatment.</p><p><strong>Results: </strong>All patients completed the study. Compared with baseline, both groups exhibited reductions in VAS scores for MP and global quality of life at all follow-up time points, with statistical differences at 3, 4, and 6 months in the D5W group (P < 0.05), as well as those at one, 3, and 4 months in the steroid group (P < 0.05). The D5W group exhibited greater improvement than the steroid group in VAS scores for MP and global quality of life at 4 and 6 months (P < 0.05), and demostrated a more successful clinical response at 6 months (P < 0.05). No adverse effects were reported in the D5W group during the study period, while 6 patients in the steroid group reported an adverse effect.</p><p><strong>Limitations: </strong>A longer follow-up period is necessary; the exact mechanism of D5W is not clear.</p><p><strong>Conclusions: </strong>Ultrasound-guided perineural injection therapy of D5W is more beneficial than corticosteroid injection for MP at 4 to 6 months posttreatment. Additionally, D5W displays a better safety profile than corticosteroid. Thus, we suggest D5W as a more suitable injectate for patients with MP.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E835-E842"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770999","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":"Dose Equivalence of Remimazolam and Propofol for Loss of Consciousness in Pediatric Patients: A Randomized Clinical Trial.","authors":"Yang Shen, Ying Sun, Yan-Ting Wang, Zhe-Zhe Peng, Jie Bai, Ji-Jian Zheng, Ma-Zhong Zhang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam and propofol can be used interchangeably for general anesthesia. However, no dosing recommendations exist for the intravenous bolus administration of remimazolam during general anesthesia induction in pediatric patients. Determining the appropriate dose for anesthesia induction in pediatric patients is crucial for safe and effective surgical procedures.</p><p><strong>Objectives: </strong>The study aimed to determine the median effective dose (ED50) for loss of consciousness (LOC) with remimazolam and propofol in pediatric patients and establish the dose equivalence between these anesthetics.</p><p><strong>Study design: </strong>A prospective, randomized, single-center trial.</p><p><strong>Setting: </strong>A tertiary pediatric hospital in China from January 2023 to July 2023.</p><p><strong>Methods: </strong>Pediatric patients aged 3 to 15 years, undergoing elective surgery under general anesthesia, were included. Patients were randomized to receive either remimazolam (in doses of 0.1, 0.15, 0.2, 0.25, and 0.3 mg/kg-1) or propofol (in doses of 0.75, 1.0, 1.25, and 1.5 mg/kg-1) via intravenous bolus. The primary measure consisted of determining the ED50 for LOC with remimazolam, and the secondary measure consisted of establishing the dose equivalence between remimazolam and propofol.</p><p><strong>Results: </strong>The calculated ED50 for remimazolam was 0.19 mg/kg-1 (95% CI: 0.10-0.35), and that for propofol was 1.11 mg/kg-1 (95% CI: 0.53-2.15). This finding indicates that remimazolam is approximately 5.8 times more potent than propofol.</p><p><strong>Limitations: </strong>In this study, the anesthesiologist could not be blinded to the different appearances of remimazolam and propofol, and the LOC assessment method may have introduced bias. Furthermore, the recommended dose for remimazolam induction was not tested directly within this trial, suggesting a need for further research.</p><p><strong>Conclusions: </strong>Remimazolam demonstrates significantly higher sedative efficacy for pediatric patients than does propofol. An induction dose of 0.34 mg/kg-1 remimazolam could be recommended for general anesthesia induction, considering the safety and effectiveness of a 2 mg/kg-1 dose of propofol.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"521-528"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771203","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":"Novel Injectable Nerve Stimulation Electrode Placed on the Dorsal Root Ganglion Using an Extravertebral Approach: A Feasibility Study in Cadavers.","authors":"Bart Billet, Christian Jessen, Bernhard Moriggl, Derrick Liu, Emily Szabo, Stephan Nieuwoudt, Alaa Abd-Elsayed, Amol Soin, Thomas Fichtner Bendtsen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Dorsal root ganglion stimulation (DRGS) is an established method for treating persistent and severe pain conditions. However, performing DRGS has significant challenges. Current DRGS systems are expensive, hindering accessibility for many patients and health care systems. Additionally, placing DRGS devices requires specialized training in epidural techniques and lead anchoring methods. Technical and financial requirements also limit the clinical applicability and availability of DRGS.</p><p><strong>Objectives: </strong>This study evaluated the feasibility of a new method for rapidly delivering near- DRG stimulation in human cadavers. The method involves a fluoroscopy-guided transforaminal approach using a fully implantable, injectable electrode, and its associated delivery system.</p><p><strong>Study design: </strong>A human cadaver feasibility study.</p><p><strong>Setting: </strong>A cadaver laboratory.</p><p><strong>Methods: </strong>In this study, 3 anesthesiologist pain physicians received training on the injectable electrode device and delivery system using spine phantom models. They then applied the device's associated implantation techniques to 2 adult male cadavers. In the first cadaver, a single injectable electrode was placed near the left L2 lumbar DRG. In the second cadaver, injectable electrodes were placed near the left L1 and L2 DRG levels, and a benchmark DRGS device was installed at the left L1 level using fluoroscopic guidance. A careful anatomical dissection was then performed for each implanted device.</p><p><strong>Results: </strong>The stimulating contacts of the injectable electrodes were accurately positioned within one mm of the DRG at the lumbar L1 and L2 levels in both cadavers. The distances of both the injectable lead and benchmark DRGS device at the L1 level were measured as one mm from the posterior aspect of the DRG.</p><p><strong>Limitations: </strong>The findings of this study are based on anatomical examinations of a limited number of human cadavers and may not fully represent living human anatomy.</p><p><strong>Conclusions: </strong>To our knowledge, this feasibility cadaver study is the first of its kind to examine the accuracy and efficiency of a fluoroscopy-guided transforaminal approach to place injectable electrodes near the DRG. These promising results suggest that this method could be a viable alternative to existing DRGS techniques, warranting further investigation into its clinical potential.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E899-E907"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771252","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":"Prevalence and Risk Factors for Persistent Spinal Pain Syndrome Type II Following Spinal Surgery: A Nationwide Retrospective Cohort Study.","authors":"Tak Kyu Oh, In-Ae Song","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Persistent Spinal Pain Syndrome Type II (PSPS II) is a major health concern in patients undergoing spinal surgery. However, there are little data on the prevalence and risk factors of PSPS II post spinal surgery.</p><p><strong>Objectives: </strong>We examined the prevalence and factors associated with diagnosing PSPS II post spinal surgery using a nationwide database in the Republic of Korea.</p><p><strong>Study design: </strong>A retrospective, population-based cohort study.</p><p><strong>Setting: </strong>Nationwide cohort study in the Republic of Korea.</p><p><strong>Methods: </strong>Adult patients who underwent spinal surgery under general anesthesia from January 1, 2016 through December 31, 2020 were included. Patients previously diagnosed with PSPS II were excluded from the study in order to focus only on patients who were newly diagnosed post spinal surgery. We determined that a PSPS II diagnosis must be made within  one year of the date of spinal surgery, with an additional evaluation for diagnoses occurring within 2 years to capture longer-term cases. A multivariate logistic regression model was developed to identify the factors associated with diagnosing PSPS II post spinal surgery.</p><p><strong>Results: </strong>In total, 530,644 patients who underwent spinal surgery were included. Of these, 25.6% and 31.5% were diagnosed with PSPS II within one and 2 years post spinal surgery, respectively. The multivariate logistic regression model indicated that being a woman, old age, being a member of a medical aid program group, an increased Charlson Comorbidity Index score, discectomy, laminectomy, and lumbar level surgery were associated with an increased prevalence of PSPS II within one year post spinal surgery. Similar results were observed in the multivariate logistic regression model for PSPS II within 2 years post spinal surgery.</p><p><strong>Limitation: </strong>Our study's retrospective cohort design is a limitation.</p><p><strong>Conclusions: </strong>This population-based cohort analysis found a 25.6% prevalence of PSPS II within one year post spinal surgery and 31.5% within two years post spinal surgery. Identified risk factors include old age, being a woman, economic poverty, comorbid status, underlying disability, type of surgery, and lumbar-level surgery. A large dataset was used to document the prevalence and risk factors for PSPS II post spinal surgery.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"555-563"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Analgesia Techniques Following Thoracic Surgery: A Systematic Review and Network Meta-analysis.","authors":"Meijuan Yang, Xiaomei Zhang, Gang Liu, Xingwang Zhang, Wenjun Yan, Dong Zhang","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Regional analgesia techniques have become the basis of multimodal analgesia for acute and chronic pain. They are widely used in thoracic surgery, but the best treatment is still uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to compare and rank the effectiveness of regional analgesia techniques for thoracic surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A systematic review and network meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, MEDLINE, Embase, Cochrane Library, Science-Direct, and Web of Science were searched for articles published from inception through the end of January 2023. The network meta-analysis was conducted using Stata 15.1 software (StataCorp, LLC). The certainty of evidence was assessed by using Confidence in Network Meta-analysis (CINeMA https://cinema.ispm.unibe.ch/ A (unibe.ch). The primary outcome was cumulative opioid consumption within postoperative 24 hours. The secondary outcomes included pain scores at postoperative 6 hours, 12 hours, and 24 hours.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 32 trials with 1,996 patients and 11 techniques were included. No major network inconsistency or heterogeneity were found. Postoperative opioid consumption within postoperative 24 hours was decreased most by continuous extrapleural block (cEPB) (standardized mean difference [SMD] = 0.00; 95% CI,: 0.00-0.00), followed by continuous thoracic epidural analgesia (cTEA) and continuous serratus plane block (cSAPB). In the postoperative 6 hour analysis, pain scores were  decreased most by cTEA (SMD = 0.16; 95% CI,: 0.05-0.49), followed by thoracic paravertebral block (TPVB) and ESPB (erector spinae plane block). In the postoperative 12 hour analysis, pain scores were decreased most by cSAPB (SMD = 0.12; 95% CI, 0.011.84), followed by TPVB and cTEA. In the postoperative 24 hour analysis, pain scores were decreased most by ESPB (SMD = 0.09; 95% CI, 0.030.32), followed by cSAPB and continuous thoracic paravertebral block (cTPVB).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our study has several limitations. First, 4 enrolled studies had a sample size of less than 40 patients. Second, the different regimens were potential factors contributing to heterogeneity, such as local anesthetic dose and volume, infusion time, infusion mode, adding adjuncts, and rescue analgesic regimens. Third, the number of primary and secondary outcomes is limited. Fourth, the number of randomized controlled trials for cEPB is limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The cTEA and cSAPB techniques are more likely to reduce the cumulative opioid consumption within 24 hours. The cTEA, cSAPB, ESPB techniques were more likely to improve pain at postoperative 6, 12, and 24 hours. Therefore, cTEA, cSAPB, and ESPB are the first choices for pain relief post thoracic surgery, whereas wound infiltration, intercostal block, continuous wound infiltration, and continuous intercostal block were less likely to be effective. We need more high-q","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E803-E818"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Robot-Assisted and Fluoroscopy-Assisted Percutaneous Kyphoplasty for Bone Cement Distribution and Clinical Efficacy.","authors":"Hui Tao, Zhiwei Huang, Shanzhong Shao, Ruoyu Yang, Kun Yang, Yinshun Zhang, Wei Li, Fulong Dong, Jun Qian, Cailiang Shen","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The distribution of bone cement after percutaneous kyphoplasty (PKP) affects its clinical efficacy in patients with osteoporosis. Robotic and traditional treatment of osteoporotic vertebral compression fractures (OVCFs) have both been established as effective, but no studies have compared these 2 modalities in terms of bone cement distribution and clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the bone cement distribution and clinical efficacy of robot-assisted percutaneous kyphoplasty to those of fluoroscopy-assisted percutaneous kyphoplasty for the treatment of OVCFs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Department of Orthopedics and Spine Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A single-center, retrospective observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data from 151 patients with OVCFs who underwent PKP between January 2020 and July 2022 were analyzed retrospectively. The patients were divided into 3 groups: robot-assisted unipedicular percutaneous kyphoplasty (RAUPK), fluoroscopy-assisted unipedicular percutaneous kyphoplasty (FAUPK), and fluoroscopy-assisted bipedicular percutaneous kyphoplasty (FABPK). The operation time, intraoperative blood loss, bone cement injection volume, bone cement distribution, and complications (vascular and nerve injury, bone cement leakage, and re-fracture) of each procedure were recorded. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, Cobb angle, and anterior height of the injured vertebrae were compared among the 3 groups preoperatively, one day postoperatively, and at the final follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;No puncture failures occurred in any of the 3 groups. The mean follow-up period was 20.0 ± 5.2 months. The postoperative VAS scores, ODI, anterior vertebral heights, and Cobb angles of all patients were significantly improved compared to the preoperative values (P &lt; 0.05). There were no significant differences in the VAS score, ODI score, Cobb angle, anterior vertebral height ratio preoperatively or one day postoperatively among the 3 groups (P &gt; 0.05). The groups' comparative rates of intraoperative blood loss and complications also showed no significant differences (P &gt; 0.05). At the last follow-up, the VAS and ODI scores of the RAUPK group were lower than those of the FAUPK group (P &lt; 0.05), as were the anterior height of the injured vertebra and Cobb angle of the RAUPK group (P &lt; 0.05). The operation time, bone cement injection volume, and bone cement distribution in the RAUPK group were superior to those in the FAUPK group (P &lt; 0.05). Nevertheless, there were no significant differences in the VAS, ODI, Cobb angle, or anterior vertebral height at the last follow-up between the FABPK group and the RAUPK group (P &gt; 0.05). Those 2 groups also showed no significant difference in operation time, intraoperative blood loss, bone cement distrib","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E953-E963"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Nerve Stimulation Using High-Frequency Electromagnetic Coupling Technology to Power an Implanted Neurostimulator with a Separate Receiver at the Superior Cluneal Nerve for Treatment of Chronic Back Pain Due to Neuralgia: A Retrospective Study.","authors":"David Lindley, Adrianna Anders","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Low back pain is a highly prevalent condition with substantial costs. Superior cluneal neuralgia is present in up to 14% of low back pain cases. This etiology of back pain is often overlooked because the symptoms of superior cluneal neuralgia manifest similarly to those of other conditions, such as radiculopathy and sacroiliac joint pain. Peripheral nerve stimulation (PNS) is an emerging pain management modality used to treat various chronic pain conditions. This retrospective study will examine the outcomes of patients who have back pain caused by neuralgia and are treated with the permanent Freedom® PNS System (Curonix LLC) at the superior cluneal nerve.</p><p><strong>Objectives: </strong>The primary objective was to examine the responder rate (proportion of patients who experienced greater than 50% relief) and changes in pain scores after the trial procedure. Secondary objectives included changes in pain scores from at least one month after permanent implantation, adverse event occurrences, changes in function and quality of life, and reductions in medication usage.</p><p><strong>Setting: </strong>This was a retrospective single-site study. All procedures were performed by the same interventional pain physician.</p><p><strong>Methods: </strong>A retrospective chart review was conducted to assess baseline and follow-up parameters. Inclusion criteria consisted of requirements that patients be 18 years or older and have a confirmed superior cluneal neuralgia diagnosis responsible for their pain presentation. Exclusion criteria included the presence of another active implanted device for pain management. The 11-point verbal rating scale (VRS) was used to assess pain scores.</p><p><strong>Results: </strong>Twenty-one patients were included in this study. All 21 responded to the trial procedure with a 77% average reduction in VRS scores. At the follow-up (mean = 11 months), 20 patients reported an average 57% reduction in pain scores with the verbal rating scale. The same proportion of patients reported improved function and quality of life. Five patients reported reduced medication usage, including one who stopped taking pain medication altogether. No complications were reported.</p><p><strong>Limitations: </strong>We were limited to the data available in the patient charts since this was a retrospective study investigating the efficacy and safety of the Freedom® PNS System for patients with refractory chronic back pain.</p><p><strong>Conclusion: </strong>When used to target the superior cluneal nerve, the Curonix Freedom® PNS System is an effective and safe treatment for neuralgia-caused chronic lower back pain resistant to conservative therapy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E937-E942"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}