Pain physician最新文献

{"title":"Association Between Systemic Inflammation Response Index and All-Cause Mortality in Individuals with Chronic Pain: Evidence from NHANES 1999-2004.","authors":"Liang-Wen Li, Chen-Yu Zhu, Yunjie Chen, Jun Yang, Li Song","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a common condition that has been linked to systemic inflammation. In recent years, the system inflammation response index (SIRI) has aroused researchers' interest as a novel inflammatory biomarker. The association between SIRI and mortality in individuals with chronic pain remains unclear.</p><p><strong>Objectives: </strong>To explore the association between SIRI and all-cause mortality in individuals with chronic pain, and to assess the index's potential as a tool for risk stratification in this population.</p><p><strong>Study design: </strong>A population-based prospective cohort study.</p><p><strong>Setting: </strong>The National Health and Nutrition Examination Survey (NHANES) 1999-2004, with mortality follow-up through December 31, 2019.</p><p><strong>Methods: </strong>Cox proportional hazards regression models were employed to evaluate the association between log10-transformed SIRI and all-cause mortality in the chronic pain population, adjusting for demographic and health-related factors. To handle missing data, multiple imputation by chained equations was performed, generating 5 imputed datasets. Nonlinear relationships were examined using restricted cubic spline (RCS) regression and piecewise models to explore potential threshold effects.</p><p><strong>Results: </strong>The study included 1,938 patients with chronic pain, of whom 647 died during follow-up. Higher log10(SIRI) was associated with higher all-cause mortality in fully adjusted models (hazard ratio [HR] per one-unit increase, 2.56; 95% confidence interval [CI], 1.67-3.94; P < 0.001). Compared to patients in the lowest SIRI tertile, those in the highest tertile had a higher mortality risk (HR, 1.45; 95% CI, 1.11-1.90; P < 0.001). RCS analyses further suggested a nonlinear association between SIRI and mortality, with a steeper increase in risk at higher SIRI levels. The association appeared stronger among adults aged ≥ 52 years.</p><p><strong>Limitations: </strong>Chronic pain status was self-reported using a duration-based definition (≥ 3 months) and lacked detailed clinical characterization and treatment data.</p><p><strong>Conclusions: </strong>In adults with chronic pain, higher SIRI was associated with a higher risk of all-cause mortality, with a more pronounced association in older adults. SIRI may be useful for mortality risk stratification in this population.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"E417-E427"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670621","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 Efficacy and Safety of Pregabalin Combined with Venlafaxine in Fibromyalgia Patients: Protocol for a Prospective, Randomized, Open-Label, Blinded-Endpoint Trial.","authors":"Minying Liu, Ruilin He, Likui Wang, Jian Cui, Daying Zhang, Bifa Fan, Fang Luo, Shuiqing Li","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia (FM) is a chronic condition characterized by widespread pain and a range of somatic and psychological symptoms that impose a substantial burden on patients. While pregabalin is an approved and effective monotherapy for many individuals with FM, the efficacy of this medication is often incomplete, particularly for symptoms like fatigue and anxiety. Combination therapy incorporating selective serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine, has shown promise for enhancing therapeutic outcomes. Venlafaxine, an SNRI with demonstrated efficacy as an FM treatment, has a distinct pharmacological mechanism from pregabalin. However, the synergistic potential of pregabalin and venlafaxine in combination has not been formally evaluated.</p><p><strong>Objectives: </strong>This study protocol describes a trial designed to test the hypothesis that the combination of pregabalin and venlafaxine is superior to pregabalin monotherapy in providing pain relief to patients with FM.</p><p><strong>Study design: </strong>This is a multicenter, prospective, randomized, open-label, blinded-endpoint study.</p><p><strong>Setting: </strong>This study will be conducted at 7 different hospitals.</p><p><strong>Methods: </strong>We will recruit 750 adults with a diagnosis of FM and moderate-to-severe pain. Patients will be randomly assigned in a one-to-one ratio to receive either pregabalin monotherapy or combination therapy consisting of pregabalin and venlafaxine for 12 weeks. Both groups will follow a flexible, forced-titration schedule to achieve the maximum tolerated dose. While the patients and treating physicians will be aware of the treatment allocation, the outcome assessors will remain blinded.</p><p><strong>Results: </strong>The primary outcome is the mean daily pain intensity at week 4, measured on an 11-point numeric rating scale. Secondary outcomes will be evaluated at baseline and at weeks one, 2, 4, 8, and 12 after the treatment initiation. Secondary outcomes include the worst pain intensity, the responder rates (≥ 30% and ≥ 50% pain reduction), the dose of pregabalin and/or venlafaxine, the Revised FM Impact Questionnaire, the Brief Pain Inventory severity and interference subscales, the 36-Item Short Form Survey (SF-36), the Medical Outcomes Study Sleep Scale, the Beck Depression Inventory-II, and adverse events (AEs) occuring throughout the study. Statistical analyses will be performed on the modified intention-to-treat population.</p><p><strong>Limitations: </strong>An open-label design will be employed, with patient follow-up limited to 12 weeks.</p><p><strong>Conclusion: </strong>If the combination of pregabalin and venlafaxine proves to be more effective and better tolerated than pregabalin monotherapy, the combination therapy could establish a new standard of care for FM patients who struggle to achieve sufficient pain relief through nonpharmacological therapies.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 5","pages":"335-343"},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670325","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":"Updated 2026 Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines.","authors":"Laxmaiah Manchikanti, Mahendra R Sanapati, Sheri L Albers, Alan D Kaye, Vinita Singh, Nebojsa Nick Knezevic, Rajesh Naidu Janapala, Amol Soin, Annu Navani, Adam M Kaye, Ahad Mussarat, Alexander Bautista, Dajie Wang, Paul J Christo, Maged Mina, Daneshvari R Solanki, Devi Nampiaparampil, Gerard Limerick, John Manor, Kris Ferguson, Lynn Cintron, Michael Bottros, Shirley Chen, Shivam S Shah, Vahid Grami, Douglas P Beall, Shalini Shah, Sairam Atluri, Mittal S Prajapati, Alaa Abd-Elsayed, Salahadin Abdi, Steve Aydin, Sanjay Bakshi, Joseph Cabaret, Aaron K Calodney, Kenneth D Candido, Christopher G Gharibo, Mayank Gupta, Michael Harned, Standiford Helm Ii, Sachin Sunny Jha, Radomir Kosanovic, Vidyasagar Pampati, Ramarao Pasupuleti, Bradley W Wargo, Hermant Kalia, Gary Schwartz, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic axial spinal pain is a major contributor to disability and healthcare expenditures, with facet joints recognized as one of the established sources of pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multidisciplinary panel of experts from various medical and pharmaceutical disciplines, convened by the American Society of Interventional Pain Physicians (ASIPP), reviewed the available evidence, considered patient perspectives, and formulated recommendations for facet joint interventions in the management of chronic pain.The methodology included the development of key questions with evidence-based statements and recommendations. Grading of the evidence and recommendations followed a modified approach described by ASIPP, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and the Agency for Healthcare Research and Quality (AHRQ) methods for grading strength of recommendations. The evidence review included existing guidelines, systematic reviews, comprehensive reviews, randomized controlled trials (RCTs), and observational studies evaluating the effectiveness and safety of facet joint interventions in chronic pain management.In the development of consensus statements and guidelines, a modified Delphi technique was utilized to minimize bias related to group interactions. Panelists without a primary conflict of interest voted on approval of specific guideline statements. Each panelist was permitted to suggest revisions to guideline wording and provide additional qualifying remarks or comments regarding implementation of the guidelines in clinical practice. To achieve consensus and inclusion in the final guidelines, each guideline statement required at least 80% agreement among eligible panel members without a primary conflict of interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 48 authors participated in the development of these guidelines, of whom 39 participated in the voting process. A total of 37 recommendations were developed, with 100% acceptance for all items. The Summary of Recommendations is presented separately. These recommendations addressed diagnostic, therapeutic, and special considerations related to facet joint interventions. For diagnostic and therapeutic interventions, the level of evidence ranged from II to III, with moderate to strong recommendations. For special considerations and safety assessments, the level of evidence ranged from II to V. The evidence provided recommendations regarding diagnosis, treatment, sedation, concurrent antithrombotic therapy, and precautions required in special clinical circumstances.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The limitations of these guidelines include a paucity of high-quality studies in some aspects of diagnosis and therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;These guidelines for face","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 4S","pages":"S1-S228"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345968","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":"An Updated (2026) Best-Evidence Synthesis Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain.","authors":"Laxmaiah Manchikanti, Mark V Boswell, Mahendra R Sanapati, Alan D Kaye, Miles Day, Nebojsa Nick Knezevic, Mittal S Prajapati, Amol Soin, Annu Navani, Vidyasagar Pampati, Christopher G Gharibo, Devi Nampiaparampil, Vivek Manocha, Navneet Boddu, Sairam Atluri, Shalini Shah, Alexander Bautista, Vinita Singh, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic axial spinal pain is one of the leading causes of disability. The literature demonstrates that expenditures for low back and neck pain continue to rise, not only in parallel with increasing disability, but also with escalating healthcare costs, accounting for the highest spending among multiple disease categories. Based on current evidence utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been identified as potential sources of spinal pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Methodological quality of the included studies was assessed using the Quality Appraisal of Reliability Studies (QAREL) instrument. Only diagnostic accuracy studies meeting at least 50% of the predefined inclusion criteria were included in the analysis.The strength of evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Levels of evidence were classified using a modified best evidence synthesis, ranging from Level I to Level V.Data sources included relevant literature identified through PubMed and other electronic searches published from 1966 through September 2025, Cochrane reviews, and manual searches of the bibliographies of primary and review articles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Eligible studies were required to use placebo-controlled or comparative local anesthetic blocks. A positive diagnostic standard was defined as at least 50% pain relief from baseline scores along with the ability to perform previously painful movements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The available evidence demonstrated Level I for lumbar facet joint nerve blocks, based on 18 studies employing dual diagnostic blocks, demonstrating 75% to 80% pain relief, with an average prevalence of 16% to 45% and estimated or presumed false-positive rates of 25% to 50%.Evidence for the diagnosis of cervical facet joint pain using cervical facet joint nerve blocks is Level II, derived from 12 controlled diagnostic accuracy studies, showing substantial heterogeneity and internal inconsistency. Reported prevalence ranged from 36% to 67% with ≥ 80% pain relief and estimated or presumed false-positive rates of 26% to 63%.The level of evidence for the diagnostic accuracy of thoracic facet joint nerve blocks is Level II, based on 3 studies using dual diagnostic blocks, demonstrating 80% or greater pain relief, with prevalence ranging from 34% to 48% and estimated or presumed false-positive rates ranging from 42% to 58%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Limitations of this systematic review include the limited number of studies involving the thoracic spine, ongoing debate regarding the appropriate reference standar","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 4S","pages":"S229-S271"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Diagnostic Guidance for Chronic Complex Regional Pain Syndrome Type I and Type II from The American Society of Interventional Physicians (ASIPP)\".","authors":"Janet H Bultitude, Janne Gierthmuhlen, Michael C Ferraro, Andreas Goebel, Heike Rittner, Debbie Bean, Frank Birklein, Tara Packham, Masihiko Sumitani, Paul J Austin, Peter Drummond, R Norman Harden, Stephen Bruehl","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E257-E259"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"BMJ Publications on Interventional Techniques Do Not Meet Appropriateness Criteria of Conducting a Rapid Review: A Comprehensive Review\".","authors":"Jason W Busse, Xiaoqin Wang, Liang Yao, Stephane Genevay, Gordon H Guyatt, Thomas Agoritsas","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E265-E267"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212093","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 of Radiofrequency Ablation in Managing Chronic Axial Spinal Pain of Facet Joint Origin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Laxmaiah Manchikanti, Emilija Knezevic, Nebojsa Nick Knezevic, Mahendra Sanapati, Alan D Kaye, Vinita Singh, Ramarao Pasupuleti, Mittal S Prajapati, Navneet Boddu, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic axial spinal pain is a major cause of disability. The literature shows that expenditures related to low back and neck pain and other musculoskeletal disorders continue to rise, not only due to disability but also due to increasing healthcare costs, accounting for the highest expenditure among various disease categories. Based on current evidence utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been identified as potential sources of spinal pain. Therapeutic facet joint interventional modalities for axial spinal pain include radiofrequency ablation, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency ablation as a therapeutic modality in managing chronic axial spinal pain of facet joint origin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A systematic review and meta-analysis of randomized controlled trials (RCTs) utilizing 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;The available literature on radiofrequency ablation in axial spinal pain was reviewed. The quality assessment criteria utilized included the Cochrane review criteria to assess risk of bias and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials. The evidence was graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The level of evidence was determined based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V.A comprehensive literature search of multiple databases from 1966 to June 2025, including manual searches of the bibliographies of relevant review articles, was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into both qualitative and quantitative analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome measure was the proportion of patients achieving significant pain relief and functional improvement of greater than 50% for at least 6 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This assessment identified 17 RCTs, including 14 high-quality and 3 moderate-quality studies based on Cochrane criteria, and 11 high-quality and 6 moderate-quality studies based on IPM-QRB criteria. Based on the GRADE assessment, 8 trials demonstrated at least moderate levels of impact and certainty, whereas 7 trials showed low impact with low certainty, and 2 trials demonstrated very low impact and certainty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Despite the availability of multiple studies, the relative paucity of h","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"205-240"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212082","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":"Match Program Signaling in Pain Medicine Fellowship Applications: Association with Interview Outcomes and Implications for a Shrinking Applicant Pipeline.","authors":"Alexander Bautista, Meredith Barad, Trent D Emerick, Yashar Eshraghi, Prentiss Lawson, Saba Javed, Tolga Suvar, Christine Oryhan, Thelma Wright, Kristen Noon","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pain Medicine fellowship programs have reported increasing numbers of unfilled positions in recent match cycles, accompanied by a growing perception that the applicant pipeline is shrinking. In response to concerns regarding application volume and applicant-program fit, the Electronic Residency Application Service® (ERAS) introduced program signaling for the Pain Medicine fellowship in the 2024-2025 application cycle. Of note, Pain Medicine was the first fellowship across all medical specialties to utilize signaling, with further plans by ERAS to expand access to signaling to other fellowships in the future. However, the effectiveness of this intervention in the context of fewer applications to the field remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the association between ERAS program signaling and interview invitation rates in Pain Medicine fellowship applications, and to contextualize signaling outcomes alongside longitudinal National Resident Matching Program® (NRMP) match trends and unfilled positions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our study integrated data from 3 sources: NRMP Specialties Matching Service reports (2019-2025), Association of American Medical Colleges ERAS signaling dashboards (2024-2025), and a post match survey distributed to all 442 applicants in the 2025 cycle. Primary outcomes included interview invitation rates by signal status and applicant type (MD, DO, international medical graduate [IMG]). Secondary outcomes included match rates at signaled vs nonsignaled programs and applicant perceptions of signaling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cross-sectional.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty-five applicants responded (14.7% response rate), 86.1% matched. Applicants utilized a mean of 4.6 of the 5 available signals. Interview invitation rates were substantially higher for signaled applications than for nonsignaled applications across all applicant types. Among applicants who sent signals, interview rates were 70.3% for MDs, 58.3% for DOs, and 34.1% for IMGs, compared with 39.7%, 32.3%, and 18.0%, respectively, among nonsignaled applications. The signal-associated increase in interview rate was greatest for MD applicants (30.6 percentage points), followed by DOs (26.0 percentage points) and IMGs (16.1 percentage points). Of matched respondents, 70.7% matched at a program they had signaled. Applicant perceptions of signaling were mixed, with 64.1% reporting it as useful and 35.9% reporting it as useless.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Program signaling is strongly associated with increased interview invitation rates in Pain Medicine fellowship applications and appears to improve applicant-program alignment, particularly for MD applicants. However, the differential benefits across applicant types raise equity concerns, and signaling cannot address the fundamental workforce changes driving a reduced applicant pool. Sustainable recruitment strategies must extend be","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"245-250"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212175","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":"Ligamentum Flavum Average Thickness: A Novel MRI Parameter for Diagnosing Lumbar Central Spinal Stenosis.","authors":"Yu Wang, Xuanhang Zhang, Jiahao Xie, Kaifeng Liu, Xinyu Liu, Kunqi Li, Jian Xiong, Jianying Zheng, Panjie Xu, Zhongmin Zhang, Wei Ji","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Hypertrophy of the ligamentum flavum (LF) is a primary cause of lumbar central spinal stenosis (LCSS). Conventional metrics of LF hypertrophy, however, have limitations. Using ligamentum flavum thickness (LFT), measured at the midpoint of the thicker side of the LF, can miss heterogeneous thickening, while the metric known as the ligamentum flavum area (LFA) is confounded by anatomical variations in LF length. To overcome these limitations, we introduced and validated a novel parameter, ligamentum flavum average thickness (LFAT).</p><p><strong>Objectives: </strong>To evaluate the diagnostic performance of LFAT for LCSS and compare the metric with conventional MRI parameters.</p><p><strong>Study design: </strong>A retrospective observational study.</p><p><strong>Setting: </strong>A single center in Guangzhou, China.</p><p><strong>Methods: </strong>This retrospective study analyzed T2-weighted axial MR images from 166 patients with LCSS and 168 asymptomatic controls. Using receiver operating characteristic (ROC) curve analysis, we compared the diagnostic performance of the novel parameter, LFAT-the more hypertrophied side of the ligamentum flavum area (LFA') divided by its curvilinear length-with 3 conventional metrics: LFT-the midpoint thickness of the more hypertrophied LF side, LFA-the total cross-sectional area of the LF, and LFA'.</p><p><strong>Results: </strong>ROC analysis revealed that of all the parameters, the LFAT demonstrated the highest diagnostic accuracy, with an area under the curve (AUC) of 0.909 (95% CI, 0.879-0.940). This performance was significantly superior to that of LFT (AUC = 0.852), LFA' (AUC = 0.851), and LFA (AUC = 0.782) (all P < 0.05). At an optimal cutoff of 3.35 mm, LFAT yielded a sensitivity of 86.7% and a specificity of 81.5%.</p><p><strong>Limitations: </strong>Major limitations of this study include its retrospective, single-center design, the use of a control group comprising patients with hip pathologies rather than healthy volunteers, and an exclusive focus on hypertrophy of the ligamentum flavum (LFH) as a contributor to LCSS.</p><p><strong>Conclusion: </strong>With its superior diagnostic accuracy over traditional metrics, LFAT shows considerable promise as a more objective and reliable parameter for the clinical diagnosis of LCSS.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E247-E255"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212106","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":"In Response to Comment on \"Diagnostic Guidance for Chronic Complex Regional Pain Syndrome Type I and Type II from The American Society of Interventional Physicians (ASIPP)\".","authors":"Christopher G Gharibo, Miles Day, Steve Aydin, Alan D Kaye, Salahadin Abdi, Sudhir A Diwan, Lisa V Doan, Danielle Feng, Kris Ferguson, Kirolos Georges, Andrew Kaufman, Nebojsa Nick Knezevic, Sean Li, Franzes A Liongson, Devi Nampiaparampil, Annu Navani, Mahendra Sanapati, Michael Schatman, Amol Soin, Peter S Staats, Giustino Varrassi, Jing Wang, Laxmaiah Manchikanti","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E261-E264"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212101","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}