Pain physician最新文献

{"title":"Platelet-Rich Plasma Treatment for the Lumbar Spine: A Review and Discussion of Existing Gaps.","authors":"Ji-Eun Irene Yum, Arthur J De Luigi, Gregory L Umphrey, Bryan K Ganter, Min Yoo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Platelet-rich plasma (PRP) is obtained by centrifuging autologous whole blood to extract a layer concentrated with platelets, growth factors found in platelet granules, and cytokines. These components work together to promote and facilitate the healing process at sites of injury. An increasing number of clinical studies are assessing the efficacy of PRP as a treatment for lower back pain.</p><p><strong>Objectives: </strong>Lumbar back pain is a significant cause of years lived with disability. This paper conducts a thorough review of clinical studies on intradiscal, facet-joint, epidural, and mixed-target PRP interventions in the lumbar spine. Furthermore, gaps in the current literature regarding lumbar spinal PRP injections are identified to help guide future clinical trials.</p><p><strong>Study design: </strong>Literature review.</p><p><strong>Methods: </strong>An initial search was conducted using Ovid MEDLINE, focusing on PRP injections in the spine. Boolean operators were used to combine MeSH terms and key words such as \"spine,\" \"lumbar spine,\" \"thoracic spine,\" \"cervical spine,\" \"intervertebral disc,\" \"platelet-rich plasma,\" and \"inject.\" The search revealed an absence of papers about PRP injections into the cervical and thoracic spine, so the review was written with a specific focus on the lumbar spine. For the purposes of this paper, the selected manuscripts were separated into categories of intradiscal, facet-joint, epidural, and mixed-target PRP injections.</p><p><strong>Results: </strong>A multitude of case reports, case series, prospective clinical studies, and randomized controlled trials have yielded results supporting the use of intradiscal, facet-joint, and epidural PRP injections in the lumbar spine. However, a handful of papers suggest that PRP lacks efficacy in improving lumbar back pain and function. With the relative dearth of literature assessing the effects of spinal PRP injections, additional double-blinded randomized trials are needed. Important findings from available studies include the observation of PRP's increased efficacy over time, the correlation of the number of targeted injection sites with the efficacy of PRP injections, and the correlation of platelet count with PRP injections' efficacy.</p><p><strong>Limitations: </strong>There exists wide variability in PRP preparation protocols and in the methods of assessing PRP's therapeutic benefits between each study that evaluates PRP's effects in the lumbar spine.</p><p><strong>Conclusions: </strong>All clinical studies evaluating PRP as a form of treatment for the lumbar spine should include full transparency and details about the methods used for PRP preparation and injection. Future double-blinded randomized trials can fill in existing gaps by assessing the effects of platelet concentration and dose on the extent of clinical improvement as well as by establishing an expected timeline for clinical improvement after PRP injections. Cro","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"283-302"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860539","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":"Reporting the Location and Extent of Pain in Adolescents: A Test-Retest Reliability Study.","authors":"Anna Folli, Deborah Falla, Corrado Cescon, Federica Vanoni, Emiliano Soldini, Marco Barbero","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>A pain drawing is a self-administered assessment that requires the patient to shade in on a body chart the areas in which he or she experiences pain, regardless of the intensity. Pain drawings have already been validated in several adult populations.</p><p><strong>Objectives: </strong>The aim of this study is to establish adolescents' test-retest reliability in reporting the extent and location of their pain using a paper-based pain drawing.</p><p><strong>Study design: </strong>A one-day test-retest reliability study was set up.</p><p><strong>Setting: </strong>The study took place in 2 separate locations-a pediatric hospital and a private physiotherapy practice in Ticino, in the southern part of Switzerland. This reliability study was approved by the local ethics committee of Ticino (2021-00492 CE 3832).</p><p><strong>Methods: </strong>Adolescents with musculoskeletal pain (aged 11-16 years) were included. All participants were asked to shade the areas in which they experienced pain over the previous week. After the administration of a questionnaire and the acquisition of further personal data, the pain drawing was administered again. The pain drawings were then scanned and analyzed using a digital platform, which allowed the extraction of pain extent and location values. The test-retest reliability was evaluated on these data. The intraclass correlation coefficient and Bland-Altman analysis were used to assess the reliability of the reporting of the pain extent, whereas the Jaccard similarity coefficient was used to calculate the reliability of the reporting of the pain location.</p><p><strong>Results: </strong>The reporting of the pain extent was observed to have excellent test-retest reliability: ICC2,1: 0.959 (95% CI: 0.925-0.978). The Bland-Altman analysis showed a mean difference close to 0: -0.010% (limits of agreements -0.962 to 0.942). The reliability of the reporting of pain location was also supported by the Jaccard index mean score of 0.82 (± 0.19).</p><p><strong>Limitations: </strong>Reliability of reporting may vary depending on the nature of the pain, its duration, or the type of disorder and body areas involved.</p><p><strong>Conclusions: </strong>Adolescents complaining musculoskeletal pain showed reliability in reporting pain extent and location using pain drawings.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E637-E643"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860542","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":"Heeding Pain's Prescription.","authors":"James Giordano, John R Shook","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Newer definitions of pain remain suggestive of categorization by mainly neurological or psychological bases. All pain recruits cortical interpretation for any sort of directive effects in awareness, attention, and action. That unity of purpose in pain's multi-pathway manifestations can inspire neurophilosophical reflections on the existentiality, subjectivity, and sociality of pain. Pain is neither so subjective as to be relieved of meaning, nor so objective that multi-modal approaches can take turns at targeting its relief. The problem of objectifying the subjective is essential for addressing issues of assessing and treating pain. Integrative plans for pain care make sense if and when all aspects of pain's character are deemed to be integral, and are actually integrated in both theory in practice. A standpoint on the \"entity-identity\" of pain afflicting the whole person implies that pain is expressed behaviorally and as articulately as circumstances permit. Pain speaks, even for those not able to speak, as their patterns of brain activity may be representative of pain. Heeding pain's prescriptive voice requires collective interpretations before attempting coordinated treatments. Pain's prescription will remain unfilled until its full reality is recognized at a personal level, where comprehensive care is mobilized for the whole patient. Heeding pain looks to the central figure that is never absent from any painful situation, namely the individual person-in-pain. That holistic and humanistic value to mobilizing resources against pain should be reflected in the practice of pain medicine, and the craft of the pain physician.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"349-354"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860535","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 \"Stellate Ganglion Destruction With Alcohol Versus Thermal Ablation for Chronic Post-Mastectomy Pain: A Randomized Trial\".","authors":"Hui Li, Jun Ye, Xie Yang Ding, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E648-E649"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860529","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":"Technique of Awake Computed Tomography-guided Percutaneous Balloon Compression of the Gasserian Ganglion for Trigeminal Neuralgia.","authors":"Bing Huang, Huidan Lin, Ming Yao, Keyue Xie, Yong Fei, Li Zhang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique's curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped.</p><p><strong>Objectives: </strong>This study aimed to upgrade classic PBC to awake computed tomography (CT)-guided PBC technology under conscious local anesthesia and analgesia monitoring.</p><p><strong>Study design: </strong>Prospective clinical study.</p><p><strong>Setting: </strong>Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China.</p><p><strong>Methods: </strong>Puncture was designed and guided by CT scanning, and the curative effect was assessed by asking the patients about what they are feeling during the operation.</p><p><strong>Results: </strong>CT can design the puncture path and accurately guide puncture, observe the position and shape of the balloon through 3-dimensional reconstruction during the operation, and judge the curative effect according to the patient's chief concern.</p><p><strong>Limitations: </strong>Local anesthetic analgesia is not perfect, resulting in some patients experiencing pain during surgery.</p><p><strong>Conclusions: </strong>PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient's chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E619-E626"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860543","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 Comprehensive Overview of the Stellate Ganglion Block Throughout the Past Three Decades: A Bibliometric Analysis.","authors":"Ying Ren, Zhen Zhang, Hong-Ping Li, Peng-Ju Zhang, Jietai Duo, Hao Kong","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Over the past 3 decades, clinicians and scholars have used and studied the stellate ganglion block (SGB) extensively, making this field a highly anticipated research hot spot. To the best of our knowledge, there has been no bibliometric analysis of the SGB until now.</p><p><strong>Objective: </strong>Our study aimed to complete multiple tasks regarding SGB research: identify the collaboration and impact of countries, institutions, journals, and authors, evaluate the knowledge base, trace the trends in hot spots, and explore the emerging topics relevant to the field.</p><p><strong>Study design: </strong>A bibliometric analysis.</p><p><strong>Methods: </strong>Publications that were associated with the SGB and published between the years of 1993 and 2022 were retrieved from the Web of Science Core Collection on September 21st, 2023. CiteSpace 6.1.R6 and VOSviewer 1.6.18 were used to perform bibliometric and knowledge-map analyses.</p><p><strong>Results: </strong>This study found a total of 837 publications originating from 51 countries and 1006 institutions. These articles were published in 393 journals. The United States was the country that produced the most articles focused on SGB, and the University of California, Los Angeles was the institution associated with the greatest number of publications. The anesthesiology and cardiology journals surveyed for this study published the most articles and received the most citations. Among the authors whose works were examined, Kitajima T had the greatest number of published articles, and Lipov E was the most frequently cited co-author. Five main domains of SGB research included electrical storm and refractory ventricular arrhythmia, breast cancer and climacteric medicine, post-traumatic stress disorder, pain management, and cerebrovascular diseases. The latest hot topics involving this field focused on SGB's anti-arrhythmic and anti-cerebral vasospasm effects and its treatment of long COVID syndrome.</p><p><strong>Limitations: </strong>Data were retrieved only from the WoSCC; therefore, publications in other databases might have been missed.</p><p><strong>Conclusion: </strong>This comprehensive bibliometric analysis conducted a complete overview of SGB research, which was helpful in furthering our understanding of research trends and locating research hot spots and gaps in this domain. This field is developing rapidly and will garner significant and continuous attention from future scholars.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E597-E610"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860460","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":"Repetitive Transcranial Magnetic Stimulation of the Dorsolateral Prefrontal Cortex for Phantom Limb Pain.","authors":"Deepanshu Vats, Renu Bhatia, Samreen Fatima, Rajkumar Yadav, Sushma Sagar, Nida Mir, Maroof A Khan, Akanksha Singh","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Phantom limb pain (PLP) is a prevalent and distressing occurrence in 60-80% of individuals who have undergone amputations. Recent research underscores the significance of maladaptive cortical plasticity in the genesis of PLP, emphasizing the importance of targeting cortical areas for therapeutic interventions. Repetitive transcranial magnetic stimulation (rTMS), a noninvasive tool for cortical stimulation, demonstrates effectiveness in treating various chronic pain conditions of neuropathic origin. Nevertheless, there exists a limited body of research investigating the application of rTMS as a therapeutic intervention specifically for managing PLP. Notably, the dorsolateral prefrontal cortex (DLPFC) plays a crucial role in central pain processing, suggesting its potential as a key therapeutic target in PLP treatment. There is a lack of adequate data regarding the effectiveness of DLPFC-targeting rTMS in alleviating the pain experienced by PLP patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;In this study, our aim was to investigate the impact of 10 sessions of DLPFC-targeting rTMS on the pain status of individuals experiencing PLP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Randomized controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Traumatic amputees reporting to the tertiary care center with PLP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was approved by the Institute Ethics Committee (IECPG-299/27.04.2022) and registered in the Clinical Trials Registry of India (CTRI/2022/07/043938). Nineteen patients suffering from PLP were recruited and randomized into real or sham rTMS groups. In the real rTMS group, patients received 10 sessions of rTMS at the DLPFC contralateral to the amputation site. The rTMS, administered at 90% of the resting motor threshold (RMT), was delivered as 8 trains of 150 pulses per train at the rate of one Hz and an inter-train interval of 60 seconds. The total number of pulses per session was 1,200. The sham group received 10 sessions of sham rTMS through the perpendicular placement of an rTMS coil over the DLPFC. These sessions lasted for the same duration and included the same sounds as the real group but involved no active stimulation. The patients' pain status was evaluated using the Visual Analog Scale (VAS) at baseline, at the end of each session of real or sham rTMS and at the 15th, 30th, and 60th day after the the completion of real or sham therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A significant decrease in VAS scores was noted after 10 sessions of real rTMS that targeted the DLPFC, in contrast to the sham rTMS group. The real rTMS group's reduction in VAS scores also persisted during the follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;A few patients had to drop out due to physical restrictions and financial constraints. Consequently, only a small number of individuals were able to complete the study protocol successfully.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A regimen of 10 sessions of real rTMS of","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E589-E595"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860541","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":"Trainee Insight into Pain Fellowship Programs: A Critical Evaluation of the Current Educational System by the APPD.","authors":"Sayed Emal Wahezi, Tahereh Naeimi, Moorice Caparo, Trent D Emerick, Heejung Choi, Yashar Eshraghi, Magdalena Anitescu, Kiran Patel, Rene Przkora, Thelma Wright, Susan Moeschler, Meredith Barad, Stephanie Rand, Mooyeon Oh-Park, Benjamin Seidel, Ugur Yener, Jonathan Alerte, Naum Shaparin, Alan D Kaye, Lynn Kohan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Since 1992, when the Accreditation Council of Graduate Medical Education (ACGME) acknowledged pain medicine as a subspecialty, the field has experienced significant growth in its number of programs, diversity of sponsoring specialties, treatment algorithms, and popularity among applicants. These shifts prompted changes to the educational model, overseen by program directors (PDs) and the ACGME. The pool of pain fellowship applicants also changed during that period.</p><p><strong>Objectives: </strong>This study aims to investigate trainees' reasons for applying to pain medicine fellowship programs as well as the applicants' specific expectations, interests, and motivations, thereby contributing to the remodeling and universal improvement of programs across the country.</p><p><strong>Study design: </strong>Online survey via SurveyMonkey. The online questionnaire targeted pain fellowship applicants in 2023 and current fellows in the US.</p><p><strong>Methods: </strong>Our study was designed by board members of the Association of Pain Program Directors (APPD). The board disseminated a survey to those who applied to ACGME Pain Medicine fellowships in 2023 as well as to existing fellows. The survey was emailed to residency and fellowship PDs for dissemination to their trainees. The participants answered a 12-question survey on their reasons for pursuing pain medicine fellowships, expectations of and beyond those fellowships, and educational adjustments.</p><p><strong>Results: </strong>There were 283 survey participants (80% applicants in residency training and 20% fellows). Participants ranked basic interventional procedures and a strong desire to learn advanced procedures as the most significant factors in pursuing a pain fellowship. Most trainees (70%) did not wish to pursue a 2-year fellowship, and 50% desired to go into private practice.</p><p><strong>Limitations: </strong>The relatively small number of respondents is a limitation that could introduce sampling error. Since most of the respondents were from the fields of physical medicine and rehabilitation (PM&R) and anesthesia, the use of convenience sampling reduced our ability to generalize the results to the wider community. Furthermore, approximately 80% of the trainees were residents, who might have had less experience in or knowledge of the survey's particulars than did the fellows.</p><p><strong>Conclusion: </strong>This survey demonstrated that procedural volume and diversity were important factors in trainees' decisions to apply to the field of pain medicine; however, extending the duration of a pain fellowship was not an option survey participants favored. Therefore, PDs and educational stakeholders in pain fellowship training need to develop creative strategies to maintain competitive applicants' interest while they adapt to our evolving field.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E627-E636"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860546","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":"Understanding the Anatomy of Retroperitoneal Interfascial Space: Implications for Regional Anesthesia.","authors":"Mengmeng Bao, Huili Li, Peiqi Shao, Rong Shi, Yun Wang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Fascial plane block techniques have evolved considerably in recent years. Unlike the conventional peripheral nerve block methods, the fascial plane block's effect can be predicted based on fascial anatomy and does not require a clear vision of the target nerves. The anatomy of the retroperitoneal interfascial space is complex, since it comprises multiple compartments, including the transversalis fascia (TF), the retroperitoneal fasciae (RF), and the peritoneum. For this reason, an in-depth, accurate understanding of the retroperitoneal interfascial space's anatomical characteristics is necessary for perceiving the related regional blocks and mechanisms that lie underlie the dissemination of local anesthetics (LAs) outside or within the various retroperitoneal compartments.</p><p><strong>Objectives: </strong>This review aims to summarize the retroperitoneum's anatomical characteristics and elucidate the various communications among different interfascial spaces as well as their clinical significance in regional blocks, including but not limited to the anterior quadratus lumborum block (QLB), the fascia iliaca compartment block (FICB), the transversalis fascia plane block (TFPB), and the preperitoneal compartment block (PCB).</p><p><strong>Study design: </strong>This is a narrative review of pertinent studies on the use of retroperitoneal spaces in regional anesthesia (RA).</p><p><strong>Methods: </strong>We conducted searches in multiple databases, including PubMed, MEDLINE, and Embase, using \"retroperitoneal space,\" \"transversalis fascia,\" \"renal fascia,\" \"quadratus lumborum block,\" \"nerve block,\" and \"liquid diffusion\" as some of the keywords.</p><p><strong>Results: </strong>The anatomy of the retroperitoneal interfascial space has a significant influence on the injectate spread in numerous RA blocking techniques, particularly the QLB, FICB, and TFPB approaches. Furthermore, the TF is closely associated with the QLB, and the extension between the TF and iliac fascia offers a potential pathway for LAs.</p><p><strong>Limitations: </strong>The generalizability of our findings is limited by the insufficient number of randomized controlled trials (RCTs).</p><p><strong>Conclusions: </strong>Familiarity with the anatomy of the retroperitoneal fascial space could enhance our understanding of peripheral nerve blocks. By examining the circulation in the fascial space, we may gain a more comprehensive understanding of the direction and degree of injectate diffusion during RA as well as the block's plane and scope, possibly resulting in effective analgesia and fewer harmful clinical consequences.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"E567-E577"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860547","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 Landscape of Pain Medicine for Women Physicians: A Perspective.","authors":"Amanda Jankelovits, Robert M Chow, Paragi Rana, Kanishka Rajput","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The gender bias in academic anesthesiology is well known. Women are not only a minority in the field but also underrepresented in leadership positions. Reported reasons for this underrepresentation include barriers to career advancement, lack of mentorship, and differences in compensation, among others. Interventional pain, a competitive procedural subspecialty of anesthesiology, sees the trickle-down effects of this disparity. According to a report from the ACGME that sorted medical subspecialties by number of female trainees, pain medicine ranked in the bottom quartile across all disciplines from 2008-2016.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To better understand the landscape for women physicians in the field of pain medicine, we undertook this investigation to review the knowledge about the topic and what questions remain unanswered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This study is a review of the current literature and aims to summarize and describe the landscape of pain medicine for women physicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;All literature review and manuscript preparation took place at the Yale University School of Medicine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a comprehensive search using the PubMed, Scopus, and Cochrane databases for the combined terms \"gender disparity,\" \"pain medicine,\" and \"anesthesiology,\" limiting our search to the year 2000 onward for the most recent literature on the topic. Our initial search retrieved 38 articles. All relevant articles pertaining to this perspective piece were collated. The available literature is discussed below.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Women are underrepresented in interventional pain. The grim scarcity of female pain physicians is unlikely to improve soon, since while the number of Accreditation Council for Graduate Medical Education pain fellowship programs continues to grow, women trainees comprise only between 22-25% of all pain medicine fellows. Additionally, although studies have compared the numbers of male interventional pain faculty to their female counterparts in academic hospitals and shown the ratio to range from 71.84-82% to 18-28.52%, respectively, no studies have truly explored the landscape for women physicians in private practice. Patients prefer and have better experiences with physicians who are racially and ethnically like themselves. In fact, the preference for and the lack of female clinicians have been associated with delayed pursuit of care and adverse health outcomes. The consequences of the burnout and attrition caused by the gender disparity, especially in a field like pain medicine, cannot be understate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The review might not have been comprehensive, and relevant studies might not have been included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;While the gender disparity in academia is well documented for both anesthesiology and pain medicine, the reasons for this disparity have not been","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 5","pages":"317-320"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860544","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}