Pain physician最新文献

{"title":"A Novel Ultrasonographic Method to Quickly and Accurately Access the C2 Dorsal Root Ganglion.","authors":"Liangliang He, Wenxing Zhao, Po-Yi Paul Su, Xu Liao, Jie Zhao, Zhi Dou, Hongyan Wang, Liqiang Yang, Zhonghui Guan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Occipital neuralgia manifests as pain in the cutaneous distribution of occipital nerves, with the greater occipital nerve stemming from the C2 spinal nerve and the lesser occipital nerve originating from the C2 and C3 spinal nerves. While pulsed radiofrequency ablation of the C2 dorsal root ganglion (DRG) is an effective treatment for refractory occipital neuralgia, accessing the C2 DRG remains a clinical challenge even under fluoroscopic guidance.</p><p><strong>Objective: </strong>We aimed to develop an ultrasonographic method for quickly and accurately accessing the C2 DRG.</p><p><strong>Study design: </strong>This is a prospective, observational cohort study.</p><p><strong>Setting: </strong>Our study was conducted in the Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China.</p><p><strong>Methods: </strong>Unlike the C3-C8 foramina, which are ventral to the corresponding facet joints, the C2 foramen is positioned more posteriorly, dorsal to the C1-C2 atlantoaxial joint and longitudinally aligns with the cervical facet joints of C2-C3 and C3-C4. This unique anatomical feature allowed us to rapidly identify the C2 foramen in the sonographic longitudinal-axis view, what we call the \"Stage-light Sign.\" Further exposure of the C2 DRG in the oblique-axis view we call the \"Turtle Sign.\" The following procedural parameters were prospectively obtained: the time required to identify the C2 DRG target, the time needed to reach the target from the point of skin puncture, the number of puncture attempts required to reach the target, and the minimum sensory testing voltage to evoke paresthesia responses in the cutaneous occipital nerve distributions. Clinical outcomes were assessed by serial pain severity using the Numeric Rating Scale at baseline and up to 3 months post the C2 DRG pulsed radiofrequency ablation procedure.</p><p><strong>Results: </strong>The correct placement of the needle tip was initially confirmed with fluoroscopy, with the injected contrast medium distributed along the C2 spinal nerve. Importantly, electrical sensory stimulation elicited paresthesia in the headache area in all patients, with the required voltage being 0.35 ± 0.02 V. Furthermore, treatment outcomes supported the correct needle tip position, as pulsed radiofrequency ablation treatment led to sustained pain reduction. It took 36.2 ± 2.2 seconds to obtain the final \"TurtleSign\" view of the C2 DRG. Once the target was identified, it required a single puncture attempt to reach it, with a duration of 36.3 ± 2.5 seconds from puncturing the skin to reaching the target.</p><p><strong>Limitation: </strong>We only followed patients for up to 3 months postprocedure.</p><p><strong>Conclusion: </strong>We have developed an ultrasonographic method to quickly and accurately access the C2 DRG, which has the potential to greatly facilitate treating the C2 DRG for managing occipital neuralgia.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E927-E935"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770996","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":"Computed Tomography-guided Percutaneous Bilateral Neurolytic Celiac Plexus Block with Alcohol for Upper Abdominal Visceral Cancer Pain.","authors":"Bing Huang, Dan Wu, YaJing Chen, Yingjie Hua, Zhongwei Zhao, Xufang Huang, Qiaoying Rao, Lu Liu, Jianliang Sun","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The neurolytic celiac plexus block (NCPB) can be introduced through the posterior para-aortic, anterior para-aortic, posterior transaortic, or endoscopic anterior para-aortic puncture approach, as well as the posterior approach via the intervertebral disc. To reduce the complications of puncture, this block's original manual blind puncture technique can be improved upon by using a C-arm fluoroscope, computed tomography (CT), or an ultrasound, the last of which may be endoscopic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To observe the distribution of absolute alcohol and its analgesic effect on cancer-induced upper abdominal visceral pain during percutaneous NCPB through the anterior and posterior diaphragmatic crura under CT guidance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Clinical research study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Thirty-eight patients (19 men and 19 women) with advanced carcinomatous epigastric pain were enrolled in this study. The patients were 47-88 (mean, SD: 64.9 ± 8.8) years old, weighed 37-62 kg (mean, SD: 51.6 ± 12.3), and had a grade III or IV physical status on the classification system established by the American Society of Anesthesiologists. The left and right punctures were made through the T12-L1 intervertebral space under CT guidance. The left side was punctured through the paravertebral and diaphragmatic crura to the anterolateral side of the anterior abdominal aorta of the diaphragmatic crus; and the right side was punctured via the posterior approach through the intervertebral disc to the posterior abdominal aorta of the diaphragmatic crus and then to the exterior. A solution consisting of 8 mL of 1% lidocaine and 1 mL of 30% iohexol was injected. If this injectate wholly or partly surrounded the abdominal aorta, then injecting anhydrous alcohol was deemed practicable. Fifteen mL of absolute alcohol containing 10 mL iohexol were injected into the left and right sides 15 minutes later. The alcohol diffusion was observed by CT. The pain Visual Analog Scale was used to evaluate the analgesic effect before NCPB and one hour, one week, one month, 3 months, and 6 months after the treatment. Any treatment-related complications were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All patients were punctured at the predetermined position under CT guidance. Among the 23 patients whose injection of absolute alcohol surrounded the abdominal aorta completely, 19 (82.6%) stopped taking analgesic drugs altogether; of the 8 patients whose injection of absolute alcohol surrounded 75% of the abdominal aorta, 6 (75%) stopped taking oxycodone. In the 7 patients whose injection of absolute alcohol surrounded only 50% of the abdominal aorta, the pain was alleviated to varying degrees, but only 2 (28.6%) stopped taking oxycodone completely, and the other 5 patients still needed oral oxycodone. No ab","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E919-E926"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771199","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":"L5-S3 Compared to L5-S2 Full-Endoscopic Rhizotomy and Ablation Under a Navigation System for Sacroiliac Joint Pain: A Comparative Study.","authors":"Jae Hwan Lee, Kuo-Tai Chen, Ying-Chieh Chen, Chien-Min Chen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain (CLBP) with sacroiliac joint (SIJ) involvement is a prevalent issue in health care. Surgical intervention, employing an endoscopic technique with a navigation system, targets and ablates nociceptive nerve fibers associated with SIJ pain, although the clinical effect of omitting rhizotomy of the lateral sacral branch of S3 remains uncertain.</p><p><strong>Objectives: </strong>This study aimed to compare the clinical outcomes of 2 full-endoscopic rhizotomy and ablation (FERA) techniques for SIJ pain and to determine the effect of omitting rhizotomy of the lateral sacral branch of S3 on patient outcomes.</p><p><strong>Study design: </strong>This study adopted a retrospective cohort study design.</p><p><strong>Setting: </strong>This study was conducted at a single medical institution by a neurosurgeon.</p><p><strong>Methods: </strong>From January 2018 through March 2021, the records of 73 patients undergoing L5-S3 or L5-S2 FERA for SIJ pain associated with CLBP were retrospectively reviewed. The patients were evaluated using the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI) for functional disability, and MacNab criteria for satisfaction. The procedures were guided by 3-D robotic C-arm navigation. The L5-S3 FERA group underwent rhizotomy and ablation of the L5-S3 lateral branches, whereas the L5-S2 FERA group did not undergo rhizotomy of the S3 lateral sacral branch.</p><p><strong>Results: </strong>Both groups showed significant  improvements at one year in VAS and ODI scores with similar trends. The L5-S2 FERA group had a shorter operative time, particularly bilaterally, without complications. Although the L5-S3 FERA group initially presented a slightly higher recurrence rate at 6 months, their recurrence rate was equal with that of the L5-S2 FERA group at one year. Furthermore, the MacNab criteria showed comparable satisfaction rates in both groups.</p><p><strong>Limitation: </strong>This was a small retrospective study.</p><p><strong>Conclusion: </strong>L5-S2 FERA demonstrated clinical outcomes similar to those of L5-S3 FERA for pain relief, functional improvement, and satisfaction. Omitting S3 lateral branch rhizotomy did not adversely affect the outcomes. Surgeons may consider omitting S3 lateral branch rhizotomy for SIJ pain treatment, thereby reducing operative time while maintaining patient benefits.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E943-E951"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771231","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":"Mindfulness Meditation for Fibromyalgia Syndrome: A Systematic Review and Meta-analysis.","authors":"Shuo Meng, Chunfeng Cao, Minghua Zhang, Jing Dong, Minpeng Lu","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The effectiveness of mindfulness meditation (MM) for the treatment of fibromyalgia syndrome (FMS) is unknown and needs to be updated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed at investigating the effectiveness of MM for the treatment of FMS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search of relevant studies published from the databases' inception through April 12, 2023 was conducted within the following databases: Cochrane Library, Embase, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO. We included randomized controlled trials that reported at least one of the following outcome indicators: the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburg Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI), and the Perceived Stress Scale (PSS). Results are presented in terms of mean difference (MD), supplemented by 95% CIs The I2 statistic assessed heterogeneity across 3 distinct observational time frames. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to appraise the robustness of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ten randomized controlled trials were selected from 1,377 citations (n = 818). Various MM regimens were reported (type of mindfulness, duration, schemes, and ingredients). Among 818 patients, very low to moderate evidence indicated that MM could reduce FIQ in the short-term (MD = -6.20; 95% CI,-8.51 to -3.89; P &lt; 0.05; GRADE: moderate); a lower PSQI score (MD = -1.84; 95% CI, -3.35 to -0.33; P &lt; 0.05; GRADE: very low); a reduce BDI score (MD = -3.26; 95% CI, -5.77 to -0.76; P &lt; 0.05; GRADE: moderate); and a decreased PSS score (MD = -4.85; 95% CI, -8.22 to -1.49; P &lt; 0.05; GRADE: very low). At medium-term follow-up, MM consistently reduced the BDI score (MD = -2.88; 95% CI, -4.98 to -0.79; P &lt; 0.05; GRADE: moderate) and decreased the PSS score (MD = -2.76; 95% CI, -4.82 to -0.70; P &lt; 0.05; GRADE: moderate) but there was no significant difference in FIQ scores (MD = -2.78; 95% CI, -6.32 to 0.76; P &gt; 0.05; GRADE: low) and PSQI scores (MD = -1.28; 95% CI, -3.35 to -0.80; P &gt; 0.05; GRADE: very low). However, at long-term follow-up, MM still reduced FIQ scores (MD = -6.09; 95% CI, -9.01 to -3.16; P &lt; 0.05; GRADE: moderate).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The relatively small sample size and the average quality of the included studies may have introduced biases. The time and method of meditation in the included studies were not completely unified, and there were confounding factors. Additionally, the limited amount of available literature is a challenge. Despite focusing on randomized controlled trials, there is heterogeneity among these studies. Future research should aim for larger, higher-quality studies to address these limitations and provide a more comprehensive understanding of MM's effectiveness in fibromyalgia management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"479-494"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771249","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":"Predicting Responses to Interventional Pain Management Techniques for Chronic Low Back Pain: A Single-Center Observational Study (PReTi-Back Study).","authors":"Santiago Garcia-Hernandez, Fernando Higuero-Cantonero, Francisco de la Gala Garcia, Ángel Alonso Chico, Javier Blanco Aceituno, Sara Zapatero Garcia, José Laureano Aguilar Godoy, Javier Hortal Iglesias, Ana Esther Lopez Perez, Ignacio Garutti","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Exploring factors linked to the outcomes of certain interventional pain management techniques may optimize the selection of candidates for those procedures. Our hypothesis is that factors that influence responses to interventional therapies for chronic low back pain (CLBP) can be identified by analyzing a prospective cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our main aim is to identify the factors that may be associated with adult patients' responses to interventional therapies for the treatment of CLBP after 4 weeks of follow-up. Secondary objectives include the development of a predictive model and the establishment of a predictive score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;The PReTi-Back (Predicting REsponse to interventional Therapies In chronic BACK pain) study is an observational prospective single-center study, employing a nonprobability-sampling method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Our population consists of adult outpatients with CLBP in a chronic pain unit of a tertiary hospital. The procedures we evaluated included epidural steroid injections, medial branch blocks and denervations, dorsal root ganglion blocks, and pulsed radiofrequency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ratings on the Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) were measured at the baseline and after 4 weeks of follow-up. The primary outcome of the study was composite and was evaluated at 4 weeks. A positive response to an intervention was defined as the simultaneous occurrence of a decrease of at least 2 points in the NPRS score and a decrease of at least 20% in the ODI score. A predictive model was constructed using logistic regression analysis, which incorporated 14 variables selected in advance. A predictive score was developed based on the odds ratios of the model variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Four hundred patients were recruited. Of these patients, 368 completed follow-up, 49 were excluded, and 319 were included in the analysis. The interventional therapies provided a positive response to 85 patients (26.6%) at 4 weeks. Listhesis, radicular compression, and satisfaction with previous interventional therapies were positively associated with the positive response, and their ORs were close to 2. Meanwhile, obesity and persistent spinal pain syndrome type 2 (PSPS-2) had negative associations with the outcome, presenting ORs close to 0.5. The models were statistically significant and exhibited satisfactory goodness of fit. The area under the curve was 0.67 (95% CI, 0.60-0.74). Both models exhibited low sensitivity but high specificity. The synthesis of the prediction score had little impact on its discriminatory capacity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The subgroup analysis revealed that both listhesis and radicular compression were associated with the response to epidural therapies but not with the response to medial branch therapies. The score was efficient in ruling out those who would no","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E851-E863"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771310","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 Review of Etiological Biomarkers for Fibromyalgia and Their Therapeutic Implications.","authors":"Marc Russo, Danielle Santarelli, Peter Georgius, Paul J Austin","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fibromyalgia is a complex condition that has long puzzled the medical community. Hypotheses to explain the chronic widespread pain associated with the disease have evolved significantly over the years. However, research efforts to identify disease-specific biomarkers and develop effective treatments have been largely unsuccessful.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The goals of this study were to review potential etiological biomarkers for fibromyalgia, focusing on micro-inflammation and metabolic syndrome, and to discuss the clinical implications of the review findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A narrative review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Relevant literature was obtained via Medline/PubMed, using the following search terms: fibromyalgia[ti] (\"metabolic syndrome\" OR \"metabolic disease\" OR biomarker*[ti] OR micro-inflammation OR sub-inflammation OR \"low-level inflammation\" OR \"low-grade inflammation\"). Results were filtered for the English language and screened for inclusion in the review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Articles included in the review covered the topics of pain, immune response/inflammation, micro-inflammation, metabolic syndrome, gut dysbiosis, oxidative stress, and stress response. Various molecules have been proposed as pain biomarkers for fibromyalgia, including neurotransmitters, neuropeptides, growth factors, and cytokines with possible etiological relevance. Recent genome-wide expression profiling suggests connections among low-level inflammation, termed \"micro-inflammation,\" and the upregulation of genes involved in antibacterial and innate immune system response as well as those involved in clinical features, including high body mass index (BMI) and comorbid depression, in a subgroup of fibromyalgia patients. A set of 5 differentially expressed inflammatory genes have been identified as potential biomarkers of a micro-inflammation fibromyalgia subtype. Proposed triggers of micro-inflammation include bacterial disease and gut dysbiosis. Metabolic syndrome may be causative or consequential, while comorbid depression may be associated with dysbiosis and/or micro-inflammation through the gut-immune-brain axis. A potential new treatment approach based on this information has been proposed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;External validation of potential etiological biomarkers is needed. Further investigations to ascertain the involvement of metabolic syndrome and gut dysbiosis and support the proposed treatment paradigm are warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Fibromyalgia is likely the result of multiple causative factors, genetic and environmental. To date, no clear, reliable etiological biomarker for fibromyalgia has been identified. The considerable variability among patients suggests the presence of multiple disease subtypes with different pathophysiological mechanisms. Effective treatment therefore requires a multimodal, multidisciplinary approach that targ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"495-506"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771003","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 Between Multimedia and Written Informed Consent for Lumbar Transforaminal Epidural Steroid Injection: A Randomized Controlled Pilot Trial.","authors":"Sunmin Kim, Nam Woo Kim, Francis Nahm, Eun Joo Choi, Pyung Bok Lee","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Informed consent is a crucial ethical and legal requirement in medical practice to ensure that patients understand the risks, benefits, and alternatives of medical procedures. Recent advances in multimedia technology have facilitated the exploration of multimedia consent, aiming to enhance patient understanding and satisfaction. Ascertaining that patients have full comprehension of the procedures before opting to undergo them is especially important now that instances of such procedures as lumbar transforaminal epidural steroid injections (TESIs) are increasing.</p><p><strong>Objectives: </strong>To determine the effectiveness of multimedia consent forms for lumbar transforaminal steroid injections.</p><p><strong>Study design: </strong>Randomized clinical trial.</p><p><strong>Setting: </strong>Outpatient multidisciplinary pain medicine center of a tertiary hospital.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted with 30 patients who received lumbar TESIs for lumbar radiculopathy. Patients were randomly assigned to either the multimedia consent group (Group M) or the conventional paper consent group (Group C). This study evaluated patients' comprehension of the procedure, their anxiety levels (using the State-Trait Anxiety Inventory short form), and the patients' post-procedure satisfaction.</p><p><strong>Results: </strong>Group M showed significantly greater understanding of the procedure and reported lower levels of anxiety than did Group C (P = 0.041; P = 0.03). However, there were no statistically significant differences in post-procedure satisfaction between the groups (P = 0.25). These findings suggest that multimedia consent can effectively improve patient comprehension and reduce anxiety without significantly affecting patient satisfaction.</p><p><strong>Limitations: </strong>First, the limited sample size of 30 patients restricts the applicability of our findings to a wider population, suggesting a need for larger studies to better assess the effects of multimedia consent. Second, conducting the study in a single hospital might have introduced bias. Multicenter research may provide a more diverse and accurate evaluation of the efficacy of multimedia consent.</p><p><strong>Conclusion: </strong>This pilot study contributes to the growing evidence supporting the use of multimedia consent to enhance patient understanding and reduce anxiety, marking a promising direction for improving informed consent practices for less invasive procedures, such as lumbar TESIs. Further research is required to fully explore the benefits and limitations of multimedia consent forms in various medical settings.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"529-535"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771195","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":"Nucleus Pulposus Allograft Supplementation in Patients with Lumbar Discogenic Pain: Initial 6-month Outcomes from a Prospective Clinical Pilot Study.","authors":"Douglas P Beall, Timothy T Davis, Kasra Amirdelfan, Ramana K Naidu, Michael J DePalma, Shrif Costandi, Jacob W Fleming, Edward S Yoon, Timothy Ganey, Jon E Block, Nagy Mekhail","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Preventing disc degeneration remains a clinical challenge; patients experiencing chronic lumbar discogenic pain have limited treatment options. Minimally invasive intradiscal procedures such as allogeneic nucleus pulposus (NP) injection have the potential to fill the treatment gap between failed conservative care and spine surgery.</p><p><strong>Objectives: </strong>Our study sought to evaluate the magnitude and durability of improvement in back function in patients with chronic lumbar discogenic pain followed for 6 months after a single intradiscal injection of minimally manipulated, off-the-shelf processed NP allograft (VIA Disc NP®, VIVEX Biologics, Inc.) at up to 2 vertebral levels.</p><p><strong>Study design: </strong>Single-arm, prospective, multicenter, pilot study.</p><p><strong>Setting: </strong>Academic and private practice outpatient clinics.</p><p><strong>Methods: </strong>A total of 29 patients with symptomatic lumbar discogenic pain refractory to conservative care who had a back function score of  40-80 points on the Oswestry Disability Index (ODI), ≥ 6 on an 11-point back pain Numeric Rating Scale (NRS-11) and corresponding imaging evidence of disc degeneration were enrolled. A single dose, intradiscal injection of approximately 100 mg of NP allograft mixed with sterile saline was administered to the affected level or levels.</p><p><strong>Results: </strong>The average ODI and NRS-11 improvements between baseline and 6-months postprocedure were 54.8% (95% CI, 41.3-68.3) and 52.9% (95% CI, 34.7-71.1) respectively (P < 0.001). A minimal clinically important difference of ≥ 30% improvement over baseline was achieved in 79% (22 of 28) and 68% (19 of 28) of patients for ODI and NRS-11, respectively. At 6-months postprocedure, 64% (18 of 28) of patients had an NRS-11 score ≥ 3.</p><p><strong>Limitations: </strong>This pilot study did not employ a concurrent control group and the clinical follow-up was limited to 6 months.</p><p><strong>Conclusions: </strong>These pilot findings demonstrate the feasibility of treating patients with symptomatic lumbar disc degeneration with a single intradiscal injection of allogeneic NP to provide significant and durable improvements in back function and pain.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E865-E871"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771306","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":"Spinal Cord Stimulator Complication Rates: A Single-Institution, 22-Year Study (1999-2021).","authors":"Johnson S Ho, Michael Glicksman, Kyle Kang, Emily X Zhang, Anh T Phung, Alexandra Thérond, Alexandra C Fonseca, Evgeny Bulat, Michael E Schatman, Alan D Kaye, Jamal Hasoon, Cyrus Yazdi, Jatinder Gill, Qing Ruan, Christopher L Robinson, Thomas Simopoulos","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Since the initial introduction in 1967 of spinal cord stimulation (SCS) in the field of neuromodulation, SCS has been utilized to treat a multitude of chronic pain disorders refractory to both conservative and surgical management. Although efficacious when indicated, SCS has associated risks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The goals of this study are to explore the trend of rates of SCS complications in 2 approximately equally sized cohorts (1999-2015 and 2016-2021) within a single institution over a 22-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A tertiary care academic hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective chart review with pre-existing institutional review board approval was performed on 2 cohorts, one comprising 257 patients between 2016 and 2021 and the other comprising 262 patients between 1999 and 2015, who underwent percutaneous SCS implantation provided by 2 experienced interventional chronic pain specialists. The patients' demographics and complications were recorded in the REDCAP database. Data were collected on complications of both the biological (allergic/foreign-body reactions, dural puncture/leaks, infections, pain over implantation site, poor wound healing, skin erosions, neurological injuries, and subcutaneous/epidural hematomas) and device-related (electrical leaks, inadequate pain coverage, lead fractures, lead migrations, ligamentum flavum stimulation, recharging/battery failures, and unwanted stimulation) varieties. The chart review included records that started 6 months prior to SCS placement and ended at a period of at least one year of follow-up after placement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the patients studied between 2016 and 2021, the mean age was 58.5 ± 13.0 years, with men representing 46.3% and women 53.7% of the patients studied. Of those studied between 1999 and 2015, the mean age was 50.6 +/- 12.3 years, with men representing 42.4% of the patients and women 57.6%. The overall complication rates were 14.0% (36/257) and 38.9% (102/262) for 2016-2021 and 1999-2015, respectively. The rate of biological complications was nearly 3 times lower in the 2016-2021 group than in the 1999-2015 group (4.3% [11/257] vs 12.2% [32/262], P &lt; 0.001). In the 1999-2015 group, the leading biological complication was infection, the rate of which decreased in the 2016-2021 group (3.4% [9/262] vs 1.9% [5/257], P &lt; 0.42). The rate of device complications was nearly 3 times lower in the 2016-2021 group than in the 1999-2015 group (9.7% [25/257] vs. 26.7% [70/262], P &lt; 0.0001). The leading device complication was inadequate pain coverage (12.2% [32/262] vs 7.4% [19/257], P &lt; 0.08). No serious neurological injury or death occurred in either cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Limitations were inherent to this study's design, since it was a retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E909-E917"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771317","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 \"The Safety and Effectiveness of Orthobiologic Injections for Discogenic Chronic Low Back Pain: A Multicenter Prospective, Crossover, Randomized Controlled Trial with 12 Months Follow-up\".","authors":"Merve Sekizkardes, Savas Sencan, Serdar Kokar, Osman Hakan Gunduz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"27 8","pages":"E966-E967"},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771093","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}