Pain physician最新文献

{"title":"Comparison of Local Anesthetic Concentration in Pericapsular Nerve Group (PENG) Block for Total Hip Arthroplasty Under Spinal Anesthesia: A Randomized Controlled Trial.","authors":"Ilke Akay Akgul, Nur Canbolat, Mehmet I Buget, Demet Altun, Cengiz Sen, Kemalettin Koltka","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The pericapsular nerve group (PENG) block is a novel regional technique that provides adequate postoperative analgesia without producing motor weakness during hip surgery.</p><p><strong>Objectives: </strong>We sought to compare the postoperative analgesic effectiveness of the PENG block with varying concentrations of local anesthetic in total hip arthroplasty.</p><p><strong>Study design: </strong>Prospective, randomized, double-blind trial registered with the ClinicalTrials.gov (NCT04900116).</p><p><strong>Setting: </strong>Department of Anesthesiology, Istanbul University Faculty of Medicine, Istanbul, Turkey.</p><p><strong>Methods: </strong>Ninety-one patients aged 18-80 with an American Society of Anesthesiologists Physical Status Classification of I-III undergoing total hip arthroplasty under spinal anesthesia with a PENG block were included in this study. Patients were divided into 4 groups: Group One received 20 mL of 0.5% bupivacaine; Group 2 received 20 mL of 0.25% bupivacaine; Group 3 received 20 mL of 0.125% bupivacaine; and Group 4 received 20 mL of saline as a control. Visual Analog Scale pain scores, morphine consumption, nausea, vomiting, and quadriceps weakness were evaluated at postoperative hours 0 (the end of surgery), 6, 12, 24, and 48. In addition, we recorded the first ambulation time; breakthrough morphine need; hospitalization duration; patient and surgeon satisfaction; preoperative and postoperative first month Beck-depression scores; and any complications.</p><p><strong>Results: </strong>Groups One and 2 had significantly lower Visual Analog Scale scores and morphine consumption than the control group (P = 0.001 and P = 0.001, respectively). Quadriceps weakness was significantly higher in Group One at postoperative hour 0 (P = 0.011). Nausea and vomiting were significantly lower in Group One than in the other groups at postoperative hours 12 and 24 (P = 0.007 and P = 0.027, respectively). The length of hospital stay was significantly shorter in Group One than in the control group (P = 0.048).</p><p><strong>Limitations: </strong>This was a single-center study with no standardized quantitative measurement method for assessing quadriceps weakness.</p><p><strong>Conclusion: </strong>The PENG block with 20 mL of 0.5% bupivacaine in total hip arthroplasty provides effective postoperative analgesia by reducing opioid side effects and hospital stay, as evidenced by low pain scores and morphine consumption.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E183-E191"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212118","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":"Combined Intrathecal Dexmedetomidine and Adductor Canal Block for Analgesia in Total Knee Arthroplasty: A Randomized Controlled Trial.","authors":"Sherif Kamal Arafa, Ahmed Abdelaziz A Shama, Mohammad Fouad Algyar, Ahmed Sayed Abdelaziz El Saily, Ahmed Mhamed Elatter, Mai Younes Taha","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Pain management following total knee arthroplasty (TKA) is critical for enhancing outcomes such as minimizing opioid consumption and hospital stay, overall function, and rehabilitation.</p><p><strong>Objectives: </strong>To evaluate the effectiveness of combined intrathecal dexmedetomidine (ITD) and adductor canal block (ACB) in relieving post TKA pain.</p><p><strong>Study design: </strong>Double-blind, randomized controlled trial.</p><p><strong>Setting: </strong>KafrElsheikh University, Kafrelsheikh, Arab Republic of Egypt.</p><p><strong>Methods: </strong>A total of 75 patients, aged 18 to 75, who underwent TKA under spinal anesthesia participated in this double-blind, randomized controlled trial.. Three equal sets of patients were formed. Group ITD patients received 15 mg of hyperbaric bupivacaine in 3 mL via intrathecal injection, with 5 μg of dexmedetomidine (DEX) in 0.5 mL (total volume 3.5 mL) and an ACB with 20 mL of 0.9% saline. Group ACB patients received an intrathecal injection containing 15 mg of hyperbaric bupivacaine along with 0.5 mL of saline and an ACB with 20 mL of 0.25% bupivacaine. Group ITD+ACB patients received 15 mg of hyperbaric bupivacaine in 3 mL via intrathecal injection, with 5 μg in 0.5 mL of DEX and an ACB using 20 mL of 0.25% bupivacaine. The amount of morphine taken in the first postoperative 48 hours was the primary outcome.</p><p><strong>Results: </strong>Compared to Group ITD and Group ACB, the total amount of morphine needed in the first postoperative 24 and 48 hours was significantly lower in Group ITD+ACB, and in group ACB compared to group ITD (P < 0.05). Visual Analog Scale pain scores were markedly reduced in Group ITD+ACB and in Group ACB than in Group ITD at postoperative 4 hours (P = 0.018 and P = 0.041, respectively); in Group ITD+ACB than in Group ITD and Group ACB at postoperative 8 hours (P = 0.005 and P = 0.011, respectively); and in Group ITD+ACB compared to Group ITD at postoperative 12 hours (P = 0.005). The time to the first rescue analgesic was notably longer in Group ITD+ACB compared to Group ITD and Group ACB (P value < 0.05)and in Group ACB compared to Group ITD (P < 0.001). Side effects were similar in all 3 groups.</p><p><strong>Limitations: </strong>Our trial had a relatively limited sample size and was conducted at a single center.</p><p><strong>Conclusions: </strong>Combined ITD and ACB were superior in TKA postoperative pain management and required decreased postoperative analgesia without significant side effects compared to ACB alone or ITD alone.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E201-E208"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Multimodal Analgesia on Postoperative Pain Management: A Study From a Pain-Free Hospital Project.","authors":"Zhen-Yu Ren, Xuan Zang, Wen-Yi Fan, Wen-Huan Li, Li Yang, Rong-Sheng Zhao, Mao Xu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>We identified significant gaps in perioperative pain management for sports medicine surgery at our hospital, including a high incidence of severe postoperative pain possibly due to a lack of preemptive analgesia.</p><p><strong>Objective: </strong>We aimed to improve pain management outcomes by optimizing multimodal analgesia, which was implemented by the \"Pain-Free Hospital\" project at Peking University Third Hospital.</p><p><strong>Study design: </strong>A single-center retrospective observational study.</p><p><strong>Setting: </strong>Peking University Third Hospital.</p><p><strong>Methods: </strong>A total of 6,610 sports medicine surgery patients seen from July 2022 through August 2023 were divided into baseline (the first 3 months) and intervention (the subsequent 11 months) phases. Data on postoperative Numeric Rating Scale (NRS-11) pain scores and analgesic utilization were extracted from the hospital information system. Analgesic consumption was measured by the Analgesic Use Rate (AUR) and Number of Defined Daily Doses (DDDs). The DDD value of each drug is provided by the World Health Organization (WHO). The proportion of Days with Severe Pain (DSP, NRS-11 ≥ 7) was assessed on the first postoperative day and over the first 3 days.</p><p><strong>Results: </strong>We addressed the gap in preemptive analgesia, with its implementation rate increasing from 0% to 53.8%. Etoricoxib (not approved for use in the United States by the FDA) use increased significantly (AUR: 13.4% to 53.2%; DDDs: 116.0 to 433.1), while pethidine use decreased significantly (AUR: 48.5% to 19.6%; DDDs: 47.1 to 17.0). These changes were accompanied by significant reductions in severe postoperative pain: DSP declined from 21.3% to 8.8% on the first postoperative day and from 10.8% to 4.8% over the first 3 days.</p><p><strong>Limitation: </strong>As a single-center retrospective study in a tertiary hospital in the People's Republic of China's capital, the regional patient pool may limit the generalizability of our findings. Additionally, the study did not account for the potential effect of COVID-19 on patient severity, surgical patterns, and analgesic prescription diversity during the pandemic.</p><p><strong>Conclusion: </strong>Our study demonstrates that implementing a structured perioperative protocol emphasizing preemptive analgesia and multimodal analgesia resulted in pain management effects, including decreased incidences of severe postoperative pain and reduced analgesic opioid consumption.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E239-E246"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212176","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":"Artificial Intelligence in Interventional Pain: Can ChatGPT Match Fellowship-Level Expertise?: A Comparative Analysis of Accuracy and Readability.","authors":"Merve Sekizkardes, Savas Sencan, Serdar Kokar, Osman Hakan Gunduz","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The transforaminal epidural steroid injection (TFESI) is a widely used interventional procedure for managing radicular pain. Although TFESI is well established as a safe and effective treatment, patients frequently seek detailed explanations regarding its procedural steps, expected outcomes, and potential risks. Artificial intelligence (AI)-based platforms, particularly large language models (LLMs) such as ChatGPT, have emerged as accessible sources of periprocedural medical information. However, the accuracy, readability, and empathy of AI-generated responses in the context of interventional pain management remain uncertain.</p><p><strong>Objectives: </strong>To compare the accuracy and readability of responses generated by ChatGPT and fellowship-trained pain medicine physicians to common patient questions about TFESIs and to assess the potential utility of AI in patient education and periprocedural guidance.</p><p><strong>Study design: </strong>A cross-sectional comparative study.</p><p><strong>Methods: </strong>Twenty frequently asked patient questions about TFESIs were retrospectively identified from pain clinic consultations and submitted individually to ChatGPT-4o and to fellowship-level physicians. Two interventional pain specialists independently evaluated all responses for accuracy and empathy using a 5-point Likert scale; discrepancies were resolved by a third reviewer. Readability was analyzed using the Readable® tool kit across 7 indices: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGRL), Gunning Fog Index, SMOG Index, Coleman-Liau Index, average word and sentence length, and estimated overall reach.</p><p><strong>Results: </strong>Both sources delivered highly accurate responses. However, ChatGPT's answers had significantly lower FRES scores, reflecting reduced reading ease, and higher scores across all other readability indices, indicating greater linguistic complexity and lower accessibility. These responses required a higher level of education to understand. Although empathy scores for ChatGPT were lower than the physicians', the difference was not statistically significant.</p><p><strong>Limitations: </strong>This study assessed a single AI platform (ChatGPT-4o). Accuracy and empathy ratings were performed subjectively by 2 pain specialists, which might have limited generalizability. Additionally, AI-generated responses can vary with software updates, reducing reproducibility across time.</p><p><strong>Conclusion: </strong>ChatGPT provides accurate information regarding TFESIs but demonstrates lower readability and a less empathetic tone than answers given by fellowship-trained physicians. With targeted improvements in clarity and patient-centered communication, AI holds potential as a useful adjunct in patient education and clinical support.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"251-257"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212095","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 \"BMJ Publications on Interventional Techniques Do Not Meet Appropriateness Criteria of Conducting a Rapid Review: A Comprehensive Review\".","authors":"Laxmaiah Manchikanti, Mahendra Sanapati, Amol Soin, Alan D Kaye, Alaa Abd-Elsayed, Christopher G Gharibo, Allen Dennis, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E269-E270"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212127","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":"Development and Validation of a Novel Clinical Prediction Model for Postherpetic Neuralgia: Integrating Inflammatory and Coagulation Biomarkers.","authors":"YanPi Li, NaiChong Hu, Bifa Fan, XiYun Wang, Botao Liu, Peng Mao, Yi Zhang, YiFan Li","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Postherpetic neuralgia (PHN) is the most common and debilitating complication of herpes zoster, yet predicting PHN occuring remains challenging.</p><p><strong>Objectives: </strong>Our study aimed to develop and validate a clinical prediction model for PHN based on key demographic, serological, and clinical parameters.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>This study included 202 patients with herpes zoster treated at the China-Japan Friendship Hospital from December 2023 through November 2024.</p><p><strong>Methods: </strong>Eligible patients were classified into PHN (n = 89) and non-PHN (n = 113) groups. Clinical and laboratory data were extracted from electronic medical records. Univariate logistic regression (P < 0.20) identified candidate predictors, which were further refined using least absolute shrinkage and selection operator regression. A multivariate logistic regression model was constructed, and a predictive nomogram was developed. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis.</p><p><strong>Results: </strong>Four independent predictors were identified: age ≥ 60 years (odds ratio [OR] = 8.45; 95% CI. 3.94-18.12; P < 0.001), higher pain intensity measured by the Numeric Rating Scale (OR = 1.31; 95% CI, 1.07-1.61; P = 0.009), elevated D-dimer levels (D-dimer > 0.5 mg/L) (OR = 2.19; 95% CI, 1.10-4.36; P = 0.026), and lower neutrophil-to-lymphocyte ratio (≤ 3) (OR = 0.22; 95% CI, 0.10-0.49; P < 0.001). The final model demonstrated robust predictive accuracy (AUC = 0.83; 95% CI, 0.78-0.89) and good calibration (Hosmer-Lemeshow test, P = 0.326). A decision curve analysis confirmed the model's clinical utility within a risk threshold range of 8%-85%.</p><p><strong>Limitations: </strong>Our study is limited by its single-center design and small sample size.</p><p><strong>Conclusion: </strong>Our study developed a reliable and clinically applicable nomogram for PHN prediction in patients with herpes zoster. The model incorporates age, pain intensity, D-dimer level, and neutrophil-to-lymphocyte ratio,, enabling early risk stratification and optimized patient management. Future prospective studies are warranted to validate this model's utility across diverse populations.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E229-E237"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212177","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":"Opioid-free Anesthesia for Enhancing Recovery Quality at Postoperative 24 Hours: A Systematic Review and Meta-analysis.","authors":"Fei Wang, Yihao Zhu, Megchan Ou, Zhongyu Shi, Mengxue Liu, Fei Peng, Tao Zhu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Opioid-free anesthesia (OFA) is becoming increasingly common, yet its effects on early postoperative recovery remain unclear.</p><p><strong>Objective: </strong>Our study assessed the effect of OFA on postoperative recovery compared to opioid-based anesthesia (OBA).</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched MEDLINE, the Cochrane Library, Embase, BIOSIS, and Web of Science concluding on December 19, 2024, for randomized controlled trials comparing OFA and OBA in adults (≥ 18 years). Data were extracted, and risk of bias was assessed using the Cochrane RoB 2.0 tool (The Nordic Cochrane Centre for The Cochrane Collaboration). The primary outcome was recovery quality at postoperative 24 hours. Random-effects meta-analyses were conducted. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Our meta-analysis was registered with PROSPERO (ID CRD42024621490).</p><p><strong>Results: </strong>Sixteen trials with a total of 1,968 patients were included in our meta-analysis. OFA was statistically significance associatedwith an improved Quality of Recovery (QoR)-40 score (mean difference 6.33; 95% CI, 3.48-9.17; very low certainty) and QoR-15 score at postoperative 24 hours (mean difference 10; 95% CI, 2.25-17.74; low certainty) compared to OBA. OFA was a statistical significance associated with a reduced risk of postoperative nausea and vomiting, as well as a shorter stay in the postanesthesia care unit. OFA did not reduce postoperative pain and extubation time.</p><p><strong>Limitations: </strong>Our meta-analysis has high heterogeneity, with a predominance of women and middle-aged populations in the included studies. Additionally, side effects related to OFA were not analyzed.</p><p><strong>Conclusions: </strong>Our systematic review and meta-analysis concluded that it is uncertain whether OFA is superior to OBA in improving postoperative recovery quality. However, OFA leads to a statistically significant reduction in the incidence of postoperative nausea and vomiting. The evidence was primarily drawn from small trials involving elective surgeries. While our results support using OFA, larger and high-quality studies are needed to validate its effect on postoperative recovery quality.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E139-E149"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212104","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":"Percutaneous Intradiscal Hydrogel Implantation Versus Sham Control for Chronic Discogenic Low Back Pain: A Randomized Controlled Double-Blind Trial.","authors":"Eva Koetsier, Hannah Engel, Paolo Maino, Alessandro Cianfoni, Luca Scascighini, Pietro Scarone, Dominique E Kuhlen, Jan Willem Kallewaard, Sander M J van Kuijk","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Degenerative disc disease is a leading cause of low back pain. Conservative treatments like pain medication and exercise therapy have shown mixed results, while procedures like fusion surgery carry risks such as adjacent segment disorder and surgical morbidity. Therefore, there is a critical need for treatments that bridge the gap between conservative care and surgery.</p><p><strong>Objective: </strong>To assess the efficacy of intradiscal hydrogel implantation compared with sham treatment of intradiscal injection of saline in patients with chronic discogenic low back pain.</p><p><strong>Study design: </strong>Prospective, double-blind, randomized, controlled, multicenter trial.</p><p><strong>Setting: </strong>Two tertiary interventional pain care centers in Switzerland and in the Netherlands.</p><p><strong>Methods: </strong>Forty-nine patients with chronic discogenic low back pain unresponsive to conservative treatment were randomized to receive either intradiscal hydrogel implantation or a sham treatment. Control Group patients could cross over to hydrogel treatment after 6 months. The primary outcome was pain improvement at 6 months. Secondary outcomes included disability, quality of life, employment status, Patient Global Impression of Change score, analgesic use, disc space height, and disc degeneration. Adverse events were continually assessed.</p><p><strong>Results: </strong>At 6 months postprocedure, the Hydrogel Group patients had improved pain scores compared to Control Group patients, though not statistically significant (P = 0.070). Six out of 24 patients in the Hydrogel Group reported much improvement on their Patient Global Impression of Change scores, compared to 0 out of 25 in the Control Group (P = 0.008). Within-group disability improvements were statistically significant in the Hydrogel Group but not in the Control Group. No significant differences were found between groups in disability, quality of life, or employment status. Only one serious adverse event was reported-a patient from the Hydrogel Group was hospitalized due to a possible exacerbation of low back pain 6 days postprocedure.</p><p><strong>Limitations: </strong>This trial's limitations include strict eligibility criteria and questions about the validity of intradiscal saline as a placebo.</p><p><strong>Conclusions: </strong>This trial suggests that percutaneous intradiscal hydrogel implantation may reduce chronic discogenic pain and disability, with significant Patient Global Impression of Change improvements, though larger trials are needed to confirm efficacy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"E217-E227"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212150","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":"When Outcomes Become Currency: Reconsidering Value in Interventional Pain Management Under Emerging Episode-Based Payment Models.","authors":"Brian E Bernhardt, Alan D Kaye, Laxmaiah Manchikanti","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The transition toward value-based care in the United States has introduced episode-based payment models that increasingly tie physician reimbursement to longitudinal costs and standardized outcomes. The Centers for Medicare & Medicaid Services (CMS) Ambulatory Specialty Model (ASM), targeting chronic low back pain (cLBP), represents a pivotal extension of this framework into interventional pain management. While intended to reduce low-value utilization, such models risk redefining clinical success in ways that may not align with the heterogeneous and biopsychosocial nature of chronic pain. This perspective examines the potential for outcome-driven reimbursement to incentivize risk selection, marginalize clinically meaningful but non-durable functional gains, and exacerbate existing health disparities. Based on available literature, we propose a \"Value Plus\" framework incorporating enhanced risk adjustment and patient-centered composite outcomes to better align economic incentives with the realities of chronic pain care. In conclusion, in the field of interventional pain management, withdrawal of multiple conflicting models (ASM, WISER, etc.), and addition of a payment model including a value plus framework would better align incentives with the realities of delivering care to chronic pain patients.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"241-243"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212100","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":"Mismatch Between MRI-Defined Stenotic Level and Epidurographic Block in Lumbar Degenerative Disorders: A Retrospective Study of Trans-Sacral Canalplasty.","authors":"Daigo Arimura, Akira Shinohara, Mitsuru Saito","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Trans-sacral canalplasty (TSCP) is a minimally invasive epidural adhesiolysis technique positioned between conventional block therapy and open surgery. However, the relationship among MRI-defined levels of stenosis, epidurographic block patterns, and clinical effectiveness remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the clinical significance of mismatch between MRI-defined levels of stenosis and epidurographic block as well as to evaluate the short-term outcomes and feasibility of adhesiolysis in patients undergoing TSCP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A university hospital in Japan and an affiliated institution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We reviewed all patients who underwent TSCP between October 2024 and August 2025. Baseline characteristics, diagnosis, surgical history, and minimum dural sac area at L3/4, L4/5, and L5/S (measured on MRI using ImageJ2) were assessed. Epidurography was performed to identify block levels, and cases were categorized as concordant (MRI-defined level of stenosis = block level) or discordant (mismatch). Discordant cases were subclassified into a \"tail-stop\" type (in which contrast stopped in a position caudal to the MRI-defined level of stenosis) and a \"pass-through\" type (in which these levels differed). Clinical effectiveness was defined as an improvement in low back pain or leg pain at one week after the procedure. Feasibility of adhesiolysis was also evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-eight patients underwent TSCP during the study period. Nine (32.1%) showed concordance between MRI-defined levels of stenosis and epidurographic block sites, and 19 patients (67.9%) showed discordance (tail-stop, n = 11; pass-through, n = 8). Overall, 23 patients (82.1%) experienced clinical improvement. The effectiveness rate was 66.7% (6/9) in the concordance group and 89.5% (17/19) in the discordance group; however, the difference was not statistically significant (P = 0.290). In the discordance group, there was a significant difference in gender distribution between subgroups, with men predominating in the tail-stop subtype and women in the pass-through subtype (P = 0.024), but not in age, diagnosis, surgical history, or minimum dural sac area. Epidural dissection was successful in 21 patients (75.0%), with no significant difference between the effective and noneffective groups (73.9% vs 80.0%, P &gt; 0.999).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;A single-center retrospective design, small sample size, and short-term follow-up of only one week.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;TSCP demonstrated favorable short-term clinical effectiveness, even in cases with mismatches between MRI and epidurographic findings. The feasibility of adhesiolysis may contribute to the clinical success of TSCP. Epidurographic mismatch should not be considered a contraindication for TSCP, and our findings su","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 3","pages":"281-287"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212173","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}