Pain Practice最新文献

{"title":"Gender Disparities in Interventional Pain Medicine: Representation, Leadership, and Compensation.","authors":"Marissa Catalanotto, Serena Jiyeon Kim, Saba Javed","doi":"10.1111/papr.70160","DOIUrl":"10.1111/papr.70160","url":null,"abstract":"<p><strong>Introduction: </strong>Despite increasing representation of women in medicine overall, significant gender disparities persist in procedural specialties such as interventional pain medicine. Women remain underrepresented as speakers at national pain conferences and in leadership roles. Additionally, a pay gap between female and male pain physicians remains. This study aims to objectively demonstrate the above-mentioned inequities.</p><p><strong>Methods: </strong>National conference faculty were analyzed across five major pain societies (ASRA, NANS, AAPM, ASIPP, ASPN) from 2020 to 2024 annual conference agendas. Gender was assigned based on publicly available information. Leadership roles were assessed by identifying the gender of pain fellowship program directors and pain medicine department chairs. Lastly, using the Association of American Medical Colleges (AAMC) Faculty Salary Report (2021-2024), we examined the compensation gap and difference in salary growth rates between genders.</p><p><strong>Results: </strong>Across national conferences, only 25% of speakers were female, with ASRA demonstrating the most consistent female representation. Of the pain medicine fellowship programs studied, there were 36 (32.7%) female program directors and 25 (23.8%) female department chairs. Programs led by female program directors had significantly higher proportions of female faculty (OR = 1.97, CI [1.45, 2.68], p < 0.0001). Salary data revealed that at every academic rank, women in pain medicine faculty earned less than their male counterparts. Additionally, there is a statistically significant difference between the salary growth rates of male and female associate professors between 2021 and 2024 (F = 12.25, p < 0.05).</p><p><strong>Conclusion: </strong>Substantial gender disparities remain in visibility at national conferences, academic leadership, and compensation in pain medicine. Female-led academic programs demonstrate more gender-diverse faculties, highlighting the importance of representation in leadership. Focused efforts are needed to promote mentorship, equitable hiring, and transparency in pay and speaking opportunities to foster a more inclusive field.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70160"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Patterns and Trajectory of Continued Opioid Use in Opioid-Naïve Patients After Curative-Intent Elective Cancer Surgery-A Prospective Cohort Study.","authors":"Kenny Kwon Ho Lee, Chin Hang Yiu, Jonathan Penm, Amanda Johns","doi":"10.1111/papr.70162","DOIUrl":"10.1111/papr.70162","url":null,"abstract":"<p><strong>Background: </strong>Post-discharge opioid use patterns in opioid-naïve patients following cancer surgery remain poorly characterized, particularly during the early transition period after discharge.</p><p><strong>Aim: </strong>To determine the prevalence of continued opioid use 7 days after discharge and to identify predictors and cessation trajectories over 30 days post-discharge.</p><p><strong>Methods: </strong>A prospective single-center cohort study enrolled opioid-naïve patients undergoing curative-intent elective cancer surgery across three surgical specialties (breast, gynecological oncology, and head and neck) between June 2021 and January 2023. The primary outcome was patient-reported opioid use at Day 7 post-discharge. Multivariable logistic regression identified independent predictors; Kaplan-Meier analysis estimated time-to-cessation by pre-discharge opioid exposure group.</p><p><strong>Results: </strong>Among 107 opioid-naïve patients, 42% continued opioid use beyond 7 days. Patients who continued opioids had higher pain interference, more opioid-related adverse events, and higher opioid consumption during 24 h prior to discharge (p < 0.05). In multivariable analysis, having opioids in 24 h prior to discharge (adjusted odds ratio [aOR] 4.46; 95% CI 1.56-12.7), first-time cancer surgery (aOR 6.06; 95% CI 1.45-25.6), and higher stage of cancer (aOR 1.50; 95% CI 1.00-2.23) were independently associated with continued opioid use. Kaplan-Meier graph analysis demonstrated significantly different cessation trajectories between pre-discharge opioid exposure groups (log rank p < 0.001).</p><p><strong>Conclusion: </strong>Continued opioid use in the first week following cancer surgery is common. Pre-discharge opioid exposure and disease burden independently predict delayed cessation. Opioid use in the final 24 h before discharge represents a practical, clinically accessible signal for risk stratification and individualized opioid stewardship.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70162"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenol Neurolysis in Pain and Palliative Medicine.","authors":"Jeroen H A Creemers, Rachel J H Smits, Alopi M Patel, Robert T M van Dongen, Cornelis K Kramers, Jacqueline M Bos, Selina E I van der Wal","doi":"10.1111/papr.70153","DOIUrl":"10.1111/papr.70153","url":null,"abstract":"<p><strong>Background: </strong>Pain is a common symptom in palliative care and affects patients' quality of life considerably. Standard analgesics are sometimes insufficient and are associated with substantial side effects. Neurolysis, the targeted destruction of nerves using thermal or chemical agents, offers an additional option for managing localized pain in palliative care. Phenol, a widely available chemical neurolytic agent known for its painless injection and hyperbaric properties when dissolved in glycerin, can effectively relieve refractory cancer pain.</p><p><strong>Methods: </strong>A literature review was conducted on the pharmacology, toxicology, and indications of phenol in interventional pain and palliative medicine.</p><p><strong>Results: </strong>Despite its use as a neurolytic agent for nearly a century, our current understanding of phenol's pharmacological properties, toxicity, and efficacy stems mainly from case series and small studies, often published decades ago. To date, no uniform guidelines exist, nor is there consensus on the optimal application of phenol in clinical practice, resulting in variability among practitioners. Chronic pain syndromes affect up to 30% of the global population, prompting the expansion of phenol neurolysis to new applications, such as joint denervation and sympathetic blocks in non-cancer pain. Understanding the mechanism of action of phenol and standardizing its clinical use are crucial for integrating this technique into broader pain management strategies.</p><p><strong>Conclusion: </strong>This review provides a comprehensive overview of the mechanisms, indications, benefits, and safety of phenol neurolysis in pain and palliative medicine, aiming to support its evidence-based use in clinical practice.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70153"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Scoring System for Predicting Procedural Difficulty in Supraneural L5 TFESI: The L5 TFESI Difficulty Score (LTDS).","authors":"Chul Kim, Jun Hyeong Song","doi":"10.1111/papr.70163","DOIUrl":"10.1111/papr.70163","url":null,"abstract":"<p><strong>Introduction: </strong>Supraneural transforaminal epidural steroid injections (TFESI) at the L5 level are widely used to manage lumbosacral radiculopathy. However, fluoroscopic barriers such as prominent osteophytes and altered transverse process morphology can complicate needle advancement and reduce the likelihood of optimal injectate delivery. Despite these procedural challenges, no standardized grading system currently exists to objectively quantify anatomical complexity or predict technical difficulty during L5 supraneural TFESI.</p><p><strong>Methods: </strong>This study included 584 L5 supraneural TFESI cases performed in 273 L5 radicular lesions aged above 60. All procedures were performed under standardized fluoroscopic guidance by a single experienced pain physician using a consistent supraneural approach. The LTDS comprises six fluoroscopic criteria reflecting anatomical barriers at the L5/S1 level. The patients were stratified into three LTDS groups (Low, 0-3; Middle, 4-6; High, 7-10). Procedural outcomes were assessed based on needle position and the pattern of contrast spread. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative performance of the LTDS for predicting epidurogram failure.</p><p><strong>Results: </strong>Higher LTDS scores were significantly associated with longer procedure times and lower rates of optimal TFESI execution. Each one-point increase in LTDS decreased the odds of successful injection by approximately 40%. ROC analysis demonstrated fair discriminative ability (AUC = 0.707; 95% CI, 0.651-0.764; p < 0.001). While an LTDS threshold of ≥ 5.5 provided the optimal balance between sensitivity and specificity, higher thresholds showed markedly increased specificity, indicating that the LTDS preferentially identifies cases with a high likelihood of technical difficulty rather than serving as a sensitive screening tool. The inter- and intra-rater reliabilities of the LTDS were high (Cronbach's α = 0.886 and 0.891, respectively).</p><p><strong>Conclusions: </strong>The LTDS demonstrates meaningful discriminative performance and high reliability for stratifying technical difficulty in L5 supraneural TFESI. Rather than functioning as a rigid predictor of failure, the LTDS serves as a practical decision-support tool that may assist in preprocedural planning, approach selection, and operator training in patients with advanced lumbar degeneration.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70163"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Health Beliefs Model of Long-Term Prescription Opioid Use for Chronic Pain.","authors":"Lauren Wilson, Carissa van den Berk-Clark, Rachel Moore, Jennifer B Kottenstette, Mark D Sullivan, Jeffrey F Scherrer","doi":"10.1111/papr.70177","DOIUrl":"10.1111/papr.70177","url":null,"abstract":"<p><strong>Background: </strong>Although there is little evidence that very long-term (> 1 year) prescription opioid use is effective for non-cancer pain management, many patients continue prescription opioid use for many years. Interest in quitting and beliefs about opioid risks and benefits have not been measured in this patient population.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 20 non-cancer chronic pain patients who reported using daily prescription opioid use for > 1 year and either discontinued (n = 10) or continued use (n = 10) within the past 2 years. Grounded theory analysis was utilized to identify themes and to develop a theoretical model using the health beliefs model as a framework.</p><p><strong>Results: </strong>Patients who continued to use opioids tended to perceive themselves as not vulnerable to addiction, had pronounced fear of pain, and perceived opioids as the best option for pain control. Patients who quit reported concerns about becoming addicted, had experience with medication for addiction treatment, and valued non-opioid pain management.</p><p><strong>Conclusions: </strong>Educating patients about the numerous physical and psychiatric consequences of chronic opioid use is warranted. Additional research is needed to measure physician beliefs about the risks and benefits of very long-term opioid use among adherent patients.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70177"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148016822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Closed Loop Spinal Cord Stimulation for Chronic Back and Leg Pain: A Systematic Review.","authors":"Tony K George, Usman Latif, Christopher Lam, Aimee Abbott-Korumi, Bartlomiej Olko, Robert Lee, Kyle Downey, Mateusz Graca, Alfred Tria, Timothy Deer, Jason Pope, David Lee, Rohit Aiyer","doi":"10.1111/papr.70166","DOIUrl":"10.1111/papr.70166","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) is an established therapy for chronic pain of the trunk and limbs. Conventional open-loop systems are sometimes limited by habituation, positional variability, and inconsistent neural recruitment. Closed-loop SCS is an approach that uses evoked compound action potentials (ECAPs) to adjust stimulation in real time to maintain consistent therapeutic effects. A systematic review is indicated to bring clarity to the efficacy and safety of these systems.</p><p><strong>Objective: </strong>To evaluate the efficacy of closed-loop SCS for chronic back and leg pain in persistent spinal pain syndromes.</p><p><strong>Methods: </strong>A comprehensive search of MEDLINE, Embase, Scopus, ScienceDirect, Cochrane Library, Google Scholar, and clinicaltrials.gov was conducted through April 2025. Eligible studies included Randomized Controlled Trials (RCT), prospective or retrospective cohort studies, and real-world observational studies evaluating closed-loop SCS in adults with lumbar radiculopathy, chronic back and leg pain, or persistent spinal pain syndromes. Outcomes included pain intensity, percentage of pain relief, disability, health-related quality of life, mood, sleep, and opioid use. Risk of bias was assessed using the Review Manager (Revman) tool within the Cochrane Collaboration resources.</p><p><strong>Results: </strong>Four eligible studies met inclusion criteria for chronic back and leg pain, with responder rates (≥ 50% pain reduction) ranging from 68% to 92% and high-responder rates (≥ 80% pain reduction) from 50% to 60% across follow-up periods up to 36 months. Significant improvements were observed in disability (ODI), sleep quality (PSQI), mood (POMS), and quality of life (EQ-5D-5L). The EVOKE RCT trial demonstrated closed-loop SCS superiority over open-loop stimulation in both pain reduction and functional outcomes. Opioid use decreased substantially, with up to 83% of patients reducing or discontinuing opioids at 24 months. Reported adverse events were consistent with those seen in conventional SCS, and no unexpected safety concerns were identified.</p><p><strong>Conclusion: </strong>Growing evidence suggests closed-loop SCS provides predictive and durable pain relief with concurrent functional improvements in chronic back and leg pain, with additional benefits in opioid reduction for persistent spinal pain syndromes.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD42024580458.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70166"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looming Concerns With Gabapentin Oversight: Balancing Safety and Access.","authors":"Saba Javed, Larry C Driver, Jay Karri","doi":"10.1111/papr.70158","DOIUrl":"10.1111/papr.70158","url":null,"abstract":"<p><p>Gabapentin is one of the most frequently prescribed analgesic medications in the United States, commonly used for treating neuropathic pain conditions. While generally thought to have a favorable adverse effect profile, emerging data have implicated gabapentin in cases of respiratory depression and overdose-deaths, especially when combined with opioids and other central nervous system depressants. As a result, a growing number of states have reclassified gabapentin as a Schedule-V controlled substance. However, such regulations may risk varied unintended consequences, such as restricting access to a valuable nonopioid analgesic and potentially facilitating illicit market activity. As such, vulnerable populations, particularly those in rural and low-income areas, may face increased barriers to care. This commentary evaluates the rationale for regulating gabapentin, examines the potential risks associated with such oversight, and suggests a way forward to reduce misuse while maintaining access to gabapentin for patients who genuinely need it.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70158"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation (rTMS) in Peripheral Neuropathic Pain: A GRADE-Assessed Meta-Analysis of Randomized Sham-Controlled Trials.","authors":"Omar Khaled Abdelsalam, Rashad G Mohamed, Mostafa Adel T Mahmoud, Ali I Abbas Dawoud, Rehab Salama Saleh Labib, Belal Mohamed Hamed, Maickel AbdelMeseh, Sohieb Hedawy, Moaz Elsayed Abouelmagd, Abdallah Abbas, Ahmed M Raslan","doi":"10.1111/papr.70169","DOIUrl":"10.1111/papr.70169","url":null,"abstract":"<p><strong>Background: </strong>Peripheral neuropathic pain (PNP) results from damage to peripheral nerves, leading to intractable or exaggerated pain. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive therapeutic method that modulates cortical neuronal activity and can promote endogenous opioid release, with a potential analgesic effect. This meta-analysis evaluates the efficacy and safety of rTMS use in PNP patients.</p><p><strong>Methods: </strong>We systematically searched PubMed, Web of Science, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) evaluating rTMS in PNP. The primary outcome was pain intensity. Statistical analysis was performed using Review Manager version 5.4.1. Risk of bias was assessed using the Cochrane RoB 2 tool, and a random-effects model was used to compute pooled estimates, expressed as standardized mean differences (SMD), mean differences (MD), and risk ratios (RR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Nine studies with 435 patients were included. rTMS significantly improved pain intensity (SMD = -1.11, 95% CI: [-1.72, -0.49]; p = 0.0004) and achieved a 30% reduction in pain (RR = 3.31, 95% CI: [0.98, 11.20]; p = 0.05). Improvements in sleep quality (SMD = -1.02, p = 0.26) and Patient Global Impression of Change were not statistically significant (RR = 1.70, p = 0.13). Safety analysis showed no significant increase in adverse events such as headache (RR = 1.32, p = 0.1), dizziness, pain at the stimulation site, sleep disturbances, or cognitive complaints.</p><p><strong>Conclusion: </strong>rTMS significantly reduces pain in PNP patients without major safety concerns. While findings support its clinical utility, high heterogeneity and limited long-term data suggest further standardized trials are warranted.</p><p><strong>Prospero registration: </strong>CRD42024628350.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70169"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Phenotypes and the Effects of Interdisciplinary Pain Treatment in Pediatric Complex Regional Pain Syndrome.","authors":"Violeta Dimova, Edin T Randall, Amanda Cao, Bjarne Schmalbach, Mariesa Cay, Christian Maihöfner, Frank Birklein, Navil Sethna, Jaymin Upadhyay","doi":"10.1111/papr.70157","DOIUrl":"10.1111/papr.70157","url":null,"abstract":"<p><strong>Background: </strong>This investigation aimed to replicate phenotypes in pediatric complex regional pain syndrome (CRPS) previously identified in adult CRPS patients. The impact of an intensive pain therapeutic approach in pediatric CRPS was also evaluated.</p><p><strong>Methods: </strong>Neurological examination data were obtained from two samples of children with CRPS (cohort #1; N = 24 and cohort #2; N = 14). The structure among CRPS signs was analyzed on pooled data from cohorts #1 and 2 using hierarchical clustering. A phenotype score was quantified for patients and then submitted to unsupervised k-means clustering. Patients in cohort #2 were enrolled in a 4-6-week treatment program consisting of psychological, physical, and occupational therapy. Questionnaires about pain and mental and physical health were evaluated at treatment admission and discharge.</p><p><strong>Results: </strong>A two-cluster structure of CRPS signs could be replicated in the pediatric population. Cluster #1 includes skin color, temperature, and edema resembling peripheral inflammation (\"peripheral\" phenotype). Cluster #2 grouped together motor disorders, minor injury, glove/stocking-like sensory deficits, and allodynia (\"central\" phenotype). K-means clustering also showed three phenotypes, \"peripheral\" (N = 12), \"central\" (N = 10), and \"mixed\" (N = 17), similar to adults. The impact of treatment was revealed for pain affect, pain behavior, psychological distress, depression, pain catastrophizing levels, as well as physical activity and strength (Cohen's d = [0.8-1.3]).</p><p><strong>Conclusions: </strong>CRPS phenotypes reflecting major pathophysiological mechanisms of peripheral inflammation and central reorganization are identifiable in adult and pediatric patients, suggesting phenomenological features of the disease. An intensive interdisciplinary pain treatment approach was effective in reducing CRPS severity and restoring function in pediatric CRPS.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70157"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of the Use of Interspinous Spacers in the Treatment of Lumbar Spinal Stenosis: Mapping Gap and Scoping Review.","authors":"Juan Carlos Acevedo-Gonzalez, Valentina Velasco-Muñoz, Juan Jacobo Ramirez-Triana, Danuby Adriana Buitrago-Lopez","doi":"10.1111/papr.70156","DOIUrl":"10.1111/papr.70156","url":null,"abstract":"<p><strong>Objectives: </strong>Low back pain is a common pathology in the general population. In people over 60 years of age, it is associated with degenerative changes that cause narrowing of the vertebral canal. Its treatment includes conservative measures and even surgery with decompression and fusion. In those patients with moderate symptoms, the use of interspinous spacers emerged as a minimally invasive therapeutic option. This scoping review seeks to map the existing literature on the use of interspinous spacers and identify knowledge gaps to clarify their real position in the stepwise approach to low back pain.</p><p><strong>Materials and methods: </strong>This study as a scoping review, conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the PRISMA-ScR guidelines. The type of synthesis chosen was descriptive and mapping-based, allowing for the inclusion of diverse study designs (randomized controlled trials, observational studies, case series, clinical guidelines, and relevant reviews) to capture a comprehensive overview of the field. This approach was selected because the existing literature is heterogeneous in terms of intervention protocols, clinical outcomes, and follow-up duration, and the effectiveness and indications for interspinous spacers (ISD) remain controversial. The search was extended from the inception of the databases until November 2025. The program \"Rayyan\" was used to collect the information and facilitate the analysis process. Each of the authors independently reviewed the summary of all the articles found and applied the following inclusion criteria: systematic review, clinical trials, observational studies, and case series.</p><p><strong>Exclusion: </strong>articles in cadavers or made in the laboratory.</p><p><strong>Results: </strong>A total of 522 articles were found in the databases consulted, of which 95 duplicate articles were eliminated. The criteria (Inclusion/Exclusion) were applied to the 427 identified articles based on the independent reading of the abstracts by each of the authors in the Rayyan platform, and 110 articles were excluded. The 317 selected articles were reviewed completely by each of the authors to finally obtain 101 articles included in the review.</p><p><strong>Conclusions: </strong>The use of ISD in the treatment of moderate LSS may be controversial. Although the clinical results seem conclusive about the usefulness in controlling symptoms, more studies are needed to compare these technologies with new surgical procedures and especially new biomechanical concepts. The efforts made to treat patients with moderate LSS appropriately should continue to be channeled into optimizing techniques.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"26 5","pages":"e70156"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}