Interventional Pain Medicine最新文献

英文中文

Regenerative medicine: Are we at a crossroads for interventional pain medicine or just another phase? 再生医学：我们是处在介入性疼痛医学的十字路口，还是仅仅是另一个阶段？

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100718

Christopher L. Robinson , Milan P. Stojanovic , Zachary L. McCormick

引用次数: 0

Perioperative considerations for intrathecal pumps: A practical guide 鞘内泵围手术期注意事项：实用指南

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100719

Ahmad R. Saleh MD, MPH , Eileen T. Jin MD , Pritesh Topiwala MD , David Hao MD, MS

引用次数: 0

Thermal radiofrequency of the sphenopalatine ganglion in persistent idiopathic facial pain using a suprazygomatic approach: Case report 应用颧上入路对持续特发性面部疼痛的蝶腭神经节进行热射频检查：病例报告

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100716

Fabricio Andres Lasso Andrade , Gabriel Gaviria Suarez , Alejandro Fernández Escobar , Roberto Carlo Rivera Díaz , Denny Marcela Achicanoy Puchana , Javier Esteban Toro-López

Introduction

The sphenopalatine ganglion (SPG) is a key structure in the pathophysiology of various craniofacial pain syndromes with autonomic manifestations, integrating parasympathetic, sympathetic, and trigeminal fibers within the trigemino-autonomic reflex. Modulation of these pathways through nerve block or radiofrequency has shown effectiveness in managing pain and associated autonomic symptoms. However, no previous reports have described the use of a suprazygomatic approach for thermal radiofrequency of the SPG.

Case report

We present the case of a 70-year-old man with a one-year history of left-sided persistent idiopathic facial pain (PFPS), characterized by paroxysmal exacerbations in the V1–V2 territories, epiphora, and nasal congestion, without evidence of structural lesions or classical neuropathy. After unsuccessful treatment with carbamazepine and a diagnostic Gasserian ganglion block, a suprazygomatic SPG block with 1 % lidocaine was performed, achieving 80 % pain relief lasting four weeks. Upon recurrence of pain, fluoroscopy-guided thermal radiofrequency (TRF) of the SPG (80 °C, 60 s) was conducted, resulting in sustained improvement (NRS 1/10) at six months, with no sensory deficits or adverse effects. This case demonstrated that the suprazygomatic approach provides a safe route to access the pterygopalatine fossa.

Conclusion

Thermal radiofrequency of the SPG via the suprazygomatic approach may represent an effective and safe alternative for treating persistent idiopathic facial pain with autonomic features.

蝶腭神经节（SPG）是具有自主神经表现的各种颅面疼痛综合征病理生理学中的关键结构，在三叉神经-自主神经反射中整合副交感神经、交感神经和三叉神经纤维。通过神经阻滞或射频对这些通路进行调节，在控制疼痛和相关的自主神经症状方面已显示出有效性。然而，没有先前的报道描述了使用斜颧上入路对火炮的热射频。病例报告：我们报告了一名70岁男性患者，有1年的左侧持续性特发性面部疼痛（PFPS）病史，其特征是V1-V2区域的阵发性加重、眼红和鼻塞，没有结构性病变或典型神经病变的证据。在卡马西平和诊断性Gasserian神经节阻滞治疗失败后，使用1%利多卡因进行颧上SPG阻滞治疗，持续四周，达到80%的疼痛缓解。疼痛复发后，对SPG进行透视引导下的热射频（TRF）（80°C, 60 s）， 6个月时持续改善（NRS 1/10），无感觉缺陷或不良反应。本病例表明，合颧上入路为进入翼腭窝提供了一条安全的途径。结论经颧上肌入路热射频治疗具有自主神经特征的持续性特发性面部疼痛是一种安全有效的治疗方法。

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引用次数: 0

The effectiveness of lumbar medial branch radiofrequency ablation using a three-tined electrode: A real-world cross-sectional cohort study 使用三针电极射频消融腰椎内侧支的有效性：一项真实世界的横断面队列研究

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100711

Napatpaphan Kanjanapanang , Hasan Sen , Amanda N. Cooper , Audrey Adler , Akbar Nabi , Blake Dickenson , William Tang , Chase Young , Taylor Burnham , Alexandra E. Fogarty , Allison Glinka Przybysz , Aaron M. Conger , Zachary L. McCormick

Background

Lumbar medial branch radiofrequency ablation (LMBRFA) is an established treatment for chronic lumbar zygapophysial (facet) joint pain. Three-tined radiofrequency technology may simplify the procedure compared to conventional techniques, but long-term outcomes require further investigation.

Objectives

To assess long-term outcomes of three-tined LMBRFA utilizing a perpendicular approach.

Methods

This study reviewed electronic medical records of patients who underwent three-tined LMBRFA from 2022 to 2024. Clinical outcomes were assessed at ≥6 months post-procedure via standardized telephone survey, including numerical rating scale (NRS) pain scores, patient global impression of change (PGIC), and opioid utilization. The primary outcome was the proportion of patients achieving ≥50 % NRS pain reduction. Secondary outcomes included PGIC scores ≥6 (“much improved” or better) and changes in opioid use. Poisson regression evaluated select predictors of treatment response.

Results

Outcomes were collected from 71 patients at a mean follow-up of 12.5 ± 2.4 months. The primary outcome was achieved by 43.7 % (95 %CI: 32.8–55.2) of patients at mean follow-up, with higher success rates at 6–12 months (51.7 %) compared to 12–18 months (38.1 %; p = 0.332). At average follow-up, 53.5 % (95 %CI: 42.0–64.6) of patients reported PGIC scores ≥6, while opioid analgesic use was significantly reduced from baseline (75 % opioid cessation rate among baseline opioid users). Advanced age, repeat LMBRFA, and shorter follow-up were associated with a greater likelihood of treatment success.

Conclusion

In this cohort, approximately half of patients selected for three-tined perpendicular LMBRFA by guideline-concordant diagnostic blocks went on to experience ≥50 % pain relief for up to 12 months. Opioid analgesic use was significantly reduced compared to baseline.

背景：腰椎内侧支射频消融术（LMBRFA）是治疗慢性腰椎关节突（小关节）疼痛的常用方法。与传统技术相比，三次射频技术可以简化手术过程，但长期效果需要进一步研究。目的利用垂直入路评估三次LMBRFA的长期疗效。方法本研究回顾了2022 - 2024年接受三次LMBRFA治疗的患者的电子病历。临床结果在手术后≥6个月通过标准化电话调查进行评估，包括数值评定量表（NRS）疼痛评分、患者总体印象变化（PGIC）和阿片类药物使用。主要结局是达到≥50% NRS疼痛减轻的患者比例。次要结局包括PGIC评分≥6（“明显改善”或更好）和阿片类药物使用的变化。泊松回归评估了治疗反应的预测因子。结果71例患者，平均随访12.5±2.4个月。平均随访时，43.7% （95% CI: 32.8-55.2）的患者达到了主要结局，6-12个月的成功率（51.7%）高于12-18个月的成功率（38.1%;p = 0.332）。在平均随访中，53.5% （95% CI: 42.0-64.6）的患者报告PGIC评分≥6，而阿片类镇痛药的使用比基线显著减少（基线阿片类药物使用者中75%的阿片类药物戒烟率）。高龄、重复LMBRFA和较短的随访与更大的治疗成功可能性相关。在该队列中，根据指南一致性诊断块选择三次垂直LMBRFA的患者中，约有一半的患者在长达12个月的时间内疼痛缓解≥50%。与基线相比，阿片类镇痛药的使用显著减少。

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引用次数: 0

Peripheral nerve stimulation for the treatment of anterior cutaneous nerve entrapment syndrome: A case report and literature review 外周神经刺激治疗前皮神经卡压综合征1例报告并文献复习

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100653

Royce Copeland , Yacoub Khatab , Ravinderjit Singh , Emanuel N. Husu

Background

Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain condition characterized by irritation or compression of abdominal wall intercostal nerve branches called the anterior cutaneous nerves. Peripheral nerve stimulation (PNS) has become an effective treatment option for painful sensory neuropathic conditions, including mononeuropathies and nerve entrapment syndromes. This report describes a successful case of using temporary PNS to treat ACNES and reviews the available literature on the use of PNS for the treatment of ACNES.

Case presentation

A 38-year-old female with a complex abdominal medical and surgical history presented to the pain medicine clinic for intractable burning pain and pressure in the left upper quadrant of the periumbilical region. Given the patient's clinical history and the nature of her presenting symptoms, ACNES was considered as a potential diagnosis. The diagnosis was confirmed through a series of successful diagnostic rectus sheath nerve blocks. A two-month temporary peripheral nerve stimulator trial targeting the left anterior cutaneous nerve was completed, and it resulted in 80 % pain reduction at 3 and 6-month follow-up evaluations, with returning pain at the 8-month assessment.

Conclusion

Chronic abdominal pain in patients with a complex history of abdominal surgery should alert pain specialists to consider the possibility of an ACNES diagnosis. Current evidence supporting PNS for ACNES is limited to a small number of case reports showing successful treatment; however, larger-scale and more robust studies are needed to determine the effectiveness and safety of this method. This study contributes to the existing body of literature, highlighting that PNS may serve as a valuable treatment option for individuals with chronic abdominal wall pain secondary to ACNES whose pain is refractory to conservative management strategies.

背景：前皮神经卡压综合征（ACNES）是一种以腹壁肋间神经分支（即前皮神经）受到刺激或压迫为特征的神经性疼痛。周围神经刺激（PNS）已成为一种有效的治疗选择疼痛的感觉神经性疾病，包括单神经病变和神经卡压综合征。本报告描述了一个使用临时PNS治疗ACNES的成功案例，并回顾了使用PNS治疗ACNES的现有文献。病例介绍一位38岁女性，腹部病史和手术史复杂，因脐周左上象限难治性烧灼痛和压力就诊于疼痛门诊。鉴于患者的临床病史和她的表现症状的性质，ACNES被认为是一个潜在的诊断。通过一系列成功的诊断性直肌鞘神经阻滞证实了诊断。一项针对左前皮神经的为期两个月的临时外周神经刺激试验已经完成，在3个月和6个月的随访评估中，疼痛减轻了80%，在8个月的评估中，疼痛再次出现。结论有复杂腹部手术史的慢性腹痛患者应提醒疼痛专科医生考虑ACNES诊断的可能性。目前支持PNS治疗ACNES的证据仅限于少数显示治疗成功的病例报告；然而，需要更大规模和更有力的研究来确定这种方法的有效性和安全性。本研究补充了现有文献，强调PNS可能是ACNES继发慢性腹壁疼痛患者的一种有价值的治疗选择，这些患者的疼痛对保守治疗策略难以治愈。

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引用次数: 0

Distribution of epiphyseal nutrient foramina in the distal femur: Implications for anterior knee joint denervation 股骨远端骺营养孔的分布：对膝关节前断神经的影响

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100708

John Tran , Alicia J. Chung , Ian bell , Brent Lanting , Zachary L. McCormick , Eldon Loh

Background

Sensory afferents supplying subchondral bone could mediate pain from the knee joint. Intrinsic innervation originates externally and follows blood vessels through nutrient foramina. Therefore, targeting the intrinsic innervation of subchondral bone can be achieved by capturing extrinsic innervation prior to their entry into the nutrient foramina. Understanding of extrinsic innervation of the knee joint as well as the distribution of the epiphyseal nutrient foramina are important. Currently, the distribution of nutrient foramina has not been analyzed. The objective of this osteological study was to quantify the distribution of nutrient foramina in the distal femur to inform knee joint denervation strategies.

Methods

A convenience sample of 19 bony femurs was used in this study. The distal end of each specimen was photographed to obtain standardized lateral, medial, and anterior views. The location of nutrient foramina was documented. Each photograph was imported into ImageJ and the distribution of nutrient foramina was quantified.

Results

Location of epiphyseal nutrient foramina was variable on distal femur. Laterally, distribution of nutrient foramina showed percentages of 11.5 %, 44.7 %, 36.5 %, and 7.3 % in the first, second, third, and fourth quadrants, respectively. Distribution on the medial distal femur showed percentages of 12.4 %, 40.4 %, 35.5 %, and 11.5 % in the first, second, third, and fourth quadrants, respectively. Anteriorly, distribution showed a difference between the medial and lateral halves with percentages of 71.1 % and 28.9 %, respectively.

Conclusions

Epiphyseal nutrient foramina are important conduits that enable extrinsic innervation to enter and supply the subchondral bone. The location and distribution of the nutrient foramina of the distal femur reported in this study can be used to optimize nerve blocks and denervation techniques to manage chronic knee joint pain from osteoarthritis.

背景：供应软骨下骨的感觉传入神经可介导膝关节疼痛。内在神经支配起源于外部，通过营养孔跟随血管。因此，针对软骨下骨的内在神经支配，可以通过在其进入营养孔之前捕获外在神经支配来实现。了解膝关节的外神经支配以及骨骺营养孔的分布是很重要的。目前还没有对营养孔的分布进行分析。本骨学研究的目的是量化股骨远端营养孔的分布，为膝关节去神经支配策略提供信息。方法采用方便标本19根股骨。对每个标本的远端进行拍照，以获得标准化的外侧、内侧和前部视图。记录了营养孔的位置。将每张照片导入ImageJ，量化营养孔的分布。结果股骨远端骨骺营养孔位置不同。营养孔的横向分布在第一、第二、第三和第四象限分别为11.5%、44.7%、36.5%和7.3%。股骨内侧远端分布在第一、第二、第三和第四象限的百分比分别为12.4%、40.4%、35.5%和11.5%。在前面，分布显示内侧和外侧之间的差异，百分比分别为71.1%和28.9%。结论骨骺营养孔是外源性神经进入软骨下骨并供给软骨下骨的重要通道。本研究报道的股骨远端营养孔的位置和分布可用于优化神经阻滞和去神经支配技术，以治疗骨关节炎引起的慢性膝关节疼痛。

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引用次数: 0

A case report: Infrazygomatic approach neurocryoablation of the sphenopalatine ganglion under cone beam computer tomography guidance in treating refractory headaches 锥束计算机断层引导下颧下入路蝶腭神经节冷冻消融治疗顽固性头痛1例

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100706

Logan F. Condon , Ryu Komatsu , Jiang Wu

Introduction

The sphenopalatine ganglion (SPG) drives the cranial autonomic symptoms associated with trigeminal autonomic cephalalgias, migraine, and trigeminal neuralgia. Infrazygomatic approach SPG block serves as the gold standard for both prognostic and therapeutic intervention for management of refractory headache with autonomic symptoms. However, this intervention often provides only short-term relief. Identification of novel interventions that provide more durable relief is imperative.

Case

An 84-year-old female with chronic headache featuring autonomic cranial symptoms that failed both medication and conservative intervention management. Patient responded well to infrazygomatic approach SPG block using combined cone beam CT and fluoroscopy guidance, however, experienced fading therapeutic response over the years. Subsequently, patient underwent neurocryoablation of the SPG, from which, satisfactory and sustained improvement of her headache pain was achieved at six month follow up.

Conclusion

This is the first case demonstrating the clinical feasibility and therapeutic outcomes of SPG neurocryoablation in treating refractory headaches.

蝶腭神经节（SPG）驱动与三叉神经痛、偏头痛和三叉神经痛相关的颅自主神经症状。颧骨下入路SPG阻滞是治疗伴有自主神经症状的难治性头痛的预后和治疗干预的金标准。然而，这种干预往往只能提供短期的缓解。确定新的干预措施，提供更持久的缓解是必要的。一例84岁女性慢性头痛，伴有自主神经症状，药物治疗和保守干预治疗均失败。在锥形束CT和透视引导下，患者对颧下入路SPG阻滞反应良好，但随着时间的推移，治疗反应逐渐消退。随后，患者接受了SPG神经冷冻消融，在6个月的随访中，患者的头痛得到了满意和持续的改善。结论首次证实了SPG神经冷冻消融治疗顽固性头痛的临床可行性和疗效。

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引用次数: 0

Subject: Letters to the editor: Re: rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: A retrospective study utilizing a large national database 主题：致编辑的信：Re：椎体神经消融后腰椎压缩性骨折的发生率：一项利用大型国家数据库的回顾性研究

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100712

Patricia Zheng, Conor O'Neill

引用次数: 0

Intrathecal drug delivery for chronic abdominal pain: A case series 鞘内给药治疗慢性腹痛：一个病例系列

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100703

Harold Burke , Michael Liu , Salim M. Hayek

Introduction

Chronic Abdominal Pain (CAP) is a pervasive and challenging global health issue. In a 2023 United States National Health Interview Survey, CAP was present in almost 3 % of all respondents. Various interventional procedures, such as sympathetic nerve blocks (SNBs), thoracolumbar sympathetic ablations, and spinal cord stimulation (SCS), have shown mixed efficacy in managing CAP. This case series describes refractory CAP that is effectively managed with IDD after a treatment algorithm to first distinguish nociceptive pain from a centrally mediated process, but only when the AGA ROME IV criteria for CAP is met.

Methods

Four patients were identified in clinical practice as suitable candidates for an IDD for refractory, non-centrally mediated CAP. Two of the patients had constant CAP meeting the ROME IV AGA diagnostic criteria for CAP and therefore underwent a DDE-ultimately with findings suggestive of visceral or somatic pain given a >70 % reduction in pain after administration of the local anesthetic and confirmation of a sensory level change, but not after the administration of normal saline prior. (Tabe 1). All patients underwent a continuous intrathecal catheter trial, except for one patient with cystic fibrosis and unpredictable pancreatitis pain episodes, who had failed a spinal cord stimulator implant and proceeded straight to an IDDS implant.

Results

IDD effectively managed refractory CAP across these four cases, with implantation durations ranging from 1.5 to 10 years. All patients remained off systemic opioids and maintained complete functional independence-specifically their Activities of Daily Living (ADLs) as well as Instrumental ADLs.

Discussion

Effective management of CAP begins with a precise diagnosis that distinguishes between nociceptive and centrally mediated pain. Once centrally mediated pain is excluded, and provided patients did not experience sufficient analgesia with other less invasive interventions, targeted treatment for visceral/nociceptive pain with intrathecal drug delivery can be attempted. This case series highlights IDD as a promising alternative to other interventional therapies for refractory CAP, offering durable pain relief with potentially fewer complications.

慢性腹痛（CAP）是一个普遍和具有挑战性的全球健康问题。在2023年美国全国健康访谈调查中，几乎3%的受访者存在CAP。各种介入治疗方法，如交感神经阻滞（SNBs）、胸腰段交感神经消融和脊髓刺激（SCS），在治疗CAP方面显示出不同的疗效。本病例系列描述了在治疗算法首先区分伤害性疼痛和中枢介导过程后，用IDD有效治疗难治性CAP的难治性CAP，但只有在满足AGA ROME IV CAP标准的情况下。方法：在临床实践中，4例患者被确定为难治性非中枢介导性CAP的合适IDD候选人。其中2例患者的持续性CAP符合ROME IV AGA对CAP的诊断标准，因此接受了dde，最终发现提示内脏或躯体疼痛，在给予局麻药并确认感觉水平改变后疼痛减轻了70%，但在给予生理盐水后没有。(课程1)。所有患者都进行了连续的鞘内导管试验，除了一名患有囊性纤维化和不可预测的胰腺炎疼痛发作的患者，他在脊髓刺激器植入失败后直接进行了IDDS植入。结果4例患者中，sidd有效控制了难治性CAP，植入时间从1.5年到10年不等。所有患者都没有使用全身性阿片类药物，并保持了完全的功能独立性，特别是他们的日常生活活动（adl）和工具性adl。CAP的有效管理始于对伤害性疼痛和中枢介导性疼痛的精确诊断。一旦排除了中枢介导的疼痛，并且患者在其他侵入性较小的干预措施下没有获得足够的镇痛，可以尝试鞘内给药靶向治疗内脏/伤害性疼痛。本病例系列强调IDD作为难治性CAP的其他介入治疗的有希望的替代方法，提供持久的疼痛缓解，潜在的并发症更少。

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引用次数: 0

Letter to the Editor: Intellectual conflicts of interest in spinal cord stimulation research - The gap between theoretical knowledge and clinical expertise 致编辑的信：脊髓刺激研究中的知识冲突-理论知识与临床专业知识之间的差距

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100715

Hemant Kalia , Scott Pritzlaff , Konstantin Slavin

引用次数: 0

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