Pub Date : 2026-01-30DOI: 10.1016/j.inpm.2026.100738
Richard Derby , Yakov Vorobeychik
<div><h3>Background</h3><div>Provocative discography is controversial because it couples mechanically induced disc stimulation to a subjective pain report and is often interpreted as a simple yes/no test of “discogenic pain.” Pressure–volume–controlled discography (“discometry”) allows disc provocation to be treated as a dose–response experiment using static pressure above opening (ΔP) and cumulative mechanical work (W), rather than pressure alone.</div></div><div><h3>Objective</h3><div>To determine whether discs that reproduce a patient's concordant pain under pressure–volume control exhibit a distinct low-dose onset phenotype compared with discs that never declare, and to interpret these patterns in the context of annular versus vertebrogenic pain mechanisms.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed pressure–volume–controlled lumbar discography from a single outpatient spine practice. Discs were injected in fixed volume increments with static plateau pressures recorded at each step under protocol caps (ΔP ≤ 50 psi above opening; volume ≤3.5 mL). For each disc, we identified either the onset event (first 0.5 mL step with definite concordant pain ≥4/10, sustained ≥30 s) or a final-negative (censored) event if no onset occurred under the caps (i.e., the disc “never declared”). Static ΔP at the event (ΔP_event) and cumulative mechanical work (W_event = Σ ΔP × ΔV) were calculated, and an energy-equivalent stiffness (K_eq = 2W/V<sup>2</sup>) was derived. We compared onset versus censored doses across MRI morphologies (normal, fissured, disrupted), within encounters containing both positive and negative discs, and across apparatus conditions, and examined the volume step at which onset occurred.</div></div><div><h3>Results</h3><div>Structurally abnormal discs that reproduced the presenting pain almost always did so at relatively low ΔP_event and W_event, yet with moderate-to-severe pain intensity at onset. Discs that never declared under the same protocol caps tolerated substantially higher ΔP_event and W_event, and morphologically normal discs clustered at the extreme of high-dose tolerance with rare positive responses. This separation between low-dose onset and high-dose tolerance persisted within fissured and disrupted strata, within encounters (positive vs negative discs in the same patient), and after stiffness normalization using K_eq, arguing against generalized “softness” as the sole explanation. In a subset with complete step-index data, most onset-positive discs declared by approximately 1.7 mL of injected volume and nearly all by 1.7–2.2 mL under slow, staged injection.</div></div><div><h3>Conclusion</h3><div>These findings support a reproducible low-dose, high-intensity concordant pain phenotype in structurally abnormal discs, most consistent with chemically and mechanically sensitized nociceptors in the annulus and at the annulus–endplate junction. Other discs—whether morphologically normal or with more prominent v
{"title":"Quantitative discometry: Low-dose concordant pain onset identifies sensitized annular nociceptors under pressure–volume–controlled provocation","authors":"Richard Derby , Yakov Vorobeychik","doi":"10.1016/j.inpm.2026.100738","DOIUrl":"10.1016/j.inpm.2026.100738","url":null,"abstract":"<div><h3>Background</h3><div>Provocative discography is controversial because it couples mechanically induced disc stimulation to a subjective pain report and is often interpreted as a simple yes/no test of “discogenic pain.” Pressure–volume–controlled discography (“discometry”) allows disc provocation to be treated as a dose–response experiment using static pressure above opening (ΔP) and cumulative mechanical work (W), rather than pressure alone.</div></div><div><h3>Objective</h3><div>To determine whether discs that reproduce a patient's concordant pain under pressure–volume control exhibit a distinct low-dose onset phenotype compared with discs that never declare, and to interpret these patterns in the context of annular versus vertebrogenic pain mechanisms.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed pressure–volume–controlled lumbar discography from a single outpatient spine practice. Discs were injected in fixed volume increments with static plateau pressures recorded at each step under protocol caps (ΔP ≤ 50 psi above opening; volume ≤3.5 mL). For each disc, we identified either the onset event (first 0.5 mL step with definite concordant pain ≥4/10, sustained ≥30 s) or a final-negative (censored) event if no onset occurred under the caps (i.e., the disc “never declared”). Static ΔP at the event (ΔP_event) and cumulative mechanical work (W_event = Σ ΔP × ΔV) were calculated, and an energy-equivalent stiffness (K_eq = 2W/V<sup>2</sup>) was derived. We compared onset versus censored doses across MRI morphologies (normal, fissured, disrupted), within encounters containing both positive and negative discs, and across apparatus conditions, and examined the volume step at which onset occurred.</div></div><div><h3>Results</h3><div>Structurally abnormal discs that reproduced the presenting pain almost always did so at relatively low ΔP_event and W_event, yet with moderate-to-severe pain intensity at onset. Discs that never declared under the same protocol caps tolerated substantially higher ΔP_event and W_event, and morphologically normal discs clustered at the extreme of high-dose tolerance with rare positive responses. This separation between low-dose onset and high-dose tolerance persisted within fissured and disrupted strata, within encounters (positive vs negative discs in the same patient), and after stiffness normalization using K_eq, arguing against generalized “softness” as the sole explanation. In a subset with complete step-index data, most onset-positive discs declared by approximately 1.7 mL of injected volume and nearly all by 1.7–2.2 mL under slow, staged injection.</div></div><div><h3>Conclusion</h3><div>These findings support a reproducible low-dose, high-intensity concordant pain phenotype in structurally abnormal discs, most consistent with chemically and mechanically sensitized nociceptors in the annulus and at the annulus–endplate junction. Other discs—whether morphologically normal or with more prominent v","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100738"},"PeriodicalIF":0.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.inpm.2026.100740
Julia Zhu , David Hao , Robert Jason Yong
Background
YouTube is an open-access platform increasingly used for both medical and patient education, but its user-generated content is not subject to peer review and shows wide variability in accuracy and quality. Celiac plexus blocks are technically complex procedures that are presented on YouTube, yet the educational quality of these instructional videos has not yet been systematically evaluated.
Objective
To evaluate the educational quality of YouTube videos on celiac plexus blocks and to explore the utility of ChatGPT-4o as a secondary, adjunctive tool for assessing video quality.
Methods
YouTube was searched on June 2nd, 2025 using the keywords “celiac plexus neurolysis,” “celiac block for cancer pain,” “celiac plexus block,” and “celiac plexus injection.” The 17 most-viewed videos were independently evaluated by two board-certified chronic pain physicians and by ChatGPT-4o using a modified DISCERN scale (mDISCERN), the Global Quality Scale (GQS), and a usefulness classification.
Results
Based on human expert ratings, only 18 % of videos contained highly reliable information as assessed by the mDISCERN scale, and 24 % demonstrated moderate to excellent information quality on the Global Quality Scale. Overall, 65 % of videos were classified as useful. Inter-rater reliability between human experts ranged from poor to moderate across the three scales of evaluation, while agreement between human expert and ChatGPT-4o assessment was poor.
Conclusions
The educational quality of YouTube videos on celiac plexus blocks was generally poor. Unlike similar studies investigating other procedures, the quality of videos produced by physician and hospital sources was not better than that of videos by nonacademic sources. These findings highlight the need to improve the quality of educational content produced by physicians, hospitals, and professional societies.
{"title":"Assessing the educational quality of YouTube videos on celiac plexus blocks: Expert review and AI-based evaluation","authors":"Julia Zhu , David Hao , Robert Jason Yong","doi":"10.1016/j.inpm.2026.100740","DOIUrl":"10.1016/j.inpm.2026.100740","url":null,"abstract":"<div><h3>Background</h3><div>YouTube is an open-access platform increasingly used for both medical and patient education, but its user-generated content is not subject to peer review and shows wide variability in accuracy and quality. Celiac plexus blocks are technically complex procedures that are presented on YouTube, yet the educational quality of these instructional videos has not yet been systematically evaluated.</div></div><div><h3>Objective</h3><div>To evaluate the educational quality of YouTube videos on celiac plexus blocks and to explore the utility of ChatGPT-4o as a secondary, adjunctive tool for assessing video quality.</div></div><div><h3>Methods</h3><div>YouTube was searched on June 2nd, 2025 using the keywords “celiac plexus neurolysis,” “celiac block for cancer pain,” “celiac plexus block,” and “celiac plexus injection.” The 17 most-viewed videos were independently evaluated by two board-certified chronic pain physicians and by ChatGPT-4o using a modified DISCERN scale (mDISCERN), the Global Quality Scale (GQS), and a usefulness classification.</div></div><div><h3>Results</h3><div>Based on human expert ratings, only 18 % of videos contained highly reliable information as assessed by the mDISCERN scale, and 24 % demonstrated moderate to excellent information quality on the Global Quality Scale. Overall, 65 % of videos were classified as useful. Inter-rater reliability between human experts ranged from poor to moderate across the three scales of evaluation, while agreement between human expert and ChatGPT-4o assessment was poor.</div></div><div><h3>Conclusions</h3><div>The educational quality of YouTube videos on celiac plexus blocks was generally poor. Unlike similar studies investigating other procedures, the quality of videos produced by physician and hospital sources was not better than that of videos by nonacademic sources. These findings highlight the need to improve the quality of educational content produced by physicians, hospitals, and professional societies.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100740"},"PeriodicalIF":0.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.inpm.2026.100737
Matthew W. Kaufman , Gerald Yeung , Joshua Rittenberg , Lisa Huynh , Matthew Smuck , Joshua Levin
Background
The C1-2 joint is a unique structure that when arthritic, can cause pain and restrictions in cervical rotation. Steroid injections into the lateral C1-2 joint can be performed, but the literature on outcomes is limited.
Objective
To describe one tertiary spine center's outcomes in treating presumed C1-2 joint pain via intra-articular steroid injections over a recent 10-year period.
Methods
Consecutive patients were identified using an institutional research repository database tool with the search terminology “C1-2”, “atlantoaxial joint”, or “AA joint” from January 2014 to January 2024. Patients were included in the analysis if they had received a C1-2 joint steroid injection and early follow-up outcomes were available in the electronic medical record system.
Results
Outcome data was available on 52 patients over a 10-year period. Success was defined as ≥50 % improvement in the NRS pain score. Nineteen patients (37 % [95 % CI: 24–50 %]) reported a successful outcome at two weeks post-procedure. Longer-term outcomes data was not available.
Discussion/conclusion
Intra-articular lateral C1-2 joint steroid injections may provide modest short-term pain relief in some patients with presumed C1-2 joint pain.
{"title":"Early outcomes from intra-articular lateral C1-2 joint steroid injections: A retrospective case series","authors":"Matthew W. Kaufman , Gerald Yeung , Joshua Rittenberg , Lisa Huynh , Matthew Smuck , Joshua Levin","doi":"10.1016/j.inpm.2026.100737","DOIUrl":"10.1016/j.inpm.2026.100737","url":null,"abstract":"<div><h3>Background</h3><div>The C1-2 joint is a unique structure that when arthritic, can cause pain and restrictions in cervical rotation. Steroid injections into the lateral C1-2 joint can be performed, but the literature on outcomes is limited.</div></div><div><h3>Objective</h3><div>To describe one tertiary spine center's outcomes in treating presumed C1-2 joint pain via intra-articular steroid injections over a recent 10-year period.</div></div><div><h3>Methods</h3><div>Consecutive patients were identified using an institutional research repository database tool with the search terminology “C1-2”, “atlantoaxial joint”, or “AA joint” from January 2014 to January 2024. Patients were included in the analysis if they had received a C1-2 joint steroid injection and early follow-up outcomes were available in the electronic medical record system.</div></div><div><h3>Results</h3><div>Outcome data was available on 52 patients over a 10-year period. Success was defined as ≥50 % improvement in the NRS pain score. Nineteen patients (37 % [95 % CI: 24–50 %]) reported a successful outcome at two weeks post-procedure. Longer-term outcomes data was not available.</div></div><div><h3>Discussion/conclusion</h3><div>Intra-articular lateral C1-2 joint steroid injections may provide modest short-term pain relief in some patients with presumed C1-2 joint pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100737"},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.inpm.2025.100734
Eric K. Holder , Amelia Ni , David Levi , International Pain and Spine Intervention Society's Patient Safety Committee
This FactFinder presents a brief summary of the evidence and outlines recommendations regarding periprocedural management of patients on glucagon-like peptide-1 receptor agonists (GLP-1RA) therapy undergoing elective pain procedures under conscious sedation. Based on current multi-society guidance statements, patients without risk factors may continue GLP-1RA therapy in the periprocedural window. However, periprocedural management should incorporate a complete risk assessment and shared decision-making involving the patient, the prescribing care team, the physician, and anesthesia personnel (if involved). It is also recommended that the performing physician carefully consider the necessity of conscious sedation on a case-by-case basis, as it is not necessary in most scenarios.
{"title":"GLP-1 receptor agonists and conscious sedation","authors":"Eric K. Holder , Amelia Ni , David Levi , International Pain and Spine Intervention Society's Patient Safety Committee","doi":"10.1016/j.inpm.2025.100734","DOIUrl":"10.1016/j.inpm.2025.100734","url":null,"abstract":"<div><div>This FactFinder presents a brief summary of the evidence and outlines recommendations regarding periprocedural management of patients on glucagon-like peptide-1 receptor agonists (GLP-1RA) therapy undergoing elective pain procedures under conscious sedation. Based on current multi-society guidance statements, patients without risk factors may continue GLP-1RA therapy in the periprocedural window. However, periprocedural management should incorporate a complete risk assessment and shared decision-making involving the patient, the prescribing care team, the physician, and anesthesia personnel (if involved). It is also recommended that the performing physician carefully consider the necessity of conscious sedation on a case-by-case basis, as it is not necessary in most scenarios.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100734"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.inpm.2025.100733
Mark R. DeCotiis
Introduction
Duplication of a vertebral pedicle is a rare congenital anatomic variant with limited representation in the medical literature. Such anomalies are thought to arise during intrauterine or early postnatal phases of osseous development. Aberrant pedicle duplication can result in the creation of a “pseudo foramen,” with potential clinical implications that are not well characterized.
Case
A patient presented with symptoms of painful burning sensations and paresthesias within the right groin and anterior thigh, consistent with upper lumbar radiculopathy. Advanced imaging of the lumbar spine revealed neuroforaminal stenosis associated with a “pseudo foramen” at L2, created by pedicle duplication. Together with clinical suspicion, results of a transforaminal epidural steroid injection supported the conclusion that the neuroforaminal stenosis at this level contributed to the patient's symptoms. This report examines the embryological origins and imaging findings of pedicle formation, considers the spectrum of pedicle duplication and semi-segmented hemivertebra, and reviews relevant imaging findings.
Conclusion
This case highlights the importance of carefully reviewing lumbar imaging modalities. Not only is there observation of a rare duplication of vertebral pedicles, but also a thorough review of available literature suggests that this is the first case to specifically report on clinically significant stenosis occurring within a “pseudo foramen.”
{"title":"Pedicle paradox: Duplicate vertebral pedicles creating a rare “pseudo foramen” with symptomatic foraminal stenosis","authors":"Mark R. DeCotiis","doi":"10.1016/j.inpm.2025.100733","DOIUrl":"10.1016/j.inpm.2025.100733","url":null,"abstract":"<div><h3>Introduction</h3><div>Duplication of a vertebral pedicle is a rare congenital anatomic variant with limited representation in the medical literature. Such anomalies are thought to arise during intrauterine or early postnatal phases of osseous development. Aberrant pedicle duplication can result in the creation of a “pseudo foramen,” with potential clinical implications that are not well characterized.</div></div><div><h3>Case</h3><div>A patient presented with symptoms of painful burning sensations and paresthesias within the right groin and anterior thigh, consistent with upper lumbar radiculopathy. Advanced imaging of the lumbar spine revealed neuroforaminal stenosis associated with a “pseudo foramen” at L2, created by pedicle duplication. Together with clinical suspicion, results of a transforaminal epidural steroid injection supported the conclusion that the neuroforaminal stenosis at this level contributed to the patient's symptoms. This report examines the embryological origins and imaging findings of pedicle formation, considers the spectrum of pedicle duplication and semi-segmented hemivertebra, and reviews relevant imaging findings.</div></div><div><h3>Conclusion</h3><div>This case highlights the importance of carefully reviewing lumbar imaging modalities. Not only is there observation of a rare duplication of vertebral pedicles, but also a thorough review of available literature suggests that this is the first case to specifically report on clinically significant stenosis occurring within a “pseudo foramen.”</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100733"},"PeriodicalIF":0.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.inpm.2025.100731
Victor M. Silva-Ortiz , Anna Gisse López-Uribe , Sergio A. Pozo-Flores , Christopher L. Robinson
Background
Radicular pain may originate from various etiologies, among which epidural fibrosis is a significant contributor. Epidural scarring can induce pain through multiple pathophysiological mechanisms, notably by entrapping spinal nerve roots and disrupting the integrity of the myelin sheath.
Objective
To present a safe and practical technique for performing neuroplasty via the S1 foramen, utilizing a Tuohy or introducer needle guided by a reference spinal needle under fluoroscopic imaging. This caudal-to-cephalic approach ensures precise catheter advancement and builds upon previously described methods by Silva et al.
Design
Technical note.
Methods
For the described approach, we considered the anatomical dimensions of the sacral canal, with particular attention to the measurements at the level of the S1 foramen. This measurement is crucial, as it determines the available space for positioning the introducer needle and safely advancing the neuroplasty catheter in a caudal-to-cephalic direction.
Conclusion
This technique enables safer and more effective S1 foraminal neuroplasty by incorporating depth information through the use of reference spinal needles under fluoroscopic guidance. It facilitates tunnel-view access, which was previously unattainable, and improves procedural outcomes, particularly benefiting clinicians with less experience in fluoroscopically guided interventions.
{"title":"S1 foraminal neuroplasty using a reference spinal needle. A technical note","authors":"Victor M. Silva-Ortiz , Anna Gisse López-Uribe , Sergio A. Pozo-Flores , Christopher L. Robinson","doi":"10.1016/j.inpm.2025.100731","DOIUrl":"10.1016/j.inpm.2025.100731","url":null,"abstract":"<div><h3>Background</h3><div>Radicular pain may originate from various etiologies, among which epidural fibrosis is a significant contributor. Epidural scarring can induce pain through multiple pathophysiological mechanisms, notably by entrapping spinal nerve roots and disrupting the integrity of the myelin sheath.</div></div><div><h3>Objective</h3><div>To present a safe and practical technique for performing neuroplasty via the S1 foramen, utilizing a Tuohy or introducer needle guided by a reference spinal needle under fluoroscopic imaging. This caudal-to-cephalic approach ensures precise catheter advancement and builds upon previously described methods by Silva et al.</div></div><div><h3>Design</h3><div>Technical note.</div></div><div><h3>Methods</h3><div>For the described approach, we considered the anatomical dimensions of the sacral canal, with particular attention to the measurements at the level of the S1 foramen. This measurement is crucial, as it determines the available space for positioning the introducer needle and safely advancing the neuroplasty catheter in a caudal-to-cephalic direction.</div></div><div><h3>Conclusion</h3><div>This technique enables safer and more effective S1 foraminal neuroplasty by incorporating depth information through the use of reference spinal needles under fluoroscopic guidance. It facilitates tunnel-view access, which was previously unattainable, and improves procedural outcomes, particularly benefiting clinicians with less experience in fluoroscopically guided interventions.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100731"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-03DOI: 10.1016/j.inpm.2025.100730
Laurens Peene
{"title":"Continuing anticoagulant and antiplatelet drugs in patients undergoing cervical transforaminal epidural steroid infiltraties: Is the benefit worth the risk?","authors":"Laurens Peene","doi":"10.1016/j.inpm.2025.100730","DOIUrl":"10.1016/j.inpm.2025.100730","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100730"},"PeriodicalIF":0.0,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1016/j.inpm.2025.100727
Elizabeth Roux , Amitabh Gulati , Anuj Bhatia , David Hao
Background
The substantial health burdens and prevalence of cancer-related pain both during and after treatment underscore the need for expanded access to cancer pain specialists and therapeutic pain treatments. Despite growing demand, cancer pain specialists face substantial barriers to providing effective care.
Objective
This exploratory study sought to characterize perspectives from a small group of international pain experts to examine patterns of utilization and perceived accessibility of interventional therapies across cancer types and clinical practice settings.
Methods
An international, anonymous survey of cancer pain experts, identified via rigorous definition criteria, was conducted using the Qualtrics platform. The survey evaluated eight cancer-related pain categories: head and neck cancer, pleural and rib-based lung cancer, pancreatic cancer, pelvic cancer, lumbosacral spine cancer, extremity cancer, chemotherapy-induced peripheral neuropathy, and bone metastases. Respondents were asked to indicate which treatments they currently use for each type of cancer and which they would use if they had access to them.
Results
Cancer pain experts reported limited access to procedures with greater complexity. Some procedures had substantial variability in use and accessibility, specifically SCS, ITDD, permanent PNS, and nucleus tractus cordotomy. Complementary and alternative therapies were desirable but largely unavailable, particularly in academic settings.
Conclusion
Despite the growing need for cancer pain management, specialists continue to face substantial barriers to delivering effective care. This exploratory survey of cancer pain experts identified patterns of reported use and access limitations for therapies across cancer types and practice settings. These findings suggest a relationship between procedural complexity and access barriers, with utilization and availability shaped by institutional resources and practice settings.
{"title":"Access to interventional therapies for cancer pain: An exploratory survey of cancer pain experts","authors":"Elizabeth Roux , Amitabh Gulati , Anuj Bhatia , David Hao","doi":"10.1016/j.inpm.2025.100727","DOIUrl":"10.1016/j.inpm.2025.100727","url":null,"abstract":"<div><h3>Background</h3><div>The substantial health burdens and prevalence of cancer-related pain both during and after treatment underscore the need for expanded access to cancer pain specialists and therapeutic pain treatments. Despite growing demand, cancer pain specialists face substantial barriers to providing effective care.</div></div><div><h3>Objective</h3><div>This exploratory study sought to characterize perspectives from a small group of international pain experts to examine patterns of utilization and perceived accessibility of interventional therapies across cancer types and clinical practice settings.</div></div><div><h3>Methods</h3><div>An international, anonymous survey of cancer pain experts, identified via rigorous definition criteria, was conducted using the Qualtrics platform. The survey evaluated eight cancer-related pain categories: head and neck cancer, pleural and rib-based lung cancer, pancreatic cancer, pelvic cancer, lumbosacral spine cancer, extremity cancer, chemotherapy-induced peripheral neuropathy, and bone metastases. Respondents were asked to indicate which treatments they currently use for each type of cancer and which they would use if they had access to them.</div></div><div><h3>Results</h3><div>Cancer pain experts reported limited access to procedures with greater complexity. Some procedures had substantial variability in use and accessibility, specifically SCS, ITDD, permanent PNS, and nucleus tractus cordotomy. Complementary and alternative therapies were desirable but largely unavailable, particularly in academic settings.</div></div><div><h3>Conclusion</h3><div>Despite the growing need for cancer pain management, specialists continue to face substantial barriers to delivering effective care. This exploratory survey of cancer pain experts identified patterns of reported use and access limitations for therapies across cancer types and practice settings. These findings suggest a relationship between procedural complexity and access barriers, with utilization and availability shaped by institutional resources and practice settings.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100727"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Persistent pain following total knee arthroplasty (TKA) is a challenging condition to manage. Conceivably, persistent pain may be mediated by residual innervation to the subchondral bone. In the previous anatomical literature, targeting the middle two quadrants of the lateral and medial aspects of the distal femur was suggested to optimize capture of subchondral bone innervation. In this case report, we describe a modified injection protocol at the level of the epicondyle that provided pain relief for a patient with persistent post-TKA pain after failing to respond to genicular nerve diagnostic blocks at the classical target sites.
Case report
An 84-year-old female had right TKA in 2023 for severe osteoarthritis. The patient had right genicular nerve diagnostic blocks at the classical target sites for consideration of possible radiofrequency ablation (RFA). A 1 mL volume of contrast was injected at each location, followed by 1 mL of 0.5 % bupivacaine. The patient reported no relief from these diagnostic blocks. The patient subsequently had repeated diagnostic blocks, using a modified protocol, where two injections were performed at each of the superomedial, superolateral, and inferomedial quadrant of the knee. Following the second procedure, the patient reported 100 % pain relief for 5 hours. The patient has been scheduled for an RFA procedure.
Conclusion
In the current case report, a modified genicular nerve diagnostic block protocol provided pain relief for a post-TKA patient after failure of a classical injection technique. This suggests that a modified injection protocol may be necessary to select post-TKA patients for joint denervation. Future anatomical and clinical research is required.
{"title":"Modified genicular nerve diagnostic blocks for persistent pain post total knee arthroplasty: A case report","authors":"John Tran , Melissa Calleja , Brent Lanting , Eldon Loh","doi":"10.1016/j.inpm.2025.100732","DOIUrl":"10.1016/j.inpm.2025.100732","url":null,"abstract":"<div><h3>Introduction</h3><div>Persistent pain following total knee arthroplasty (TKA) is a challenging condition to manage. Conceivably, persistent pain may be mediated by residual innervation to the subchondral bone. In the previous anatomical literature, targeting the middle two quadrants of the lateral and medial aspects of the distal femur was suggested to optimize capture of subchondral bone innervation. In this case report, we describe a modified injection protocol at the level of the epicondyle that provided pain relief for a patient with persistent post-TKA pain after failing to respond to genicular nerve diagnostic blocks at the classical target sites.</div></div><div><h3>Case report</h3><div>An 84-year-old female had right TKA in 2023 for severe osteoarthritis. The patient had right genicular nerve diagnostic blocks at the classical target sites for consideration of possible radiofrequency ablation (RFA). A 1 mL volume of contrast was injected at each location, followed by 1 mL of 0.5 % bupivacaine. The patient reported no relief from these diagnostic blocks. The patient subsequently had repeated diagnostic blocks, using a modified protocol, where two injections were performed at each of the superomedial, superolateral, and inferomedial quadrant of the knee. Following the second procedure, the patient reported 100 % pain relief for 5 hours. The patient has been scheduled for an RFA procedure.</div></div><div><h3>Conclusion</h3><div>In the current case report, a modified genicular nerve diagnostic block protocol provided pain relief for a post-TKA patient after failure of a classical injection technique. This suggests that a modified injection protocol may be necessary to select post-TKA patients for joint denervation. Future anatomical and clinical research is required.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100732"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：