Pub Date : 2025-08-23DOI: 10.1016/j.inpm.2025.100623
David A. Provenzano , Bradley Holt , Michael Danko , Joseph Atallah , Maaz Iqbal , Binit Shah , Albert Singh , Harsh Sachdeva , Ella Ver Donck , Bart Liebrand , Erik Shaw , Sherri Haas , Rajat Sekhar , Ann Pan , Daniel S. Halperin , Edward Goldberg
Introduction
Cervical facet joint syndrome (CFJS) is a common cause of chronic neck pain. While numerous studies have demonstrated the effectiveness of radiofrequency ablation (RFA) for facetogenic pain, its use in treating CFJS remains a subject of ongoing debate.
Objective
Here, we sought to evaluate real-world clinical outcomes in cervical RFA-treated patients with chronic cervical facetogenic pain.
Methods
The RAPID study (Clinicaltrials.gov identifier: NCT04673032) is an international, multicenter, prospective study of patients using a commercially-available radiofrequency ablation system for the treatment of chronic pain, provided per standard of care. Patients were monitored at study follow-up visits (1-, 3-. 6-, 12-, and 24-months post-index procedure). Key clinical endpoint measures collected and evaluated include numeric pain rating scale (NPRS), Oswestry Disability Index (functional disability, ODI), EQ-5D-5L (quality-of-life), and Patient Global Impression of Change (PGIC).
Results
A total of 56 patients were enrolled in this cervical facetogenic pain cohort. At both 6 (n = 49) and 12 months (n = 40), mean NPRS pain scores significantly decreased from a baseline of 6.0 ± 1.9 to 3.3 ± 2.8 and 3.3 ± 2.2, respectively (p < 0.0001). Oswestry Disability Index (ODI) scores also improved, dropping by 7.9- and 9.7-points from a baseline of 32.7 (p < 0.0001). Treatment response rates (≥50 % pain relief) were 81 % at 1 month and 80 % at 12 months. Improvements in quality-of-life (EQ-5D-5L) and self-reported change (PGIC) were also consistently observed.
Conclusions
The cervical RFA cohort in the RAPID study demonstrated consistent, clinically meaningful improvements in pain, function, quality-of-life, and treatment satisfaction across all follow-up visits, underscoring the real-world effectiveness of RFA for appropriately selected patients with cervical facetogenic pain.
{"title":"Assessment of real-world, prospective outcomes in patients treated with cervical radiofrequency ablation for chronic pain (RAPID)","authors":"David A. Provenzano , Bradley Holt , Michael Danko , Joseph Atallah , Maaz Iqbal , Binit Shah , Albert Singh , Harsh Sachdeva , Ella Ver Donck , Bart Liebrand , Erik Shaw , Sherri Haas , Rajat Sekhar , Ann Pan , Daniel S. Halperin , Edward Goldberg","doi":"10.1016/j.inpm.2025.100623","DOIUrl":"10.1016/j.inpm.2025.100623","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical facet joint syndrome (CFJS) is a common cause of chronic neck pain. While numerous studies have demonstrated the effectiveness of radiofrequency ablation (RFA) for facetogenic pain, its use in treating CFJS remains a subject of ongoing debate.</div></div><div><h3>Objective</h3><div>Here, we sought to evaluate real-world clinical outcomes in cervical RFA-treated patients with chronic cervical facetogenic pain.</div></div><div><h3>Methods</h3><div>The RAPID study (<span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> identifier: NCT04673032) is an international, multicenter, prospective study of patients using a commercially-available radiofrequency ablation system for the treatment of chronic pain, provided per standard of care. Patients were monitored at study follow-up visits (1-, 3-. 6-, 12-, and 24-months post-index procedure). Key clinical endpoint measures collected and evaluated include numeric pain rating scale (NPRS), Oswestry Disability Index (functional disability, ODI), EQ-5D-5L (quality-of-life), and Patient Global Impression of Change (PGIC).</div></div><div><h3>Results</h3><div>A total of 56 patients were enrolled in this cervical facetogenic pain cohort. At both 6 (n = 49) and 12 months (n = 40), mean NPRS pain scores significantly decreased from a baseline of 6.0 ± 1.9 to 3.3 ± 2.8 and 3.3 ± 2.2, respectively (p < 0.0001). Oswestry Disability Index (ODI) scores also improved, dropping by 7.9- and 9.7-points from a baseline of 32.7 (p < 0.0001). Treatment response rates (≥50 % pain relief) were 81 % at 1 month and 80 % at 12 months. Improvements in quality-of-life (EQ-5D-5L) and self-reported change (PGIC) were also consistently observed.</div></div><div><h3>Conclusions</h3><div>The cervical RFA cohort in the RAPID study demonstrated consistent, clinically meaningful improvements in pain, function, quality-of-life, and treatment satisfaction across all follow-up visits, underscoring the real-world effectiveness of RFA for appropriately selected patients with cervical facetogenic pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100623"},"PeriodicalIF":0.0,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888861","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 : 2025-08-22DOI: 10.1016/j.inpm.2025.100635
Allison Glinka Przybysz , To-Nhu Vu , Andrew J.B. Pisansky , Nathaniel M. Schuster , Samir Sheth , David S. Cheng , Steven M. Lobel , Danielle Binler , Belinda Duszynski , Aaron Conger , Byron J. Schneider , Ryan Mattie
Objective
To assess the effectiveness of dorsal column spinal cord stimulation (SCS) in treating persistent spinal pain syndrome — Type 2 (PSPS-T2).
Design
Systematic review.
Methods
PICOS (Population, Intervention, Comparison, Outcomes, and Studies) criteria were developed to include randomized controlled trials (RCTs) examining dorsal column stimulation for PSPS-T2 compared to conventional medical management or sham. Eight reviewers independently assessed publications through April 2025 and utilized the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework to evaluate the overall quality of evidence. Outcomes included measures of pain, function, quality of life, and adverse events.
Results
Of the 1988 publications initially screened, six publications were included, comprising a total of 448 participants, of which 257 were randomized to an SCS trial and 220 ultimately received SCS implants. Follow-up periods for the primary endpoints varied across the studies, ranging from 1 month to 2 years. For studies reporting success rates for achieving at least a 50% reduction in pain, responder rates spanned from 14% to 80% in the tonic SCS groups, compared with 3%–20% for CMM. The mean improvement in pain levels between 1 month and 6 months varied between 16% and 48% for tonic SCS, 16 and 17% for burst SCS, −15% and 16% for CMM, and 10 and 16% for sham. The mean improvement in function at six months ranged from 21 to 45% for the tonic SCS group, compared with 0–21% for CMM. Adverse events reported in these studies included lead migration (10–14%), IPG site pain (1–12%), infection (6.9–10%), and dural puncture (6%). Cochrane risk of bias assessments revealed low risks for one-third of the included studies, while some concerns were noted for over half of the studies. According to the GRADE system, based on the available RCTs, there is moderate-quality evidence overall that SCS is clinically effective in reducing pain and disability in patients with PSPS-T2 at 6 months.
Discussion/conclusion
Substantial proportions of patients achieved ≥50% relief at 6 months following tonic SCS when compared with CMM, demonstrating clinical effectiveness. Significant improvements in function and quality of life were observed at study endpoints ranging from 3 to 24 months following tonic SCS. No studies included in this review utilized newer and potentially more effective SCS technologies such as closed loop, high frequency, or multiple waveform SCS. The only sham-controlled study included did not demonstrate efficacy of burst SCS. Adverse event rates, including infection and implant site pain, varied significantly between studies, with the newer and older studies representing the lower and upper ends of these ranges, respectively.
目的评价脊髓背柱刺激(SCS)治疗2型持续性脊柱疼痛综合征(PSPS-T2)的疗效。DesignSystematic审查。方法采用spicos (Population, Intervention, Comparison, Outcomes and Studies)标准,纳入随机对照试验(RCTs),检查PSPS-T2的背柱刺激与常规医疗管理或假治疗的比较。8位审稿人独立评估了截至2025年4月的出版物,并利用推荐、评估、发展和评估等级(GRADE)框架评估证据的整体质量。结果包括疼痛、功能、生活质量和不良事件的测量。结果在最初筛选的1988篇出版物中,包括6篇出版物,共448名参与者,其中257名被随机分配到SCS试验中,220名最终接受了SCS植入物。各研究的主要终点随访时间各不相同,从1个月到2年不等。在报告成功减轻至少50%疼痛的研究中,强直性SCS组的应答率为14%至80%,而CMM组的应答率为3%至20%。在1个月至6个月期间,强直性SCS的疼痛水平平均改善在16%至48%之间,破裂性SCS为16%至17%,CMM为- 15%至16%,假手术为10%至16%。在6个月时,强直性SCS组的平均功能改善范围为21%至45%,而CMM组为0-21%。这些研究中报告的不良事件包括铅迁移(10-14%)、IPG部位疼痛(1-12%)、感染(6.9-10%)和硬脑膜穿刺(6%)。Cochrane偏倚风险评估显示,三分之一的纳入研究的风险较低,而超过一半的研究存在一些问题。根据GRADE系统,基于现有的随机对照试验,总体上有中等质量的证据表明SCS在临床有效地减轻PSPS-T2患者6个月时的疼痛和残疾。讨论/结论:与CMM相比,大量患者在强直性SCS治疗后6个月获得≥50%的缓解,证明了临床有效性。在强直性SCS后3 - 24个月的研究终点观察到功能和生活质量的显著改善。本综述中没有研究使用更新的和可能更有效的SCS技术,如闭环、高频或多波形SCS。纳入的唯一一项假对照研究没有证明SCS的有效性。不良事件发生率,包括感染和植入部位疼痛,在不同的研究之间差异很大,新的和旧的研究分别代表了这些范围的下限和上限。
{"title":"A systematic review of evidence comparing spinal cord stimulation to sham or conservative medical management in the treatment of persistent spinal pain syndrome - Type 2","authors":"Allison Glinka Przybysz , To-Nhu Vu , Andrew J.B. Pisansky , Nathaniel M. Schuster , Samir Sheth , David S. Cheng , Steven M. Lobel , Danielle Binler , Belinda Duszynski , Aaron Conger , Byron J. Schneider , Ryan Mattie","doi":"10.1016/j.inpm.2025.100635","DOIUrl":"10.1016/j.inpm.2025.100635","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effectiveness of dorsal column spinal cord stimulation (SCS) in treating persistent spinal pain syndrome — Type 2 (PSPS-T2).</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>PICOS (Population, Intervention, Comparison, Outcomes, and Studies) criteria were developed to include randomized controlled trials (RCTs) examining dorsal column stimulation for PSPS-T2 compared to conventional medical management or sham. Eight reviewers independently assessed publications through April 2025 and utilized the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework to evaluate the overall quality of evidence. Outcomes included measures of pain, function, quality of life, and adverse events.</div></div><div><h3>Results</h3><div>Of the 1988 publications initially screened, six publications were included, comprising a total of 448 participants, of which 257 were randomized to an SCS trial and 220 ultimately received SCS implants. Follow-up periods for the primary endpoints varied across the studies, ranging from 1 month to 2 years. For studies reporting success rates for achieving at least a 50% reduction in pain, responder rates spanned from 14% to 80% in the tonic SCS groups, compared with 3%–20% for CMM. The mean improvement in pain levels between 1 month and 6 months varied between 16% and 48% for tonic SCS, 16 and 17% for burst SCS, −15% and 16% for CMM, and 10 and 16% for sham. The mean improvement in function at six months ranged from 21 to 45% for the tonic SCS group, compared with 0–21% for CMM. Adverse events reported in these studies included lead migration (10–14%), IPG site pain (1–12%), infection (6.9–10%), and dural puncture (6%). Cochrane risk of bias assessments revealed low risks for one-third of the included studies, while some concerns were noted for over half of the studies. According to the GRADE system, based on the available RCTs, there is moderate-quality evidence overall that SCS is clinically effective in reducing pain and disability in patients with PSPS-T2 at 6 months.</div></div><div><h3>Discussion/conclusion</h3><div>Substantial proportions of patients achieved ≥50% relief at 6 months following tonic SCS when compared with CMM, demonstrating clinical effectiveness. Significant improvements in function and quality of life were observed at study endpoints ranging from 3 to 24 months following tonic SCS. No studies included in this review utilized newer and potentially more effective SCS technologies such as closed loop, high frequency, or multiple waveform SCS. The only sham-controlled study included did not demonstrate efficacy of burst SCS. Adverse event rates, including infection and implant site pain, varied significantly between studies, with the newer and older studies representing the lower and upper ends of these ranges, respectively.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100635"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886662","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 : 2025-08-21DOI: 10.1016/j.inpm.2025.100629
Javier De Andrés Ares MD PhD FIPP
{"title":"Advancing the diagnosis and treatment of posterior ligamentous complex inflammatory syndrome (PLCIS) in chronic axial low back pain","authors":"Javier De Andrés Ares MD PhD FIPP","doi":"10.1016/j.inpm.2025.100629","DOIUrl":"10.1016/j.inpm.2025.100629","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100629"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886661","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 : 2025-08-21DOI: 10.1016/j.inpm.2025.100633
Meha Aggarwal , Marshall Yuan , David Hao
Background
As cancer survival improves, chronic cancer-related pain is an increasing clinical concern. Interventional procedures offer targeted, opioid-sparing pain relief, yet the quality and readability of online educational materials about these options remain poorly understood.
Objective
To evaluate the availability, quality, and readability of online educational resources on interventional cancer pain management available from National Cancer Institute (NCI)-designated cancer centers.
Methods
We conducted a cross-sectional analysis of 65 NCI-designated clinical cancer center websites to identify patient-facing content discussing interventional cancer pain procedures. Eligible materials were evaluated for quality using the DISCERN instrument and for readability using seven validated metrics. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Statistical comparisons were performed using t-tests.
Results
Only 20 of 65 cancer center websites (31%) contained relevant educational materials. Sixty qualifying texts were identified: 28 full articles and 32 substantial mentions (≥50 words). The mean DISCERN score was 37 ± 9, indicating poor quality. Articles scored significantly higher than substantial mentions (mean difference 9.4 points, p < 0.001). The ICC for DISCERN scores was 0.872 (p < 0.001), reflecting good inter-rater agreement. Readability analysis revealed an average reading level equivalent to the 11th grade across all metrics, significantly higher than the NIH-recommended 8th-grade level (p < 0.001). Substantial mentions were significantly more difficult to read than articles (p < 0.001).
Conclusions
Online materials on cancer pain interventions are generally scarce, low in quality, and written above nationally recommended reading levels. These findings highlight the need for cancer centers to improve online education materials using plain language and health literacy tools to better support informed decision-making.
{"title":"Assessing the availability, readability, and content of online patient Education materials for cancer pain interventions: A cross-sectional analysis of major cancer center websites","authors":"Meha Aggarwal , Marshall Yuan , David Hao","doi":"10.1016/j.inpm.2025.100633","DOIUrl":"10.1016/j.inpm.2025.100633","url":null,"abstract":"<div><h3>Background</h3><div>As cancer survival improves, chronic cancer-related pain is an increasing clinical concern. Interventional procedures offer targeted, opioid-sparing pain relief, yet the quality and readability of online educational materials about these options remain poorly understood.</div></div><div><h3>Objective</h3><div>To evaluate the availability, quality, and readability of online educational resources on interventional cancer pain management available from National Cancer Institute (NCI)-designated cancer centers.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis of 65 NCI-designated clinical cancer center websites to identify patient-facing content discussing interventional cancer pain procedures. Eligible materials were evaluated for quality using the DISCERN instrument and for readability using seven validated metrics. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Statistical comparisons were performed using t-tests.</div></div><div><h3>Results</h3><div>Only 20 of 65 cancer center websites (31%) contained relevant educational materials. Sixty qualifying texts were identified: 28 full articles and 32 substantial mentions (≥50 words). The mean DISCERN score was 37 ± 9, indicating poor quality. Articles scored significantly higher than substantial mentions (mean difference 9.4 points, p < 0.001). The ICC for DISCERN scores was 0.872 (p < 0.001), reflecting good inter-rater agreement. Readability analysis revealed an average reading level equivalent to the 11th grade across all metrics, significantly higher than the NIH-recommended 8th-grade level (p < 0.001). Substantial mentions were significantly more difficult to read than articles (p < 0.001).</div></div><div><h3>Conclusions</h3><div>Online materials on cancer pain interventions are generally scarce, low in quality, and written above nationally recommended reading levels. These findings highlight the need for cancer centers to improve online education materials using plain language and health literacy tools to better support informed decision-making.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100633"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878769","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 : 2025-08-20DOI: 10.1016/j.inpm.2025.100631
Sandy Christiansen , Rosa Garcia , Daniel A. Jimenez , Shauna Rakshe
Background
An unprecedented volume of interventional procedures has entered the pain medicine market, including many “advanced” interventional pain procedures. Given the rapid influx, there is concern that there is discordance between what is taught in pain medicine fellowship programs and done in post-graduate practice.
Objective
The goal of the study was to compare sales volumes of advanced procedure devices in academic versus non-academic practice settings to better understand the status quo of procedural practice patterns. This information will be critical to establish a baseline understanding of where advanced pain procedures are happening for future comparison.
Methods
This cross-sectional observational study examines relative percentages of industry-reported device sales to academic versus non-academic practices from January 1, 2023 to December 31, 2023 in predefined regions of the United States. The data were tabulated and reported as means with corresponding ranges.
Results
Six companies, representing nine distinct interventional pain procedures, certified the requested data. The region with the lowest relative mean device sales at academic institutions was the West (10 %) and the highest was the Northeast (22 %). The procedure with the lowest relative mean sales at academic institutions was dorsal root ganglion stimulation (4 %) and the highest was vertebral body cooled radiofrequency for bone tumors (30 %).
Conclusion
This study highlights the difference between the relative percentage sales of advanced procedure devices in non-academic versus academic institutions, favoring non-academic sites of service. Yet, for each reported pain procedure, there were device sales in academic settings for almost all regions. It will be essential to continue to monitor how academic procedural training compares to post-graduate practice realities to tailor future educational offerings.
{"title":"Where are advanced interventional pain procedures happening?","authors":"Sandy Christiansen , Rosa Garcia , Daniel A. Jimenez , Shauna Rakshe","doi":"10.1016/j.inpm.2025.100631","DOIUrl":"10.1016/j.inpm.2025.100631","url":null,"abstract":"<div><h3>Background</h3><div>An unprecedented volume of interventional procedures has entered the pain medicine market, including many “advanced” interventional pain procedures. Given the rapid influx, there is concern that there is discordance between what is taught in pain medicine fellowship programs and done in post-graduate practice.</div></div><div><h3>Objective</h3><div>The goal of the study was to compare sales volumes of advanced procedure devices in academic versus non-academic practice settings to better understand the status quo of procedural practice patterns. This information will be critical to establish a baseline understanding of where advanced pain procedures are happening for future comparison.</div></div><div><h3>Methods</h3><div>This cross-sectional observational study examines relative percentages of industry-reported device sales to academic versus non-academic practices from January 1, 2023 to December 31, 2023 in predefined regions of the United States. The data were tabulated and reported as means with corresponding ranges.</div></div><div><h3>Results</h3><div>Six companies, representing nine distinct interventional pain procedures, certified the requested data. The region with the lowest relative mean device sales at academic institutions was the West (10 %) and the highest was the Northeast (22 %). The procedure with the lowest relative mean sales at academic institutions was dorsal root ganglion stimulation (4 %) and the highest was vertebral body cooled radiofrequency for bone tumors (30 %).</div></div><div><h3>Conclusion</h3><div>This study highlights the difference between the relative percentage sales of advanced procedure devices in non-academic versus academic institutions, favoring non-academic sites of service. Yet, for each reported pain procedure, there were device sales in academic settings for almost all regions. It will be essential to continue to monitor how academic procedural training compares to post-graduate practice realities to tailor future educational offerings.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100631"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866835","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 : 2025-08-20DOI: 10.1016/j.inpm.2025.100632
Asher Smuek , Rishi Bakshi , Romeo Mays , Lisa Huynh , Joshua Levin , Joshua Rittenberg , Matthew Smuck
Background
“Is this injection going to hurt?” Physicians typically answer this from experience since accurate answers are not available in the literature.
Objective
To quantify pain during common lumbosacral spine injections and compare to baseline pain prior to the injections. Analyze differences based on demographic and procedure variables.
Methods
This is a secondary analysis of prospectively collected data from a multicenter trial of patients undergoing bilateral symmetric transforaminal epidural (TFE), facet joint (FJ), or sacroiliac joint (SIJ) injections. Numeric pain ratings (0-10) were obtained at baseline in preop (“What is your current pain?”) and for each injection procedure (“How much did this injection hurt from start to finish?”) first on the right side then the left. Between group comparisons used Chi-squared and ANOVA for categorical and continuous variables, respectively. T-tests compared various pain responses, and multivariate regression determined factors associated with higher procedure pain.
Results
From 244 injections (124 TFE, 60 FJ, 60 SIJ) on 122 consecutive patients (mean age 57.2, 50 % female), age and BMI did not differ between injection groups while sex did (p = 0.001) with more FJ males and SIJ females. Mean baseline pain was statistically equivalent between demographic and injection groups. Mean procedure pain was consistently higher than mean baseline pain, however this difference was small and non-significant for TFE (4.0 vs 3.8) and FJ (3.9 vs 3.3), but larger and significant for SIJ (5.3 vs. 3.6; p = 0.0001). In the multivariate regression analysis only 2 variables remained associated with higher procedure pain, older age (p < 0.0001) and SIJ injection group (p = 0.0021).
Conclusion
The majority of patients (79.1 %) report mild or moderate pain during common lumbosacral spine injections. The average procedure pain of 4.3 on the NPRS scale was only 0.7 points higher than baseline pain recorded in pre-op. Procedure pain from TFE and FJ injections is statistically equivalent to baseline pain and to each other, while SIJ injections produce higher procedure pain with a significant +1.7 point mean increase in pain from baseline. Finally, older adults report significantly greater procedure pain compared to those under 65 years old.
“打针会痛吗?”医生通常根据经验回答这个问题,因为在文献中没有准确的答案。目的量化普通腰骶椎注射时的疼痛,并与注射前的基线疼痛进行比较。根据人口统计和程序变量分析差异。方法:这是一项前瞻性多中心试验收集的数据的二次分析,这些患者接受双侧对称经椎间孔硬膜外(TFE)、小关节(FJ)或骶髂关节(SIJ)注射。在术前基线时获得数值疼痛评分(0-10)(“你目前的疼痛是什么?”)以及每个注射过程(“从开始到结束,注射有多痛?”)先在右边,然后在左边。组间比较分别对分类变量和连续变量使用卡方和方差分析。t检验比较了各种疼痛反应,多变量回归确定了与较高手术疼痛相关的因素。结果连续122例患者(平均年龄57.2岁,女性占50%)接受244次注射(TFE 124次,FJ 60次,SIJ 60次),注射组间年龄和BMI无差异,性别有差异(p = 0.001), FJ男性多于SIJ女性。人口统计学组和注射组的平均基线疼痛在统计学上是相等的。平均手术疼痛始终高于平均基线疼痛,然而TFE (4.0 vs 3.8)和FJ (3.9 vs 3.3)的差异很小且不显著,但SIJ的差异更大且显著(5.3 vs 3.6; p = 0.0001)。在多变量回归分析中,只有2个变量与较高的手术疼痛、年龄(p < 0.0001)和SIJ注射组(p = 0.0021)相关。结论:大多数患者(79.1%)报告腰骶椎注射时出现轻度或中度疼痛。NPRS量表的平均手术疼痛为4.3分,仅比术前记录的基线疼痛高0.7分。TFE和FJ注射的手术疼痛在统计学上与基线疼痛相当,并且彼此相等,而SIJ注射产生更高的手术疼痛,疼痛比基线平均增加1.7点。最后,与65岁以下的人相比,老年人报告的手术疼痛明显更大。
{"title":"“Is this injection going to hurt?” Quantifying the pain experience during common lumbosacral spine injections","authors":"Asher Smuek , Rishi Bakshi , Romeo Mays , Lisa Huynh , Joshua Levin , Joshua Rittenberg , Matthew Smuck","doi":"10.1016/j.inpm.2025.100632","DOIUrl":"10.1016/j.inpm.2025.100632","url":null,"abstract":"<div><h3>Background</h3><div>“Is this injection going to hurt?” Physicians typically answer this from experience since accurate answers are not available in the literature.</div></div><div><h3>Objective</h3><div>To quantify pain during common lumbosacral spine injections and compare to baseline pain prior to the injections. Analyze differences based on demographic and procedure variables.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of prospectively collected data from a multicenter trial of patients undergoing bilateral symmetric transforaminal epidural (TFE), facet joint (FJ), or sacroiliac joint (SIJ) injections. Numeric pain ratings (0-10) were obtained at baseline in preop (“What is your current pain?”) and for each injection procedure (“How much did this injection hurt from start to finish?”) first on the right side then the left. Between group comparisons used Chi-squared and ANOVA for categorical and continuous variables, respectively. T-tests compared various pain responses, and multivariate regression determined factors associated with higher procedure pain.</div></div><div><h3>Results</h3><div>From 244 injections (124 TFE, 60 FJ, 60 SIJ) on 122 consecutive patients (mean age 57.2, 50 % female), age and BMI did not differ between injection groups while sex did (p = 0.001) with more FJ males and SIJ females. Mean baseline pain was statistically equivalent between demographic and injection groups. Mean procedure pain was consistently higher than mean baseline pain, however this difference was small and non-significant for TFE (4.0 vs 3.8) and FJ (3.9 vs 3.3), but larger and significant for SIJ (5.3 vs. 3.6; p = 0.0001). In the multivariate regression analysis only 2 variables remained associated with higher procedure pain, older age (p < 0.0001) and SIJ injection group (p = 0.0021).</div></div><div><h3>Conclusion</h3><div>The majority of patients (79.1 %) report mild or moderate pain during common lumbosacral spine injections. The average procedure pain of 4.3 on the NPRS scale was only 0.7 points higher than baseline pain recorded in pre-op. Procedure pain from TFE and FJ injections is statistically equivalent to baseline pain and to each other, while SIJ injections produce higher procedure pain with a significant +1.7 point mean increase in pain from baseline. Finally, older adults report significantly greater procedure pain compared to those under 65 years old.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100632"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866834","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 : 2025-08-15DOI: 10.1016/j.inpm.2025.100626
Sayed E. Wahezi , Ugur Yener , Suwannika Palee
{"title":"Authors' response to the letter to the editor on “Tendon modification with percutaneous ultrasound-guided tenotomy using TENEX®: A histological and macroscopic analysis of a bovine cadaveric model.”","authors":"Sayed E. Wahezi , Ugur Yener , Suwannika Palee","doi":"10.1016/j.inpm.2025.100626","DOIUrl":"10.1016/j.inpm.2025.100626","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100626"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842108","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 : 2025-08-15DOI: 10.1016/j.inpm.2025.100625
Clark C. Smith MD, MPH
{"title":"Reassessing the risks of Cervical Transforaminal Epidural Steroid Injections (CTFESI)","authors":"Clark C. Smith MD, MPH","doi":"10.1016/j.inpm.2025.100625","DOIUrl":"10.1016/j.inpm.2025.100625","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100625"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842127","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 : 2025-08-14DOI: 10.1016/j.inpm.2025.100624
Emily Bellow, Derek Johnson, Sandi Bajrami, William Caldwell
Background
The Intracept procedure was the first FDA-cleared technique for basivertebral nerve ablation, a minimally invasive treatment for vertebrogenic chronic low back pain. While prior studies support its effectiveness, data in patients with osteoporosis and osteopenia remains limited.
Objective
To evaluate the safety and effectiveness of basivertebral nerve ablation with a specific focus on pain reduction, functional improvement, and the incidence of post-procedure vertebral compression fractures.
Methods
A retrospective chart review was conducted on patients who underwent the Intracept procedure at our institution from November 2019 to January 2025. Bone density status was categorized using available DEXA scans. Patients were stratified into a Reduced Bone Density group (N = 32), consisting of 23 patients with osteopenia and 9 with osteoporosis, and the overall cohort (N = 134). Pain severity was assessed using the Visual Analog Scale (VAS) at baseline and at the 4–6-week post-procedure follow-up visit, and functional improvement was determined based on patient-reported outcomes at the same time point. Post-procedure complications, including vertebral compression fractures, were monitored until the most recent available follow-up.
Results
A significant decrease in VAS was observed for the overall cohort (7.04 vs. 3.78, p < 0.001) and the Reduced Bone Density group (6.75 vs. 4.13, p < 0.001). Functional improvement was reported by 79.1 % of patients in the overall study population and 78.1 % of patients in the Reduced Bone Density group. No post-procedure vertebral compression fractures were observed in the entire cohort, with a mean follow-up length of 18.07 months.
Conclusion
The Intracept procedure demonstrated significant pain reduction and functional improvement in the overall cohort and in patients with reduced bone density. Notably, no post-procedure vertebral compression fractures were observed, even in patients with osteoporosis and osteopenia. These findings contribute to the growing body of independent literature supporting the safety and effectiveness of the Intracept procedure and offer real-world insight into its use in patients with reduced bone density.
背景:该手术是首个获得fda批准的椎体神经消融技术,是一种治疗椎体源性慢性腰痛的微创治疗方法。虽然先前的研究支持其有效性,但骨质疏松症和骨质减少患者的数据仍然有限。目的评价基椎神经消融术的安全性和有效性,特别关注疼痛减轻、功能改善和术后椎体压缩性骨折的发生率。方法回顾性分析2019年11月至2025年1月在我院行内置管术的患者。使用DEXA扫描对骨密度状态进行分类。将患者分层分为骨密度降低组(N = 32),其中骨质减少组23例,骨质疏松组9例,整体队列(N = 134)。在基线和术后4 - 6周随访时使用视觉模拟量表(VAS)评估疼痛严重程度,并根据患者报告的同一时间点的结果确定功能改善情况。术后并发症,包括椎体压缩性骨折,一直监测到最近的随访。结果整个队列的VAS评分显著下降(7.04 vs. 3.78, p <;0.001)和骨密度降低组(6.75 vs. 4.13, p <;0.001)。总体研究人群中79.1%的患者和骨密度降低组中78.1%的患者报告功能改善。整个队列中未观察到术后椎体压缩性骨折,平均随访时间为18.07个月。结论:在整个队列和骨密度降低的患者中,截骨术显示出明显的疼痛减轻和功能改善。值得注意的是,即使在骨质疏松和骨质减少的患者中,也没有观察到术后椎体压缩性骨折。这些发现有助于越来越多的独立文献支持内截骨术的安全性和有效性,并为其在骨密度降低患者中的应用提供了真实的见解。
{"title":"Safety and effectiveness of basivertebral nerve ablation in patients with osteoporosis and osteopenia: A real-world study","authors":"Emily Bellow, Derek Johnson, Sandi Bajrami, William Caldwell","doi":"10.1016/j.inpm.2025.100624","DOIUrl":"10.1016/j.inpm.2025.100624","url":null,"abstract":"<div><h3>Background</h3><div>The Intracept procedure was the first FDA-cleared technique for basivertebral nerve ablation, a minimally invasive treatment for vertebrogenic chronic low back pain. While prior studies support its effectiveness, data in patients with osteoporosis and osteopenia remains limited.</div></div><div><h3>Objective</h3><div>To evaluate the safety and effectiveness of basivertebral nerve ablation with a specific focus on pain reduction, functional improvement, and the incidence of post-procedure vertebral compression fractures.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted on patients who underwent the Intracept procedure at our institution from November 2019 to January 2025. Bone density status was categorized using available DEXA scans. Patients were stratified into a Reduced Bone Density group (N = 32), consisting of 23 patients with osteopenia and 9 with osteoporosis, and the overall cohort (N = 134). Pain severity was assessed using the Visual Analog Scale (VAS) at baseline and at the 4–6-week post-procedure follow-up visit, and functional improvement was determined based on patient-reported outcomes at the same time point. Post-procedure complications, including vertebral compression fractures, were monitored until the most recent available follow-up.</div></div><div><h3>Results</h3><div>A significant decrease in VAS was observed for the overall cohort (7.04 vs. 3.78, p < 0.001) and the Reduced Bone Density group (6.75 vs. 4.13, p < 0.001). Functional improvement was reported by 79.1 % of patients in the overall study population and 78.1 % of patients in the Reduced Bone Density group. No post-procedure vertebral compression fractures were observed in the entire cohort, with a mean follow-up length of 18.07 months.</div></div><div><h3>Conclusion</h3><div>The Intracept procedure demonstrated significant pain reduction and functional improvement in the overall cohort and in patients with reduced bone density. Notably, no post-procedure vertebral compression fractures were observed, even in patients with osteoporosis and osteopenia. These findings contribute to the growing body of independent literature supporting the safety and effectiveness of the Intracept procedure and offer real-world insight into its use in patients with reduced bone density.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100624"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842107","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}