Pub Date : 2025-06-01DOI: 10.1016/j.inpm.2025.100601
Mingda Chen , Sercan Tosun , Nicolas R. Thompson , Kush K. Goyal
Background
Genicular nerve blocks (GNB) for knee pain secondary to osteoarthritis (OA) are often performed with an anesthetic only, but corticosteroid can be used as an adjuvant with the goal of extending therapeutic relief. The efficacy of GNB with corticosteroid has been established in small, randomized trials, but its effectiveness in practice remains largely unknown.
Objectives
Evaluate the therapeutic effect of GNB with corticosteroid using patient-reported outcomes (PROs) in a large patient sample.
Methods
Data from consecutive GNBs with corticosteroid performed at an academic medical center from 2015 to 2024 was collected retrospectively. We included all patients aged ≥18 who received a GNB with corticosteroid for chronic knee pain due to OA, and excluded diagnostic GNBs with anesthetic alone and procedures performed using non-classical/modified techniques. Comparisons between pre-versus post-procedure PROs were by mixed-effect regression models with multiple testing corrections.
Results
A total of 123 GNBs (96 patients) with corticosteroid were identified. Post-procedurally, the mean NRS reductions were 3.56 (2–30 days), 2.14 (1–3 months), 1.92 (3–6 months), and 1.23 (6–12 months). 50 % of the patients maintained a pain reduction greater than or equal to the NRS MCID of −2.0 for at least 6.9 months. Post-procedure improvements in PROMIS-GH and PHQ9 were not clinically significant. Mean time to total knee arthroplasty was 16.5 months in 13.5 % of patients (13/96). For active opioid users, opioid usage was significantly decreased from the baseline 28.01 ± 13.20 MME/day to 13.58 ± 16.23 MME/day (p < 0.002) in the first 6 months post-GNB, and this opioid reduction was maintained at 15.59 ± 12.51 MME/day (p < 0.05) after the initial 6-month follow-up period.
Conclusion
For the majority of patients who received GNB with corticosteroid, we observed statistically and clinically significant pain reduction for 3 months or more in this cohort. While more comparative studies are required to evaluate its effectiveness, GNB with corticosteroid has promising potential as a safe and effective treatment for chronic knee pain.
{"title":"Genicular nerve block with corticosteroid for chronic knee Pain: Patient-Reported outcomes across 9-years of practice","authors":"Mingda Chen , Sercan Tosun , Nicolas R. Thompson , Kush K. Goyal","doi":"10.1016/j.inpm.2025.100601","DOIUrl":"10.1016/j.inpm.2025.100601","url":null,"abstract":"<div><h3>Background</h3><div>Genicular nerve blocks (GNB) for knee pain secondary to osteoarthritis (OA) are often performed with an anesthetic only, but corticosteroid can be used as an adjuvant with the goal of extending therapeutic relief. The efficacy of GNB with corticosteroid has been established in small, randomized trials, but its effectiveness in practice remains largely unknown.</div></div><div><h3>Objectives</h3><div>Evaluate the therapeutic effect of GNB with corticosteroid using patient-reported outcomes (PROs) in a large patient sample.</div></div><div><h3>Methods</h3><div>Data from consecutive GNBs with corticosteroid performed at an academic medical center from 2015 to 2024 was collected retrospectively. We included all patients aged ≥18 who received a GNB with corticosteroid for chronic knee pain due to OA, and excluded diagnostic GNBs with anesthetic alone and procedures performed using non-classical/modified techniques. Comparisons between pre-versus post-procedure PROs were by mixed-effect regression models with multiple testing corrections.</div></div><div><h3>Results</h3><div>A total of 123 GNBs (96 patients) with corticosteroid were identified. Post-procedurally, the mean NRS reductions were 3.56 (2–30 days), 2.14 (1–3 months), 1.92 (3–6 months), and 1.23 (6–12 months). 50 % of the patients maintained a pain reduction greater than or equal to the NRS MCID of −2.0 for at least 6.9 months. Post-procedure improvements in PROMIS-GH and PHQ9 were not clinically significant. Mean time to total knee arthroplasty was 16.5 months in 13.5 % of patients (13/96). For active opioid users, opioid usage was significantly decreased from the baseline 28.01 ± 13.20 MME/day to 13.58 ± 16.23 MME/day (p < 0.002) in the first 6 months post-GNB, and this opioid reduction was maintained at 15.59 ± 12.51 MME/day (p < 0.05) after the initial 6-month follow-up period.</div></div><div><h3>Conclusion</h3><div>For the majority of patients who received GNB with corticosteroid, we observed statistically and clinically significant pain reduction for 3 months or more in this cohort. While more comparative studies are required to evaluate its effectiveness, GNB with corticosteroid has promising potential as a safe and effective treatment for chronic knee pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100601"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184645","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 : 2025-06-01DOI: 10.1016/j.inpm.2025.100596
Emmy Duerr , Emily Rodriguez , Meron Nephtalem , Emmanuel Mensah , John R. Duffy , Thomas Cha , Jessica Aidlen , Chadi Tannoury , Michael D. Perloff , Keren Ladin , David Hao , Theresa Williamson
Introduction
Degenerative lumbar spine disease significantly impairs quality of life, yet racial and socioeconomic disparities in surgical treatment persist, particularly among BIPOC (Black, Indigenous, and Persons of Color) patients, who often experience worse outcomes and are less likely to undergo surgery despite similar or higher pain levels.
Objectives
This study explored factors that influence treatment decisions among BIPOC and Non-Hispanic White (NHW) patients with degenerative lumbar spine disease, with a focus on understanding how these factors may contribute to disparities in surgical care utilization.
Methods
An explorative qualitative study was conducted using semi-structured interviews with 20 patients (10 BIPOC, 10 NHW) considering lumbar spine surgery for spinal stenosis or disc herniation at three major academic institutions in Massachusetts. Thematic analysis identified key themes related to emotional suffering, financial concerns, support systems, and familiarity with spine surgery.
Results
BIPOC patients expressed greater anxiety about surgery, often shaped by prior negative healthcare experiences and broader systemic mistrust. Financial and occupational concerns were more significant for BIPOC patients, who frequently prioritized employment over symptom relief. In contrast, NHW patients more often cited quality-of-life goals as their primary motivator. While perception of support systems were comparable between the groups, emotional suffering was universally reported emotional suffering, with participants using terms such as “miserable,” “scared,” “embarrassed,” and “ashamed.”
Conclusion
Emotional, financial, and trust-related differences shape surgical decision-making among racially and ethnically diverse patients with lumbar spine disease. Incorporating culturally responsive communication strategies and decision aids that address patients fears, values, and social contexts may enhance shared decision-making and promote more equitable access to spine surgery.
{"title":"Perspectives on treatment decision-making across racial groups in adults with degenerative lumbar disease – A pilot study","authors":"Emmy Duerr , Emily Rodriguez , Meron Nephtalem , Emmanuel Mensah , John R. Duffy , Thomas Cha , Jessica Aidlen , Chadi Tannoury , Michael D. Perloff , Keren Ladin , David Hao , Theresa Williamson","doi":"10.1016/j.inpm.2025.100596","DOIUrl":"10.1016/j.inpm.2025.100596","url":null,"abstract":"<div><h3>Introduction</h3><div>Degenerative lumbar spine disease significantly impairs quality of life, yet racial and socioeconomic disparities in surgical treatment persist, particularly among BIPOC (Black, Indigenous, and Persons of Color) patients, who often experience worse outcomes and are less likely to undergo surgery despite similar or higher pain levels.</div></div><div><h3>Objectives</h3><div>This study explored factors that influence treatment decisions among BIPOC and Non-Hispanic White (NHW) patients with degenerative lumbar spine disease, with a focus on understanding how these factors may contribute to disparities in surgical care utilization.</div></div><div><h3>Methods</h3><div>An explorative qualitative study was conducted using semi-structured interviews with 20 patients (10 BIPOC, 10 NHW) considering lumbar spine surgery for spinal stenosis or disc herniation at three major academic institutions in Massachusetts. Thematic analysis identified key themes related to emotional suffering, financial concerns, support systems, and familiarity with spine surgery.</div></div><div><h3>Results</h3><div>BIPOC patients expressed greater anxiety about surgery, often shaped by prior negative healthcare experiences and broader systemic mistrust. Financial and occupational concerns were more significant for BIPOC patients, who frequently prioritized employment over symptom relief. In contrast, NHW patients more often cited quality-of-life goals as their primary motivator. While perception of support systems were comparable between the groups, emotional suffering was universally reported emotional suffering, with participants using terms such as “miserable,” “scared,” “embarrassed,” and “ashamed.”</div></div><div><h3>Conclusion</h3><div>Emotional, financial, and trust-related differences shape surgical decision-making among racially and ethnically diverse patients with lumbar spine disease. Incorporating culturally responsive communication strategies and decision aids that address patients fears, values, and social contexts may enhance shared decision-making and promote more equitable access to spine surgery.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100596"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204894","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 : 2025-06-01DOI: 10.1016/j.inpm.2025.100591
David A. Provenzano , Julie Pilitsis , Christine Hunt
{"title":"Managing radicular pain in patients with normal MRIs: Challenges and insights?","authors":"David A. Provenzano , Julie Pilitsis , Christine Hunt","doi":"10.1016/j.inpm.2025.100591","DOIUrl":"10.1016/j.inpm.2025.100591","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100591"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222608","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 : 2025-06-01DOI: 10.1016/j.inpm.2025.100593
Mustafa Turgut Yildizgoren , Sema Nur Mutlu Ekici , Burak Ekici
Percutaneous needle electrolysis (PNE) applies low-voltage direct current to human tissue, inducing localized electrolysis. This process triggers controlled inflammation and promotes tissue repair. Hydrogen gas, a byproduct of electrolysis, appears as hyperechoic spots on ultrasound imaging, whereas other products such as sodium hydroxide and chlorine gas are less visible. PNE has demonstrated effectiveness in cases resistant to conventional therapies, including chronic lateral epicondylitis. Written informed consent were obtained from the patient.
{"title":"Biochemical reactions and ultrasound insights in percutaneous needle electrolysis therapy","authors":"Mustafa Turgut Yildizgoren , Sema Nur Mutlu Ekici , Burak Ekici","doi":"10.1016/j.inpm.2025.100593","DOIUrl":"10.1016/j.inpm.2025.100593","url":null,"abstract":"<div><div>Percutaneous needle electrolysis (PNE) applies low-voltage direct current to human tissue, inducing localized electrolysis. This process triggers controlled inflammation and promotes tissue repair. Hydrogen gas, a byproduct of electrolysis, appears as hyperechoic spots on ultrasound imaging, whereas other products such as sodium hydroxide and chlorine gas are less visible. PNE has demonstrated effectiveness in cases resistant to conventional therapies, including chronic lateral epicondylitis. Written informed consent were obtained from the patient.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100593"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194644","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 : 2025-05-30DOI: 10.1016/j.inpm.2025.100594
Andrew R. Stephens, Adem F. Aktas, Ramzi El-Hassan
Background
Basivertebral nerve radiofrequency ablations (BVNRFA) have shown efficacy in improving chronic back pain for indicated patients.
Objective
The purpose of this study was to evaluate health care utilization outcomes after BVNRFA in a large cohort utilizing a global database.
Methods
TriNetX, a global health research network, was queried from 2022 to 2025 for patients who underwent BVNRFA utilizing CPT codes and 1 year pre-procedure and post-procedure opioid use and spine interventions were recorded. Pre-procedure and post-procedure outcomes were compared using a chi-square test with significance set at p < 0.05. The rate of spine surgery within 1 year after BVNRFA was also reported.
Results
A total of 1,118 patients underwent BVNRFA during this time frame at contributing health care systems with appropriate follow-up. Post-procedure opioid use was less than pre-procedure opioid use (57 % vs 51 %, p = 0.006). The number of patients who received spine interventions after BVNRFA were significantly lower compared to patients who received spine interventions prior with lumbar transforaminal epidural steroid injections decreasing from 21 % to 12 % (p < 0.001), lumbar interlaminar steroid injections decreasing from 18 % to 11 % (p < 0.001), and radiofrequency ablations decreasing from 25 % to 13 % (p < 0.001). Only 47 patients had CPT codes related to post-procedure vertebral column spine surgery. Specifically, there were 11 patients who had CPT codes for posterior lumbar fusion (CPT 22630), 10 had lateral lumbar fusion (CPT 22533), and 10 had anterior codes (CPT 22558). There were 0 patients who underwent total disc replacement (CPT 22857).
Conclusions
This administrative database study demonstrated significantly less opioid use and spine interventions within 1 year after BVNRFA compared to 1 year prior. This study also demonstrated low rates of spine surgery within 1 year after BVNRFA.
背景：椎体神经射频消融术（BVNRFA）已显示出改善慢性背痛患者的疗效。目的本研究的目的是利用全球数据库评估BVNRFA后的医疗保健利用结果。方法strinetx是一个全球健康研究网络，从2022年到2025年，使用CPT代码对接受BVNRFA的患者进行了查询，记录了1年的术前和术后阿片类药物使用和脊柱干预。术前和术后结果比较采用卡方检验，显著性设置为p <；0.05. BVNRFA术后1年内脊柱手术率也有报道。结果在这段时间内，共有1118名患者在提供适当随访的卫生保健系统中接受了BVNRFA。术后阿片类药物使用少于术前阿片类药物使用（57% vs 51%, p = 0.006）。BVNRFA后接受脊柱干预的患者数量明显低于之前接受腰椎经椎间孔硬膜外类固醇注射的脊柱干预的患者数量，从21%降至12% (p <；0.001)，腰椎椎板间类固醇注射从18%下降到11% (p <；0.001)，射频消融从25%下降到13% (p <；0.001)。只有47例患者有与术后脊柱手术相关的CPT代码。具体来说，有11例患者的CPT编码为后路腰椎融合（CPT 22630）， 10例为侧路腰椎融合（CPT 22533）， 10例为前路融合（CPT 22558）。0例患者行全椎间盘置换术（CPT 22857）。结论：该管理数据库研究表明，与一年前相比，BVNRFA后1年内阿片类药物使用和脊柱干预明显减少。该研究还表明，BVNRFA术后1年内脊柱手术率较低。
{"title":"Decrease in opioid use and spinal interventions after basivertebral nerve ablation","authors":"Andrew R. Stephens, Adem F. Aktas, Ramzi El-Hassan","doi":"10.1016/j.inpm.2025.100594","DOIUrl":"10.1016/j.inpm.2025.100594","url":null,"abstract":"<div><h3>Background</h3><div>Basivertebral nerve radiofrequency ablations (BVNRFA) have shown efficacy in improving chronic back pain for indicated patients.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate health care utilization outcomes after BVNRFA in a large cohort utilizing a global database.</div></div><div><h3>Methods</h3><div>TriNetX, a global health research network, was queried from 2022 to 2025 for patients who underwent BVNRFA utilizing CPT codes and 1 year pre-procedure and post-procedure opioid use and spine interventions were recorded. Pre-procedure and post-procedure outcomes were compared using a chi-square test with significance set at p < 0.05. The rate of spine surgery within 1 year after BVNRFA was also reported.</div></div><div><h3>Results</h3><div>A total of 1,118 patients underwent BVNRFA during this time frame at contributing health care systems with appropriate follow-up. Post-procedure opioid use was less than pre-procedure opioid use (57 % vs 51 %, p = 0.006). The number of patients who received spine interventions after BVNRFA were significantly lower compared to patients who received spine interventions prior with lumbar transforaminal epidural steroid injections decreasing from 21 % to 12 % (p < 0.001), lumbar interlaminar steroid injections decreasing from 18 % to 11 % (p < 0.001), and radiofrequency ablations decreasing from 25 % to 13 % (p < 0.001). Only 47 patients had CPT codes related to post-procedure vertebral column spine surgery. Specifically, there were 11 patients who had CPT codes for posterior lumbar fusion (CPT 22630), 10 had lateral lumbar fusion (CPT 22533), and 10 had anterior codes (CPT 22558). There were 0 patients who underwent total disc replacement (CPT 22857).</div></div><div><h3>Conclusions</h3><div>This administrative database study demonstrated significantly less opioid use and spine interventions within 1 year after BVNRFA compared to 1 year prior. This study also demonstrated low rates of spine surgery within 1 year after BVNRFA.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100594"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168849","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 : 2025-05-30DOI: 10.1016/j.inpm.2025.100598
Glenn R. Buttermann , Matthew Thorson , Louis C. Saeger
<div><h3>Background</h3><div>Epidural corticosteroid injections have long been used to treat pain and inflammation associated with low back conditions including symptoms due to lumbar herniated disc, HNP; spinal stenosis, SS; and degenerative disc disease, DDD. Amniotic fluid, AF, is rich in the proteins and factors that are believed to contribute to healing by minimizing inflammation. AF injections in non-spinal conditions have been shown to be safe and avoid adverse effects related to steroids.</div></div><div><h3>Objectives</h3><div>To investigate the safety and efficacy of a single amniotic fluid injection into the lumbar epidural space for the treatment of low back pain. Specifically, this pilot study was to define indications for future large scale comparative studies.</div></div><div><h3>Methods</h3><div>This IRB approved prospective clinical study of 3 cohorts included 20 patients each with HNP, SS, and DDD with a 1-year follow-up. Patients were enrolled who had LBP ± leg symptoms for >2 months, with clinical and MRI findings for HNP, SS, or DDD. Inclusion criteria necessitated that study patients had not responded to medications, physical therapy, and/or chiropractic. After obtaining consent, 20 patients in each diagnostic group (HNP, SS, and DDD) had 2 cc′s transforaminal epidural AF injected at the primary symptomatic level using fluoroscopy. Pre- and post-procedure outcomes measurements were obtained at follow-up periods of 2–3 weeks, 6–8 weeks, 3–4 months, 6–8 months and 1 year. Outcome measures were Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Scale (ODI), Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and pain medication usage. Using the VAS and ODI measurements, Minimal Clinical Important Difference (MCID) and Success (50 % improvement) rates were derived.</div></div><div><h3>Results</h3><div>The average age (years) of HNP, stenosis, and DDD patients was 46, 60, and 46 respectively. There were no complications or other adverse effects. HNP patients had the greatest reduction in symptoms with average LBP VAS improvement from 6.3 to 2.9, leg VAS from 5.9 to 2.2, ODI from 37 to 19, and PROMIS Physical component 13.1 to 14.7. SS patients had LBP VAS improvement from 6.8 to 5.3, leg VAS from 5.8 to 3.1, ODI from 46 to 33 and PROMIS Physical component 10.9 to 13.0. DDD patients had LBP VAS from 7.0 to 4.8, leg VAS from 3.9 to 2.7, ODI from 41 to 37 and PROMIS Physical component 12.0 to 13.1. HNP patients had a significant reduction in pain medication use. Over the one year follow-up, the HNP group had the greatest rate of attaining MCID (65 %–79 %) and Success (47 %–60 %). SS had a similar rate of Success for leg pain. ODI MCDI and Success rates were significantly greater for HNP vs the other 2 groups. Overall, 15 % of patients had additional injections and 20 % went on to surgery.</div></div><div><h3>Conclusions</h3><div>AF epidural injections are most effective for patients with lu
{"title":"Effectiveness of epidural amniotic fluid injection for low back pain","authors":"Glenn R. Buttermann , Matthew Thorson , Louis C. Saeger","doi":"10.1016/j.inpm.2025.100598","DOIUrl":"10.1016/j.inpm.2025.100598","url":null,"abstract":"<div><h3>Background</h3><div>Epidural corticosteroid injections have long been used to treat pain and inflammation associated with low back conditions including symptoms due to lumbar herniated disc, HNP; spinal stenosis, SS; and degenerative disc disease, DDD. Amniotic fluid, AF, is rich in the proteins and factors that are believed to contribute to healing by minimizing inflammation. AF injections in non-spinal conditions have been shown to be safe and avoid adverse effects related to steroids.</div></div><div><h3>Objectives</h3><div>To investigate the safety and efficacy of a single amniotic fluid injection into the lumbar epidural space for the treatment of low back pain. Specifically, this pilot study was to define indications for future large scale comparative studies.</div></div><div><h3>Methods</h3><div>This IRB approved prospective clinical study of 3 cohorts included 20 patients each with HNP, SS, and DDD with a 1-year follow-up. Patients were enrolled who had LBP ± leg symptoms for >2 months, with clinical and MRI findings for HNP, SS, or DDD. Inclusion criteria necessitated that study patients had not responded to medications, physical therapy, and/or chiropractic. After obtaining consent, 20 patients in each diagnostic group (HNP, SS, and DDD) had 2 cc′s transforaminal epidural AF injected at the primary symptomatic level using fluoroscopy. Pre- and post-procedure outcomes measurements were obtained at follow-up periods of 2–3 weeks, 6–8 weeks, 3–4 months, 6–8 months and 1 year. Outcome measures were Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Scale (ODI), Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and pain medication usage. Using the VAS and ODI measurements, Minimal Clinical Important Difference (MCID) and Success (50 % improvement) rates were derived.</div></div><div><h3>Results</h3><div>The average age (years) of HNP, stenosis, and DDD patients was 46, 60, and 46 respectively. There were no complications or other adverse effects. HNP patients had the greatest reduction in symptoms with average LBP VAS improvement from 6.3 to 2.9, leg VAS from 5.9 to 2.2, ODI from 37 to 19, and PROMIS Physical component 13.1 to 14.7. SS patients had LBP VAS improvement from 6.8 to 5.3, leg VAS from 5.8 to 3.1, ODI from 46 to 33 and PROMIS Physical component 10.9 to 13.0. DDD patients had LBP VAS from 7.0 to 4.8, leg VAS from 3.9 to 2.7, ODI from 41 to 37 and PROMIS Physical component 12.0 to 13.1. HNP patients had a significant reduction in pain medication use. Over the one year follow-up, the HNP group had the greatest rate of attaining MCID (65 %–79 %) and Success (47 %–60 %). SS had a similar rate of Success for leg pain. ODI MCDI and Success rates were significantly greater for HNP vs the other 2 groups. Overall, 15 % of patients had additional injections and 20 % went on to surgery.</div></div><div><h3>Conclusions</h3><div>AF epidural injections are most effective for patients with lu","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100598"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168615","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 : 2025-05-29DOI: 10.1016/j.inpm.2025.100597
Laura Furtado-Pessoa-de-Mendonca , Sebastian Encalada , Alejandro Hallo-Carrasco , Johanna Mosquera-Moscoso , Matthew A. Cascio , Robert Pagan-Rosado , Michael D. Osborne , Jason S. Eldrige , Christine L. Hunt
Introduction
Herpes Zoster, or shingles, is an infection caused by the reactivation of the latent Varicella zoster virus within a sensory ganglion, leading to painful skin lesions localized along dermatomes. Patients undergoing pain medicine procedures involving steroids may face an elevated risk of shingles, which can significantly impact their quality of life. Though rare, HZ has been reported following minimally invasive procedures, such as epidural steroid injections.
Objectives
We evaluated the prevalence of shingles within 31 days after epidural steroid injections within Mayo Enterprise sites.
Methods
A retrospective chart review included all patients who reported a new HZ event within 31 days after receiving an epidural steroid injection. Information on patient demographics, procedure details, and potential risk factors for herpes zoster was assessed using qualitative analysis.
Results
A total of 50,270 epidural injections were performed during the analyzed period. After initial screening, 149 patients were included for chart review, and 37 individuals met the inclusion criteria. Within this subgroup, the median age was 72, and 21 patients were female (56.76 %). The mean timeframe from the procedure until onset of symptoms of infection as reported in the medical record was 15.9 days. Among the patients in the study, 24 patients (64.86 %) had an identified immunocompromised status, and 28 (75.68 %) had an incomplete vaccination status at the time of infection.
Conclusion
The incidence of HZ following ESI is low. Other risk factors linked to HZ were identified in our cohort, confounding a possible causal relationship. Prospective studies are needed to elucidate any relationship between ESI and HZ.
{"title":"Herpes zoster prevalence following epidural steroid injections: a retrospective review","authors":"Laura Furtado-Pessoa-de-Mendonca , Sebastian Encalada , Alejandro Hallo-Carrasco , Johanna Mosquera-Moscoso , Matthew A. Cascio , Robert Pagan-Rosado , Michael D. Osborne , Jason S. Eldrige , Christine L. Hunt","doi":"10.1016/j.inpm.2025.100597","DOIUrl":"10.1016/j.inpm.2025.100597","url":null,"abstract":"<div><h3>Introduction</h3><div>Herpes Zoster, or shingles, is an infection caused by the reactivation of the latent Varicella zoster virus within a sensory ganglion, leading to painful skin lesions localized along dermatomes. Patients undergoing pain medicine procedures involving steroids may face an elevated risk of shingles, which can significantly impact their quality of life. Though rare, HZ has been reported following minimally invasive procedures, such as epidural steroid injections.</div></div><div><h3>Objectives</h3><div>We evaluated the prevalence of shingles within 31 days after epidural steroid injections within Mayo Enterprise sites.</div></div><div><h3>Methods</h3><div>A retrospective chart review included all patients who reported a new HZ event within 31 days after receiving an epidural steroid injection. Information on patient demographics, procedure details, and potential risk factors for herpes zoster was assessed using qualitative analysis.</div></div><div><h3>Results</h3><div>A total of 50,270 epidural injections were performed during the analyzed period. After initial screening, 149 patients were included for chart review, and 37 individuals met the inclusion criteria. Within this subgroup, the median age was 72, and 21 patients were female (56.76 %). The mean timeframe from the procedure until onset of symptoms of infection as reported in the medical record was 15.9 days. Among the patients in the study, 24 patients (64.86 %) had an identified immunocompromised status, and 28 (75.68 %) had an incomplete vaccination status at the time of infection.</div></div><div><h3>Conclusion</h3><div>The incidence of HZ following ESI is low. Other risk factors linked to HZ were identified in our cohort, confounding a possible causal relationship. Prospective studies are needed to elucidate any relationship between ESI and HZ.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100597"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169035","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 : 2025-05-26DOI: 10.1016/j.inpm.2025.100592
Timothy Olivier , Zilin Ma , Ankit Patel , Weibin Shi , Mohammed Murtuza , Nicole E. Hatchard , Xiaoyu Norman Pan , Thiru M. Annaswamy
Background
Artificial intelligence (AI) is becoming more integrated into healthcare, with large language models (LLMs) like ChatGPT being widely used by patients to answer medical questions. Given the increasing reliance on AI for health-related information, it's important to evaluate how well these models perform in addressing common patient concerns, especially in procedural medicine. To date, no studies have specifically examined AI's role in addressing patient questions related to epidural steroid injections (ESIs), making this an important area for investigation.
Objective
This study examines ChatGPT's ability to answer patient questions about epidural steroid injections (ESIs), focusing on response accuracy, readability, and overall usefulness. Our aim was to evaluate and compare the content, accuracy, and user-friendliness of AI-generated information on common peri-procedural questions and complications associated with ESIs, thereby extending the application of AI as a triage tool into pain management and interventional spine procedures.
Methods
We formulated and compiled 29 common patient questions about ESIs and tested ChatGPT's responses in both general and specific formats. Two interventional pain specialists reviewed the AI-generated answers, assessing them for accuracy, clarity, empathy, and directness using a Likert scale. Readability scores were calculated using Flesch-Kincaid Reading Level and Flesch Reading Ease scales. Statistical analyses were performed to compare general versus specific responses.
Results
General queries led to longer, more detailed responses, but readability was similar between general and specific formats. Subjective analysis showed that general responses were rated higher for accuracy, clarity, and responsiveness. However, neither format demonstrated strong empathy, and some general queries resulted in off-topic responses, underscoring the importance of precise wording when interacting with AI.
Conclusion
ChatGPT can provide clear and largely accurate answers to patient questions about ESIs, with general prompts often producing more complete responses. However, AI-generated content still has limitations, particularly in conveying empathy and avoiding tangential information. These findings highlight the need for thoughtful prompt design and further research into how AI can be integrated into clinical workflows while ensuring accuracy and patient safety.
{"title":"Assessing ChatGPT responses to patient questions on epidural steroid injections: A comparative study of general vs specific queries","authors":"Timothy Olivier , Zilin Ma , Ankit Patel , Weibin Shi , Mohammed Murtuza , Nicole E. Hatchard , Xiaoyu Norman Pan , Thiru M. Annaswamy","doi":"10.1016/j.inpm.2025.100592","DOIUrl":"10.1016/j.inpm.2025.100592","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is becoming more integrated into healthcare, with large language models (LLMs) like ChatGPT being widely used by patients to answer medical questions. Given the increasing reliance on AI for health-related information, it's important to evaluate how well these models perform in addressing common patient concerns, especially in procedural medicine. To date, no studies have specifically examined AI's role in addressing patient questions related to epidural steroid injections (ESIs), making this an important area for investigation.</div></div><div><h3>Objective</h3><div>This study examines ChatGPT's ability to answer patient questions about epidural steroid injections (ESIs), focusing on response accuracy, readability, and overall usefulness. Our aim was to evaluate and compare the content, accuracy, and user-friendliness of AI-generated information on common peri-procedural questions and complications associated with ESIs, thereby extending the application of AI as a triage tool into pain management and interventional spine procedures.</div></div><div><h3>Methods</h3><div>We formulated and compiled 29 common patient questions about ESIs and tested ChatGPT's responses in both general and specific formats. Two interventional pain specialists reviewed the AI-generated answers, assessing them for accuracy, clarity, empathy, and directness using a Likert scale. Readability scores were calculated using Flesch-Kincaid Reading Level and Flesch Reading Ease scales. Statistical analyses were performed to compare general versus specific responses.</div></div><div><h3>Results</h3><div>General queries led to longer, more detailed responses, but readability was similar between general and specific formats. Subjective analysis showed that general responses were rated higher for accuracy, clarity, and responsiveness. However, neither format demonstrated strong empathy, and some general queries resulted in off-topic responses, underscoring the importance of precise wording when interacting with AI.</div></div><div><h3>Conclusion</h3><div>ChatGPT can provide clear and largely accurate answers to patient questions about ESIs, with general prompts often producing more complete responses. However, AI-generated content still has limitations, particularly in conveying empathy and avoiding tangential information. These findings highlight the need for thoughtful prompt design and further research into how AI can be integrated into clinical workflows while ensuring accuracy and patient safety.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100592"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134973","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}
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