Pub Date : 2025-06-24DOI: 10.1016/j.inpm.2025.100603
Nurbanu Hindioglu Dogan, Serdar Kokar, Savas Sencan, Osman Hakan Gunduz
Epidural analgesia is a valuable modality in managing cancer-related pain, particularly when systemic therapies are insufficient or poorly tolerated. This letter presents a case of technically challenging epidural catheterization in a patient with vertebral metastases, emphasizing the procedural difficulties posed by altered spinal anatomy and prior neuraxial interventions.
{"title":"Letter to the editor: Challenging epidural catheterization in a patient with vertebral metastases","authors":"Nurbanu Hindioglu Dogan, Serdar Kokar, Savas Sencan, Osman Hakan Gunduz","doi":"10.1016/j.inpm.2025.100603","DOIUrl":"10.1016/j.inpm.2025.100603","url":null,"abstract":"<div><div>Epidural analgesia is a valuable modality in managing cancer-related pain, particularly when systemic therapies are insufficient or poorly tolerated. This letter presents a case of technically challenging epidural catheterization in a patient with vertebral metastases, emphasizing the procedural difficulties posed by altered spinal anatomy and prior neuraxial interventions.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100603"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366640","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 : 2025-06-21DOI: 10.1016/j.inpm.2025.100604
Alexandre J. Bourcier MD, MSc , Christina Im BA , Jane Phan BA , Michelle Nwufo MSc , Miad Hadaegh MD , Colton M. Malesovas MD , Jae Jung MD , Kyle Yang MD , Jonathan Droessler MD
{"title":"Spinal cord stimulation for Tarlov cyst-related pain: Initial success and subsequent explantation in an elderly patient","authors":"Alexandre J. Bourcier MD, MSc , Christina Im BA , Jane Phan BA , Michelle Nwufo MSc , Miad Hadaegh MD , Colton M. Malesovas MD , Jae Jung MD , Kyle Yang MD , Jonathan Droessler MD","doi":"10.1016/j.inpm.2025.100604","DOIUrl":"10.1016/j.inpm.2025.100604","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100604"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335875","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.2025.100599
Katharine A. Smolinski , Christopher Radlicz , Hasan Sen , Amanda N. Cooper , Brook Martin , Alycia Amatto , Allison Glinka Przybysz , Robert Burnham , Aaron M. Conger , Zachary L. McCormick , Taylor R. Burnham
Background
Outcomes following sacral lateral branch radiofrequency neurotomy (SLBRFN) likely depend on patient selection criteria; however, commonly used criteria vary considerably. Refinement of selection criteria for SLBRFN may improve treatment outcomes. This study investigated common prognostic block-based selection criteria and treatment success following SLBRFN.
Methods
In this retrospective cohort study, consecutive patients from two Canadian musculoskeletal pain management clinics who underwent SLBRFN over a 6-year period (2016–2022) were identified by electronic medical record. Patients were categorized according to several prognostic block paradigms based on number of blocks (single vs. dual), block type (lateral branch block [LBB] vs. intra-articular block [IAB]), and subsequent percentage of pain relief. Six block criteria were established: 1 = LBB/LBB≥80 %; 2 = IAB/LBB≥80 %; 3 = LBB/LBB 50–79 %; 4 = IAB/LBB 50–79 %; 5 = LBB≥80 %; 6 = LBB 50–79 %. Treatment success was assessed at three months post-SLBRFN using two criteria: (1) the primary study outcome of ≥50 % numerical rating scale (NRS) pain reduction and (2) a secondary outcome of Pain Disability Quality-of-Life Questionnaire (PDQQ) score improvement by the minimal clinically important difference (MCID). Logistic regression analyses evaluated the association between block criteria and treatment success following SLBRFN.
Results
281 consecutive patients (75.1 % female, 61.8 ± 14.2 years of age, BMI 29.4 ± 6.6 kg/m2) were included. Cohort success rates for pain and functional improvement were 43.4 % (95 % CI: 37.8–49.3) and 46.6 % (95 % CI: 40.9–52.5), respectively. After adjusting for demographics and cannula type/SLBRFN technique, none of the odds ratios for the six prognostic block paradigms showed statistical significance.
Conclusion
Nearly 50 % of patients who underwent SLBRFN reported clinically significant improvement in pain and disability at three months post-procedure, regardless of prognostic block selection criteria. These results suggest that multiple block strategies may determine eligibility for SLBRFN.
{"title":"What is the optimal block selection paradigm for predicting a successful treatment outcome following sacral lateral branch radiofrequency neurotomy? A real-world cohort study","authors":"Katharine A. Smolinski , Christopher Radlicz , Hasan Sen , Amanda N. Cooper , Brook Martin , Alycia Amatto , Allison Glinka Przybysz , Robert Burnham , Aaron M. Conger , Zachary L. McCormick , Taylor R. Burnham","doi":"10.1016/j.inpm.2025.100599","DOIUrl":"10.1016/j.inpm.2025.100599","url":null,"abstract":"<div><h3>Background</h3><div>Outcomes following sacral lateral branch radiofrequency neurotomy (SLBRFN) likely depend on patient selection criteria; however, commonly used criteria vary considerably. Refinement of selection criteria for SLBRFN may improve treatment outcomes. This study investigated common prognostic block-based selection criteria and treatment success following SLBRFN.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, consecutive patients from two Canadian musculoskeletal pain management clinics who underwent SLBRFN over a 6-year period (2016–2022) were identified by electronic medical record. Patients were categorized according to several prognostic block paradigms based on number of blocks (single vs. dual), block type (lateral branch block [LBB] vs. intra-articular block [IAB]), and subsequent percentage of pain relief. Six block criteria were established: 1 = LBB/LBB≥80 %; 2 = IAB/LBB≥80 %; 3 = LBB/LBB 50–79 %; 4 = IAB/LBB 50–79 %; 5 = LBB≥80 %; 6 = LBB 50–79 %. Treatment success was assessed at three months post-SLBRFN using two criteria: (1) the primary study outcome of ≥50 % numerical rating scale (NRS) pain reduction and (2) a secondary outcome of Pain Disability Quality-of-Life Questionnaire (PDQQ) score improvement by the minimal clinically important difference (MCID). Logistic regression analyses evaluated the association between block criteria and treatment success following SLBRFN.</div></div><div><h3>Results</h3><div>281 consecutive patients (75.1 % female, 61.8 ± 14.2 years of age, BMI 29.4 ± 6.6 kg/m<sup>2</sup>) were included. Cohort success rates for pain and functional improvement were 43.4 % (95 % CI: 37.8–49.3) and 46.6 % (95 % CI: 40.9–52.5), respectively. After adjusting for demographics and cannula type/SLBRFN technique, none of the odds ratios for the six prognostic block paradigms showed statistical significance.</div></div><div><h3>Conclusion</h3><div>Nearly 50 % of patients who underwent SLBRFN reported clinically significant improvement in pain and disability at three months post-procedure, regardless of prognostic block selection criteria. These results suggest that multiple block strategies may determine eligibility for SLBRFN.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100599"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189478","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.2025.100601
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}
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