Pub Date : 2025-12-17DOI: 10.1016/j.inpm.2025.100723
Michael J. Derr , Chelsey M. Hoffmann , Likitha Somasekhar , Tejaswini Pisati , Bradley F. Thompson , Kogulavadanan Arumaithurai , Matthew J. Pingree , Paul M. Scholten
<div><h3>Background</h3><div>Obesity and spine pain are both highly prevalent and disabling conditions with complex, overlapping etiologies. While prior research has explored the link between body mass index (BMI) and low back pain (LBP), the multidimensional impact of elevated BMI on physical, mental, and social health among patients with spine disorders has not been sufficiently elucidated.</div></div><div><h3>Objectives</h3><div>This study aimed to examine the associations between BMI and a range of patient-reported outcomes (PROs) including pain severity, opioid utilization and seven Patient-Reported Outcomes Information System Computer Adaptive Test (PROMIS-CAT) domains that measure physical, mental, and social health in individuals with spine-related pain.</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients presenting to a quaternary academic institution's spine center for evaluation was performed. Demographic, BMI and PRO data (PROMIS-CAT in the domains of Anxiety, Depression, Fatigue, Pain Interference, Physical Function, Sleep Disturbance, Ability to Participate in Social Roles and Activities, and Pain Intensity as well as self-reported opioid utilization) available in the medical record were retrieved. Relationships between BMI and PROMIS data were evaluated with pairwise Z-tests for proportions.</div></div><div><h3>Results</h3><div>A total of 3756 patients were included in the analysis, and the distribution of BMIs was like that of the general US population. Compared to patients with Normal BMI, the Class II and III Obesity groups had a greater proportion of patients reporting Moderate and Severe Pain Interference, Physical Function impairments, and Ability to Participate in Social Roles and Activities. They also used opioid medications more often. There was no significant difference in Pain Intensity within the Pre-Obesity, Class I, II or III Obesity groups. However, No Pain was significantly more common than all other categories of pain severity within the No Obesity group. The No Obesity group also demonstrated decreased rates of Mild and Moderate Fatigue, Moderate and Severe Pain Interference, Mild and Moderate Physical Function, Mild and Moderate Ability to Participate in Social Roles and Activities, and opioid utilization when compared to those having Normal levels in each of those PROMIS domains or who did not use opioid medication.</div></div><div><h3>Conclusions</h3><div>Complex and inconsistent relationships exist between BMI and biopsychosocial functioning among patients with spine pain. Generally, lower frequencies of impairment are present in non-obese patients (specifically for Fatigue, Pain Interference, Physical Function, Ability to Participate in Social Roles and Activities, and Pain Intensity) and higher frequencies of impairment are observed in patients with an elevated BMI (most consistently for Depression, Pain Interference, Physical Function Ability to Participate in Social Roles and Activiti
{"title":"Associations between body mass index and patient reported biopsychosocial outcomes among patients with spine pain","authors":"Michael J. Derr , Chelsey M. Hoffmann , Likitha Somasekhar , Tejaswini Pisati , Bradley F. Thompson , Kogulavadanan Arumaithurai , Matthew J. Pingree , Paul M. Scholten","doi":"10.1016/j.inpm.2025.100723","DOIUrl":"10.1016/j.inpm.2025.100723","url":null,"abstract":"<div><h3>Background</h3><div>Obesity and spine pain are both highly prevalent and disabling conditions with complex, overlapping etiologies. While prior research has explored the link between body mass index (BMI) and low back pain (LBP), the multidimensional impact of elevated BMI on physical, mental, and social health among patients with spine disorders has not been sufficiently elucidated.</div></div><div><h3>Objectives</h3><div>This study aimed to examine the associations between BMI and a range of patient-reported outcomes (PROs) including pain severity, opioid utilization and seven Patient-Reported Outcomes Information System Computer Adaptive Test (PROMIS-CAT) domains that measure physical, mental, and social health in individuals with spine-related pain.</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients presenting to a quaternary academic institution's spine center for evaluation was performed. Demographic, BMI and PRO data (PROMIS-CAT in the domains of Anxiety, Depression, Fatigue, Pain Interference, Physical Function, Sleep Disturbance, Ability to Participate in Social Roles and Activities, and Pain Intensity as well as self-reported opioid utilization) available in the medical record were retrieved. Relationships between BMI and PROMIS data were evaluated with pairwise Z-tests for proportions.</div></div><div><h3>Results</h3><div>A total of 3756 patients were included in the analysis, and the distribution of BMIs was like that of the general US population. Compared to patients with Normal BMI, the Class II and III Obesity groups had a greater proportion of patients reporting Moderate and Severe Pain Interference, Physical Function impairments, and Ability to Participate in Social Roles and Activities. They also used opioid medications more often. There was no significant difference in Pain Intensity within the Pre-Obesity, Class I, II or III Obesity groups. However, No Pain was significantly more common than all other categories of pain severity within the No Obesity group. The No Obesity group also demonstrated decreased rates of Mild and Moderate Fatigue, Moderate and Severe Pain Interference, Mild and Moderate Physical Function, Mild and Moderate Ability to Participate in Social Roles and Activities, and opioid utilization when compared to those having Normal levels in each of those PROMIS domains or who did not use opioid medication.</div></div><div><h3>Conclusions</h3><div>Complex and inconsistent relationships exist between BMI and biopsychosocial functioning among patients with spine pain. Generally, lower frequencies of impairment are present in non-obese patients (specifically for Fatigue, Pain Interference, Physical Function, Ability to Participate in Social Roles and Activities, and Pain Intensity) and higher frequencies of impairment are observed in patients with an elevated BMI (most consistently for Depression, Pain Interference, Physical Function Ability to Participate in Social Roles and Activiti","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100723"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841682","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 : 2025-12-16DOI: 10.1016/j.inpm.2025.100721
Christopher Zarembinski, J. Patrick Johnson
Introduction
The anatomy of the vertebral artery (VA) can be variable around the C1 and C2 vertebrae, which can pose risk during cervical spine instrumentation and pain blocks. A patient with prior cerebellar astrocytoma required a C2 nerve root block for treatment of occipital neuralgia. Precise location of the VA was questioned due to previous posterior C1 arch excision.
Case
The objective was to describe the utility of CT angiogram (CTA) in describing VA location in planning the C2 nerve root block. Once determined that the VA was not in proximity of the lateral atlantoaxial joint (LAA), then the C2 nerve block was completed uneventfully with resolution of occipital pain.
Conclusions
The CTA was critical in determining VA location in advance of C2 nerve root block, and can be used with regularity when vascular anatomy is questioned.
{"title":"Fluoroscopic C2 selective nerve root block enabled with CT angiogram","authors":"Christopher Zarembinski, J. Patrick Johnson","doi":"10.1016/j.inpm.2025.100721","DOIUrl":"10.1016/j.inpm.2025.100721","url":null,"abstract":"<div><h3>Introduction</h3><div>The anatomy of the vertebral artery (VA) can be variable around the C1 and C2 vertebrae, which can pose risk during cervical spine instrumentation and pain blocks. A patient with prior cerebellar astrocytoma required a C2 nerve root block for treatment of occipital neuralgia. Precise location of the VA was questioned due to previous posterior C1 arch excision.</div></div><div><h3>Case</h3><div>The objective was to describe the utility of CT angiogram (CTA) in describing VA location in planning the C2 nerve root block. Once determined that the VA was not in proximity of the lateral atlantoaxial joint (LAA), then the C2 nerve block was completed uneventfully with resolution of occipital pain.</div></div><div><h3>Conclusions</h3><div>The CTA was critical in determining VA location in advance of C2 nerve root block, and can be used with regularity when vascular anatomy is questioned.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100721"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760841","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 : 2025-12-01DOI: 10.1016/j.inpm.2025.100718
Christopher L. Robinson , Milan P. Stojanovic , Zachary L. McCormick
{"title":"Regenerative medicine: Are we at a crossroads for interventional pain medicine or just another phase?","authors":"Christopher L. Robinson , Milan P. Stojanovic , Zachary L. McCormick","doi":"10.1016/j.inpm.2025.100718","DOIUrl":"10.1016/j.inpm.2025.100718","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100718"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693700","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 : 2025-12-01DOI: 10.1016/j.inpm.2025.100716
Fabricio Andres Lasso Andrade , Gabriel Gaviria Suarez , Alejandro Fernández Escobar , Roberto Carlo Rivera Díaz , Denny Marcela Achicanoy Puchana , Javier Esteban Toro-López
Introduction
The sphenopalatine ganglion (SPG) is a key structure in the pathophysiology of various craniofacial pain syndromes with autonomic manifestations, integrating parasympathetic, sympathetic, and trigeminal fibers within the trigemino-autonomic reflex. Modulation of these pathways through nerve block or radiofrequency has shown effectiveness in managing pain and associated autonomic symptoms. However, no previous reports have described the use of a suprazygomatic approach for thermal radiofrequency of the SPG.
Case report
We present the case of a 70-year-old man with a one-year history of left-sided persistent idiopathic facial pain (PFPS), characterized by paroxysmal exacerbations in the V1–V2 territories, epiphora, and nasal congestion, without evidence of structural lesions or classical neuropathy. After unsuccessful treatment with carbamazepine and a diagnostic Gasserian ganglion block, a suprazygomatic SPG block with 1 % lidocaine was performed, achieving 80 % pain relief lasting four weeks. Upon recurrence of pain, fluoroscopy-guided thermal radiofrequency (TRF) of the SPG (80 °C, 60 s) was conducted, resulting in sustained improvement (NRS 1/10) at six months, with no sensory deficits or adverse effects. This case demonstrated that the suprazygomatic approach provides a safe route to access the pterygopalatine fossa.
Conclusion
Thermal radiofrequency of the SPG via the suprazygomatic approach may represent an effective and safe alternative for treating persistent idiopathic facial pain with autonomic features.
{"title":"Thermal radiofrequency of the sphenopalatine ganglion in persistent idiopathic facial pain using a suprazygomatic approach: Case report","authors":"Fabricio Andres Lasso Andrade , Gabriel Gaviria Suarez , Alejandro Fernández Escobar , Roberto Carlo Rivera Díaz , Denny Marcela Achicanoy Puchana , Javier Esteban Toro-López","doi":"10.1016/j.inpm.2025.100716","DOIUrl":"10.1016/j.inpm.2025.100716","url":null,"abstract":"<div><h3>Introduction</h3><div>The sphenopalatine ganglion (SPG) is a key structure in the pathophysiology of various craniofacial pain syndromes with autonomic manifestations, integrating parasympathetic, sympathetic, and trigeminal fibers within the trigemino-autonomic reflex. Modulation of these pathways through nerve block or radiofrequency has shown effectiveness in managing pain and associated autonomic symptoms. However, no previous reports have described the use of a suprazygomatic approach for thermal radiofrequency of the SPG.</div></div><div><h3>Case report</h3><div>We present the case of a 70-year-old man with a one-year history of left-sided persistent idiopathic facial pain (PFPS), characterized by paroxysmal exacerbations in the V1–V2 territories, epiphora, and nasal congestion, without evidence of structural lesions or classical neuropathy. After unsuccessful treatment with carbamazepine and a diagnostic Gasserian ganglion block, a suprazygomatic SPG block with 1 % lidocaine was performed, achieving 80 % pain relief lasting four weeks. Upon recurrence of pain, fluoroscopy-guided thermal radiofrequency (TRF) of the SPG (80 °C, 60 s) was conducted, resulting in sustained improvement (NRS 1/10) at six months, with no sensory deficits or adverse effects. This case demonstrated that the suprazygomatic approach provides a safe route to access the pterygopalatine fossa.</div></div><div><h3>Conclusion</h3><div>Thermal radiofrequency of the SPG via the suprazygomatic approach may represent an effective and safe alternative for treating persistent idiopathic facial pain with autonomic features.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100716"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693588","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 : 2025-12-01DOI: 10.1016/j.inpm.2025.100711
Napatpaphan Kanjanapanang , Hasan Sen , Amanda N. Cooper , Audrey Adler , Akbar Nabi , Blake Dickenson , William Tang , Chase Young , Taylor Burnham , Alexandra E. Fogarty , Allison Glinka Przybysz , Aaron M. Conger , Zachary L. McCormick
Background
Lumbar medial branch radiofrequency ablation (LMBRFA) is an established treatment for chronic lumbar zygapophysial (facet) joint pain. Three-tined radiofrequency technology may simplify the procedure compared to conventional techniques, but long-term outcomes require further investigation.
Objectives
To assess long-term outcomes of three-tined LMBRFA utilizing a perpendicular approach.
Methods
This study reviewed electronic medical records of patients who underwent three-tined LMBRFA from 2022 to 2024. Clinical outcomes were assessed at ≥6 months post-procedure via standardized telephone survey, including numerical rating scale (NRS) pain scores, patient global impression of change (PGIC), and opioid utilization. The primary outcome was the proportion of patients achieving ≥50 % NRS pain reduction. Secondary outcomes included PGIC scores ≥6 (“much improved” or better) and changes in opioid use. Poisson regression evaluated select predictors of treatment response.
Results
Outcomes were collected from 71 patients at a mean follow-up of 12.5 ± 2.4 months. The primary outcome was achieved by 43.7 % (95 %CI: 32.8–55.2) of patients at mean follow-up, with higher success rates at 6–12 months (51.7 %) compared to 12–18 months (38.1 %; p = 0.332). At average follow-up, 53.5 % (95 %CI: 42.0–64.6) of patients reported PGIC scores ≥6, while opioid analgesic use was significantly reduced from baseline (75 % opioid cessation rate among baseline opioid users). Advanced age, repeat LMBRFA, and shorter follow-up were associated with a greater likelihood of treatment success.
Conclusion
In this cohort, approximately half of patients selected for three-tined perpendicular LMBRFA by guideline-concordant diagnostic blocks went on to experience ≥50 % pain relief for up to 12 months. Opioid analgesic use was significantly reduced compared to baseline.
{"title":"The effectiveness of lumbar medial branch radiofrequency ablation using a three-tined electrode: A real-world cross-sectional cohort study","authors":"Napatpaphan Kanjanapanang , Hasan Sen , Amanda N. Cooper , Audrey Adler , Akbar Nabi , Blake Dickenson , William Tang , Chase Young , Taylor Burnham , Alexandra E. Fogarty , Allison Glinka Przybysz , Aaron M. Conger , Zachary L. McCormick","doi":"10.1016/j.inpm.2025.100711","DOIUrl":"10.1016/j.inpm.2025.100711","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar medial branch radiofrequency ablation (LMBRFA) is an established treatment for chronic lumbar zygapophysial (facet) joint pain. Three-tined radiofrequency technology may simplify the procedure compared to conventional techniques, but long-term outcomes require further investigation.</div></div><div><h3>Objectives</h3><div>To assess long-term outcomes of three-tined LMBRFA utilizing a perpendicular approach.</div></div><div><h3>Methods</h3><div>This study reviewed electronic medical records of patients who underwent three-tined LMBRFA from 2022 to 2024. Clinical outcomes were assessed at ≥6 months post-procedure via standardized telephone survey, including numerical rating scale (NRS) pain scores, patient global impression of change (PGIC), and opioid utilization. The primary outcome was the proportion of patients achieving ≥50 % NRS pain reduction. Secondary outcomes included PGIC scores ≥6 (“much improved” or better) and changes in opioid use. Poisson regression evaluated select predictors of treatment response.</div></div><div><h3>Results</h3><div>Outcomes were collected from 71 patients at a mean follow-up of 12.5 ± 2.4 months. The primary outcome was achieved by 43.7 % (95 %CI: 32.8–55.2) of patients at mean follow-up, with higher success rates at 6–12 months (51.7 %) compared to 12–18 months (38.1 %; <em>p</em> = 0.332). At average follow-up, 53.5 % (95 %CI: 42.0–64.6) of patients reported PGIC scores ≥6, while opioid analgesic use was significantly reduced from baseline (75 % opioid cessation rate among baseline opioid users). Advanced age, repeat LMBRFA, and shorter follow-up were associated with a greater likelihood of treatment success.</div></div><div><h3>Conclusion</h3><div>In this cohort, approximately half of patients selected for three-tined perpendicular LMBRFA by guideline-concordant diagnostic blocks went on to experience ≥50 % pain relief for up to 12 months. Opioid analgesic use was significantly reduced compared to baseline.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100711"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623903","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}
Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain condition characterized by irritation or compression of abdominal wall intercostal nerve branches called the anterior cutaneous nerves. Peripheral nerve stimulation (PNS) has become an effective treatment option for painful sensory neuropathic conditions, including mononeuropathies and nerve entrapment syndromes. This report describes a successful case of using temporary PNS to treat ACNES and reviews the available literature on the use of PNS for the treatment of ACNES.
Case presentation
A 38-year-old female with a complex abdominal medical and surgical history presented to the pain medicine clinic for intractable burning pain and pressure in the left upper quadrant of the periumbilical region. Given the patient's clinical history and the nature of her presenting symptoms, ACNES was considered as a potential diagnosis. The diagnosis was confirmed through a series of successful diagnostic rectus sheath nerve blocks. A two-month temporary peripheral nerve stimulator trial targeting the left anterior cutaneous nerve was completed, and it resulted in 80 % pain reduction at 3 and 6-month follow-up evaluations, with returning pain at the 8-month assessment.
Conclusion
Chronic abdominal pain in patients with a complex history of abdominal surgery should alert pain specialists to consider the possibility of an ACNES diagnosis. Current evidence supporting PNS for ACNES is limited to a small number of case reports showing successful treatment; however, larger-scale and more robust studies are needed to determine the effectiveness and safety of this method. This study contributes to the existing body of literature, highlighting that PNS may serve as a valuable treatment option for individuals with chronic abdominal wall pain secondary to ACNES whose pain is refractory to conservative management strategies.
{"title":"Peripheral nerve stimulation for the treatment of anterior cutaneous nerve entrapment syndrome: A case report and literature review","authors":"Royce Copeland , Yacoub Khatab , Ravinderjit Singh , Emanuel N. Husu","doi":"10.1016/j.inpm.2025.100653","DOIUrl":"10.1016/j.inpm.2025.100653","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain condition characterized by irritation or compression of abdominal wall intercostal nerve branches called the anterior cutaneous nerves. Peripheral nerve stimulation (PNS) has become an effective treatment option for painful sensory neuropathic conditions, including mononeuropathies and nerve entrapment syndromes. This report describes a successful case of using temporary PNS to treat ACNES and reviews the available literature on the use of PNS for the treatment of ACNES.</div></div><div><h3>Case presentation</h3><div>A 38-year-old female with a complex abdominal medical and surgical history presented to the pain medicine clinic for intractable burning pain and pressure in the left upper quadrant of the periumbilical region. Given the patient's clinical history and the nature of her presenting symptoms, ACNES was considered as a potential diagnosis. The diagnosis was confirmed through a series of successful diagnostic rectus sheath nerve blocks. A two-month temporary peripheral nerve stimulator trial targeting the left anterior cutaneous nerve was completed, and it resulted in 80 % pain reduction at 3 and 6-month follow-up evaluations, with returning pain at the 8-month assessment.</div></div><div><h3>Conclusion</h3><div>Chronic abdominal pain in patients with a complex history of abdominal surgery should alert pain specialists to consider the possibility of an ACNES diagnosis. Current evidence supporting PNS for ACNES is limited to a small number of case reports showing successful treatment; however, larger-scale and more robust studies are needed to determine the effectiveness and safety of this method. This study contributes to the existing body of literature, highlighting that PNS may serve as a valuable treatment option for individuals with chronic abdominal wall pain secondary to ACNES whose pain is refractory to conservative management strategies.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100653"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624041","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 : 2025-12-01DOI: 10.1016/j.inpm.2025.100707
Zachary L. McCormick , Belinda Duszynski , Sarah Cartagena , Kevin Barrette , Timothy M. Curtis , Joshua M. Rosenow , Alison Stout , William David Mauck
{"title":"Multisociety response to the proposed multi-jurisdictional local coverage determination on peripheral nerve blocks and procedures for chronic pain: A critical moment in Healthcare Policy for the United States","authors":"Zachary L. McCormick , Belinda Duszynski , Sarah Cartagena , Kevin Barrette , Timothy M. Curtis , Joshua M. Rosenow , Alison Stout , William David Mauck","doi":"10.1016/j.inpm.2025.100707","DOIUrl":"10.1016/j.inpm.2025.100707","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100707"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747001","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 : 2025-12-01DOI: 10.1016/j.inpm.2025.100708
John Tran , Alicia J. Chung , Ian bell , Brent Lanting , Zachary L. McCormick , Eldon Loh
Background
Sensory afferents supplying subchondral bone could mediate pain from the knee joint. Intrinsic innervation originates externally and follows blood vessels through nutrient foramina. Therefore, targeting the intrinsic innervation of subchondral bone can be achieved by capturing extrinsic innervation prior to their entry into the nutrient foramina. Understanding of extrinsic innervation of the knee joint as well as the distribution of the epiphyseal nutrient foramina are important. Currently, the distribution of nutrient foramina has not been analyzed. The objective of this osteological study was to quantify the distribution of nutrient foramina in the distal femur to inform knee joint denervation strategies.
Methods
A convenience sample of 19 bony femurs was used in this study. The distal end of each specimen was photographed to obtain standardized lateral, medial, and anterior views. The location of nutrient foramina was documented. Each photograph was imported into ImageJ and the distribution of nutrient foramina was quantified.
Results
Location of epiphyseal nutrient foramina was variable on distal femur. Laterally, distribution of nutrient foramina showed percentages of 11.5 %, 44.7 %, 36.5 %, and 7.3 % in the first, second, third, and fourth quadrants, respectively. Distribution on the medial distal femur showed percentages of 12.4 %, 40.4 %, 35.5 %, and 11.5 % in the first, second, third, and fourth quadrants, respectively. Anteriorly, distribution showed a difference between the medial and lateral halves with percentages of 71.1 % and 28.9 %, respectively.
Conclusions
Epiphyseal nutrient foramina are important conduits that enable extrinsic innervation to enter and supply the subchondral bone. The location and distribution of the nutrient foramina of the distal femur reported in this study can be used to optimize nerve blocks and denervation techniques to manage chronic knee joint pain from osteoarthritis.
{"title":"Distribution of epiphyseal nutrient foramina in the distal femur: Implications for anterior knee joint denervation","authors":"John Tran , Alicia J. Chung , Ian bell , Brent Lanting , Zachary L. McCormick , Eldon Loh","doi":"10.1016/j.inpm.2025.100708","DOIUrl":"10.1016/j.inpm.2025.100708","url":null,"abstract":"<div><h3>Background</h3><div>Sensory afferents supplying subchondral bone could mediate pain from the knee joint. Intrinsic innervation originates externally and follows blood vessels through nutrient foramina. Therefore, targeting the intrinsic innervation of subchondral bone can be achieved by capturing extrinsic innervation prior to their entry into the nutrient foramina. Understanding of extrinsic innervation of the knee joint as well as the distribution of the epiphyseal nutrient foramina are important. Currently, the distribution of nutrient foramina has not been analyzed. The objective of this osteological study was to quantify the distribution of nutrient foramina in the distal femur to inform knee joint denervation strategies.</div></div><div><h3>Methods</h3><div>A convenience sample of 19 bony femurs was used in this study. The distal end of each specimen was photographed to obtain standardized lateral, medial, and anterior views. The location of nutrient foramina was documented. Each photograph was imported into ImageJ and the distribution of nutrient foramina was quantified.</div></div><div><h3>Results</h3><div>Location of epiphyseal nutrient foramina was variable on distal femur. Laterally, distribution of nutrient foramina showed percentages of 11.5 %, 44.7 %, 36.5 %, and 7.3 % in the first, second, third, and fourth quadrants, respectively. Distribution on the medial distal femur showed percentages of 12.4 %, 40.4 %, 35.5 %, and 11.5 % in the first, second, third, and fourth quadrants, respectively. Anteriorly, distribution showed a difference between the medial and lateral halves with percentages of 71.1 % and 28.9 %, respectively.</div></div><div><h3>Conclusions</h3><div>Epiphyseal nutrient foramina are important conduits that enable extrinsic innervation to enter and supply the subchondral bone. The location and distribution of the nutrient foramina of the distal femur reported in this study can be used to optimize nerve blocks and denervation techniques to manage chronic knee joint pain from osteoarthritis.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100708"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624045","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 : 2025-12-01DOI: 10.1016/j.inpm.2025.100706
Logan F. Condon , Ryu Komatsu , Jiang Wu
Introduction
The sphenopalatine ganglion (SPG) drives the cranial autonomic symptoms associated with trigeminal autonomic cephalalgias, migraine, and trigeminal neuralgia. Infrazygomatic approach SPG block serves as the gold standard for both prognostic and therapeutic intervention for management of refractory headache with autonomic symptoms. However, this intervention often provides only short-term relief. Identification of novel interventions that provide more durable relief is imperative.
Case
An 84-year-old female with chronic headache featuring autonomic cranial symptoms that failed both medication and conservative intervention management. Patient responded well to infrazygomatic approach SPG block using combined cone beam CT and fluoroscopy guidance, however, experienced fading therapeutic response over the years. Subsequently, patient underwent neurocryoablation of the SPG, from which, satisfactory and sustained improvement of her headache pain was achieved at six month follow up.
Conclusion
This is the first case demonstrating the clinical feasibility and therapeutic outcomes of SPG neurocryoablation in treating refractory headaches.
{"title":"A case report: Infrazygomatic approach neurocryoablation of the sphenopalatine ganglion under cone beam computer tomography guidance in treating refractory headaches","authors":"Logan F. Condon , Ryu Komatsu , Jiang Wu","doi":"10.1016/j.inpm.2025.100706","DOIUrl":"10.1016/j.inpm.2025.100706","url":null,"abstract":"<div><h3>Introduction</h3><div>The sphenopalatine ganglion (SPG) drives the cranial autonomic symptoms associated with trigeminal autonomic cephalalgias, migraine, and trigeminal neuralgia. Infrazygomatic approach SPG block serves as the gold standard for both prognostic and therapeutic intervention for management of refractory headache with autonomic symptoms. However, this intervention often provides only short-term relief. Identification of novel interventions that provide more durable relief is imperative.</div></div><div><h3>Case</h3><div>An 84-year-old female with chronic headache featuring autonomic cranial symptoms that failed both medication and conservative intervention management. Patient responded well to infrazygomatic approach SPG block using combined cone beam CT and fluoroscopy guidance, however, experienced fading therapeutic response over the years. Subsequently, patient underwent neurocryoablation of the SPG, from which, satisfactory and sustained improvement of her headache pain was achieved at six month follow up.</div></div><div><h3>Conclusion</h3><div>This is the first case demonstrating the clinical feasibility and therapeutic outcomes of SPG neurocryoablation in treating refractory headaches.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100706"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623901","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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