Pub Date : 2026-03-01Epub 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":"2026-03-01","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 : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.inpm.2025.100722
Jeffrey R. Merz-Herrala , Felipe Ocampo , Christopher R. Abrecht , J. Ben Arevalo , Nu Cindy Chai
Background
Pain is a leading complaint in Emergency Department (ED) visits, yet historically, few Emergency Physicians (EPs) have pursued fellowship training in Pain Medicine. In recent years, however, applications from EPs have risen sharply, contrasting with declines in other specialties. Despite this growth, there has been no systematic analysis of how Emergency Medicine (EM) training overlaps with the required competencies of the Pain Medicine fellowship. To our knowledge, this study represents the first such effort.
Methods
We systematically compared the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Pain Medicine with five core EM training documents: the ACGME Program Requirements for EM, ACGME EM Milestones, ACGME Key Index Procedures, ACGME Procedure Logs, and the American Board of Emergency Medicine (ABEM) EM Model of Clinical Practice. Each ACGME Pain Medicine Program Requirement was evaluated by a group of Pain and EM physicians for its degree of overlap with these EM training frameworks and categorized as having significant, partial, or minimal overlap in competency.
Results
EM training exhibits a strong overlap with Pain Medicine in patient care, encompassing neurologic and musculoskeletal evaluation, psychiatric assessment, and the diagnosis of acute and chronic pain. EPs also demonstrate procedural strengths in airway management, intravenous access, ultrasound-guided interventions, life support, procedural sedation, managing emergencies, along with medical knowledge in acute pain management, medication detoxification, and treatment of substance use disorders. Gaps were identified in the interpretation of electrodiagnostic studies, advanced imaging, prescription of rehabilitation strategies, long-term opioid management, and advanced fluoroscopic and neuromodulation procedures. These findings highlight EM's strong foundation in acute care and procedures, while clarifying domains that require targeted fellowship training.
Conclusions
EPs contribute valuable skills to Pain Medicine but require structured opportunities to address predictable training gaps. Electives, mentorship, and flexible curricula may help bridge these deficiencies.
{"title":"Emergency physicians in pain medicine: Workforce trends, competency overlap, gaps, and opportunities for integration","authors":"Jeffrey R. Merz-Herrala , Felipe Ocampo , Christopher R. Abrecht , J. Ben Arevalo , Nu Cindy Chai","doi":"10.1016/j.inpm.2025.100722","DOIUrl":"10.1016/j.inpm.2025.100722","url":null,"abstract":"<div><h3>Background</h3><div>Pain is a leading complaint in Emergency Department (ED) visits, yet historically, few Emergency Physicians (EPs) have pursued fellowship training in Pain Medicine. In recent years, however, applications from EPs have risen sharply, contrasting with declines in other specialties. Despite this growth, there has been no systematic analysis of how Emergency Medicine (EM) training overlaps with the required competencies of the Pain Medicine fellowship. To our knowledge, this study represents the first such effort.</div></div><div><h3>Methods</h3><div>We systematically compared the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Pain Medicine with five core EM training documents: the ACGME Program Requirements for EM, ACGME EM Milestones, ACGME Key Index Procedures, ACGME Procedure Logs, and the American Board of Emergency Medicine (ABEM) EM Model of Clinical Practice. Each ACGME Pain Medicine Program Requirement was evaluated by a group of Pain and EM physicians for its degree of overlap with these EM training frameworks and categorized as having significant, partial, or minimal overlap in competency.</div></div><div><h3>Results</h3><div>EM training exhibits a strong overlap with Pain Medicine in patient care, encompassing neurologic and musculoskeletal evaluation, psychiatric assessment, and the diagnosis of acute and chronic pain. EPs also demonstrate procedural strengths in airway management, intravenous access, ultrasound-guided interventions, life support, procedural sedation, managing emergencies, along with medical knowledge in acute pain management, medication detoxification, and treatment of substance use disorders. Gaps were identified in the interpretation of electrodiagnostic studies, advanced imaging, prescription of rehabilitation strategies, long-term opioid management, and advanced fluoroscopic and neuromodulation procedures. These findings highlight EM's strong foundation in acute care and procedures, while clarifying domains that require targeted fellowship training.</div></div><div><h3>Conclusions</h3><div>EPs contribute valuable skills to Pain Medicine but require structured opportunities to address predictable training gaps. Electives, mentorship, and flexible curricula may help bridge these deficiencies.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100722"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-11DOI: 10.1016/j.inpm.2025.100726
Nicholas R. Bender , Ramzi El-Hassan
Background
Low back pain (LBP) is highly prevalent, with the sacroiliac joint (SIJ) implicated in up to ∼30 % of cases. Intra-articular steroid injections are an established treatment for SIJ pain. Several risk factors—including lumbosacral fusion, total hip arthroplasty, pelvic fracture, inflammatory bowel disease, and seronegative spondyloarthropathy—are known to predispose patients to SIJ pain. However, it remains unclear whether these preconditions predict treatment response.
Objective
To determine whether the presence of known SIJ pain risk factors correlates with improved patient-reported outcomes following SIJ intra-articular steroid injection.
Methods
A retrospective cohort study was conducted at the University of Rochester using electronic medical records from September 1, 2013 to February 1, 2023. Patients aged 18–95 years with SIJ pain who underwent fluoroscopic or ultrasound-guided SIJ injection and completed Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI) and/or Physical Function (PF) surveys before and after injection were included. Outcomes were compared between patients with and without preconditions. Statistical significance was set at p < 0.05. Cohen's d test was preformed to determine the effect of having a precondition.
Results
Of 4780 patients identified, 91 completed PROMIS PI and 168 completed PROMIS PF surveys within the required timeframe. Among these, 27 (PI) and 40 (PF) had a precondition. The mean PI score change was 0.854 in the precondition group and 0.509 in the non-precondition group; PF score change was 1.30 and −0.378, respectively. Neither within-group changes nor between-group differences reached statistical significance (PI p = 0.739; PF p = 0.114). The effect size, measured by Cohen's d, of preconditions versus no preconditions, was d = 0.08 in the PI group, indicating little to no effect. The effect size, measured by Cohen's d, of preconditions versus no preconditions, was d = 0.28 in the PF group, indicating a small effect.
Conclusion
The presence of established SIJ pain risk factors did not predict improved response to intra-articular steroid injection when using t-test for comparison. When using Cohen's d test however, a small effect size of (d = 0.28) was shown for increased PF following SIJ injections in patients with preconditions compared to patients without preconditions. This finding may indicate that patients with the preconditions investigated in this study can be expected to have a marginally better physical function following SIJ injection compared to their peers without preconditions. These findings suggest that preconditions such as fusion, arthroplasty, or inflammatory disease may influence injection efficacy. Larger multicenter studies are warranted to validate these results.
{"title":"Intra-articular sacroiliac joint steroid injection in patients with risk factors may have greater effect","authors":"Nicholas R. Bender , Ramzi El-Hassan","doi":"10.1016/j.inpm.2025.100726","DOIUrl":"10.1016/j.inpm.2025.100726","url":null,"abstract":"<div><h3>Background</h3><div>Low back pain (LBP) is highly prevalent, with the sacroiliac joint (SIJ) implicated in up to ∼30 % of cases. Intra-articular steroid injections are an established treatment for SIJ pain. Several risk factors—including lumbosacral fusion, total hip arthroplasty, pelvic fracture, inflammatory bowel disease, and seronegative spondyloarthropathy—are known to predispose patients to SIJ pain. However, it remains unclear whether these preconditions predict treatment response.</div></div><div><h3>Objective</h3><div>To determine whether the presence of known SIJ pain risk factors correlates with improved patient-reported outcomes following SIJ intra-articular steroid injection.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted at the University of Rochester using electronic medical records from September 1, 2013 to February 1, 2023. Patients aged 18–95 years with SIJ pain who underwent fluoroscopic or ultrasound-guided SIJ injection and completed Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI) and/or Physical Function (PF) surveys before and after injection were included. Outcomes were compared between patients with and without preconditions. Statistical significance was set at p < 0.05. Cohen's d test was preformed to determine the effect of having a precondition.</div></div><div><h3>Results</h3><div>Of 4780 patients identified, 91 completed PROMIS PI and 168 completed PROMIS PF surveys within the required timeframe. Among these, 27 (PI) and 40 (PF) had a precondition. The mean PI score change was 0.854 in the precondition group and 0.509 in the non-precondition group; PF score change was 1.30 and −0.378, respectively. Neither within-group changes nor between-group differences reached statistical significance (PI p = 0.739; PF p = 0.114). The effect size, measured by Cohen's d, of preconditions versus no preconditions, was d = 0.08 in the PI group, indicating little to no effect. The effect size, measured by Cohen's d, of preconditions versus no preconditions, was d = 0.28 in the PF group, indicating a small effect.</div></div><div><h3>Conclusion</h3><div>The presence of established SIJ pain risk factors did not predict improved response to intra-articular steroid injection when using <em>t</em>-test for comparison. When using Cohen's d test however, a small effect size of (d = 0.28) was shown for increased PF following SIJ injections in patients with preconditions compared to patients without preconditions. This finding may indicate that patients with the preconditions investigated in this study can be expected to have a marginally better physical function following SIJ injection compared to their peers without preconditions. These findings suggest that preconditions such as fusion, arthroplasty, or inflammatory disease may influence injection efficacy. Larger multicenter studies are warranted to validate these results.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100726"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-12DOI: 10.1016/j.inpm.2025.100734
Eric K. Holder , Amelia Ni , David Levi , International Pain and Spine Intervention Society's Patient Safety Committee
This FactFinder presents a brief summary of the evidence and outlines recommendations regarding periprocedural management of patients on glucagon-like peptide-1 receptor agonists (GLP-1RA) therapy undergoing elective pain procedures under conscious sedation. Based on current multi-society guidance statements, patients without risk factors may continue GLP-1RA therapy in the periprocedural window. However, periprocedural management should incorporate a complete risk assessment and shared decision-making involving the patient, the prescribing care team, the physician, and anesthesia personnel (if involved). It is also recommended that the performing physician carefully consider the necessity of conscious sedation on a case-by-case basis, as it is not necessary in most scenarios.
{"title":"GLP-1 receptor agonists and conscious sedation","authors":"Eric K. Holder , Amelia Ni , David Levi , International Pain and Spine Intervention Society's Patient Safety Committee","doi":"10.1016/j.inpm.2025.100734","DOIUrl":"10.1016/j.inpm.2025.100734","url":null,"abstract":"<div><div>This FactFinder presents a brief summary of the evidence and outlines recommendations regarding periprocedural management of patients on glucagon-like peptide-1 receptor agonists (GLP-1RA) therapy undergoing elective pain procedures under conscious sedation. Based on current multi-society guidance statements, patients without risk factors may continue GLP-1RA therapy in the periprocedural window. However, periprocedural management should incorporate a complete risk assessment and shared decision-making involving the patient, the prescribing care team, the physician, and anesthesia personnel (if involved). It is also recommended that the performing physician carefully consider the necessity of conscious sedation on a case-by-case basis, as it is not necessary in most scenarios.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100734"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-24DOI: 10.1016/j.inpm.2026.100743
Emily Bellow, Jennifer Bae, Jeffrey Zhang, Sandi Bajrami, Derek Johnson, William Caldwell
Background
Patients with psychiatric conditions experience higher rates of chronic low back pain (LBP) compared to the general population and frequently face worse outcomes, including delayed diagnosis, higher rates of opioid dependence, and suboptimal pain management. Despite the high burden of chronic LBP on patients with psychiatric illnesses, the effectiveness of interventional pain management procedures in this population remains understudied.
Objective
This study sought to evaluate early pain reduction and functional outcomes following BVN ablation in patients with psychiatric conditions.
Methods
A retrospective chart review was conducted on patients who underwent BVN ablation at our institution from November 2019 to January 2025. For patient group designation and comparison, we identified Patients with Psychiatric Conditions (PCC, N = 52) and Patients without Psychiatric Conditions (Non-PPC, N = 82). Psychiatric diagnoses included anxiety disorders, major depressive disorder, bipolar disorder, Tourette's syndrome, and substance use disorders. Pain severity was assessed using the Visual Analog Scale (VAS) at baseline and at the 4–6-week post-procedure follow-up visit, and functional improvement was determined based on documented patient-reported outcomes at the same time point.
Results
A statistically significant decrease in VAS was observed in the PPC cohort (7.4 vs. 3.71, p = 0.006) and the Non-PPC cohort (6.82 vs. 3.82, p = 0.017). When comparing the PPC cohort to the Non-PPC cohort, no statistically significant difference was observed in the percentage of patients reporting improvement in functional status after the procedure (80.8% vs. 78.0%, p = 0.706).
Conclusions
At 4–6-weeks post procedure, patients with psychiatric conditions experienced significant pain relief and improvement in functional status comparable to patients without psychiatric conditions. These findings suggest that having a documented psychiatric condition does not significantly alter early pain relief or functional improvement outcomes after BVN ablation.
背景：与一般人群相比，精神疾病患者的慢性腰痛（LBP）发生率更高，并且经常面临更糟糕的结果，包括延迟诊断、更高的阿片类药物依赖率和次优疼痛管理。尽管慢性腰痛对精神疾病患者的负担很高，但介入性疼痛管理程序在这一人群中的有效性仍未得到充分研究。目的：本研究旨在评估精神疾病患者BVN消融后的早期疼痛减轻和功能结局。方法：对2019年11月至2025年1月在我院行BVN消融的患者进行回顾性图表分析。对于患者组的指定和比较，我们确定了有精神疾病的患者（PCC, N = 52）和无精神疾病的患者（Non-PPC, N = 82）。精神病学诊断包括焦虑症、重度抑郁症、双相情感障碍、妥瑞氏综合症和物质使用障碍。在基线和术后4-6周随访时使用视觉模拟量表（VAS）评估疼痛严重程度，并根据同一时间点记录的患者报告的结果确定功能改善情况。结果：PPC组VAS评分降低（7.4比3.71,p = 0.006），非PPC组VAS评分降低（6.82比3.82,p = 0.017），差异有统计学意义。当将PPC组与非PPC组进行比较时，报告术后功能状态改善的患者百分比无统计学差异（80.8% vs 78.0%, p = 0.706）。结论：在手术后4-6周，与无精神疾病的患者相比，有精神疾病的患者经历了显著的疼痛缓解和功能状态改善。这些发现表明，有精神疾病记录并不能显著改变BVN消融后早期疼痛缓解或功能改善的结果。
{"title":"Basivertebral nerve ablation provides comparable early pain relief in patients with psychiatric conditions: A real-world study","authors":"Emily Bellow, Jennifer Bae, Jeffrey Zhang, Sandi Bajrami, Derek Johnson, William Caldwell","doi":"10.1016/j.inpm.2026.100743","DOIUrl":"10.1016/j.inpm.2026.100743","url":null,"abstract":"<div><h3>Background</h3><div>Patients with psychiatric conditions experience higher rates of chronic low back pain (LBP) compared to the general population and frequently face worse outcomes, including delayed diagnosis, higher rates of opioid dependence, and suboptimal pain management. Despite the high burden of chronic LBP on patients with psychiatric illnesses, the effectiveness of interventional pain management procedures in this population remains understudied.</div></div><div><h3>Objective</h3><div>This study sought to evaluate early pain reduction and functional outcomes following BVN ablation in patients with psychiatric conditions.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted on patients who underwent BVN ablation at our institution from November 2019 to January 2025. For patient group designation and comparison, we identified Patients with Psychiatric Conditions (PCC, N = 52) and Patients without Psychiatric Conditions (Non-PPC, N = 82). Psychiatric diagnoses included anxiety disorders, major depressive disorder, bipolar disorder, Tourette's syndrome, and substance use disorders. Pain severity was assessed using the Visual Analog Scale (VAS) at baseline and at the 4–6-week post-procedure follow-up visit, and functional improvement was determined based on documented patient-reported outcomes at the same time point.</div></div><div><h3>Results</h3><div>A statistically significant decrease in VAS was observed in the PPC cohort (7.4 vs. 3.71, p = 0.006) and the Non-PPC cohort (6.82 vs. 3.82, p = 0.017). When comparing the PPC cohort to the Non-PPC cohort, no statistically significant difference was observed in the percentage of patients reporting improvement in functional status after the procedure (80.8% vs. 78.0%, p = 0.706).</div></div><div><h3>Conclusions</h3><div>At 4–6-weeks post procedure, patients with psychiatric conditions experienced significant pain relief and improvement in functional status comparable to patients without psychiatric conditions. These findings suggest that having a documented psychiatric condition does not significantly alter early pain relief or functional improvement outcomes after BVN ablation.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100743"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/j.inpm.2026.100741
David Sherwood , Margaret Helen Rutherford Riser , Peter Chia Yeh , Augustine C. Lee , Byron Schneider
Background
Low back pain (LBP) is commonly managed under insurance-directed care models that mandate a trial of conservative treatment before authorizing advanced imaging or interventional procedures. This study prospectively evaluates the clinical outcomes of a six-week care program as mandated by insurers.
Methods
New adult patients with LBP presenting to an academic spine clinic were enrolled. Exclusion criteria included cervical complaints, worker's compensation, and litigation. Patients received treatment pathways based on physician discretion and patient adherence. Patients were categorized into four treatment pathways at their 6-week follow up: Medication + Therapy, Medication Only, Therapy Only, or Neither. Primary outcomes were Numeric Rating Scale (NRS) for pain and Oswestry Disability Index (ODI) at 6 weeks.
Results
Ninety-nine patients (mean age 57.8 years; duration of pain 52 months) completed the study. At 6 weeks, pathways including medication (Medication + Therapy and Medication Only) showed modest analgesic improvement (NRS change −1.2 and −1.8, respectively). The Therapy Only group (n = 9) showed minimal change from a lower baseline severity. Among patients prescribed physical therapy (PT), those who attended (n = 37) achieved superior 6-week scores in pain (3.8 vs 4.4, p = 0.04) and disability (20.5 vs 25.7) compared to non-attendees, though attendees had lower baseline severity. Higher PT session counts were not associated with greater symptom relief. Opioid use (n = 12) was not associated with improved outcomes.
Conclusion
Mandated conservative care produced only modest improvement in pain and/or function over 6 weeks. While medication inclusion provided consistent relief, PT attendance, rather than session frequency, was the primary factor associated with better functional status. These data support setting realistic expectations for early conservative management.
背景：腰痛（LBP）通常在保险指导的护理模式下进行管理，该模式要求在授权高级成像或介入手术之前进行保守治疗试验。本研究前瞻性地评估了由保险公司授权的为期六周的护理计划的临床结果。方法纳入到学术脊柱诊所就诊的新成年腰痛患者。排除标准包括宫颈疾病、工伤赔偿和诉讼。患者接受的治疗途径基于医生的判断和患者的依从性。在为期6周的随访中，患者被分为四种治疗途径：药物+治疗、仅药物治疗、仅治疗或两者均不治疗。主要结局是6周疼痛数值评定量表（NRS）和Oswestry残疾指数（ODI）。结果99例患者完成研究，平均年龄57.8岁，疼痛持续时间52个月。在6周时，包括药物治疗（药物+治疗和仅药物治疗）在内的途径显示出适度的镇痛改善（NRS变化分别为- 1.2和- 1.8）。仅治疗组（n = 9）显示较低基线严重程度的最小变化。在接受物理治疗（PT）的患者中，参加治疗的患者（n = 37）在疼痛（3.8 vs 4.4, p = 0.04）和残疾（20.5 vs 25.7）方面的6周评分优于未参加治疗的患者，尽管参加治疗的患者的基线严重程度较低。较高的PT会话计数与更大的症状缓解无关。阿片类药物使用（n = 12）与预后改善无关。结论：强制保守治疗仅在6周内对疼痛和/或功能有轻微改善。虽然药物治疗提供了一致的缓解，但PT出席率，而不是会话频率，是与更好的功能状态相关的主要因素。这些数据支持为早期保守治疗设定切合实际的期望。
{"title":"Insurance directed conservative care for low back pain: A prospective observational study","authors":"David Sherwood , Margaret Helen Rutherford Riser , Peter Chia Yeh , Augustine C. Lee , Byron Schneider","doi":"10.1016/j.inpm.2026.100741","DOIUrl":"10.1016/j.inpm.2026.100741","url":null,"abstract":"<div><h3>Background</h3><div>Low back pain (LBP) is commonly managed under insurance-directed care models that mandate a trial of conservative treatment before authorizing advanced imaging or interventional procedures. This study prospectively evaluates the clinical outcomes of a six-week care program as mandated by insurers.</div></div><div><h3>Methods</h3><div>New adult patients with LBP presenting to an academic spine clinic were enrolled. Exclusion criteria included cervical complaints, worker's compensation, and litigation. Patients received treatment pathways based on physician discretion and patient adherence. Patients were categorized into four treatment pathways at their 6-week follow up: Medication + Therapy, Medication Only, Therapy Only, or Neither. Primary outcomes were Numeric Rating Scale (NRS) for pain and Oswestry Disability Index (ODI) at 6 weeks.</div></div><div><h3>Results</h3><div>Ninety-nine patients (mean age 57.8 years; duration of pain 52 months) completed the study. At 6 weeks, pathways including medication (Medication + Therapy and Medication Only) showed modest analgesic improvement (NRS change −1.2 and −1.8, respectively). The Therapy Only group (n = 9) showed minimal change from a lower baseline severity. Among patients prescribed physical therapy (PT), those who attended (n = 37) achieved superior 6-week scores in pain (3.8 vs 4.4, p = 0.04) and disability (20.5 vs 25.7) compared to non-attendees, though attendees had lower baseline severity. Higher PT session counts were not associated with greater symptom relief. Opioid use (n = 12) was not associated with improved outcomes.</div></div><div><h3>Conclusion</h3><div>Mandated conservative care produced only modest improvement in pain and/or function over 6 weeks. While medication inclusion provided consistent relief, PT attendance, rather than session frequency, was the primary factor associated with better functional status. These data support setting realistic expectations for early conservative management.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100741"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-08DOI: 10.1016/j.inpm.2025.100733
Mark R. DeCotiis
Introduction
Duplication of a vertebral pedicle is a rare congenital anatomic variant with limited representation in the medical literature. Such anomalies are thought to arise during intrauterine or early postnatal phases of osseous development. Aberrant pedicle duplication can result in the creation of a “pseudo foramen,” with potential clinical implications that are not well characterized.
Case
A patient presented with symptoms of painful burning sensations and paresthesias within the right groin and anterior thigh, consistent with upper lumbar radiculopathy. Advanced imaging of the lumbar spine revealed neuroforaminal stenosis associated with a “pseudo foramen” at L2, created by pedicle duplication. Together with clinical suspicion, results of a transforaminal epidural steroid injection supported the conclusion that the neuroforaminal stenosis at this level contributed to the patient's symptoms. This report examines the embryological origins and imaging findings of pedicle formation, considers the spectrum of pedicle duplication and semi-segmented hemivertebra, and reviews relevant imaging findings.
Conclusion
This case highlights the importance of carefully reviewing lumbar imaging modalities. Not only is there observation of a rare duplication of vertebral pedicles, but also a thorough review of available literature suggests that this is the first case to specifically report on clinically significant stenosis occurring within a “pseudo foramen.”
{"title":"Pedicle paradox: Duplicate vertebral pedicles creating a rare “pseudo foramen” with symptomatic foraminal stenosis","authors":"Mark R. DeCotiis","doi":"10.1016/j.inpm.2025.100733","DOIUrl":"10.1016/j.inpm.2025.100733","url":null,"abstract":"<div><h3>Introduction</h3><div>Duplication of a vertebral pedicle is a rare congenital anatomic variant with limited representation in the medical literature. Such anomalies are thought to arise during intrauterine or early postnatal phases of osseous development. Aberrant pedicle duplication can result in the creation of a “pseudo foramen,” with potential clinical implications that are not well characterized.</div></div><div><h3>Case</h3><div>A patient presented with symptoms of painful burning sensations and paresthesias within the right groin and anterior thigh, consistent with upper lumbar radiculopathy. Advanced imaging of the lumbar spine revealed neuroforaminal stenosis associated with a “pseudo foramen” at L2, created by pedicle duplication. Together with clinical suspicion, results of a transforaminal epidural steroid injection supported the conclusion that the neuroforaminal stenosis at this level contributed to the patient's symptoms. This report examines the embryological origins and imaging findings of pedicle formation, considers the spectrum of pedicle duplication and semi-segmented hemivertebra, and reviews relevant imaging findings.</div></div><div><h3>Conclusion</h3><div>This case highlights the importance of carefully reviewing lumbar imaging modalities. Not only is there observation of a rare duplication of vertebral pedicles, but also a thorough review of available literature suggests that this is the first case to specifically report on clinically significant stenosis occurring within a “pseudo foramen.”</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100733"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-03-09DOI: 10.1016/j.inpm.2026.100749
Anthony T. Kenrick , Cameron R. Forbes , Nolan Fisher , Stacy Ruther , William D. Bichard , Mark C. Preul , D. Scott Kreiner
Background
The thoracic zygapophyseal (Z) joints, also known as facet joints, are potential sources of thoracic back pain. Historically, medial branch innervation of these joints was thought to mirror that of cervical and lumbar Z-joints. However, recent anatomical studies suggest that distinct thoracic articular branch nerves innervate these joints. This finding provides potential interventional targets for thoracic facet blockade and radiofrequency neurotomy.
Objective
This study aimed to identify the thoracic articular branch nerves for mid-thoracic joints and develop techniques for accessing these structures under fluoroscopic guidance.
Methods
Two embalmed cadavers were dissected to identify the thoracic articular branch nerves of the T6-7, T7-8, and T8-9 joints. Radiopaque markers were placed on identified nerves, and fluoroscopic imaging was used to visualize and optimize needle placement for potential articular branch blocks and neurotomy.
Results
Thoracic articular branches were successfully identified, marked, and visualized on fluoroscopy. Selective blockade of the articular branch appeared feasible using the superior aspect of the rib head adjacent to the Z-joint as a target and osseous backstop. The dorsal projection of the transverse process limited optimal cannula placement for the radiofrequency neurotomy. Individual body habitus and thoracic kyphosis also impacted viable methods for radiofrequency cannula placement. These anatomical constraints prevented the establishment of a parallel approach for monopolar radiofrequency cannula placement; however, alternative approaches were developed.
Conclusion
Accessing thoracic articular branches for neurotomy is feasible but presents technical challenges due to anatomical limitations. Further studies should explore the clinical efficacy of these techniques in managing thoracic facet-mediated pain.
{"title":"Thoracic facet joint innervation: identifying and accessing the articular branch","authors":"Anthony T. Kenrick , Cameron R. Forbes , Nolan Fisher , Stacy Ruther , William D. Bichard , Mark C. Preul , D. Scott Kreiner","doi":"10.1016/j.inpm.2026.100749","DOIUrl":"10.1016/j.inpm.2026.100749","url":null,"abstract":"<div><h3>Background</h3><div>The thoracic zygapophyseal (Z) joints, also known as facet joints, are potential sources of thoracic back pain. Historically, medial branch innervation of these joints was thought to mirror that of cervical and lumbar Z-joints. However, recent anatomical studies suggest that distinct thoracic articular branch nerves innervate these joints. This finding provides potential interventional targets for thoracic facet blockade and radiofrequency neurotomy.</div></div><div><h3>Objective</h3><div>This study aimed to identify the thoracic articular branch nerves for mid-thoracic joints and develop techniques for accessing these structures under fluoroscopic guidance.</div></div><div><h3>Methods</h3><div>Two embalmed cadavers were dissected to identify the thoracic articular branch nerves of the T6-7, T7-8, and T8-9 joints. Radiopaque markers were placed on identified nerves, and fluoroscopic imaging was used to visualize and optimize needle placement for potential articular branch blocks and neurotomy.</div></div><div><h3>Results</h3><div>Thoracic articular branches were successfully identified, marked, and visualized on fluoroscopy. Selective blockade of the articular branch appeared feasible using the superior aspect of the rib head adjacent to the Z-joint as a target and osseous backstop. The dorsal projection of the transverse process limited optimal cannula placement for the radiofrequency neurotomy. Individual body habitus and thoracic kyphosis also impacted viable methods for radiofrequency cannula placement. These anatomical constraints prevented the establishment of a parallel approach for monopolar radiofrequency cannula placement; however, alternative approaches were developed.</div></div><div><h3>Conclusion</h3><div>Accessing thoracic articular branches for neurotomy is feasible but presents technical challenges due to anatomical limitations. Further studies should explore the clinical efficacy of these techniques in managing thoracic facet-mediated pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100749"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396916","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}
Glossopharyngeal nerve block provides long-term pain relief in glossopharyngeal neuralgia patients; the nerve block can be performed using landmarks or ultrasound guidance. The present study has evaluated the efficacy of ultrasound-guided glossopharyngeal nerve block utilizing the small-sized hockey stick probe.
Methods
The present study was a prospective, observational study; twenty-five adult patients diagnosed with primary glossopharyngeal neuralgia not responding to medical management were included in this clinical trial. Glossopharyngeal nerve block was done under ultrasound guidance using hockey stick probe; patients having more than 50% reduction in numeric rating scale (NRS) score, for at least 2 h following nerve block, were enrolled in the study and followed for 6 months. The primary outcome measure was the severity of pain, measured by NRS score. Secondary outcome measures were percentage pain relief, reduction of analgesic usage, and PHQ-9 score for psychological assessment. All these assessments were done prior to the procedure and at 2 weeks, 1, 3 and 6 months after the procedure.
Results
We observed significant reduction in the NRS scores at 2 weeks (1.7 ± 1.6), 1 (1.9 ± 1.3), 3 (1.8 ± 1.3) and 6 months (2.1 ± 1.5) after Glossopharyngeal nerve block as compared to the baseline (6.1 ± 1.3; P value < 0.05); we also observed a significant pain relief (76%) and significantly reduced analgesic consumption (68%) and PHQ-9 scores (2.3 ± 1.7) compared to the baseline values (P value < 0.05).
Conclusion
Ultrasound-guided glossopharyngeal nerve block with a linear array hockey stick probe provided significant pain relief in 75% of study participants with glossopharyngeal neuralgia over a six-month follow-up period.
{"title":"Evaluation of ultrasound-guided glossopharyngeal nerve block technique: A prospective observational study","authors":"Ayushi Bansal , Sujeet Gautam , Ravisankar Manogaran , Prabhakar Mishra , Arun Kumar Gupta , Sanjay Kumar , Sandeep Khuba","doi":"10.1016/j.inpm.2026.100744","DOIUrl":"10.1016/j.inpm.2026.100744","url":null,"abstract":"<div><h3>Background</h3><div>Glossopharyngeal nerve block provides long-term pain relief in glossopharyngeal neuralgia patients; the nerve block can be performed using landmarks or ultrasound guidance. The present study has evaluated the efficacy of ultrasound-guided glossopharyngeal nerve block utilizing the small-sized hockey stick probe.</div></div><div><h3>Methods</h3><div>The present study was a prospective, observational study; twenty-five adult patients diagnosed with primary glossopharyngeal neuralgia not responding to medical management were included in this clinical trial. Glossopharyngeal nerve block was done under ultrasound guidance using hockey stick probe; patients having more than 50% reduction in numeric rating scale (NRS) score, for at least 2 h following nerve block, were enrolled in the study and followed for 6 months. The primary outcome measure was the severity of pain, measured by NRS score. Secondary outcome measures were percentage pain relief, reduction of analgesic usage, and PHQ-9 score for psychological assessment. All these assessments were done prior to the procedure and at 2 weeks, 1, 3 and 6 months after the procedure.</div></div><div><h3>Results</h3><div>We observed significant reduction in the NRS scores at 2 weeks (1.7 ± 1.6), 1 (1.9 ± 1.3), 3 (1.8 ± 1.3) and 6 months (2.1 ± 1.5) after Glossopharyngeal nerve block as compared to the baseline (6.1 ± 1.3; P value < 0.05); we also observed a significant pain relief (76%) and significantly reduced analgesic consumption (68%) and PHQ-9 scores (2.3 ± 1.7) compared to the baseline values (P value < 0.05).</div></div><div><h3>Conclusion</h3><div>Ultrasound-guided glossopharyngeal nerve block with a linear array hockey stick probe provided significant pain relief in 75% of study participants with glossopharyngeal neuralgia over a six-month follow-up period.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100744"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-25DOI: 10.1016/j.inpm.2026.100745
Mihir Joshi , Hasan Sen , Amanda N. Cooper , Brook Martin , Alycia Amatto , Allison Glinka Przybysz , Aaron M. Conger , Zachary L. McCormick , Robert Burnham , Taylor Burnham
Background
Patient selection for lumbar medial branch radiofrequency neurotomy (LMBRFN) remains a topic of debate. Different block paradigms may influence LMBRFN outcomes. This study examined the relationships between block paradigms and treatment results following LMBRFN.
Methods
A retrospective cohort study of consecutive patients undergoing first-time LMBRFN between 2016 and 2022 at two associated Canadian clinics was performed. Patients were grouped into six prognostic block paradigms based on block type (medial branch block [MBB] vs. intra-articular block [IAB]), number of blocks (single vs. dual), and percent pain relief (50–79% vs. ≥80%): 1 = MBB/MBB ≥80%, 2 = MBB/MBB 50–79%, 3 = IAB/MBB ≥80%, 4 = IAB/MBB 50–79%, 5 = MBB ≥80%, and 6 = MBB 50–79%. Treatment success was defined by (1) ≥50% reduction in numerical rating scale (NRS) pain score and (2) the minimal clinically important difference (MCID) in Pain Disability Quality-of-Life Questionnaire–Spine (PDQQ-S) at 3 months post-procedure. Logistic regression was used to assess associations between block paradigm and outcomes while controlling for select demographic and clinical factors.
Results
Among 631 included patients (57.1% female; mean age 62.3 ± 12.9 years), 46.9% achieved ≥50% NRS reduction and 47.7% met the MCID for PDQQ-S at 3 months. No significant associations were found between block paradigms and ≥50% pain relief. However, the IAB/MBB 50–79% paradigm was associated with significantly lower odds of functional improvement by the PDQQ-S (OR = 0.31; p = 0.02). Patients who were working at the time of the procedure had higher odds of treatment success with respect to pain (OR = 2.51; p < 0.01) and function (OR = 2.21; p < 0.01).
Conclusion
In this cohort, nearly half of patients experienced clinically meaningful pain reduction at 3 months post-LMBRFN, regardless of block selection criteria, challenging the need for restrictive paradigms. However, patients selected by IAB/MBB with 50–79% pain relief were less likely to experience clinically significant improvements to function. Active employment was linked to better 3-month outcomes for both pain and function, highlighting potential psychosocial factors. Larger prospective studies with long-term follow-up are needed to confirm these findings and optimize patient selection for LMBRFN.
{"title":"Evaluating prognostic block selection criteria in lumbar medical branch radiofrequency neurotomy: A retrospective cohort study","authors":"Mihir Joshi , Hasan Sen , Amanda N. Cooper , Brook Martin , Alycia Amatto , Allison Glinka Przybysz , Aaron M. Conger , Zachary L. McCormick , Robert Burnham , Taylor Burnham","doi":"10.1016/j.inpm.2026.100745","DOIUrl":"10.1016/j.inpm.2026.100745","url":null,"abstract":"<div><h3>Background</h3><div>Patient selection for lumbar medial branch radiofrequency neurotomy (LMBRFN) remains a topic of debate. Different block paradigms may influence LMBRFN outcomes. This study examined the relationships between block paradigms and treatment results following LMBRFN.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of consecutive patients undergoing first-time LMBRFN between 2016 and 2022 at two associated Canadian clinics was performed. Patients were grouped into six prognostic block paradigms based on block type (medial branch block [MBB] vs. intra-articular block [IAB]), number of blocks (single vs. dual), and percent pain relief (50–79% vs. ≥80%): 1 = MBB/MBB ≥80%, 2 = MBB/MBB 50–79%, 3 = IAB/MBB ≥80%, 4 = IAB/MBB 50–79%, 5 = MBB ≥80%, and 6 = MBB 50–79%. Treatment success was defined by (1) ≥50% reduction in numerical rating scale (NRS) pain score and (2) the minimal clinically important difference (MCID) in Pain Disability Quality-of-Life Questionnaire–Spine (PDQQ-S) at 3 months post-procedure. Logistic regression was used to assess associations between block paradigm and outcomes while controlling for select demographic and clinical factors.</div></div><div><h3>Results</h3><div>Among 631 included patients (57.1% female; mean age 62.3 ± 12.9 years), 46.9% achieved ≥50% NRS reduction and 47.7% met the MCID for PDQQ-S at 3 months. No significant associations were found between block paradigms and ≥50% pain relief. However, the IAB/MBB 50–79% paradigm was associated with significantly lower odds of functional improvement by the PDQQ-S (OR = 0.31; <em>p</em> = 0.02). Patients who were working at the time of the procedure had higher odds of treatment success with respect to pain (OR = 2.51; <em>p</em> < 0.01) and function (OR = 2.21; <em>p</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>In this cohort, nearly half of patients experienced clinically meaningful pain reduction at 3 months post-LMBRFN, regardless of block selection criteria, challenging the need for restrictive paradigms. However, patients selected by IAB/MBB with 50–79% pain relief were less likely to experience clinically significant improvements to function. Active employment was linked to better 3-month outcomes for both pain and function, highlighting potential psychosocial factors. Larger prospective studies with long-term follow-up are needed to confirm these findings and optimize patient selection for LMBRFN.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"5 1","pages":"Article 100745"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358369","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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