Interventional Pain Medicine最新文献_第4页

Subject: Letters to the editor: Re: rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: A retrospective study utilizing a large national database 主题：致编辑的信：Re：椎体神经消融后腰椎压缩性骨折的发生率：一项利用大型国家数据库的回顾性研究

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100712

Patricia Zheng, Conor O'Neill

引用次数: 0

Intrathecal drug delivery for chronic abdominal pain: A case series 鞘内给药治疗慢性腹痛：一个病例系列

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100703

Harold Burke , Michael Liu , Salim M. Hayek

Introduction

Chronic Abdominal Pain (CAP) is a pervasive and challenging global health issue. In a 2023 United States National Health Interview Survey, CAP was present in almost 3 % of all respondents. Various interventional procedures, such as sympathetic nerve blocks (SNBs), thoracolumbar sympathetic ablations, and spinal cord stimulation (SCS), have shown mixed efficacy in managing CAP. This case series describes refractory CAP that is effectively managed with IDD after a treatment algorithm to first distinguish nociceptive pain from a centrally mediated process, but only when the AGA ROME IV criteria for CAP is met.

Methods

Four patients were identified in clinical practice as suitable candidates for an IDD for refractory, non-centrally mediated CAP. Two of the patients had constant CAP meeting the ROME IV AGA diagnostic criteria for CAP and therefore underwent a DDE-ultimately with findings suggestive of visceral or somatic pain given a >70 % reduction in pain after administration of the local anesthetic and confirmation of a sensory level change, but not after the administration of normal saline prior. (Tabe 1). All patients underwent a continuous intrathecal catheter trial, except for one patient with cystic fibrosis and unpredictable pancreatitis pain episodes, who had failed a spinal cord stimulator implant and proceeded straight to an IDDS implant.

Results

IDD effectively managed refractory CAP across these four cases, with implantation durations ranging from 1.5 to 10 years. All patients remained off systemic opioids and maintained complete functional independence-specifically their Activities of Daily Living (ADLs) as well as Instrumental ADLs.

Discussion

Effective management of CAP begins with a precise diagnosis that distinguishes between nociceptive and centrally mediated pain. Once centrally mediated pain is excluded, and provided patients did not experience sufficient analgesia with other less invasive interventions, targeted treatment for visceral/nociceptive pain with intrathecal drug delivery can be attempted. This case series highlights IDD as a promising alternative to other interventional therapies for refractory CAP, offering durable pain relief with potentially fewer complications.

慢性腹痛（CAP）是一个普遍和具有挑战性的全球健康问题。在2023年美国全国健康访谈调查中，几乎3%的受访者存在CAP。各种介入治疗方法，如交感神经阻滞（SNBs）、胸腰段交感神经消融和脊髓刺激（SCS），在治疗CAP方面显示出不同的疗效。本病例系列描述了在治疗算法首先区分伤害性疼痛和中枢介导过程后，用IDD有效治疗难治性CAP的难治性CAP，但只有在满足AGA ROME IV CAP标准的情况下。方法：在临床实践中，4例患者被确定为难治性非中枢介导性CAP的合适IDD候选人。其中2例患者的持续性CAP符合ROME IV AGA对CAP的诊断标准，因此接受了dde，最终发现提示内脏或躯体疼痛，在给予局麻药并确认感觉水平改变后疼痛减轻了70%，但在给予生理盐水后没有。(课程1)。所有患者都进行了连续的鞘内导管试验，除了一名患有囊性纤维化和不可预测的胰腺炎疼痛发作的患者，他在脊髓刺激器植入失败后直接进行了IDDS植入。结果4例患者中，sidd有效控制了难治性CAP，植入时间从1.5年到10年不等。所有患者都没有使用全身性阿片类药物，并保持了完全的功能独立性，特别是他们的日常生活活动（adl）和工具性adl。CAP的有效管理始于对伤害性疼痛和中枢介导性疼痛的精确诊断。一旦排除了中枢介导的疼痛，并且患者在其他侵入性较小的干预措施下没有获得足够的镇痛，可以尝试鞘内给药靶向治疗内脏/伤害性疼痛。本病例系列强调IDD作为难治性CAP的其他介入治疗的有希望的替代方法，提供持久的疼痛缓解，潜在的并发症更少。

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引用次数: 0

Letter to the Editor: Intellectual conflicts of interest in spinal cord stimulation research - The gap between theoretical knowledge and clinical expertise 致编辑的信：脊髓刺激研究中的知识冲突-理论知识与临床专业知识之间的差距

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100715

Hemant Kalia , Scott Pritzlaff , Konstantin Slavin

引用次数: 0

The effectiveness of cervical medial branch radiofrequency ablation using a three-tined electrode: A real-world cross-sectional cohort study 使用三针电极射频消融颈内侧分支的有效性：一项真实世界的横断面队列研究

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100710

Hasan Sen , Napatpaphan Kanjanapanang , Amanda N. Cooper , Seth Bires , Audrey Adler , Akbar Nabi , Blake Dickenson , William Tang , Chase Young , Taylor Burnham , Allison Glinka Przybysz , Aaron Conger , Zachary L. McCormick

Background

Cervical medial branch radiofrequency ablation (CMBRFA) using conventional electrodes is a proven treatment for chronic cervical zygapophysial (facet) joint pain. More recently, multi-tined RFA technology has been adopted in clinical practice, warranting evaluation of treatment outcomes.

Objectives

Evaluate the effectiveness of CMBRFA using a three-tined RFA electrode for the treatment of cervical facet joint pain in a real-world cohort.

Methods

In this cross-sectional cohort study, electronic medical records of patients who underwent CMBRFA utilizing a three-tined RFA electrode at a single academic medical center between 2022 and 2024 were reviewed. Outcomes were collected at ≥6 months post-CMBRFA via standardized telephone survey, querying numerical rating scale (NRS) pain scores, patient global impression of change (PGIC) scores, and opioid use. The primary outcome was the proportion reporting ≥50 % NRS reduction. Secondary outcomes included ≥2-point NRS reduction, PGIC scores ≥6 (indicating at least “much improved”), and pre-versus post-CMBRFA opioid use. Potential predictors of treatment success were evaluated with multivariate Poisson regression analysis.

Results

66 patients were included. At mean follow-up of 16.3 ± 7.0 months, 51.5 % (95 %CI: 39.7–63.2) reported ≥50 % NRS reduction, 77.3 % (95 %CI: 65.8–85.7) experienced ≥2-point NRS reduction, and 63.6 % (95 %CI: 51.6–74.2) had PGIC ≥6. Opioid use was decreased significantly by 15.2 % (95 %CI: 5.0–25.3). Follow-up time and repeat CMBRFA were significantly associated with outcomes for PGIC.

Conclusion

In this real-world cohort, we observed clinically meaningful improvements in neck pain (defined as ≥50 % NRS reduction from baseline) in 51.5 % of participants at an average of approximately 16 months after treatment with CMBRFA using a three-tined electrode.

背景：使用传统电极的颈内侧支射频消融术（CMBRFA）是治疗慢性颈关节关节（小关节）疼痛的有效方法。最近，多次射频消融技术已在临床实践中采用，保证了治疗结果的评估。目的在现实世界队列中评估CMBRFA使用三针RFA电极治疗颈椎小关节疼痛的有效性。方法在这项横断面队列研究中，回顾了2022年至2024年间在单一学术医疗中心使用三针RFA电极进行CMBRFA的患者的电子病历。通过标准化电话调查收集cmbrfa后≥6个月的结果，查询数值评定量表（NRS）疼痛评分、患者总体印象变化（PGIC）评分和阿片类药物使用情况。主要终点为报告NRS降低≥50%的比例。次要结局包括NRS降低≥2点，PGIC评分≥6（表明至少“大大改善”），以及cmbrfa前后阿片类药物的使用。用多元泊松回归分析评估治疗成功的潜在预测因素。结果共纳入66例患者。在平均随访16.3±7.0个月时，51.5% （95% CI: 39.7-63.2）报告NRS降低≥50%，77.3% （95% CI: 65.8-85.7）报告NRS降低≥2点，63.6% （95% CI: 51.6-74.2）报告PGIC≥6。阿片类药物使用显著减少15.2% （95% CI: 5.0-25.3）。随访时间和重复CMBRFA与PGIC的预后显著相关。在这个真实世界的队列中，我们观察到51.5%的参与者在使用三针电极CMBRFA治疗后平均约16个月的颈部疼痛有临床意义的改善（定义为NRS从基线降低≥50%）。

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引用次数: 0

Feasibility of a mobile application to track longitudinal pain outcomes after epidural joint injections 跟踪硬膜外关节注射后纵向疼痛结果的移动应用程序的可行性

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100709

Patricia Z. Zheng , Ted Miclau , Brandon Goenawan , Gabriel Johnson , Conor O'Neill , Lyndly Tamura , Peter I-Kung Wu , Matthew Smuck

Background

Tracking spine intervention outcomes is costly and time-consuming, hindering research. Mobile health (mhealth) applications offer a promising solution to reduce the need to hire personnel to recruit patients and collect data. However, evidence supporting the use of mHealth to study pain and spine interventions is limited and heterogeneous.

Objectives

This study aims to understand how recruitment methods influence patient recruitment and retention in a digital study tracking pain. We hypothesize that in-person recruitment, especially with a physician rather than a research assistant, leads to higher recruitment and retention.

Methods

We designed a prospective observational study of patients scheduled for spine injections at an academic outpatient surgical center. Eligible patients were recruited via three methods: in-person research assistant, remote research assistant via phone, or in-person clinician. Upon enrollment, a mHealth application prompted patients to complete post-injection surveys at pre-defined intervals based on injection type. Enrollment and retention rates were then compared across recruitment groups.

Results

Of 194 patients approached, enrollment rates differed significantly by recruitment strategy: 94.1 % for in-person physicians (N = 32 enrolled/34 approached), 85.0 % for in-person research assistants (N = 51/60), and 30.0 % for remote research assistants (N = 30/100) (p < 0.009, Fisher's exact test). Of those recruited, survey completion rates were 74.4 % (physician-recruited patients), 55.1 % (in-person research assistant), and 58.4 % (remote research assistant). Neither demographic factors (age, sex, employment, payer type) nor injection type influenced enrollment. Retention differed significantly across groups (p = 0.0174, Kruskal-Wallis test), with physician-recruited patients completing the most surveys. Moreover, Medicare patients had significantly higher completion rates than those with Medicaid.

Conclusion

Tracking post-injection pain using mHealth applications is feasible, though success depends heavily on recruitment strategy. In-person physician-led enrollment resulted in the highest recruitment and retention rates though the drop-out rates were still significant. Future studies should focus on refining recruitment approaches to optimize patient participation.

背景：跟踪脊柱干预结果既昂贵又耗时，阻碍了研究。移动医疗（mhealth）应用程序提供了一个很有前途的解决方案，可以减少招聘人员招募患者和收集数据的需要。然而，支持使用移动健康来研究疼痛和脊柱干预措施的证据是有限的和不一致的。目的：本研究旨在了解在一项追踪疼痛的数字化研究中，招募方法如何影响患者招募和保留。我们假设，亲自招聘，特别是与医生而不是研究助理，导致更高的招聘和保留。方法我们设计了一项前瞻性观察研究，研究对象是在一家学术门诊外科中心接受脊柱注射的患者。通过现场研究助理、电话远程研究助理或现场临床医生三种方法招募符合条件的患者。在登记时，移动健康应用程序提示患者根据注射类型按预先定义的间隔完成注射后调查。然后比较不同招募组的入学率和保留率。结果在194例患者中，不同招募策略的入组率差异显著：现场医生入组率为94.1% （N = 32名入组/34名入组），现场研究助理入组率为85.0% (N = 51/60)，远程研究助理入组率为30.0% (N = 30/100) （p < 0.009， Fisher精确检验）。在这些被招募的患者中，调查完成率为74.4%（医生招募的患者），55.1%（亲自研究助理）和58.4%（远程研究助理）。人口统计学因素（年龄、性别、就业、付款人类型）和注射类型均不影响入组。保留率在各组之间差异显著（p = 0.0174， Kruskal-Wallis检验），医生招募的患者完成的调查最多。此外，医疗保险患者的完成率明显高于医疗补助患者。结论使用移动健康应用跟踪注射后疼痛是可行的，但成功与否很大程度上取决于招募策略。由医生亲自指导的注册导致了最高的招聘率和保留率，尽管辍学率仍然很高。未来的研究应侧重于改进招募方法，以优化患者参与。

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引用次数: 0

Evaluating the effectiveness of 7-min basivertebral nerve ablation in treating vertebrogenic low back pain 评价椎体神经消融7分钟治疗椎源性腰痛的疗效

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100714

Andrew R. Stephens , Gabriella H. Wozniak , Ramzi El-Hassan , Adem F. Aktas

Background

Basivertebral nerve radiofrequency ablations (BVNRFA) is an established treatment for chronic vertebrogenic low back pain. However, published studies have exclusively evaluated the effectiveness of 15-min ablations for BVNRFA. Recently, industry has recommended performing 7-min ablations but there is no literature demonstrating this as an effective procedure.

Objective

The purpose of this study was to evaluate 7-min BVNRFA outcomes of pain and function.

Methods

Retrospective review of consecutive patients with chronic (>6 months) axial midline low back pain with a reported pain score ≥4 that had failed conservative treatment with corroborating Modic type I or Modic type II changes on MRI who underwent exclusively 7-min BVNRFA was conducted at a multidisciplinary spine center. Visual analog pain scores (VAS) were collected at baseline, 1-, 3-, 6-, and 12-month post-procedure. Consistent with prior literature, success was defined two ways: achieving a ≥50 % in VAS pain reduction at post-procedure visits compared to baseline scores and achieving a reduction of VAS greater than the minimally clinical important difference of 2. Wilcoxon signed-rank test was used to compare post-procedure scores with baseline scores. Percent of patients with a successful treatment was calculated at each follow-up time period.

Results

A total of 86 patients underwent BVNRFA during the study period and 75 met inclusion criteria. VAS scores significantly improved between baseline (7.1 ± 1.9) and 1-month (3.9 ± 3.0, p < 0.001), 3-months (3.4 ± 3.0, p < 0.001), 6-months (4.4 ± 2.6; p < 0.001) and 12-months post-procedure scores (3.7 ± 2.6; p < 0.001). The percentage of patients with a successful treatment of ≥50 % in VAS pain reduction was 50.7 % (95 % CI 38.8 %, 26.7 %) at 1-month, 56.9 % (95 % CI 44.9 %, 69.0 %) at 3-months, 42.9 % (95 % CI 29.0 %, 56.7 %) at 6-months and 50.0 % (95 % CI 23.1 %, 67.9 %) at 12-months. The percentage of patients with a successful treatment of ≥2 in VAS pain reduction was 67.2 % (95 % CI: 55.9 %, 78.4 %) at 1-month, 67.7 % (95 % CI: 56.3 %, 79.1 %) at 3-months, 65.3 % (95 % CI: 52.0 %, 78.6 %) at 6-months and 70.0 %, (95 % CI: 52.1 %, 90.8 %) at 12-months

Conclusions

Although our study demonstrated that patients treated with BVNRFA with a 7-min ablation reported significant improvement in pain, the proportion of patients with a successful reduction of pain is likely lower than data published for 15-min ablations. Future controlled trials comparing outcomes and lesion sizes of 7- and 15-min BVNA are needed.

背景：椎体神经射频消融术（BVNRFA）是治疗慢性椎源性腰痛的常用方法。然而，已发表的研究专门评估了15分钟消融对BVNRFA的有效性。最近，业界建议进行7分钟的消融，但没有文献证明这是一种有效的方法。目的评价BVNRFA术后7分钟疼痛和功能的预后。方法：在多学科脊柱中心对连续的慢性（6个月）轴向中线腰痛患者进行回顾性研究，这些患者报告的疼痛评分≥4，保守治疗失败，MRI显示Modic I型或Modic II型改变，仅接受7分钟BVNRFA。在基线、术后1、3、6和12个月收集视觉模拟疼痛评分（VAS）。与先前的文献一致，成功被定义为两种方式：与基线评分相比，术后就诊时VAS疼痛减轻≥50%，VAS减轻大于2的最小临床重要差异。采用Wilcoxon符号秩检验比较术后评分与基线评分。在每个随访期间计算成功治疗的患者百分比。结果86例患者在研究期间接受了BVNRFA治疗，75例符合纳入标准。VAS评分在基线（7.1±1.9）、术后1个月（3.9±3.0,p < 0.001）、3个月（3.4±3.0,p < 0.001）、6个月（4.4±2.6,p < 0.001）和12个月评分（3.7±2.6,p < 0.001）之间显著改善。治疗成功的患者在VAS疼痛减轻≥50%的百分比为：1个月时50.7% (95% CI 38.8%, 26.7%)， 3个月时56.9% (95% CI 44.9%, 69.0%)， 6个月时42.9% (95% CI 29.0%, 56.7%)， 12个月时50.0% （95% CI 23.1%, 67.9%）。治疗≥2次成功减轻VAS疼痛的患者比例为：1个月时67.2% (95% CI: 55.9%, 78.4%)， 3个月时67.7% (95% CI: 56.3%, 79.1%)， 6个月时65.3% (95% CI: 52.0%, 78.6%), 70.0% (95% CI：结论：尽管我们的研究表明，接受BVNRFA治疗的7分钟消融患者报告疼痛有显著改善，但成功减轻疼痛的患者比例可能低于15分钟消融的数据。未来的对照试验需要比较7和15分钟BVNA的结果和病变大小。

{"title":"Evaluating the effectiveness of 7-min basivertebral nerve ablation in treating vertebrogenic low back pain","authors":"Andrew R. Stephens , Gabriella H. Wozniak , Ramzi El-Hassan , Adem F. Aktas","doi":"10.1016/j.inpm.2025.100714","DOIUrl":"10.1016/j.inpm.2025.100714","url":null,"abstract":"<div><h3>Background</h3><div>Basivertebral nerve radiofrequency ablations (BVNRFA) is an established treatment for chronic vertebrogenic low back pain. However, published studies have exclusively evaluated the effectiveness of 15-min ablations for BVNRFA. Recently, industry has recommended performing 7-min ablations but there is no literature demonstrating this as an effective procedure.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate 7-min BVNRFA outcomes of pain and function.</div></div><div><h3>Methods</h3><div>Retrospective review of consecutive patients with chronic (>6 months) axial midline low back pain with a reported pain score ≥4 that had failed conservative treatment with corroborating Modic type I or Modic type II changes on MRI who underwent exclusively 7-min BVNRFA was conducted at a multidisciplinary spine center. Visual analog pain scores (VAS) were collected at baseline, 1-, 3-, 6-, and 12-month post-procedure. Consistent with prior literature, success was defined two ways: achieving a ≥50 % in VAS pain reduction at post-procedure visits compared to baseline scores and achieving a reduction of VAS greater than the minimally clinical important difference of 2. Wilcoxon signed-rank test was used to compare post-procedure scores with baseline scores. Percent of patients with a successful treatment was calculated at each follow-up time period.</div></div><div><h3>Results</h3><div>A total of 86 patients underwent BVNRFA during the study period and 75 met inclusion criteria. VAS scores significantly improved between baseline (7.1 ± 1.9) and 1-month (3.9 ± 3.0, p < 0.001), 3-months (3.4 ± 3.0, p < 0.001), 6-months (4.4 ± 2.6; p < 0.001) and 12-months post-procedure scores (3.7 ± 2.6; p < 0.001). The percentage of patients with a successful treatment of ≥50 % in VAS pain reduction was 50.7 % (95 % CI 38.8 %, 26.7 %) at 1-month, 56.9 % (95 % CI 44.9 %, 69.0 %) at 3-months, 42.9 % (95 % CI 29.0 %, 56.7 %) at 6-months and 50.0 % (95 % CI 23.1 %, 67.9 %) at 12-months. The percentage of patients with a successful treatment of ≥2 in VAS pain reduction was 67.2 % (95 % CI: 55.9 %, 78.4 %) at 1-month, 67.7 % (95 % CI: 56.3 %, 79.1 %) at 3-months, 65.3 % (95 % CI: 52.0 %, 78.6 %) at 6-months and 70.0 %, (95 % CI: 52.1 %, 90.8 %) at 12-months</div></div><div><h3>Conclusions</h3><div>Although our study demonstrated that patients treated with BVNRFA with a 7-min ablation reported significant improvement in pain, the proportion of patients with a successful reduction of pain is likely lower than data published for 15-min ablations. Future controlled trials comparing outcomes and lesion sizes of 7- and 15-min BVNA are needed.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100714"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693699","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}

引用次数: 0

Timing and trajectory of pain and functional outcomes after basivertebral nerve ablation: a prospective cohort study 椎体神经消融后疼痛和功能结局的时间和轨迹：一项前瞻性队列研究

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100652

Charles A. Odonkor , Oghenewoma Oghenesume , Sera Yoo , Sergio Mosquera Limas , Jacky Yeung , Patrick Doherty , Sumeet Kadian , Jared Rosenberg , Sudhir K. Kadian , Peter G. Whang

Background

Basivertebral nerve ablation (BVNA) is an FDA-cleared treatment for vertebrogenic low back pain. However, limited data exist detailing the specific timing and durability of patient-reported relief.

Objective

To characterize the weekly temporal trajectory of patient-reported ≥50 % pain relief and evaluate the predictive value for short-term and sustained response.

Methods

This prospective observational cohort study included 86 consecutive patients with MRI-confirmed Modic Type 1 or 2 changes treated with intraosseous BVNA between April 2024 and April 2025 at an academic center. Patients reported weekly pain relief for 8 weeks, then again at 12 and 24 weeks. Primary outcomes were time to first ≥50 % relief and the positive and negative likelihood ratios (LR⁺, LR⁻) of early improvement for predicting response. Secondary outcomes included changes in Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and adjunctive spine interventions.

Results

Pain reduction was rapid and durable: By Week 1, 34 % of patients achieved ≥50 % relief, increasing to 76 % by Week 3 and 91 % by Week 6. These improvements plateaued through Week 12 and persisted at 24 weeks. Median time to first ≥50 % relief was 3 weeks. Early responders (Week 3) were 6.6 times more likely to maintain relief at Week 12 (LR⁺ = 6.56, 95 % CI 2.50–17.0); predictive utility peaked at Weeks 4–6 (LR⁺ 7.1–9.0; LR⁻ ≤ 0.13). Mean ODI improved from 66.5 ± 13.5 to 32.3 ± 15.8 and NRS from 8.3 ± 1.5 to 3.0 ± 2.6 (p < 0.0001 for both). Nearly 90 % achieved ≥15-point ODI and ≥2-point NRS improvement; 21 % were pain-free by Week 12. Use of adjunctive spine injections declined from 86 % pre-procedure to 22 % post-procedure (p < 0.0001).

Conclusion

This is the first study to prospectively characterize the weekly time course of response following BVNA and demonstrates early, substantial, and durable improvements in pain and function. Most patients experienced meaningful relief within 3–6 weeks, and early response was sustained through 24 weeks. These findings support BVNA as a robust real-world intervention for vertebrogenic pain and highlight the prognostic value of early pain trajectory monitoring in predicting sustained outcomes.

背景：椎体神经消融术（BVNA）是一种经fda批准的治疗椎体源性腰痛的方法。然而，详细说明患者报告的缓解的具体时间和持久性的数据有限。目的描述患者报告≥50%疼痛缓解的每周时间轨迹，并评估短期和持续反应的预测价值。该前瞻性观察队列研究纳入了2024年4月至2025年4月在某学术中心接受骨内BVNA治疗的86例mri确诊的modc 1型或2型病变患者。患者每周报告疼痛缓解，持续8周，然后在12周和24周再次报告。主要结局是到达首次≥50%缓解的时间，以及早期改善的正似然比和负似然比（LR+, LR -）用于预测缓解。次要结局包括Oswestry残疾指数（ODI）、数字评定量表（NRS）和辅助脊柱干预的变化。西班牙的缓解是快速和持久的：到第1周，34%的患者达到≥50%的缓解，到第3周增加到76%，到第6周增加到91%。这些改善在第12周趋于稳定，并持续到第24周。首次≥50%缓解的中位时间为3周。早期应答者（第3周）在第12周维持缓解的可能性是前者的6.6倍（LR+ = 6.56, 95% CI 2.50-17.0）；预测效用在第4-6周达到峰值（LR+ 7.1-9.0; LR−≤0.13）。平均ODI从66.5±13.5改善到32.3±15.8，NRS从8.3±1.5改善到3.0±2.6 （p < 0.0001）。近90% ODI改善≥15分，NRS改善≥2分；到第12周，21%的患者疼痛消失。辅助脊柱注射的使用率从术前的86%下降到术后的22% （p < 0.0001）。结论：这是第一个前瞻性描述BVNA后每周反应时间过程的研究，并证明了疼痛和功能的早期、实质性和持久改善。大多数患者在3-6周内获得有意义的缓解，早期反应持续到24周。这些发现支持BVNA作为椎体源性疼痛的一种强大的现实干预手段，并强调了早期疼痛轨迹监测在预测持续预后方面的预后价值。

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引用次数: 0

Targeting the intrinsic bone nerve supply for joint denervation in osteoarthritis: A Copernican revolution, or just another fad relegated to the graveyard of scientific history? 针对骨关节炎中关节去神经的内在骨神经供应：哥白尼式的革命，还是另一个被扔进科学史墓地的时尚？

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100704

Nafisseh S. Warner MD , Steven P. Cohen MD

引用次数: 0

2-Year clinical outcomes following combined iliotibial band and gluteus medius percutaneous ultrasound tenotomy in refractory GTPS 髂胫束联合臀中肌经皮超声肌腱切开术治疗难治性GTPS 2年临床观察

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100717

Ugur Yener , Mohamed Awad , Tahereh Naeimi , Kyle Max Mayblum , Sebastian H. Lujan Varela , Joseph M. Seldin , Hatice Begum Ciftci , Alaa Abd-Elsayed , Sayed Emal Wahezi

Background

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of chronic lateral hip pain, often refractory to conservative medical management (CMM). Combined percutaneous ultrasound-guided tenotomy (PUT) of the gluteus medius (GMed) and iliotibial band (ITB) has shown promising one-year results, but data on long-term outcomes remain limited. This study evaluates two-year clinical outcomes in patients undergoing combined GMed and ITB PUT for recalcitrant GTPS.

Methods

This retrospective cohort study included 69 patients (79 hips) treated with combined GMed and ITB PUT between January 2022 and August 2023. Baseline and follow-up data, collected for an average of 2-year, were obtained through chart review and structured phone interviews. The primary outcome was ≥50 % reduction in Numeric Rating Scale (NRS) pain scores. Secondary outcomes included side-lying tolerance, sitting-to-standing ability, responder rate and need for additional hip interventions. Responder status required both pain reduction and complete side-lying tolerance. Statistical significance was evaluated using paired t-tests with p < 0.05.

Results

Median baseline Numeric Rating Scale (NRS) pain score was 10 interquartile range (IQR 9–10), decreasing significantly to 2 (IQR 1–4) at 1, 6, and 12 months, then increasing to 6 (IQR 4–10) at 24 months (p < 0.001 vs. baseline). Rates of ≥50 % improvement in NRS were 88.6 % at 1 month, 89.6 % at 6 months, 83.0 % at 12 months, and 59.5 % at 24 months. Side-lying tolerance improved from 21.5 % hips at baseline to 88.9 % reporting improvement at 1 month and 55.7 % at 24 months (p < 0.001). Sitting-to-standing ability showed sustained improvement at 81.0 % at 24 months. Composite responder rate declined from 88.6 % at 1 month to 57.0 % at 24 months. Subsequent invasive interventions were required in a minority of cases (2.5 % total hip arthroplasty; 11.4 % repeat TENEX).

Conclusion

Combined PUT of the GMed and ITB provides durable pain relief and functional improvement in patients with refractory GTPS at two years post-procedure. Despite declining responder rates over time, this minimally invasive dual-target technique demonstrates a favorable safety profile and may delay or reduce the need for more invasive surgery. Further prospective studies are warranted to optimize patient selection and validate long-term efficacy.

背景：大转子疼痛综合征（GTPS）是慢性髋外侧疼痛的常见原因，通常难以保守治疗（CMM）。联合经皮超声引导下的臀中肌（GMed）和髂胫束（ITB）的肌腱切开术（PUT）显示出有希望的一年效果，但长期结果的数据仍然有限。这项研究评估了联合GMed和ITB PUT治疗顽固性GTPS患者的两年临床结果。方法本回顾性队列研究包括69例（79髋）患者，于2022年1月至2023年8月期间接受GMed和ITB PUT联合治疗。通过图表回顾和结构化电话访谈获得平均2年的基线和随访数据。主要结局是数字评定量表（NRS）疼痛评分降低≥50%。次要结果包括侧躺耐受性、坐立能力、应答率和额外髋关节干预的需要。反应状态需要疼痛减轻和完全侧躺耐受。采用配对t检验，p <； 0.05评价统计学意义。结果基线数值评定量表（NRS）疼痛评分中位数为10分位（IQR 9-10），在1、6和12个月时显著下降至2分位（IQR 1 - 4），在24个月时上升至6分位（IQR 4-10）（与基线相比p <； 0.001）。NRS≥50%的改善率分别为：1个月时88.6%，6个月时89.6%，12个月时83.0%，24个月时59.5%。侧躺容忍度从基线时的21.5%提高到1个月时的88.9%和24个月时的55.7% （p < 0.001）。坐-站能力在24个月时持续改善81.0%。综合应答率从1个月时的88.6%下降到24个月时的57.0%。少数病例需要后续的侵入性干预（2.5%全髋关节置换术；11.4%重复TENEX）。结论GMed和ITB联合应用可在术后2年对难治性GTPS患者提供持久的疼痛缓解和功能改善。尽管随着时间的推移应答率不断下降，但这种微创双靶技术显示出良好的安全性，并可能延迟或减少对更多侵入性手术的需要。进一步的前瞻性研究有必要优化患者选择并验证长期疗效。

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引用次数: 0

Re: “Intellectual conflicts of interest in spinal cord stimulation research – The gap between theoretical knowledge and clinical expertise” 回复：“脊髓刺激研究中的知识冲突-理论知识与临床专业知识之间的差距”

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100713

Allison Glinka Przybysz , To-Nhu Vu , Andrew J.B. Pisansky , Nathaniel M. Schuster , Samir Sheth , David S. Cheng , Steven M. Lobel , Danielle Binler , Belinda Duszynski , Aaron Conger , Byron J. Schneider , Ryan Mattie

引用次数: 0