Interventional Pain Medicine最新文献_第4页

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。

{"title":"Feasibility of a mobile application to track longitudinal pain outcomes after epidural joint injections","authors":"Patricia Z. Zheng , Ted Miclau , Brandon Goenawan , Gabriel Johnson , Conor O'Neill , Lyndly Tamura , Peter I-Kung Wu , Matthew Smuck","doi":"10.1016/j.inpm.2025.100709","DOIUrl":"10.1016/j.inpm.2025.100709","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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) (<em>p</em> < 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 (<em>p</em> = 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100709"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624046","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

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。

{"title":"Timing and trajectory of pain and functional outcomes after basivertebral nerve ablation: a prospective cohort study","authors":"Charles A. Odonkor , Oghenewoma Oghenesume , Sera Yoo , Sergio Mosquera Limas , Jacky Yeung , Patrick Doherty , Sumeet Kadian , Jared Rosenberg , Sudhir K. Kadian , Peter G. Whang","doi":"10.1016/j.inpm.2025.100652","DOIUrl":"10.1016/j.inpm.2025.100652","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>To characterize the weekly temporal trajectory of patient-reported ≥50 % pain relief and evaluate the predictive value for short-term and sustained response.</div></div><div><h3>Methods</h3><div>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<sup>+</sup>, LR<sup>−</sup>) of early improvement for predicting response. Secondary outcomes included changes in Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and adjunctive spine interventions.</div></div><div><h3>Results</h3><div>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<sup>+</sup> = 6.56, 95 % CI 2.50–17.0); predictive utility peaked at Weeks 4–6 (LR<sup>+</sup> 7.1–9.0; LR<sup>−</sup> ≤ 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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100652"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624040","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

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。

{"title":"2-Year clinical outcomes following combined iliotibial band and gluteus medius percutaneous ultrasound tenotomy in refractory GTPS","authors":"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","doi":"10.1016/j.inpm.2025.100717","DOIUrl":"10.1016/j.inpm.2025.100717","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100717"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693592","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

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

The sphenopalatine ganglion as a target in interventional pain therapy 蝶腭神经节在介入性疼痛治疗中的作用

Interventional Pain Medicine

Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100705

Stephan Klessinger

引用次数: 0

FACTFINDERS for PATIENT SAFETY: Minimizing complications in radiofrequency neurotomy: Part I—Implantable devices; Part II—Preprocedural BVNRFN imaging 患者安全的factfinder：减少射频神经切开术并发症：第一部分-植入式装置第二部分：术前BVNRFN成像

Interventional Pain Medicine

Pub Date : 2025-11-22 DOI: 10.1016/j.inpm.2025.100650

David Hao , Gerald Yeung , Haewon Lee , Zheyan Chen , Ben Laplante , Paul Kitei , Reza Ehsanian , David Levi

This series of FactFinders presents a brief summary of the evidence and outlines recommendations regarding minimizing risks with radiofrequency neurotomy procedures.

The evidence in support of the following facts is presented: (1) While data on the safety of radiofrequency neurotomy in patients with implanted devices are limited, the procedure can likely be performed safely with careful adherence to best practices and manufacturer recommendations. (2) Basivertebral nerve radiofrequency neurotomy can be performed safely and effectively at the L3 through S1 vertebral levels. Scrutiny of preprocedural imaging may minimize risk. Although the transpedicular approach is preferred, patient anatomy may dictate a non-transpedicular trajectory.

本系列的factfinder对证据进行了简要总结，并概述了如何将射频神经切开术的风险降到最低的建议。支持以下事实的证据被提出：(1)虽然射频神经切开术在植入设备患者中的安全性数据有限，但如果仔细遵守最佳实践和制造商建议，该手术可能会安全进行。(2)基底神经射频神经切开术可以在L3至S1椎体水平安全有效地进行。仔细检查手术前的影像可以将风险降到最低。虽然经椎弓根入路是首选，但患者的解剖结构可能决定非经椎弓根轨迹。

引用次数: 0

Chronic sternal pain relief after a pecto-intercostal fascial plane block: A case report 胸肋间筋膜平面阻滞后慢性胸骨疼痛缓解1例

Interventional Pain Medicine

Pub Date : 2025-11-19 DOI: 10.1016/j.inpm.2025.100655

Harlyn Naika Veloso-Evans, Kyle Wentz, Neville Campbell

Background

Chronic sternal pain is relatively common in adults and particularly in patients after surgery involving the chest wall such as with cardiac surgery or mastectomy. Treatment options for patients with chronic sternal pain have largely consisted of physical therapy and oral medications. The pecto-intercostal fascial plane block, while having proven efficacy in managing pain in the perioperative setting, has very limited evidence demonstrating its use within the outpatient setting.

Case report

This is a case of a 53-year-old female with chronic underlying sternal pain presumably from costochondritis who underwent radical bilateral mastectomy and radiation therapy for breast cancer, which significantly worsened her sternal pain. She failed conservative measures. A pecto-intercostal fascial plane block was ordered and administered. This brought 80–100 % pain relief and significant functional improvements for the patient which lasted for over three months.

Conclusion

This is a novel case where a patient with chronic sternal pain which worsened after bilateral mastectomy received a pecto-intercostal fascial plane block and had almost complete pain relief for over a three month period. Additional research is needed to further establish this procedure and its efficacy in managing patients in an outpatient setting with chronic sternal pain.

背景：慢性胸骨痛在成人中比较常见，特别是在胸壁手术后，如心脏手术或乳房切除术。慢性胸骨痛患者的治疗选择主要包括物理治疗和口服药物治疗。胸肋间筋膜平面阻滞虽然在围手术期治疗疼痛方面已被证实有效，但在门诊的应用证据非常有限。病例报告：这是一例53岁的女性，推测是由肋软骨炎引起的慢性胸骨疼痛，她因乳腺癌接受了根治性双侧乳房切除术和放射治疗，这明显加重了她的胸骨疼痛。她未能通过保守措施。嘱行胸肋间筋膜平面阻滞。这为患者带来了80 - 100%的疼痛缓解和显著的功能改善，持续了三个多月。结论：本病例为双侧乳房切除术后恶化的慢性胸骨疼痛患者，接受胸肋间筋膜平面阻滞治疗后，疼痛几乎完全缓解了三个多月。需要进一步的研究来进一步确定该程序及其在门诊治疗慢性胸骨痛患者中的疗效。

{"title":"Chronic sternal pain relief after a pecto-intercostal fascial plane block: A case report","authors":"Harlyn Naika Veloso-Evans, Kyle Wentz, Neville Campbell","doi":"10.1016/j.inpm.2025.100655","DOIUrl":"10.1016/j.inpm.2025.100655","url":null,"abstract":"<div><h3>Background</h3><div>Chronic sternal pain is relatively common in adults and particularly in patients after surgery involving the chest wall such as with cardiac surgery or mastectomy. Treatment options for patients with chronic sternal pain have largely consisted of physical therapy and oral medications. The pecto-intercostal fascial plane block, while having proven efficacy in managing pain in the perioperative setting, has very limited evidence demonstrating its use within the outpatient setting.</div></div><div><h3>Case report</h3><div>This is a case of a 53-year-old female with chronic underlying sternal pain presumably from costochondritis who underwent radical bilateral mastectomy and radiation therapy for breast cancer, which significantly worsened her sternal pain. She failed conservative measures. A pecto-intercostal fascial plane block was ordered and administered. This brought 80–100 % pain relief and significant functional improvements for the patient which lasted for over three months.</div></div><div><h3>Conclusion</h3><div>This is a novel case where a patient with chronic sternal pain which worsened after bilateral mastectomy received a pecto-intercostal fascial plane block and had almost complete pain relief for over a three month period. Additional research is needed to further establish this procedure and its efficacy in managing patients in an outpatient setting with chronic sternal pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100655"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579448","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

Comprehensive genicular nerve radiofrequency ablation for refractory knee pain using a dual-tined electrode: A technical description and cross-sectional cohort study 双电极膝神经射频消融治疗难治性膝关节疼痛：技术描述和横断面队列研究

Interventional Pain Medicine

Pub Date : 2025-11-19 DOI: 10.1016/j.inpm.2025.100656

Hasan Sen, Audrey Adler, Amanda N. Cooper, Napatpaphan Kanjanapanang, Jason E. Mascoe, Alexandra E. Fogarty, Allison Glinka Przybysz, Aaron Conger, Zachary L. McCormick

Background

Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for refractory knee pain. However, refinements of GNRFA protocols are ongoing as new technologies emerge amidst accumulating evidence supporting expanded lesioning strategies.

Objectives

Describe a novel, comprehensive GNRFA protocol utilizing dual-tined electrodes to target six genicular nerves and report clinical outcomes in a cross-sectional cohort. This technique incorporates both bipolar and monopolar ablation for precise, effective lesioning.

Methods

Consecutive patients who underwent GNRFA with the described protocol at a tertiary academic center were contacted for follow-up. Baseline demographic and clinical data were collected from electronic medical records, and outcomes were assessed via standardized telephone survey. The primary outcome was the proportion of participants with ≥50 % numerical rating scale (NRS) pain score reduction. Secondary outcomes included the respective proportions of participants with ≥2-point NRS reduction and Patient Global Impression of Change (PGIC) scores ≥6, reflecting a “much improved” or better status.

Results

Fourteen patients (16 GNRFA procedures) were included. At a mean follow-up of 9.0 ± 1.5 months, 50.0 % (95 %CI:28.0–72.0 %) of participants reported ≥50 % NRS reduction, 62.5 % (95 %CI:38.6–81.5 %) experienced ≥2-point NRS reduction, and 56.3 % (95 %CI:33.2–76.9 %) reported PGIC scores ≥6. No new opioid use, arthroplasties, or procedural complications were reported at follow-up.

Conclusion

Our expanded, 6-nerve GNRFA protocol using dual-tined electrodes provided clinically significant pain relief in most patients with no associated complications. This technique shows promise as a safe, effective treatment option for refractory knee pain due to knee osteoarthritis in patients selected by single genicular nerve blocks requiring ≥50 % pain relief. Larger prospective studies with longer follow-up are needed to confirm these findings.

膝神经射频消融术（GNRFA）是治疗顽固性膝关节疼痛的有效方法。然而，随着新技术的出现以及越来越多的证据支持扩大病变策略，GNRFA协议的改进正在进行中。目的：描述一种新的、全面的GNRFA方案，利用双针电极靶向6个膝神经，并在横断面队列中报告临床结果。该技术结合了双极和单极消融，以实现精确、有效的损伤。方法对在某三级学术中心连续接受GNRFA治疗的患者进行随访。从电子病历中收集基线人口统计和临床数据，并通过标准化电话调查评估结果。主要结局是数值评定量表（NRS）疼痛评分降低≥50%的参与者比例。次要结局包括NRS降低≥2分和患者整体印象改变（PGIC）评分≥6分的受试者比例，反映了“大大改善”或更好的状态。结果纳入14例患者（16例GNRFA手术）。在平均随访9.0±1.5个月时，50.0% （95% CI:28.0 - 72.0%）的参与者报告NRS降低≥50%，62.5% （95% CI:38.6 - 81.5%）的参与者报告NRS降低≥2点，56.3% （95% CI:33.2 - 76.9%）的参与者报告PGIC评分≥6。随访期间没有新的阿片类药物使用、关节置换术或手术并发症的报道。结论：我们的扩展的6神经GNRFA方案使用双针电极，在大多数患者中提供了临床显着的疼痛缓解，无相关并发症。该技术有望作为一种安全、有效的治疗方案，用于选择单膝神经阻滞需要≥50%疼痛缓解的膝关节骨关节炎患者的难治性膝关节疼痛。需要更大规模的前瞻性研究和更长时间的随访来证实这些发现。

{"title":"Comprehensive genicular nerve radiofrequency ablation for refractory knee pain using a dual-tined electrode: A technical description and cross-sectional cohort study","authors":"Hasan Sen, Audrey Adler, Amanda N. Cooper, Napatpaphan Kanjanapanang, Jason E. Mascoe, Alexandra E. Fogarty, Allison Glinka Przybysz, Aaron Conger, Zachary L. McCormick","doi":"10.1016/j.inpm.2025.100656","DOIUrl":"10.1016/j.inpm.2025.100656","url":null,"abstract":"<div><h3>Background</h3><div>Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for refractory knee pain. However, refinements of GNRFA protocols are ongoing as new technologies emerge amidst accumulating evidence supporting expanded lesioning strategies.</div></div><div><h3>Objectives</h3><div>Describe a novel, comprehensive GNRFA protocol utilizing dual-tined electrodes to target six genicular nerves and report clinical outcomes in a cross-sectional cohort. This technique incorporates both bipolar and monopolar ablation for precise, effective lesioning.</div></div><div><h3>Methods</h3><div>Consecutive patients who underwent GNRFA with the described protocol at a tertiary academic center were contacted for follow-up. Baseline demographic and clinical data were collected from electronic medical records, and outcomes were assessed via standardized telephone survey. The primary outcome was the proportion of participants with ≥50 % numerical rating scale (NRS) pain score reduction. Secondary outcomes included the respective proportions of participants with ≥2-point NRS reduction and Patient Global Impression of Change (PGIC) scores ≥6, reflecting a “much improved” or better status.</div></div><div><h3>Results</h3><div>Fourteen patients (16 GNRFA procedures) were included. At a mean follow-up of 9.0 ± 1.5 months, 50.0 % (95 %CI:28.0–72.0 %) of participants reported ≥50 % NRS reduction, 62.5 % (95 %CI:38.6–81.5 %) experienced ≥2-point NRS reduction, and 56.3 % (95 %CI:33.2–76.9 %) reported PGIC scores ≥6. No new opioid use, arthroplasties, or procedural complications were reported at follow-up.</div></div><div><h3>Conclusion</h3><div>Our expanded, 6-nerve GNRFA protocol using dual-tined electrodes provided clinically significant pain relief in most patients with no associated complications. This technique shows promise as a safe, effective treatment option for refractory knee pain due to knee osteoarthritis in patients selected by single genicular nerve blocks requiring ≥50 % pain relief. Larger prospective studies with longer follow-up are needed to confirm these findings.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100656"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579449","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