Interventional Pain Medicine最新文献

{"title":"Comparing the efficacy of intra-articular injection of Platelet Rich Plasma (PRP) with corticosteroids (CS) in patients with chronic zygapophyseal joint low back pain confirmed by double intra-articular diagnostic blocks: A triple-blinded randomized multicentric controlled trial with a 6-month follow-up","authors":"Anne-Marie Cauchon ,&nbsp;Christopher Mares ,&nbsp;Xin Yi Fan ,&nbsp;Marie-Claude Bois ,&nbsp;Nicola Hagemeister ,&nbsp;Nicolas Noiseux ,&nbsp;André Roy","doi":"10.1016/j.inpm.2024.100525","DOIUrl":"10.1016/j.inpm.2024.100525","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the safety and effectiveness in improving function and reducing pain of autologous PRP to corticosteroid (CS) zygapophyseal (Z-joint) intra-articular (IA) injections at six months for patients with chronic osteoarthritis Z-joint mediated low back pain (LBP).</div></div><div><h3>Design</h3><div>Prospective triple-blinded multicentric randomized controlled trial.</div></div><div><h3>Methods</h3><div>Fifty participants with radiological signs of Z-joint OA and chronic Z-joint mediated LBP confirmed by a ≥80 % pain improvement after two IA local anesthetic injections were randomized into PRP and CS groups, using a 1:1 ratio. Participants completed questionnaires at baseline, and at 1-, 3- and 6-month post-treatment, with adverse effect data collected at 1 month. Function (Oswestry disability index (ODI)), pain (Numeric Rating Scale (NRS)), treatment satisfaction (modified MacNab criteria), and quality of life (Short Form survey 36 (SF-36)) were assessed at each follow-up. The primary outcome was the percentage of participants improving their function (ODI score) above the minimal clinically important difference (MCID) of 17 points. The secondary outcomes were the percentage of participants with a &gt;50 % NRS improvement, satisfaction to treatment and mean score improvement. Proportions were compared between groups using a chi-square test. Mean scores were compared using a two-way ANOVA or the nonparametric Brunner &amp; Langer test.</div></div><div><h3>Results</h3><div>Both groups were similar at baseline, no major adverse effects occurred, and no participants were lost at follow-up. The proportion of participants improving their ODI scores above the MCID, the proportion of participants with a &gt;50 % NRS improvement, and mean ODI scores were significantly different between groups in favor of PRP at 6 months. Modified MacNab satisfaction scale, NRS and SF36 mean scores were not statistically different between groups, but all followed the same pattern: the CS groups had a greater improvement a one month, both groups were equivalent at three months and the PRP group had a greater improvement at six months.</div></div><div><h3>Conclusion</h3><div>This first triple-blinded multicentric RCT demonstrates the safety of PRP IA Z-joint injections and its superiority in improving pain and function at six months post-treatment compared to CS for patients with chronic OA Z-joint mediated LBP. To perform a blinded control study, two intra-articular treatments were compared. However, knowing that radiofrequency neurotomy (RFN) of the medial branch diagnosed by branch blocks has been standard of care for pain originating from Z-joints, further studies comparing PRP to RFN are still needed.</div></div><div><h3>Clinicaltrials gov registry number</h3><div>NCT05188820.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100525"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the effectiveness of interlaminar epidural steroid injections for cervical radiculopathy using PROMIS as an outcome measure","authors":"Andrew R. Stephens,&nbsp;Nicholas R. Bender,&nbsp;Jim M. Snyder,&nbsp;Rajeev K. Patel,&nbsp;Ramzi El-Hassan","doi":"10.1016/j.inpm.2024.100528","DOIUrl":"10.1016/j.inpm.2024.100528","url":null,"abstract":"<div><h3>Background</h3><div>Cervical interlaminar epidural steroid injections (CIESI) are frequently used to treat cervical radiculopathy due to cervical nerve root impingement.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate the therapeutic effect of CIESI for patients with cervical radiculopathy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of consecutive adult patients with cervical radicular pain and corroborative cervical spondylotic foraminal stenosis on MRI that failed at least 6 weeks of conservative management consisting of medication and physical rehabilitation seen at a multidisciplinary, tertiary academic spine center. Patient Reported Outcome Measurement Information System (PROMIS) domains of Physical Function (PF) v1.2/v2.0 and Pain Interference (PI) v1.1 were collected at all patient visits. Scores were recorded at baseline, 3-months, 6-months and 12-months post-procedure. Statistical analysis comparing baseline scores with follow-up postprocedural PROMIS scores was performed. The percentage of patients reporting improvement greater than the minimal clinically important difference (MCID) was calculated for responders and for the worst case scenario.</div></div><div><h3>Results</h3><div>179 patients met inclusion criteria. PROMIS PI at 3-, 6-, and 12-month follow-up statistically improved by 1.5 (95 % confidence interval [CI] 1.4–1.6; p = 0.02), 1.5 (95 % CI 1.4–1.6; p = 0.03) and 1.7 (95 % CI 1.6–1.8; p = 0.4), respectively. Follow-up PROMIS PF at 3-month follow-up improved by 1.6 (95 % CI 1.5–1.7; p = 0.04) but did not significantly differ at 6- or 12-month follow-up. The percentage of patients that exceeded MCID thresholds of clinical significance was 44 % (95 % CI 36%–53 %) at 3-months, 49 % (95 % CI 39%–59 %) at 6-months, and 54 % (95 % CI 41%–66 %) at 12-months. Worst case scenario analysis demonstrated that 32 % (95 % CI 36%–53 %) of patients exceeded the MCID thresholds at 3-months, 31 % (95 % CI 24%–37 %) at 6-months, and 21 % (95 % CI 15%–27 %) at 12-months.</div></div><div><h3>Discussion/conclusions</h3><div>Our study demonstrated that CIESI leads to an improvement in function and pain for patients with cervical radiculopathy. This study was limited by retrospective design, loss to follow-up, and variation in steroids used.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100528"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraosseous basivertebral nerve ablation: A 5-year pooled analysis from three prospective clinical trials","authors":"Jad G. Khalil ,&nbsp;Eeric Truumees ,&nbsp;Kevin Macadaeg ,&nbsp;Daniel T.D. Nguyen ,&nbsp;Gregory A. Moore ,&nbsp;Dylan Lukes ,&nbsp;Jeffrey Fischgrund","doi":"10.1016/j.inpm.2024.100529","DOIUrl":"10.1016/j.inpm.2024.100529","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Vertebrogenic pain is a documented source of anterior column chronic low back pain (CLBP) that stems from damaged vertebral endplates. Nociceptive signals are transmitted by the basivertebral nerve (BVN) and endplate damage is observed as Type 1 or Type 2 Modic changes (MC) on magnetic resonance imaging (MRI). The clinical impact and safety of intraosseous radiofrequency ablation of the BVN (BVNA) for the treatment of vertebrogenic pain has been demonstrated in three prospective clinical trials (two randomized and one single-arm study).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Report aggregate long-term BVNA outcomes at five years from three studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Pooled results at 5-years post-BVNA are reported for three clinical trials with similar inclusion/exclusion criteria and outcomes measurements: 1) a prospective, open label, single-arm follow-up of the treatment arm of a randomized controlled trial (RCT) comparing BVNA to sham ablation (SMART); 2) a prospective, open label, single-arm follow-up of the treatment arm of an RCT comparing BVNA to standard care (INTRACEPT); and 3) a prospective, open label, single-arm long-term follow-up study of BVNA-treated participants (CLBP Single-Arm). Paired datasets (baseline and 5-years) for mean changes in Oswestry disability index (ODI) and numeric pain scores (NPS) were analyzed using a two-sided paired &lt;em&gt;t&lt;/em&gt;-test with a 0.05 level of significance. Secondary outcomes included responder rates, patient satisfaction, adverse events, and healthcare utilization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Two hundred forty-nine (249) of 320 BVNA-treated participants (78 % participation rate) completed a five-year visit (mean of 5.6 years follow-up). At baseline, 71.9 % of these participants reported back pain for ≥5 years, 27.7 % were taking opioids, and 61.8 % had prior therapeutic lumbar spinal injections. Pain and functional improvements were significant at 5-years with a mean improvement in NPS of 4.32 ± 2.45 points (95 % CI 4.01, 4.63; p &lt; 0.0001) from 6.79 ± 1.32 at baseline and a mean improvement in ODI of 28.0 ± 17.5 (95 % CI 25.8, 30.2; p &lt; 0.0001) from 44.5 ± 11.0 at baseline. Nearly one-third (32.1 %) of patients reported being pain-free (NPS = 0) at five years, 72.7 % of patients indicated their condition improved and 68.7 % had resumed activity levels they had prior to onset of CLBP. In the sixty-nine participants taking opioids at baseline, 65.2 % were no longer taking them at 5-years, and spinal injections decreased by 58.1 %. The rate of lumbosacral treatment (therapeutic spinal injection, radiofrequency ablation, or surgery) for the same index pain source and vertebral level was 33/249 (13.2 %) at 5 years post BVNA; including a 6.0 % rate of lumbar fusion. There were no serious device or device-procedure related adverse events reported during the long-term follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In this 5-year aggregate a","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100529"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant epidural and longitudinal anterior spinal artery contrast spread in a lumbar transforaminal epidural steroid injection (TFESI)","authors":"Philip J. Koehler III ,&nbsp;Paul M. Kitei ,&nbsp;David S. Stolzenberg ,&nbsp;Elaine H. Hatch","doi":"10.1016/j.inpm.2024.100523","DOIUrl":"10.1016/j.inpm.2024.100523","url":null,"abstract":"<div><div>A 78-year-old female with a remote history of L3-4 decompression and fusion presented with several months of low back and radicular leg pain. MRI revealed moderate L2-L3 spinal canal stenosis, ligamentum flavum infolding, moderate bilateral foraminal stenosis, and a grade I retrolisthesis. A right sided L2-L3 TFESI was performed using multiplanar fluoroscopic imaging with a subpedicular supraneural approach. During live iodinated contrast injection, imaging revealed concomitant epidural and central arterial contrast spread. The needle was retracted and repeat live fluoroscopic imaging demonstrated no vascular uptake. Desired epidural and nerve root contrast spread remained in place with repeat still imaging. Dexamethasone and lidocaine were then injected. The patient suffered no adverse events. This case demonstrates that during a lumbar TFESI, it is possible to have an inadvertent arterial injection with desired epidural contrast spread, despite appropriate needle placement. It emphasizes the importance of necessary precautions, including real-time live fluoroscopy, in order to detect arterial uptake before the delivery of injectate. Without live fluoroscopy, optimal epidural flow at the targeted level can distract interventionalists from the fleeting vascular flow multiple vertebral levels away and risks continuation of the procedure with delivery of injectate.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100523"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional pain management of CRPS in the pediatric population: A literature review","authors":"Johanna Mosquera-Moscoso ,&nbsp;Jason Eldrige ,&nbsp;Sebastian Encalada ,&nbsp;Laura Furtado Pessoa de Mendonca ,&nbsp;Alejandro Hallo-Carrasco ,&nbsp;Ali Shan ,&nbsp;Amy Rabatin ,&nbsp;Maged Mina ,&nbsp;Larry Prokop ,&nbsp;Christine Hunt","doi":"10.1016/j.inpm.2024.100532","DOIUrl":"10.1016/j.inpm.2024.100532","url":null,"abstract":"<div><h3>Background</h3><div>Complex Regional Pain Syndrome (CRPS) is a condition that causes persistent and debilitating pain. It is often associated with physical injury but can also occur without identifiable trauma or ongoing injury. There are no published guidelines for CRPS treatment in the pediatric population, but interdisciplinary care, medication, and physical therapy are common approaches. Sometimes, interventional procedures such as regional anesthesia may be required to manage symptoms.</div></div><div><h3>Objective</h3><div>The objective of this literature review is to explore the different interventional pain management approaches that are currently being used and have shown effectiveness in the management of CRPS in the pediatric population.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search strategy with an experienced librarian and input from the study's principal investigator from January 1st, 2000 to April 2nd, 2024. The search was conducted in multiple databases using controlled vocabulary and keywords to identify studies relevant to invasive treatments for pediatric CRPS.</div></div><div><h3>Results</h3><div>Of 825 studies screened, 27 met inclusion criteria, predominantly case reports (70%). The analysis included 183 patients aged 7–18 years, with female predominance (81.4%). Lower extremities were most commonly affected (70.49%), and most cases (83.06%) were triggered by identifiable trauma. IASP and Budapest criteria, though not validated for pediatric populations, were inconsistently utilized across studies for CRPS diagnosis. Interventional procedures were typically implemented after failed conservative management (92.89%), which included multiple medications (e.g., pregabalin, amitriptyline, NSAIDs) combined with physical and psychological therapy. Multiple interventional procedures were often required to achieve pain relief or functional improvement. Follow-up periods were not reported in most studies and, when reported, were short, limiting the assessment of long-term intervention efficacy.</div></div><div><h3>Conclusions</h3><div>This review summarizes the different interventional pain management methods utilized to treat pediatric CRPS. While techniques such as continuous epidural anesthesia, lumbar sympathetic blocks, peripheral procedures, and spinal cord stimulation have been safely and successfully used as part of a multimodal treatment strategy, the lack of high-quality evidence and specific protocols for CRPS diagnosis and management in pediatric patients calls for further research.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100532"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postherpetic neuralgia mimicking lumbar radiculopathy","authors":"Mara Martinez-Santori,&nbsp;Diana Ekechukwu,&nbsp;Eduardo Bauer,&nbsp;Vishal Bansal,&nbsp;Kemly Philip","doi":"10.1016/j.inpm.2024.100534","DOIUrl":"10.1016/j.inpm.2024.100534","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100534"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal root ganglion stimulation provides functional improvement from debilitating abdominal pain in Crohn's disease: A 12-month follow-up","authors":"Ahmed Khawer ,&nbsp;Harman Chopra ,&nbsp;Tariq AlFarra ,&nbsp;Eellan Sivanesan","doi":"10.1016/j.inpm.2024.100524","DOIUrl":"10.1016/j.inpm.2024.100524","url":null,"abstract":"<div><h3>Background</h3><div>Crohn's disease (CD) is a chronic relapsing-remitting, immunological, inflammatory bowel disease involving any part of the gastrointestinal tract, most commonly, the terminal ileum. Abdominal pain is a prominent debilitating symptom of CD due to continuous intestinal inflammation, associated with disease severity and complications. However, abdominal pain has shown to occur even with disease remission.</div></div><div><h3>Case presentation</h3><div>A female college student with a history of Crohn's Disease was referred for severe, chronic abdominal pain, with frequent flare-ups and hospitalizations. Due to her refractory debilitating pain, DRG stimulation was initiated with leads placed at right T11 and T12. Twelve months post-implantation, the patient reports 50–60 % reduction in pain, tolerance of an oral diet without postprandial pain, no occurrence of flares since implant, and an overall improvement in function and quality of life.</div></div><div><h3>Conclusion</h3><div>This report showcases the therapeutic potential of DRG stimulation in managing intractable chronic abdominal pain in inflammatory bowel diseases such as Crohn's disease.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100524"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective cohort study of basivertebral nerve ablation for chronic low back pain in a real-world setting: 12 months follow-up","authors":"William Schnapp ,&nbsp;Moacir Schnapp ,&nbsp;Jonathan Gottlieb ,&nbsp;Lucien C. Alexandre ,&nbsp;Kenneth Martiatu ,&nbsp;Gaëtan J.-R. Delcroix","doi":"10.1016/j.inpm.2024.100446","DOIUrl":"10.1016/j.inpm.2024.100446","url":null,"abstract":"<div><h3>Background</h3><div>The basivertebral nerve, which densely supplies the vertebral endplates, is a potential source of chronic low back pain transmission in patients with Modic changes. Basivertebral nerve ablation (BVNA), a minimally invasive procedure, aims to disrupt this pain signaling.</div></div><div><h3>Objectives</h3><div>In this study, we investigated BVNA's effectiveness in treatment of vertebrogenic low back pain and we followed patients for 12 months to assess long-term effectiveness.</div></div><div><h3>Study design</h3><div>Single group prospective cohort study (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT05692440).</div></div><div><h3>Setting</h3><div>Single-center, community private practice.</div></div><div><h3>Methods</h3><div>Thirty-five patients were treated with the INTRACEPT® device (Boston Scientific, MA, USA). Thirty-one patients completed Oswestry Disability Index (ODI), Visual Analog Scale (VAS), SF-36 Physical Component Summary (PCS), and SF-36 Mental Component Summary (MCS) at baseline and follow-up visits up to 12 months.</div></div><div><h3>Results</h3><div>The average age of the 31 patients was 73.0 ± 6.34 years and 71.0 % of the population was male (N=22)) at baseline. All four self-reported outcomes (ODI, VAS, SF-36 PCS, and MCS) showed statistically and clinically significant improvements from baseline through 12 months (all p &lt; 0.001, with the exception of the SF-36 MCS at 1 month, p = 0.165). Overall, 67.7 % of patients demonstrated ODI improvements above the minimal clinically important difference (decrease of at least 15 points) and 77.4 % of patients demonstrated a decrease on the VAS above the minimal clinically important difference (≥2 cm reduction) at 12 months.</div></div><div><h3>Limitations</h3><div>Limitations of the study include the lack of a control group and potentially unintentional bias in patient selection.</div></div><div><h3>Conclusions</h3><div>BVNA demonstrates potential as an effective and minimally invasive treatment for chronic low back pain in a real-world patient cohort where substantial improvements were observed. These results align with those seen in previous randomized controlled trials (RCTs) and industry-funded studies of BVNA.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100446"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided perineural intercostal autologous platelet-rich plasma in the treatment of chronic post-thoracotomy pain syndrome – A prospective case series","authors":"César Gracia-Fabre ,&nbsp;Tomas Cuñat ,&nbsp;Eduardo Matos-Ribeiro ,&nbsp;Rosario Armand-Ugon ,&nbsp;Guilherme Ferreira-Dos-Santos","doi":"10.1016/j.inpm.2024.100448","DOIUrl":"10.1016/j.inpm.2024.100448","url":null,"abstract":"<div><h3>Background</h3><div>Post-thoracotomy pain syndrome poses a significant challenge in clinical management due to its debilitating nature. Current treatment strategies often involve multimodal approaches, including pharmacology and interventional procedures. Recently, platelet-rich plasma has emerged as a potential therapeutic option for chronic neuropathic pain, yet its efficacy in post-thoracotomy pain syndrome remains unexplored.</div></div><div><h3>Methods</h3><div>This prospective consecutive case series aimed to evaluate the effectiveness of autologous platelet-rich plasma in alleviating chronic post-thoracotomy pain syndrome. Ten patients with persistent thoracic post-surgical pain were consecutively recruited. Platelet-rich plasma was administered via ultrasound-guided perineural intercostal injections. Pain intensity, opioid consumption, and quality of life were assessed pre-treatment and at one- and three-month follow-ups.</div></div><div><h3>Results</h3><div>Platelet-rich plasma administration led to a significant reduction in pain intensity, with median Numerical Rating Scale scores decreasing from 8.5 to 3.0 at one month and 4.0 at three months post-treatment. At one month, 90 % of patients achieved a reduction in NRS scores exceeding the minimal clinically important difference (95 % CI: 71 %, 109 %), and this proportion was maintained at three months. Although opioid consumption showed a downward trend, it did not reach statistical significance. Improvements were observed in the EQ-5D-3L index and visual analogue scale scores, indicating enhanced quality of life post-treatment.</div></div><div><h3>Conclusions</h3><div>This prospective consecutive case series suggests that autologous platelet-rich plasma may offer a promising adjunctive therapy for chronic post-thoracotomy pain syndrome. However, limitations including the lack of a control group and small sample size underscore the need for further research to establish the efficacy and optimize the application of platelet-rich plasma in managing post-thoracotomy pain syndrome.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100448"},"PeriodicalIF":0.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-guided indirect percutaneous facet synovial cyst rupture combined with direct fenestration: 10-year review at a single institution","authors":"Allison Y. Yang ,&nbsp;Troy A. Hutchins ,&nbsp;Lubdha M. Shah ,&nbsp;Lacey Woods ,&nbsp;Ghazaleh Safazadeh ,&nbsp;Blair A. Winegar ,&nbsp;Anna Hudson ,&nbsp;Miriam E. Peckham","doi":"10.1016/j.inpm.2024.100447","DOIUrl":"10.1016/j.inpm.2024.100447","url":null,"abstract":"<div><h3>Background</h3><div>Facet synovial cysts (FSCs) are benign, extradural outpouchings arising from the facet joint that can cause radiculopathy. Effectiveness of CT-guided indirect percutaneous cyst rupture (IPCR) alone and direct fenestration (DF) treatment alone have previously been reported in large cohorts. We performed a retrospective review of all FSCs treated under CT-guidance at a single institution where patients underwent IPCR, and IPCR followed by DF if necessary. We hypothesized that CT-guided FSC rupture would demonstrate similar effectiveness to previously reported fluoroscopic-guided methods, with potential improvement due to the opportunity to employ the DF technique in cases of IPCR failure.</div></div><div><h3>Methods</h3><div>A search was conducted of all CT-guided FSC rupture procedures over 10 years. Data included demographics, needle gauge used for IPCR and DF, rupture success, cyst size and T2 intensity, presence of spinal hardware, and cyst location. Subsequent surgery at the level of the cyst was documented.</div></div><div><h3>Results</h3><div>90 FSC rupture attempts were performed on 75 patients (28 M/47 F). FSC rupture using IPCR had a 70.0% success rate. In 22 FSC rupture attempts, IPCR failed and was followed by DF, with a success rate of combined IPCR + DF of 90.6 %. Subsequent surgery was required for 36.0% of patients involving the same level as the cyst or cysts.</div></div><div><h3>Conclusion</h3><div>Rates of successful FSC rupture under CT-guidance increased when the indirect rupture technique could be followed by direct fenestration in cases of failure. Our findings emphasize the benefits of flexibility afforded to the operator with CT-guidance.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 4","pages":"Article 100447"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}