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Rates of knee arthroplasty after genicular nerve ablation: A retrospective study utilizing a large national database 膝神经消融后膝关节置换术的发生率:一项利用大型国家数据库的回顾性研究
Pub Date : 2025-12-31 DOI: 10.1016/j.inpm.2025.100728
Justin Chau, Chetan Potu, Trevor Anesi, Andrew Stephens

Background

Genicular nerve ablation (GNA), which includes radiofrequency ablation (GNRFA), cryoneurolysis, and chemical neurolysis, is a minimally invasive procedure with growing evidence for improved pain and functional outcomes in the treatment of knee osteoarthritis (KOA). With conservative management for KOA having variable efficacy and knee arthroplasty (KA) carrying substantial risks, there is utility in identifying if GNA may delay or defer surgery.

Objective

The purpose of this study was to assess the rate of patients receiving KA, including total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) after receiving GNA.

Methods

TriNetX, a national database, was queried for patients 18 years or older who underwent GNA between 2004 and 2025. Patients with severe medical comorbidities and patients with prior TKA or UKA were excluded. Descriptive analyses were performed using the TriNetX Analytics platform and the incidence of post-GNA TKA or UKA was calculated. Secondary analysis calculating the cumulative incidence of arthroplasty among patients without prior KA within 3 months, 6 months, 1 year, 2 years, and 5 years after GNA was also assessed.

Results

There were 6035 patients who underwent GNA during this study period and who were included in the final analysis after excluding patients with select comorbidities or who had a prior TKA or UKA. Among this cohort, 795 (13.2 %; 95 % CI 12.3–14.0) patients underwent TKA (N = 753; 12.5 %; 95 % CI 11.7–13.3) or UKA (N = 42; 0.7 %; 95 % CI 0.5–0.9) after receiving GNA. For patients without prior KA, 152 patients underwent KA at 3 months post-GNA (1.3 %; 95 % CI 1.1–1.5), 415 patients underwent KA at 6 months post-GNA (3.5 %; 95 % CI 3.2–3.9), 847 patients underwent KA at 1 year post-GNA (7.2 %; 95 % CI 6.7–7.6), 1219 patients underwent KA at 2 years post-GNA (10.3 %; 95 % CI 9.8–10.9), and 1469 patients underwent KA at 5 years post-GNA (12.4 %; 95 % CI 11.8–13.0).

Conclusion

This is the largest cohort study to identify rates of KA following GNA. We found that roughly one in eight patients in this cohort received TKA or UKA after GNA, suggesting that GNA may offer clinically meaningful symptom relief for patients with KOA, such that KA may be delayed or deferred. Causality for whether GNA delays or prevents KA cannot be established from this study. The cost effectiveness and surgical sparing efficacy of GNA for symptomatic KOA should be further explored.
膝神经消融术(GNA),包括射频消融术(GNRFA)、冷冻神经松解术和化学神经松解术,是一种微创手术,越来越多的证据表明,膝关节骨性关节炎(KOA)的治疗可以改善疼痛和功能结果。由于KOA的保守治疗疗效不一,而膝关节置换术(KA)有很大的风险,因此确定GNA是否会延迟或推迟手术是有用的。目的本研究的目的是评估患者在接受GNA后接受KA的比例,包括全膝关节置换术(TKA)或单室膝关节置换术(UKA)。方法strinetx是一个国家数据库,查询了2004年至2025年期间18岁及以上接受GNA的患者。排除有严重合并症的患者和既往有TKA或UKA的患者。使用TriNetX Analytics平台进行描述性分析,计算gna后TKA或UKA的发生率。对无KA患者在GNA后3个月、6个月、1年、2年和5年内关节置换术的累计发生率进行二次分析。结果6035例患者在本研究期间接受了GNA,并在排除了特定合并症或既往有TKA或UKA的患者后纳入最终分析。在该队列中,795例(13.2%;95% CI 12.3-14.0)患者在接受GNA后接受了TKA (N = 753; 12.5%; 95% CI 11.7-13.3)或UKA (N = 42; 0.7%; 95% CI 0.5-0.9)。对于没有既往KA的患者,152例患者在gna后3个月接受了KA (1.3%, 95% CI 1.1-1.5), 415例患者在gna后6个月接受了KA (3.5%, 95% CI 3.2-3.9), 847例患者在gna后1年接受了KA (7.2%, 95% CI 6.7-7.6), 1219例患者在gna后2年接受了KA (10.3%, 95% CI 9.8-10.9), 1469例患者在gna后5年接受了KA (12.4%, 95% CI 11.8-13.0)。结论:这是确定GNA后KA发生率的最大队列研究。我们发现该队列中大约八分之一的患者在GNA后接受了TKA或UKA,这表明GNA可能为KOA患者提供有临床意义的症状缓解,因此KA可能会延迟或推迟。GNA是否延迟或阻止KA的因果关系无法从本研究中确定。GNA治疗症状性KOA的成本效益和手术保留效果有待进一步探讨。
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引用次数: 0
Is a case of one thromboembolic event one too many? 是否一例血栓栓塞事件过多?
Pub Date : 2025-12-31 DOI: 10.1016/j.inpm.2025.100729
David Levi , Joshua Levin
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引用次数: 0
Reconsidering periosteal denervation: Anatomical redundancy and the limits of single-target interventions 重新考虑骨膜去神经支配:解剖冗余和单一目标干预的局限性
Pub Date : 2025-12-31 DOI: 10.1016/j.inpm.2025.100724
Kartik Sonawane
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引用次数: 0
Reply to “Reconsidering periosteal denervation: Anatomical redundancy and the limits of single-target interventions” 回复“重新考虑骨膜去神经支配:解剖冗余和单一目标干预的局限性”
Pub Date : 2025-12-24 DOI: 10.1016/j.inpm.2025.100725
John Tran , Brent Lanting , Zachary L. McCormick , Eldon Loh
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引用次数: 0
Time to standardize: The German Spine Society national clinical guideline on epidural injections 标准化的时间:德国脊柱学会硬膜外注射国家临床指南
Pub Date : 2025-12-18 DOI: 10.1016/j.inpm.2025.100720
Stephan Klessinger , Rezvan Ahmadi , Christopher Büttner , Hans-Raimund Casser , Christian Ewelt , Robert Fessl , Holger Koepp , Heike Norda , Hela-F. Petereit , Philipp Pieroh , Matthias Pumberger , Heike Rittner , Markus Schneider , Christoph Trumm , Hayrettin Tumani , Patrick Weidle , Daniel A. Weiss , Karsten Wiechert
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引用次数: 0
Emergency physicians in pain medicine: Workforce trends, competency overlap, gaps, and opportunities for integration 疼痛医学中的急诊医生:劳动力趋势、能力重叠、差距和整合的机会
Pub Date : 2025-12-17 DOI: 10.1016/j.inpm.2025.100722
Jeffrey R. Merz-Herrala , Felipe Ocampo , Christopher R. Abrecht , J. Ben Arevalo , Nu Cindy Chai

Background

Pain is a leading complaint in Emergency Department (ED) visits, yet historically, few Emergency Physicians (EPs) have pursued fellowship training in Pain Medicine. In recent years, however, applications from EPs have risen sharply, contrasting with declines in other specialties. Despite this growth, there has been no systematic analysis of how Emergency Medicine (EM) training overlaps with the required competencies of the Pain Medicine fellowship. To our knowledge, this study represents the first such effort.

Methods

We systematically compared the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Pain Medicine with five core EM training documents: the ACGME Program Requirements for EM, ACGME EM Milestones, ACGME Key Index Procedures, ACGME Procedure Logs, and the American Board of Emergency Medicine (ABEM) EM Model of Clinical Practice. Each ACGME Pain Medicine Program Requirement was evaluated by a group of Pain and EM physicians for its degree of overlap with these EM training frameworks and categorized as having significant, partial, or minimal overlap in competency.

Results

EM training exhibits a strong overlap with Pain Medicine in patient care, encompassing neurologic and musculoskeletal evaluation, psychiatric assessment, and the diagnosis of acute and chronic pain. EPs also demonstrate procedural strengths in airway management, intravenous access, ultrasound-guided interventions, life support, procedural sedation, managing emergencies, along with medical knowledge in acute pain management, medication detoxification, and treatment of substance use disorders. Gaps were identified in the interpretation of electrodiagnostic studies, advanced imaging, prescription of rehabilitation strategies, long-term opioid management, and advanced fluoroscopic and neuromodulation procedures. These findings highlight EM's strong foundation in acute care and procedures, while clarifying domains that require targeted fellowship training.

Conclusions

EPs contribute valuable skills to Pain Medicine but require structured opportunities to address predictable training gaps. Electives, mentorship, and flexible curricula may help bridge these deficiencies.
背景:疼痛是急诊科(ED)就诊的主要主诉,但从历史上看,很少有急诊医生(EPs)接受过疼痛医学的奖学金培训。然而,近年来,来自EPs的申请量大幅上升,而其他专业的申请量却在下降。尽管这种增长,但没有系统的分析急诊医学(EM)培训如何与疼痛医学奖学金所需的能力重叠。据我们所知,这项研究是此类努力的第一次。方法我们系统地比较了美国研究生医学教育认证委员会(ACGME)疼痛医学项目要求与5个核心EM培训文件:ACGME EM项目要求、ACGME EM里程碑、ACGME关键索引程序、ACGME程序日志和美国急诊医学委员会(ABEM) EM临床实践模型。每个ACGME疼痛医学项目要求由一组疼痛和EM医生评估其与这些EM培训框架的重叠程度,并将其分类为在能力上具有显著,部分或最小重叠。结果:在患者护理方面,sem培训与疼痛医学有很强的重叠,包括神经和肌肉骨骼评估、精神评估以及急性和慢性疼痛的诊断。EPs在气道管理、静脉注射、超声引导干预、生命支持、程序性镇静、紧急情况管理以及急性疼痛管理、药物解毒和药物使用障碍治疗方面的医学知识方面也显示出程序优势。在电诊断研究、先进成像、康复策略处方、长期阿片类药物管理以及先进的透视和神经调节程序的解释中发现了差距。这些发现突出了EM在急症护理和程序方面的坚实基础,同时明确了需要有针对性的奖学金培训的领域。结论sep为疼痛医学提供了宝贵的技能,但需要结构化的机会来解决可预测的培训缺口。选修课、导师指导和灵活的课程可以帮助弥补这些不足。
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引用次数: 0
Associations between body mass index and patient reported biopsychosocial outcomes among patients with spine pain 脊柱疼痛患者体重指数与患者报告的生物心理社会结局之间的关系
Pub Date : 2025-12-17 DOI: 10.1016/j.inpm.2025.100723
Michael J. Derr , Chelsey M. Hoffmann , Likitha Somasekhar , Tejaswini Pisati , Bradley F. Thompson , Kogulavadanan Arumaithurai , Matthew J. Pingree , Paul M. Scholten
<div><h3>Background</h3><div>Obesity and spine pain are both highly prevalent and disabling conditions with complex, overlapping etiologies. While prior research has explored the link between body mass index (BMI) and low back pain (LBP), the multidimensional impact of elevated BMI on physical, mental, and social health among patients with spine disorders has not been sufficiently elucidated.</div></div><div><h3>Objectives</h3><div>This study aimed to examine the associations between BMI and a range of patient-reported outcomes (PROs) including pain severity, opioid utilization and seven Patient-Reported Outcomes Information System Computer Adaptive Test (PROMIS-CAT) domains that measure physical, mental, and social health in individuals with spine-related pain.</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients presenting to a quaternary academic institution's spine center for evaluation was performed. Demographic, BMI and PRO data (PROMIS-CAT in the domains of Anxiety, Depression, Fatigue, Pain Interference, Physical Function, Sleep Disturbance, Ability to Participate in Social Roles and Activities, and Pain Intensity as well as self-reported opioid utilization) available in the medical record were retrieved. Relationships between BMI and PROMIS data were evaluated with pairwise Z-tests for proportions.</div></div><div><h3>Results</h3><div>A total of 3756 patients were included in the analysis, and the distribution of BMIs was like that of the general US population. Compared to patients with Normal BMI, the Class II and III Obesity groups had a greater proportion of patients reporting Moderate and Severe Pain Interference, Physical Function impairments, and Ability to Participate in Social Roles and Activities. They also used opioid medications more often. There was no significant difference in Pain Intensity within the Pre-Obesity, Class I, II or III Obesity groups. However, No Pain was significantly more common than all other categories of pain severity within the No Obesity group. The No Obesity group also demonstrated decreased rates of Mild and Moderate Fatigue, Moderate and Severe Pain Interference, Mild and Moderate Physical Function, Mild and Moderate Ability to Participate in Social Roles and Activities, and opioid utilization when compared to those having Normal levels in each of those PROMIS domains or who did not use opioid medication.</div></div><div><h3>Conclusions</h3><div>Complex and inconsistent relationships exist between BMI and biopsychosocial functioning among patients with spine pain. Generally, lower frequencies of impairment are present in non-obese patients (specifically for Fatigue, Pain Interference, Physical Function, Ability to Participate in Social Roles and Activities, and Pain Intensity) and higher frequencies of impairment are observed in patients with an elevated BMI (most consistently for Depression, Pain Interference, Physical Function Ability to Participate in Social Roles and Activiti
背景:肥胖和脊柱疼痛都是非常普遍和致残的疾病,病因复杂,重叠。虽然先前的研究已经探索了身体质量指数(BMI)和腰痛(LBP)之间的联系,但BMI升高对脊柱疾病患者身体、心理和社会健康的多维影响尚未得到充分阐明。本研究旨在研究BMI与一系列患者报告结果(PROs)之间的关系,包括疼痛严重程度、阿片类药物使用和七个患者报告结果信息系统计算机适应测试(promise - cat)域,这些域测量脊柱相关疼痛患者的身体、心理和社会健康。方法回顾性分析在某第四学术机构脊柱中心进行评估的患者。检索医疗记录中可用的人口统计学、BMI和PRO数据(焦虑、抑郁、疲劳、疼痛干扰、身体功能、睡眠障碍、参与社会角色和活动的能力、疼痛强度以及自我报告的阿片类药物使用)。BMI和PROMIS数据之间的关系用比例的两两z检验进行评估。结果共纳入3756例患者,bmi分布与美国一般人群相似。与BMI正常的患者相比,II级和III级肥胖组有更大比例的患者报告中度和重度疼痛干扰、身体功能障碍和参与社会角色和活动的能力。他们也更频繁地使用阿片类药物。肥胖前期、I级、II级和III级肥胖组的疼痛强度无显著差异。然而,在无肥胖组中,无疼痛明显比所有其他类别的疼痛严重程度更常见。与那些PROMIS域的正常水平或不使用阿片类药物的人相比,无肥胖组也表现出轻度和中度疲劳、中度和重度疼痛干扰、轻度和中度身体功能、轻度和中度参与社会角色和活动的能力和阿片类药物的使用率有所下降。结论BMI与脊柱疼痛患者的生物心理社会功能之间存在复杂且不一致的关系。一般来说,非肥胖患者出现损伤的频率较低(特别是疲劳、疼痛干扰、身体功能、参与社会角色和活动的能力以及疼痛强度),而BMI升高的患者出现损伤的频率较高(最一致的是抑郁、疼痛干扰、身体功能、参与社会角色和活动的能力以及阿片类药物利用)。
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引用次数: 0
Fluoroscopic C2 selective nerve root block enabled with CT angiogram 透视C2选择性神经根阻滞与CT血管造影
Pub Date : 2025-12-16 DOI: 10.1016/j.inpm.2025.100721
Christopher Zarembinski, J. Patrick Johnson

Introduction

The anatomy of the vertebral artery (VA) can be variable around the C1 and C2 vertebrae, which can pose risk during cervical spine instrumentation and pain blocks. A patient with prior cerebellar astrocytoma required a C2 nerve root block for treatment of occipital neuralgia. Precise location of the VA was questioned due to previous posterior C1 arch excision.

Case

The objective was to describe the utility of CT angiogram (CTA) in describing VA location in planning the C2 nerve root block. Once determined that the VA was not in proximity of the lateral atlantoaxial joint (LAA), then the C2 nerve block was completed uneventfully with resolution of occipital pain.

Conclusions

The CTA was critical in determining VA location in advance of C2 nerve root block, and can be used with regularity when vascular anatomy is questioned.
椎动脉(VA)在C1和C2椎体周围的解剖结构可能是可变的,这在颈椎内固定和疼痛阻滞时可能会造成风险。一位患有小脑星形细胞瘤的患者需要C2神经根阻滞治疗枕神经痛。由于之前切除了C1后弓,VA的精确位置受到质疑。目的是描述CT血管造影(CTA)在规划C2神经根阻滞时描述VA位置的效用。一旦确定VA不靠近外侧寰枢关节(LAA),则C2神经阻滞顺利完成,枕部疼痛得到缓解。结论CTA对C2神经根阻滞前确定VA位置至关重要,在对血管解剖有疑问时可有规律地使用。
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引用次数: 0
Regenerative medicine: Are we at a crossroads for interventional pain medicine or just another phase? 再生医学:我们是处在介入性疼痛医学的十字路口,还是仅仅是另一个阶段?
Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100718
Christopher L. Robinson , Milan P. Stojanovic , Zachary L. McCormick
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引用次数: 0
Perioperative considerations for intrathecal pumps: A practical guide 鞘内泵围手术期注意事项:实用指南
Pub Date : 2025-12-01 DOI: 10.1016/j.inpm.2025.100719
Ahmad R. Saleh MD, MPH , Eileen T. Jin MD , Pritesh Topiwala MD , David Hao MD, MS
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引用次数: 0
期刊
Interventional Pain Medicine
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