Pub Date : 2025-09-01DOI: 10.1016/j.inpm.2025.100636
Ahmed Basharat , Rohan Shah , Nick Wilcox , Gurpaij Tur , Siddarth Tripati , Prisha Kansal , Niveah Gandhi , Sreekrishna Pokuri , Gabby Chong , Charles A. Odonkor , Narayana Varhabhatla , Robert Chow
<div><h3>Background</h3><div>ChatGPT and other Large Language Models (LLMs) are not only being more readily integrated into healthcare but are also being utilized more frequently by patients to answer health-related questions. Given the increased utilization for this purpose, it is essential to evaluate and study the consistency and reliability of artificial intelligence (AI) responses. Low back pain (LBP) remains one of the most frequently seen chief complaints in primary care and interventional pain management offices.</div></div><div><h3>Objective</h3><div>This study assesses the readability, accuracy, and overall utility of ChatGPT's ability to address patients' questions concerning low back pain. Our aim is to use clinician feedback to analyze ChatGPT's responses to these common low back pain related questions, as in the future, AI will undoubtedly play a role in triaging patients prior to seeing a physician.</div></div><div><h3>Methods</h3><div>To assess AI responses, we generated a standardized list of 25 questions concerning low back pain that were split into five categories including diagnosis, seeking a medical professional, treatment, self-treatment, and physical therapy. We explored the influence of how a prompt is worded on ChatGPT by asking questions from a 4th grader to a college/reference level. One board certified interventional pain specialist, one interventional pain fellow, and one emergency medicine resident reviewed ChatGPT's generated answers to assess accuracy and clinical utility. Readability and comprehensibility were evaluated using the Flesch-Kincaid Grade Level Scale. Statistical analysis was performed to analyze differences in readability scores, word count, and response complexity.</div></div><div><h3>Results</h3><div>How a question is phrased influences accuracy in statistically significant ways. Over-simplification of queries (e.g. to a 4th grade level) degrades ChatGPT's ability to return clinically complete responses. In contrast, reference and neutral queries preserve accuracy without additional engineering. Regardless of how the question is phrased, ChatGPT's default register trends towards technical language. Readability remains substantially misaligned with health literacy standards. Verbosity correlates with prompt type, but not necessarily accuracy. Word count is an unreliable proxy for informational completeness or clinical correctness in AI outputs and most errors stem from omission, not commission. Importantly, ChatGPT does not frequently generate false claims.</div></div><div><h3>Conclusion</h3><div>This analysis complicates the assumption that “simpler is better” in prompting LLMs for clinical education. Whereas earlier work in structured conditions suggested that plain-language prompts improved accuracy, our findings indicate that a moderate reading level, not maximal simplicity, yields the most reliable outputs in complex domains like pain. This study further supports that AI LLMs can be integrated
{"title":"ChatGPT and low back pain - Evaluating AI-driven patient education in the context of interventional pain medicine","authors":"Ahmed Basharat , Rohan Shah , Nick Wilcox , Gurpaij Tur , Siddarth Tripati , Prisha Kansal , Niveah Gandhi , Sreekrishna Pokuri , Gabby Chong , Charles A. Odonkor , Narayana Varhabhatla , Robert Chow","doi":"10.1016/j.inpm.2025.100636","DOIUrl":"10.1016/j.inpm.2025.100636","url":null,"abstract":"<div><h3>Background</h3><div>ChatGPT and other Large Language Models (LLMs) are not only being more readily integrated into healthcare but are also being utilized more frequently by patients to answer health-related questions. Given the increased utilization for this purpose, it is essential to evaluate and study the consistency and reliability of artificial intelligence (AI) responses. Low back pain (LBP) remains one of the most frequently seen chief complaints in primary care and interventional pain management offices.</div></div><div><h3>Objective</h3><div>This study assesses the readability, accuracy, and overall utility of ChatGPT's ability to address patients' questions concerning low back pain. Our aim is to use clinician feedback to analyze ChatGPT's responses to these common low back pain related questions, as in the future, AI will undoubtedly play a role in triaging patients prior to seeing a physician.</div></div><div><h3>Methods</h3><div>To assess AI responses, we generated a standardized list of 25 questions concerning low back pain that were split into five categories including diagnosis, seeking a medical professional, treatment, self-treatment, and physical therapy. We explored the influence of how a prompt is worded on ChatGPT by asking questions from a 4th grader to a college/reference level. One board certified interventional pain specialist, one interventional pain fellow, and one emergency medicine resident reviewed ChatGPT's generated answers to assess accuracy and clinical utility. Readability and comprehensibility were evaluated using the Flesch-Kincaid Grade Level Scale. Statistical analysis was performed to analyze differences in readability scores, word count, and response complexity.</div></div><div><h3>Results</h3><div>How a question is phrased influences accuracy in statistically significant ways. Over-simplification of queries (e.g. to a 4th grade level) degrades ChatGPT's ability to return clinically complete responses. In contrast, reference and neutral queries preserve accuracy without additional engineering. Regardless of how the question is phrased, ChatGPT's default register trends towards technical language. Readability remains substantially misaligned with health literacy standards. Verbosity correlates with prompt type, but not necessarily accuracy. Word count is an unreliable proxy for informational completeness or clinical correctness in AI outputs and most errors stem from omission, not commission. Importantly, ChatGPT does not frequently generate false claims.</div></div><div><h3>Conclusion</h3><div>This analysis complicates the assumption that “simpler is better” in prompting LLMs for clinical education. Whereas earlier work in structured conditions suggested that plain-language prompts improved accuracy, our findings indicate that a moderate reading level, not maximal simplicity, yields the most reliable outputs in complex domains like pain. This study further supports that AI LLMs can be integrated ","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100636"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.inpm.2025.100640
Tahsin Choudhury, John Jung, Monica Barnes, SriKrishna Chandran, James T. Eckner, Michael Geisser, David J. Kohns
Background
Interventional spine and pain physicians rarely review fluoroscopic images with their patients following spine procedures. Despite high patient satisfaction with these procedures, there may be further steps to enhance the patient experience.
Objectives
The purpose of this study is to analyze the impact of physician's post-procedure fluoroscopic image review on perceived benefit, patient satisfaction, and short-term improvement.
Methods
This single blinded prospective comparative study evaluated post-procedure questionnaires following non-sedation lumbosacral transforaminal epidural steroid injection (TFESIs). The control group received a scripted verbal explanation of the procedure results. The intervention group received a similar explanation that was enhanced with a review of the fluoroscopic procedure images. The perceived benefit was assessed by asking the participants to rate the degree of helpfulness of image review. A modified Press Ganey Satisfaction Questionnaire was used to assess patient satisfaction. Short-term improvement following the procedure was measured at two weeks with a Patient Global Impression of Change (PGIC). In the case of missing PGIC data, manual chart reviews were conducted to assess outcomes.
Results
The control group (no image review) included 70 participants, while the intervention group (image reviewed) included 71. There were 95.8 % of the intervention group that rated their actual image review as helpful to very helpful, while 68.6 % of the control group felt that image review would have been helpful to very helpful. The intervention group also reported significantly higher confidence in their provider (p = 0.03). There was no significant difference between groups in other domains of patient satisfaction or short-term improvement following the spine procedure.
Conclusion
Consistent with prior literature, all participants reported high satisfaction following a lumbosacral TFESI. This study demonstrated that a brief post-procedure image review was highly beneficial and improved confidence in the care providers, whereas the control group likely underestimated the potential helpfulness of receiving an image review. Further studies are required to explore the best use of post-procedure image review and the potential further impact on patient-centered care.
{"title":"The impact on fluoroscopic image review on perceived benefit, patient satisfaction, and short-term improvement following lumbosacral epidural steroid injections","authors":"Tahsin Choudhury, John Jung, Monica Barnes, SriKrishna Chandran, James T. Eckner, Michael Geisser, David J. Kohns","doi":"10.1016/j.inpm.2025.100640","DOIUrl":"10.1016/j.inpm.2025.100640","url":null,"abstract":"<div><h3>Background</h3><div>Interventional spine and pain physicians rarely review fluoroscopic images with their patients following spine procedures. Despite high patient satisfaction with these procedures, there may be further steps to enhance the patient experience.</div></div><div><h3>Objectives</h3><div>The purpose of this study is to analyze the impact of physician's post-procedure fluoroscopic image review on perceived benefit, patient satisfaction, and short-term improvement.</div></div><div><h3>Methods</h3><div>This single blinded prospective comparative study evaluated post-procedure questionnaires following non-sedation lumbosacral transforaminal epidural steroid injection (TFESIs). The control group received a scripted verbal explanation of the procedure results. The intervention group received a similar explanation that was enhanced with a review of the fluoroscopic procedure images. The perceived benefit was assessed by asking the participants to rate the degree of helpfulness of image review. A modified Press Ganey Satisfaction Questionnaire was used to assess patient satisfaction. Short-term improvement following the procedure was measured at two weeks with a Patient Global Impression of Change (PGIC). In the case of missing PGIC data, manual chart reviews were conducted to assess outcomes.</div></div><div><h3>Results</h3><div>The control group (no image review) included 70 participants, while the intervention group (image reviewed) included 71. There were 95.8 % of the intervention group that rated their actual image review as helpful to very helpful, while 68.6 % of the control group felt that image review would have been helpful to very helpful. The intervention group also reported significantly higher confidence in their provider (p = 0.03). There was no significant difference between groups in other domains of patient satisfaction or short-term improvement following the spine procedure.</div></div><div><h3>Conclusion</h3><div>Consistent with prior literature, all participants reported high satisfaction following a lumbosacral TFESI. This study demonstrated that a brief post-procedure image review was highly beneficial and improved confidence in the care providers, whereas the control group likely underestimated the potential helpfulness of receiving an image review. Further studies are required to explore the best use of post-procedure image review and the potential further impact on patient-centered care.</div></div><div><h3>Registered</h3><div>ClinicalTrials.gov <span><span>NCT05884684</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100640"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144920149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/j.inpm.2025.100639
Andrea Perera , Teo Goroszeniuk , Keyoumars Ashkan
{"title":"Long term management of refractory angina due to cardiac syndrome X with peripheral nerve field stimulation (PNfS)","authors":"Andrea Perera , Teo Goroszeniuk , Keyoumars Ashkan","doi":"10.1016/j.inpm.2025.100639","DOIUrl":"10.1016/j.inpm.2025.100639","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100639"},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/j.inpm.2025.100638
Ryan Triglia , Andrew Walrond , Jesse Wagner , Paul M. Kitei , Jeffrey Boyd , Jeremy I. Simon
{"title":"Letter to the editor regarding \"Trends in lumbar epidural injection selection: A survey of practitioner preferences and practice patterns\"","authors":"Ryan Triglia , Andrew Walrond , Jesse Wagner , Paul M. Kitei , Jeffrey Boyd , Jeremy I. Simon","doi":"10.1016/j.inpm.2025.100638","DOIUrl":"10.1016/j.inpm.2025.100638","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100638"},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-27DOI: 10.1016/j.inpm.2025.100637
Parth Aphale, Himanshu Shekhar, Shashank Dokania
{"title":"Letter to the editor regarding “Trends in lumbar epidural injection selection: A survey of practitioner preferences and practice patterns”","authors":"Parth Aphale, Himanshu Shekhar, Shashank Dokania","doi":"10.1016/j.inpm.2025.100637","DOIUrl":"10.1016/j.inpm.2025.100637","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100637"},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-25DOI: 10.1016/j.inpm.2025.100634
Afrin Sagir , Thomas T. Simopoulos , Jyotsna V. Nagda , Alexandra C.G. Fonseca , Viet L. Cai , Nasir Hussain , Chen Liang , Jatinder S. Gill
Background
There is debate about whether a standalone anteroposterior (AP) view can distinguish epidural contrast from non-epidural contrast spread.
Objectives
This study aims to assess the accuracy of the AP (anteroposterior) and Contralateral Oblique (CLO) views in distinguishing epidural contrast spread patterns from non-epidural contrast spread patterns.
Methods
Patients undergoing lumbar epidural steroid injections consented to participate in the study. A 20-gauge Tuohy needle was advanced very close to the epidural space, and 0.5–1 ml of contrast was then injected. CLO, AP, and lateral images of non-epidural spread were saved. The AP and CLO images were randomly mixed with images from historical controls with actual epidural spread.
Results
A total of 24 false epidurograms in the AP and CLO views were mixed with an equal number of true epidurograms, resulting in 48 images each in the AP and the CLO views, respectively. Among the cohort of 10 experienced interventional pain physicians, the mean accuracy of correctly identifying epidural spread as epidural using the AP view alone was 51 % (SD 19 %). In addition, the accuracy of correctly identifying non-epidural spread as non-epidural using the AP view alone was 64 % (SD 15 %). Cohen's Kappa was 0.15, indicating minimal agreement between the interventionalists. In contrast, the mean accuracy of correctly identifying epidural spread as epidural using the CLO view alone was 99 % (SD 2 %). In addition, the accuracy of correctly identifying non-epidural spread as non-epidural using the CLO view alone was 96 % (SD 9 %). Excluding one outlier, the accuracy for the rest of the reviewers in determining non-epidural spread as non-epidural was 99 %. Cohens' Kappa was 0.95, indicating a high degree of agreement between the interventionalists.
Conclusion
This study reveals that utilizing a standalone AP view without a CLO view was inadequate to distinguish epidural from non-epidural spread. Specifically, our study supports the continued use of CLO depth views to identify epidural contrast spread correctly.
{"title":"Standalone anteroposterior contrast spread pattern is insufficient to distinguish lumbar epidural from extradural spread: A prospective study","authors":"Afrin Sagir , Thomas T. Simopoulos , Jyotsna V. Nagda , Alexandra C.G. Fonseca , Viet L. Cai , Nasir Hussain , Chen Liang , Jatinder S. Gill","doi":"10.1016/j.inpm.2025.100634","DOIUrl":"10.1016/j.inpm.2025.100634","url":null,"abstract":"<div><h3>Background</h3><div>There is debate about whether a standalone anteroposterior (AP) view can distinguish epidural contrast from non-epidural contrast spread.</div></div><div><h3>Objectives</h3><div>This study aims to assess the accuracy of the AP (anteroposterior) and Contralateral Oblique (CLO) views in distinguishing epidural contrast spread patterns from non-epidural contrast spread patterns.</div></div><div><h3>Methods</h3><div>Patients undergoing lumbar epidural steroid injections consented to participate in the study. A 20-gauge Tuohy needle was advanced very close to the epidural space, and 0.5–1 ml of contrast was then injected. CLO, AP, and lateral images of non-epidural spread were saved. The AP and CLO images were randomly mixed with images from historical controls with actual epidural spread.</div></div><div><h3>Results</h3><div>A total of 24 false epidurograms in the AP and CLO views were mixed with an equal number of true epidurograms, resulting in 48 images each in the AP and the CLO views, respectively. Among the cohort of 10 experienced interventional pain physicians, the mean accuracy of correctly identifying epidural spread as epidural using the AP view alone was 51 % (SD 19 %). In addition, the accuracy of correctly identifying non-epidural spread as non-epidural using the AP view alone was 64 % (SD 15 %). Cohen's Kappa was 0.15, indicating minimal agreement between the interventionalists. In contrast, the mean accuracy of correctly identifying epidural spread as epidural using the CLO view alone was 99 % (SD 2 %). In addition, the accuracy of correctly identifying non-epidural spread as non-epidural using the CLO view alone was 96 % (SD 9 %). Excluding one outlier, the accuracy for the rest of the reviewers in determining non-epidural spread as non-epidural was 99 %. Cohens' Kappa was 0.95, indicating a high degree of agreement between the interventionalists.</div></div><div><h3>Conclusion</h3><div>This study reveals that utilizing a standalone AP view without a CLO view was inadequate to distinguish epidural from non-epidural spread. Specifically, our study supports the continued use of CLO depth views to identify epidural contrast spread correctly.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100634"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-23DOI: 10.1016/j.inpm.2025.100623
David A. Provenzano , Bradley Holt , Michael Danko , Joseph Atallah , Maaz Iqbal , Binit Shah , Albert Singh , Harsh Sachdeva , Ella Ver Donck , Bart Liebrand , Erik Shaw , Sherri Haas , Rajat Sekhar , Ann Pan , Daniel S. Halperin , Edward Goldberg
Introduction
Cervical facet joint syndrome (CFJS) is a common cause of chronic neck pain. While numerous studies have demonstrated the effectiveness of radiofrequency ablation (RFA) for facetogenic pain, its use in treating CFJS remains a subject of ongoing debate.
Objective
Here, we sought to evaluate real-world clinical outcomes in cervical RFA-treated patients with chronic cervical facetogenic pain.
Methods
The RAPID study (Clinicaltrials.gov identifier: NCT04673032) is an international, multicenter, prospective study of patients using a commercially-available radiofrequency ablation system for the treatment of chronic pain, provided per standard of care. Patients were monitored at study follow-up visits (1-, 3-. 6-, 12-, and 24-months post-index procedure). Key clinical endpoint measures collected and evaluated include numeric pain rating scale (NPRS), Oswestry Disability Index (functional disability, ODI), EQ-5D-5L (quality-of-life), and Patient Global Impression of Change (PGIC).
Results
A total of 56 patients were enrolled in this cervical facetogenic pain cohort. At both 6 (n = 49) and 12 months (n = 40), mean NPRS pain scores significantly decreased from a baseline of 6.0 ± 1.9 to 3.3 ± 2.8 and 3.3 ± 2.2, respectively (p < 0.0001). Oswestry Disability Index (ODI) scores also improved, dropping by 7.9- and 9.7-points from a baseline of 32.7 (p < 0.0001). Treatment response rates (≥50 % pain relief) were 81 % at 1 month and 80 % at 12 months. Improvements in quality-of-life (EQ-5D-5L) and self-reported change (PGIC) were also consistently observed.
Conclusions
The cervical RFA cohort in the RAPID study demonstrated consistent, clinically meaningful improvements in pain, function, quality-of-life, and treatment satisfaction across all follow-up visits, underscoring the real-world effectiveness of RFA for appropriately selected patients with cervical facetogenic pain.
{"title":"Assessment of real-world, prospective outcomes in patients treated with cervical radiofrequency ablation for chronic pain (RAPID)","authors":"David A. Provenzano , Bradley Holt , Michael Danko , Joseph Atallah , Maaz Iqbal , Binit Shah , Albert Singh , Harsh Sachdeva , Ella Ver Donck , Bart Liebrand , Erik Shaw , Sherri Haas , Rajat Sekhar , Ann Pan , Daniel S. Halperin , Edward Goldberg","doi":"10.1016/j.inpm.2025.100623","DOIUrl":"10.1016/j.inpm.2025.100623","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical facet joint syndrome (CFJS) is a common cause of chronic neck pain. While numerous studies have demonstrated the effectiveness of radiofrequency ablation (RFA) for facetogenic pain, its use in treating CFJS remains a subject of ongoing debate.</div></div><div><h3>Objective</h3><div>Here, we sought to evaluate real-world clinical outcomes in cervical RFA-treated patients with chronic cervical facetogenic pain.</div></div><div><h3>Methods</h3><div>The RAPID study (<span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> identifier: NCT04673032) is an international, multicenter, prospective study of patients using a commercially-available radiofrequency ablation system for the treatment of chronic pain, provided per standard of care. Patients were monitored at study follow-up visits (1-, 3-. 6-, 12-, and 24-months post-index procedure). Key clinical endpoint measures collected and evaluated include numeric pain rating scale (NPRS), Oswestry Disability Index (functional disability, ODI), EQ-5D-5L (quality-of-life), and Patient Global Impression of Change (PGIC).</div></div><div><h3>Results</h3><div>A total of 56 patients were enrolled in this cervical facetogenic pain cohort. At both 6 (n = 49) and 12 months (n = 40), mean NPRS pain scores significantly decreased from a baseline of 6.0 ± 1.9 to 3.3 ± 2.8 and 3.3 ± 2.2, respectively (p < 0.0001). Oswestry Disability Index (ODI) scores also improved, dropping by 7.9- and 9.7-points from a baseline of 32.7 (p < 0.0001). Treatment response rates (≥50 % pain relief) were 81 % at 1 month and 80 % at 12 months. Improvements in quality-of-life (EQ-5D-5L) and self-reported change (PGIC) were also consistently observed.</div></div><div><h3>Conclusions</h3><div>The cervical RFA cohort in the RAPID study demonstrated consistent, clinically meaningful improvements in pain, function, quality-of-life, and treatment satisfaction across all follow-up visits, underscoring the real-world effectiveness of RFA for appropriately selected patients with cervical facetogenic pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100623"},"PeriodicalIF":0.0,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-22DOI: 10.1016/j.inpm.2025.100635
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
Objective
To assess the effectiveness of dorsal column spinal cord stimulation (SCS) in treating persistent spinal pain syndrome — Type 2 (PSPS-T2).
Design
Systematic review.
Methods
PICOS (Population, Intervention, Comparison, Outcomes, and Studies) criteria were developed to include randomized controlled trials (RCTs) examining dorsal column stimulation for PSPS-T2 compared to conventional medical management or sham. Eight reviewers independently assessed publications through April 2025 and utilized the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework to evaluate the overall quality of evidence. Outcomes included measures of pain, function, quality of life, and adverse events.
Results
Of the 1988 publications initially screened, six publications were included, comprising a total of 448 participants, of which 257 were randomized to an SCS trial and 220 ultimately received SCS implants. Follow-up periods for the primary endpoints varied across the studies, ranging from 1 month to 2 years. For studies reporting success rates for achieving at least a 50% reduction in pain, responder rates spanned from 14% to 80% in the tonic SCS groups, compared with 3%–20% for CMM. The mean improvement in pain levels between 1 month and 6 months varied between 16% and 48% for tonic SCS, 16 and 17% for burst SCS, −15% and 16% for CMM, and 10 and 16% for sham. The mean improvement in function at six months ranged from 21 to 45% for the tonic SCS group, compared with 0–21% for CMM. Adverse events reported in these studies included lead migration (10–14%), IPG site pain (1–12%), infection (6.9–10%), and dural puncture (6%). Cochrane risk of bias assessments revealed low risks for one-third of the included studies, while some concerns were noted for over half of the studies. According to the GRADE system, based on the available RCTs, there is moderate-quality evidence overall that SCS is clinically effective in reducing pain and disability in patients with PSPS-T2 at 6 months.
Discussion/conclusion
Substantial proportions of patients achieved ≥50% relief at 6 months following tonic SCS when compared with CMM, demonstrating clinical effectiveness. Significant improvements in function and quality of life were observed at study endpoints ranging from 3 to 24 months following tonic SCS. No studies included in this review utilized newer and potentially more effective SCS technologies such as closed loop, high frequency, or multiple waveform SCS. The only sham-controlled study included did not demonstrate efficacy of burst SCS. Adverse event rates, including infection and implant site pain, varied significantly between studies, with the newer and older studies representing the lower and upper ends of these ranges, respectively.
目的评价脊髓背柱刺激（SCS）治疗2型持续性脊柱疼痛综合征（PSPS-T2）的疗效。DesignSystematic审查。方法采用spicos （Population, Intervention, Comparison, Outcomes and Studies）标准，纳入随机对照试验（RCTs），检查PSPS-T2的背柱刺激与常规医疗管理或假治疗的比较。8位审稿人独立评估了截至2025年4月的出版物，并利用推荐、评估、发展和评估等级（GRADE）框架评估证据的整体质量。结果包括疼痛、功能、生活质量和不良事件的测量。结果在最初筛选的1988篇出版物中，包括6篇出版物，共448名参与者，其中257名被随机分配到SCS试验中，220名最终接受了SCS植入物。各研究的主要终点随访时间各不相同，从1个月到2年不等。在报告成功减轻至少50%疼痛的研究中，强直性SCS组的应答率为14%至80%，而CMM组的应答率为3%至20%。在1个月至6个月期间，强直性SCS的疼痛水平平均改善在16%至48%之间，破裂性SCS为16%至17%，CMM为- 15%至16%，假手术为10%至16%。在6个月时，强直性SCS组的平均功能改善范围为21%至45%，而CMM组为0-21%。这些研究中报告的不良事件包括铅迁移（10-14%）、IPG部位疼痛（1-12%）、感染（6.9-10%）和硬脑膜穿刺（6%）。Cochrane偏倚风险评估显示，三分之一的纳入研究的风险较低，而超过一半的研究存在一些问题。根据GRADE系统，基于现有的随机对照试验，总体上有中等质量的证据表明SCS在临床有效地减轻PSPS-T2患者6个月时的疼痛和残疾。讨论/结论：与CMM相比，大量患者在强直性SCS治疗后6个月获得≥50%的缓解，证明了临床有效性。在强直性SCS后3 - 24个月的研究终点观察到功能和生活质量的显著改善。本综述中没有研究使用更新的和可能更有效的SCS技术，如闭环、高频或多波形SCS。纳入的唯一一项假对照研究没有证明SCS的有效性。不良事件发生率，包括感染和植入部位疼痛，在不同的研究之间差异很大，新的和旧的研究分别代表了这些范围的下限和上限。
{"title":"A systematic review of evidence comparing spinal cord stimulation to sham or conservative medical management in the treatment of persistent spinal pain syndrome - Type 2","authors":"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","doi":"10.1016/j.inpm.2025.100635","DOIUrl":"10.1016/j.inpm.2025.100635","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effectiveness of dorsal column spinal cord stimulation (SCS) in treating persistent spinal pain syndrome — Type 2 (PSPS-T2).</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>PICOS (Population, Intervention, Comparison, Outcomes, and Studies) criteria were developed to include randomized controlled trials (RCTs) examining dorsal column stimulation for PSPS-T2 compared to conventional medical management or sham. Eight reviewers independently assessed publications through April 2025 and utilized the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework to evaluate the overall quality of evidence. Outcomes included measures of pain, function, quality of life, and adverse events.</div></div><div><h3>Results</h3><div>Of the 1988 publications initially screened, six publications were included, comprising a total of 448 participants, of which 257 were randomized to an SCS trial and 220 ultimately received SCS implants. Follow-up periods for the primary endpoints varied across the studies, ranging from 1 month to 2 years. For studies reporting success rates for achieving at least a 50% reduction in pain, responder rates spanned from 14% to 80% in the tonic SCS groups, compared with 3%–20% for CMM. The mean improvement in pain levels between 1 month and 6 months varied between 16% and 48% for tonic SCS, 16 and 17% for burst SCS, −15% and 16% for CMM, and 10 and 16% for sham. The mean improvement in function at six months ranged from 21 to 45% for the tonic SCS group, compared with 0–21% for CMM. Adverse events reported in these studies included lead migration (10–14%), IPG site pain (1–12%), infection (6.9–10%), and dural puncture (6%). Cochrane risk of bias assessments revealed low risks for one-third of the included studies, while some concerns were noted for over half of the studies. According to the GRADE system, based on the available RCTs, there is moderate-quality evidence overall that SCS is clinically effective in reducing pain and disability in patients with PSPS-T2 at 6 months.</div></div><div><h3>Discussion/conclusion</h3><div>Substantial proportions of patients achieved ≥50% relief at 6 months following tonic SCS when compared with CMM, demonstrating clinical effectiveness. Significant improvements in function and quality of life were observed at study endpoints ranging from 3 to 24 months following tonic SCS. No studies included in this review utilized newer and potentially more effective SCS technologies such as closed loop, high frequency, or multiple waveform SCS. The only sham-controlled study included did not demonstrate efficacy of burst SCS. Adverse event rates, including infection and implant site pain, varied significantly between studies, with the newer and older studies representing the lower and upper ends of these ranges, respectively.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100635"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-21DOI: 10.1016/j.inpm.2025.100629
Javier De Andrés Ares MD PhD FIPP
{"title":"Advancing the diagnosis and treatment of posterior ligamentous complex inflammatory syndrome (PLCIS) in chronic axial low back pain","authors":"Javier De Andrés Ares MD PhD FIPP","doi":"10.1016/j.inpm.2025.100629","DOIUrl":"10.1016/j.inpm.2025.100629","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100629"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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