Pub Date : 2025-07-24DOI: 10.1016/j.inpm.2025.100618
David Levi , Dustin Randall , Scott Horn , Austin Russo , Josh Gabri , Morgan Durand , Joshua Levin
Summary of background data
The risk of a symptomatic epidural bleed in patients continuing anticoagulation during most types of spinal injection procedures is extremely low. Cervical epidural steroid injections involve a unique risk of a catastrophic complication if an epidural hematoma is to occur secondary to spinal cord compression due to the anatomic confines of the cervical spinal canal. There is minimal research on the risk of cervical transforaminal epidural steroid injections (CTFESI) with anticoagulation.
Objective
Evaluate the risk of performing CTFESI with patients continuing prescribed anticoagulation medication.
Methods
A retrospective review was performed at two practice settings, a community-based outpatient practice and an academic practice, to identify all CTFESI performed between June 2018 through November 2023. Patient medical records were reviewed for the presence of anticoagulation and NSAID medication the day of the CTFESI. Data analysis used descriptive statistics to summarize the distribution of anticoagulants, NSAIDs, and cervical levels across practices, along with medication frequencies and percentages.
Results
A total of 2792 CTFESIs were performed across both settings between June 2018 and November 2023. Of those, 1040 CTFESIs (37.2 %) were performed on patients taking some form of anticoagulant medication. 277 CTFESI were performed on patients taking anticoagulants or aspirin or a combination of anticoagulants and ASA. 763 were performed on patients taking NSAIDs. There were no reported cases of symptomatic epidural hematomas or other bleeding complications in the immediate post-procedural period or up to 1 week following the procedure.
Conclusion
It is likely that CTFESI can be safely performed in patients continuing anticoagulation, aspirin (ASA), or NSAIDs. Discontinuing anticoagulants or NSAIDs for CTFESIs may not be necessary. Further studies are warranted to confirm these results.
{"title":"Safety profile of cervical transforaminal epidural steroid injections performed while maintaining anticoagulation, aspirin, or NSAIDs","authors":"David Levi , Dustin Randall , Scott Horn , Austin Russo , Josh Gabri , Morgan Durand , Joshua Levin","doi":"10.1016/j.inpm.2025.100618","DOIUrl":"10.1016/j.inpm.2025.100618","url":null,"abstract":"<div><h3>Summary of background data</h3><div>The risk of a symptomatic epidural bleed in patients continuing anticoagulation during most types of spinal injection procedures is extremely low. Cervical epidural steroid injections involve a unique risk of a catastrophic complication if an epidural hematoma is to occur secondary to spinal cord compression due to the anatomic confines of the cervical spinal canal. There is minimal research on the risk of cervical transforaminal epidural steroid injections (CTFESI) with anticoagulation.</div></div><div><h3>Objective</h3><div>Evaluate the risk of performing CTFESI with patients continuing prescribed anticoagulation medication.</div></div><div><h3>Methods</h3><div>A retrospective review was performed at two practice settings, a community-based outpatient practice and an academic practice, to identify all CTFESI performed between June 2018 through November 2023. Patient medical records were reviewed for the presence of anticoagulation and NSAID medication the day of the CTFESI. Data analysis used descriptive statistics to summarize the distribution of anticoagulants, NSAIDs, and cervical levels across practices, along with medication frequencies and percentages.</div></div><div><h3>Results</h3><div>A total of 2792 CTFESIs were performed across both settings between June 2018 and November 2023. Of those, 1040 CTFESIs (37.2 %) were performed on patients taking some form of anticoagulant medication. 277 CTFESI were performed on patients taking anticoagulants or aspirin or a combination of anticoagulants and ASA. 763 were performed on patients taking NSAIDs. There were no reported cases of symptomatic epidural hematomas or other bleeding complications in the immediate post-procedural period or up to 1 week following the procedure.</div></div><div><h3>Conclusion</h3><div>It is likely that CTFESI can be safely performed in patients continuing anticoagulation, aspirin (ASA), or NSAIDs. Discontinuing anticoagulants or NSAIDs for CTFESIs may not be necessary. Further studies are warranted to confirm these results.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100618"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696462","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 : 2025-07-17DOI: 10.1016/j.inpm.2025.100611
David Levi , Sara Tyszko , Scott Horn , Nicole Pham , Joshua Levin
Summary of background
The field of orthobiologics has attempted to address the challenge of discogenic low back pain (LBP). Research in areas such as stem cells, platelet-rich plasma, and specific growth factor injections has seen limited success.
Objective
The purpose of this trial was to determine the efficacy of a single intradiscal bone marrow concentrate (BMC) injection on pain and function for chronic discogenic LBP.
Methods
Patients with presumed discogenic LBP participated in a prospective, double-blind, randomized, sham controlled trial of a single intradiscal BMC injection compared to a sham procedure. Pain and function were assessed at baseline, 3, 6, and 12 months by Clinical Outcome Measurement Brief Instrument (COMBI) which includes the Numeric Rating Scale (NRS). Function was also assessed by the Oswestry Disability Index (ODI). The primary outcome was based upon clinical success, defined by at least 50 % pain relief from baseline to 3, 6, and 12 months.
Results
Sixty-three patients were included in the trial (45 BMC, 18 sham). There were no significant differences in the primary outcome (>50 % relief in NRS) at 3 months (40 % BMC group [95 %CI: 27–50 %] vs 33 % sham group [95 %CI: 15–56 %]), 6 months (40 % BMC [95 %CI: 27–50 %] vs 39 % sham [95 %CI: 20–61 %]), or 12 months (44 % BMC [95 %CI: 31–59 %] vs 56 % sham [95 %CI: 34–75 %]). There were no significant differences in the proportion of patients achieving at least a 30 % improvement on the ODI at 3 months (51 % BMC group [95 %CI: 37–65 %] vs 33 % sham group [95 %CI: 16–56 %]), 6 months (53 % BMC [95 %CI: 39–67 %] vs 44 % sham [95 %CI: 25–65 %]), or 12 months (56 % BMC [95 %CI: 41–69 %] vs 61 % sham [95 %CI: 39–80 %]).
Conclusions
Intradiscal BMC was equivalent to a sham procedure for chronic discogenic LBP. Both groups had a high, but statistically equivalent success rate. Unfortunately, the significant limitations of this trial, including lack of quality cell analysis, limit the ability to draw conclusions on the effectiveness of intradiscal BMC.
{"title":"Bone marrow concentrate intradiscal injection for chronic discogenic low back pain: A double-blind randomized sham-controlled trial","authors":"David Levi , Sara Tyszko , Scott Horn , Nicole Pham , Joshua Levin","doi":"10.1016/j.inpm.2025.100611","DOIUrl":"10.1016/j.inpm.2025.100611","url":null,"abstract":"<div><h3>Summary of background</h3><div>The field of orthobiologics has attempted to address the challenge of discogenic low back pain (LBP). Research in areas such as stem cells, platelet-rich plasma, and specific growth factor injections has seen limited success.</div></div><div><h3>Objective</h3><div>The purpose of this trial was to determine the efficacy of a single intradiscal bone marrow concentrate (BMC) injection on pain and function for chronic discogenic LBP.</div></div><div><h3>Methods</h3><div>Patients with presumed discogenic LBP participated in a prospective, double-blind, randomized, sham controlled trial of a single intradiscal BMC injection compared to a sham procedure. Pain and function were assessed at baseline, 3, 6, and 12 months by Clinical Outcome Measurement Brief Instrument (COMBI) which includes the Numeric Rating Scale (NRS). Function was also assessed by the Oswestry Disability Index (ODI). The primary outcome was based upon clinical success, defined by at least 50 % pain relief from baseline to 3, 6, and 12 months.</div></div><div><h3>Results</h3><div>Sixty-three patients were included in the trial (45 BMC, 18 sham). There were no significant differences in the primary outcome (>50 % relief in NRS) at 3 months (40 % BMC group [95 %CI: 27–50 %] vs 33 % sham group [95 %CI: 15–56 %]), 6 months (40 % BMC [95 %CI: 27–50 %] vs 39 % sham [95 %CI: 20–61 %]), or 12 months (44 % BMC [95 %CI: 31–59 %] vs 56 % sham [95 %CI: 34–75 %]). There were no significant differences in the proportion of patients achieving at least a 30 % improvement on the ODI at 3 months (51 % BMC group [95 %CI: 37–65 %] vs 33 % sham group [95 %CI: 16–56 %]), 6 months (53 % BMC [95 %CI: 39–67 %] vs 44 % sham [95 %CI: 25–65 %]), or 12 months (56 % BMC [95 %CI: 41–69 %] vs 61 % sham [95 %CI: 39–80 %]).</div></div><div><h3>Conclusions</h3><div>Intradiscal BMC was equivalent to a sham procedure for chronic discogenic LBP. Both groups had a high, but statistically equivalent success rate. Unfortunately, the significant limitations of this trial, including lack of quality cell analysis, limit the ability to draw conclusions on the effectiveness of intradiscal BMC.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100611"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655851","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 : 2025-07-16DOI: 10.1016/j.inpm.2025.100614
Hasan Sen, Amanda Cooper, Aaron Conger, Zachary L. McCormick, Allison Glinka Przybysz
Background
Dorsal root ganglion (DRG) stimulation has emerged as an effective, targeted neuromodulation therapy for refractory pain of the lower extremities, particularly in the setting of complex regional pain syndrome. However, preliminary evidence supporting DRG for other applications, such as peripheral neuropathy or refractory nociceptive pain, is currently limited to patient populations with discrete pain sources. We report a case of chronic, multifactorial foot pain successfully treated with a right S1 DRG stimulation after failure of multiple prior interventions including physical therapy, corticosteroid injections, and surgeries.
Case report
A 74-year-old male presented with chronic refractory right foot pain, diagnosed with L5-S1 radiculopathy, peripheral neuropathy, persistent post-surgical pain following multiple procedures, including partial toe pain, which significantly impaired his mobility and quality of life. DRG stimulation was pursued after multiple prior interventions, including physical therapy, corticosteroid injections, surgeries, and a trial of peripheral nerve stimulation (PNS) that provided only temporary relief. Following a successful stimulation trial, a permanent DRG device was implanted at the S1 level, resulting in meaningful, sustained pain relief and functional improvement.
Conclusion
DRG stimulation represents a promising treatment for refractory lower extremity pain, especially in cases where traditional therapies have failed. This case illustrates its therapeutic potential in patients with complex refractory neuropathic pain of mixed etiologies.
{"title":"Dorsal root ganglion stimulation for multifactorial refractory foot pain: A case report","authors":"Hasan Sen, Amanda Cooper, Aaron Conger, Zachary L. McCormick, Allison Glinka Przybysz","doi":"10.1016/j.inpm.2025.100614","DOIUrl":"10.1016/j.inpm.2025.100614","url":null,"abstract":"<div><h3>Background</h3><div>Dorsal root ganglion (DRG) stimulation has emerged as an effective, targeted neuromodulation therapy for refractory pain of the lower extremities, particularly in the setting of complex regional pain syndrome. However, preliminary evidence supporting DRG for other applications, such as peripheral neuropathy or refractory nociceptive pain, is currently limited to patient populations with discrete pain sources. We report a case of chronic, multifactorial foot pain successfully treated with a right S1 DRG stimulation after failure of multiple prior interventions including physical therapy, corticosteroid injections, and surgeries.</div></div><div><h3>Case report</h3><div>A 74-year-old male presented with chronic refractory right foot pain, diagnosed with L5-S1 radiculopathy, peripheral neuropathy, persistent post-surgical pain following multiple procedures, including partial toe pain, which significantly impaired his mobility and quality of life. DRG stimulation was pursued after multiple prior interventions, including physical therapy, corticosteroid injections, surgeries, and a trial of peripheral nerve stimulation (PNS) that provided only temporary relief. Following a successful stimulation trial, a permanent DRG device was implanted at the S1 level, resulting in meaningful, sustained pain relief and functional improvement.</div></div><div><h3>Conclusion</h3><div>DRG stimulation represents a promising treatment for refractory lower extremity pain, especially in cases where traditional therapies have failed. This case illustrates its therapeutic potential in patients with complex refractory neuropathic pain of mixed etiologies.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100614"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633587","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 : 2025-07-12DOI: 10.1016/j.inpm.2025.100612
Ameet Nagpal , Fred DeFrancesch , Kevin Martinez , George Rappard , D. Scott Kreiner , Jatinder S. Gill , Yakov Vorobeychik , International Pain and Spine Intervention Society
{"title":"Safety practices for interventional pain procedures: Disc access/provocation discography, vertebral augmentation, and neurostimulation procedures","authors":"Ameet Nagpal , Fred DeFrancesch , Kevin Martinez , George Rappard , D. Scott Kreiner , Jatinder S. Gill , Yakov Vorobeychik , International Pain and Spine Intervention Society","doi":"10.1016/j.inpm.2025.100612","DOIUrl":"10.1016/j.inpm.2025.100612","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100612"},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604316","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 : 2025-07-09DOI: 10.1016/j.inpm.2025.100606
Andrew R. Stephens , Ashley Rogerson , Rajeev K. Patel , Ramzi El-Hassan
Background
Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radiculopathy. Though major adverse events have been published in case reports, larger cohort studies have not demonstrated this concern.
Objective
The purpose of this study was to assess the risk of major and minor complications after CTFESIs using a large database.
Methods
TriNetX, a global health research network, was queried from January 01, 2004–May 20, 2025 for patients with cervical radiculopathy undergoing CTFESI. All diagnostic and surgical codes after CTFESI were analyzed. Specific major complications queried for were stroke, seizures, and paralysis. Nervous system, musculoskeletal, infectious, and procedural diagnoses were evaluated for complications. Complications were reported as number and percent.
Results
A total of 32,913 patients underwent CTFESI with available follow-up data. There were ≤10 (≤0.03 %) patients who had intraoperative/post-procedure complications, ≤10 (≤0.03 %) with CSF leak. There were 143 (0.4 %) patients that had cerebral vascular disease related codes. Of these, 50 (0.15 %) had cerebral infarction codes and ≤10 (≤0.03 %). There were 39 (0.12 %) patients with seizure codes, and 18 (0.5 %) patients that had paralysis codes. There were 0 (0 %) patients who had mortality related codes within a day after CTFESI.
Conclusion
This study demonstrates the risk of major complications after CTFESI in a large cohort to be low.
{"title":"Rates of complications after cervical transforaminal epidural steroid injections for patients with cervical radiculopathy utilizing a large national database","authors":"Andrew R. Stephens , Ashley Rogerson , Rajeev K. Patel , Ramzi El-Hassan","doi":"10.1016/j.inpm.2025.100606","DOIUrl":"10.1016/j.inpm.2025.100606","url":null,"abstract":"<div><h3>Background</h3><div>Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radiculopathy. Though major adverse events have been published in case reports, larger cohort studies have not demonstrated this concern.</div></div><div><h3>Objective</h3><div>The purpose of this study was to assess the risk of major and minor complications after CTFESIs using a large database.</div></div><div><h3>Methods</h3><div>TriNetX, a global health research network, was queried from January 01, 2004–May 20, 2025 for patients with cervical radiculopathy undergoing CTFESI. All diagnostic and surgical codes after CTFESI were analyzed. Specific major complications queried for were stroke, seizures, and paralysis. Nervous system, musculoskeletal, infectious, and procedural diagnoses were evaluated for complications. Complications were reported as number and percent.</div></div><div><h3>Results</h3><div>A total of 32,913 patients underwent CTFESI with available follow-up data. There were ≤10 (≤0.03 %) patients who had intraoperative/post-procedure complications, ≤10 (≤0.03 %) with CSF leak. There were 143 (0.4 %) patients that had cerebral vascular disease related codes. Of these, 50 (0.15 %) had cerebral infarction codes and ≤10 (≤0.03 %). There were 39 (0.12 %) patients with seizure codes, and 18 (0.5 %) patients that had paralysis codes. There were 0 (0 %) patients who had mortality related codes within a day after CTFESI.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the risk of major complications after CTFESI in a large cohort to be low.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100606"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579694","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 : 2025-07-03DOI: 10.1016/j.inpm.2025.100609
Bunty Shah, Yakov Vorobeychik
Introduction
The previously described posterior ligamentous complex inflammatory syndrome can result in chronic axial low back pain. This condition can be identified through MRI findings that demonstrate inflammatory changes in the compartments of the posterior ligamentous complex region, with the space of Okada serving as a connection between them. However, an effective interventional treatment for this syndrome has not yet been proposed.
Case
We present the case of a patient suffering from persistent axial low back pain who did not respond to medication or physical therapy. A SPECT scan revealed significant radiotracer uptake in the bilateral L4-L5 facet joints and the L4-L5 interspinous ligament. Given that bilateral L3-L4 diagnostic medial branch blocks yielded negative results, posterior ligamentous complex inflammatory syndrome was suspected. Injection of contrast dye into the L4-L5 interspinous adventitial bursa demonstrated the spread of contrast material from the injection site to the space of Okada and the bilateral L4-L5 facet joints. Subsequent steroid injection provided the patient with over 80 % pain relief at the five-week follow-up.
Conclusion
Patients experiencing axial low back pain, particularly those with negative diagnostic medial branch blocks, should consider undergoing a SPECT scan. This recommendation is particularly relevant in cases involving Baastrup disease or pars defects, as these conditions are often associated with the presence of the space of Okada, which is crucial for the development of PLCIS. If this diagnosis is confirmed through imaging, a steroid injection into the adventitial interspinous bursa may offer an effective treatment for PLCIS by facilitating medication distribution throughout the compartments of the posterior ligamentous complex region.
{"title":"Optimal diagnosing and interventional treatment of the posterior ligamentous complex inflammatory syndrome","authors":"Bunty Shah, Yakov Vorobeychik","doi":"10.1016/j.inpm.2025.100609","DOIUrl":"10.1016/j.inpm.2025.100609","url":null,"abstract":"<div><h3>Introduction</h3><div>The previously described posterior ligamentous complex inflammatory syndrome can result in chronic axial low back pain. This condition can be identified through MRI findings that demonstrate inflammatory changes in the compartments of the posterior ligamentous complex region, with the space of Okada serving as a connection between them. However, an effective interventional treatment for this syndrome has not yet been proposed.</div></div><div><h3>Case</h3><div>We present the case of a patient suffering from persistent axial low back pain who did not respond to medication or physical therapy. A SPECT scan revealed significant radiotracer uptake in the bilateral L4-L5 facet joints and the L4-L5 interspinous ligament. Given that bilateral L3-L4 diagnostic medial branch blocks yielded negative results, posterior ligamentous complex inflammatory syndrome was suspected. Injection of contrast dye into the L4-L5 interspinous adventitial bursa demonstrated the spread of contrast material from the injection site to the space of Okada and the bilateral L4-L5 facet joints. Subsequent steroid injection provided the patient with over 80 % pain relief at the five-week follow-up.</div></div><div><h3>Conclusion</h3><div>Patients experiencing axial low back pain, particularly those with negative diagnostic medial branch blocks, should consider undergoing a SPECT scan. This recommendation is particularly relevant in cases involving Baastrup disease or pars defects, as these conditions are often associated with the presence of the space of Okada, which is crucial for the development of PLCIS. If this diagnosis is confirmed through imaging, a steroid injection into the adventitial interspinous bursa may offer an effective treatment for PLCIS by facilitating medication distribution throughout the compartments of the posterior ligamentous complex region.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100609"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535544","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 : 2025-07-02DOI: 10.1016/j.inpm.2025.100610
Sanjeet Narang , Jason Yong , David Hao
Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination. By reframing neuraxial analgesia not as an extraordinary measure, but as a legitimate and potentially transformative option, we advocate for broader, more equitable integration of these therapies.
{"title":"Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectives","authors":"Sanjeet Narang , Jason Yong , David Hao","doi":"10.1016/j.inpm.2025.100610","DOIUrl":"10.1016/j.inpm.2025.100610","url":null,"abstract":"<div><div>Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination. By reframing neuraxial analgesia not as an extraordinary measure, but as a legitimate and potentially transformative option, we advocate for broader, more equitable integration of these therapies.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100610"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535545","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 : 2025-06-29DOI: 10.1016/j.inpm.2025.100607
Ryan Triglia , Andrew Walrond , Jesse Wagner , Paul M. Kitei , Jeffrey Boyd , Jeremy I. Simon
<div><h3>Background</h3><div>Lumbar radiculopathy is estimated to affect approximately 3–5 % of the population. Among the leading causes of radiculopathy are degenerative or congenital spinal stenosis and lumbar disc herniations, which can contribute to compression and narrowing in various regions of the spine including the neural foramen, subarticular recess, or central canal. When patients do not respond to typical conservative treatment such as medications and physical therapy, epidural steroid injections can be considered as a next step in management. There are three approaches available for accessing the lumbar epidural space: caudal, interlaminar, and transforaminal. There is no clear consensus regarding the selected approach for an epidural injection based on a patient's history, physical examination, and imaging findings, however.</div></div><div><h3>Objective</h3><div>The purpose of this study was to explore how factors such as primary residency training, fellowship training, practice setting, adherence to IPSIS guidelines, geographic location, and years of experience may influence epidural approach preferences.</div></div><div><h3>Methods</h3><div>A survey was created utilizing the Survey Monkey™ platform which was then administered by the International Pain and Spine Intervention Society (IPSIS) to all active members via email. The survey consisted of seven questions asking for demographic information including residency specialty, fellowship training, if the fellowship emphasized IPSIS guidelines, years in practice, country of practice, and practice setting. There were questions that described hypothetical clinical scenarios that provided the respondent with the pain distribution and the associated pertinent magnetic resonance imaging (MRI) findings. For each scenario, the responder was given options for type of therapeutic injection the practitioner would choose. The final two questions then asked which steroid the responder would utilize for an interlaminar and transforaminal epidural steroid injection. The survey was open for completion during a three-month period. A total of 202 IPSIS members responded, with an average of 196 responses to each question with a completion rate of 74 %.</div></div><div><h3>Results</h3><div>Most respondents completed residency in Physical Medicine and Rehabilitation (63.1 %) or Anesthesiology (29.9 %), with 67.7 % reporting fellowship training aligned with IPSIS guidelines. The most common fellowship type was ACGME-accredited pain (38.6 %), and respondents were primarily based in the U.S. (84.8 %), practicing in private multi-specialty groups (35.5 %). Experience levels were well distributed, with most in either early (<5 years, 32.1 %) or late-career (>15 years, 34.7 %) stages. Across all six clinical scenarios, the transforaminal supraneural approach was most frequently selected, especially at L4-L5 and L5-S1. Respondents selecting the most common techniques were primarily PM&R-trained and
{"title":"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.2025.100607","DOIUrl":"10.1016/j.inpm.2025.100607","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar radiculopathy is estimated to affect approximately 3–5 % of the population. Among the leading causes of radiculopathy are degenerative or congenital spinal stenosis and lumbar disc herniations, which can contribute to compression and narrowing in various regions of the spine including the neural foramen, subarticular recess, or central canal. When patients do not respond to typical conservative treatment such as medications and physical therapy, epidural steroid injections can be considered as a next step in management. There are three approaches available for accessing the lumbar epidural space: caudal, interlaminar, and transforaminal. There is no clear consensus regarding the selected approach for an epidural injection based on a patient's history, physical examination, and imaging findings, however.</div></div><div><h3>Objective</h3><div>The purpose of this study was to explore how factors such as primary residency training, fellowship training, practice setting, adherence to IPSIS guidelines, geographic location, and years of experience may influence epidural approach preferences.</div></div><div><h3>Methods</h3><div>A survey was created utilizing the Survey Monkey™ platform which was then administered by the International Pain and Spine Intervention Society (IPSIS) to all active members via email. The survey consisted of seven questions asking for demographic information including residency specialty, fellowship training, if the fellowship emphasized IPSIS guidelines, years in practice, country of practice, and practice setting. There were questions that described hypothetical clinical scenarios that provided the respondent with the pain distribution and the associated pertinent magnetic resonance imaging (MRI) findings. For each scenario, the responder was given options for type of therapeutic injection the practitioner would choose. The final two questions then asked which steroid the responder would utilize for an interlaminar and transforaminal epidural steroid injection. The survey was open for completion during a three-month period. A total of 202 IPSIS members responded, with an average of 196 responses to each question with a completion rate of 74 %.</div></div><div><h3>Results</h3><div>Most respondents completed residency in Physical Medicine and Rehabilitation (63.1 %) or Anesthesiology (29.9 %), with 67.7 % reporting fellowship training aligned with IPSIS guidelines. The most common fellowship type was ACGME-accredited pain (38.6 %), and respondents were primarily based in the U.S. (84.8 %), practicing in private multi-specialty groups (35.5 %). Experience levels were well distributed, with most in either early (<5 years, 32.1 %) or late-career (>15 years, 34.7 %) stages. Across all six clinical scenarios, the transforaminal supraneural approach was most frequently selected, especially at L4-L5 and L5-S1. Respondents selecting the most common techniques were primarily PM&R-trained and","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100607"},"PeriodicalIF":0.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510752","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 : 2025-06-28DOI: 10.1016/j.inpm.2025.100608
Tomás Caroço , Eva Kubrova , Sahil Gupta , Mark Friedrich B. Hurdle
{"title":"Letter to the Editor regarding \"Lumbar facet joint denervation targeting the medial branch in the sub-mammillary fossa: An anatomical optimization study\"","authors":"Tomás Caroço , Eva Kubrova , Sahil Gupta , Mark Friedrich B. Hurdle","doi":"10.1016/j.inpm.2025.100608","DOIUrl":"10.1016/j.inpm.2025.100608","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100608"},"PeriodicalIF":0.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502166","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 : 2025-06-25DOI: 10.1016/j.inpm.2025.100602
Mingda Chen , Sercan Tosun , Nicolas R. Thompson , Kush K. Goyal
{"title":"Corrigendum to “Genicular nerve block with corticosteroid for chronic knee Pain: Patient-Reported outcomes across 9-years of practice” [Intervent Pain Med 4 (2025) 100601]","authors":"Mingda Chen , Sercan Tosun , Nicolas R. Thompson , Kush K. Goyal","doi":"10.1016/j.inpm.2025.100602","DOIUrl":"10.1016/j.inpm.2025.100602","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100602"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471009","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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