Pain physician最新文献

Background: Transforaminal puncture is a critical element of lumbar transforaminal epidural steroid injections used to manage lumbar radicular pain. Numerous challenges persist, owing to the intricate 3-dimensional (3D) anatomy of the spine and the delicate nature of the neurovascular structures involved. Consequently, performing the puncture expeditiously, precisely, and safely is imperative. Although numerous scholars have explored methods for reconstructing 3D lumbar models from patient data, the practical application of these models in puncture path planning for transpedicular procedures remains limited. Approaches based on artificial intelligence offer promising advantages for constructing patient-specific 3D models to facilitate puncture pathways planning.

Objective: In this experimental study, we proposed a preoperative planning method utilizing 3D artificial intelligence-generated lumbar models to improve the accuracy and efficiency of the transforaminal puncture process.

Study design: A phantoms study.

Setting: The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, P.R. China.

Methods: A total of 24 puncture trials utilizing 12 phantom models were independently conducted by 2 surgeons, employing our developed preoperative planning method and conventional fluoroscopy. After one month, one of the surgeons repeated the procedure. Puncture error, characterized by the discrepancy between the preoperative planning puncture target and the actual postoperative needle puncture point (measured in millimeters), as well as puncture procedure duration (measured in minutes), were evaluated by comparing the newly developed preoperative planning method with the traditional fluoroscopy method employed in the transforaminal puncture process.

Results: The average puncture error associated with the preoperative planning method was significantly lower than the conventional fluoroscopy method (3.33 ± 0.73 mm vs 5.25 ± 0.92 mm, P < 0.001). Additionally, the average puncture time of the preoperative planning method was significantly shorter than the conventional fluoroscopy method (7.29 ± 0.95 minutes vs 11.48 ± 1.27 minutes, P < 0.001).

Limitations: Our study used a small number of models; additional clinical trials are required to validate our preoperative planning methods.

Conclusion: The preoperative planning method utilizing 3D artificial intelligence-generated lumbar models for transforaminal puncture demonstrated superior accuracy and efficiency in phantom trials over the traditional fluoroscopic method. This newly developed preoperative planning technique has the potential to significantly improve the accuracy and efficiency of the transforaminal puncture process.

Background: Glucocorticoids (GCs) are widely used in clinical practice. Through minimally invasive intervention technology, GCs act on lesions accurately. This route of administration is superior to others. However, GCs are often applied irrationally, and serious adverse reactions frequently ensue.

Objectives: The aim of this review is to provide an expert consensus for the application of GCs in minimally invasive interventional-administration routes and thereby develop a consistent philosophy among the many diverse groups interested in the use of GCs.

Setting: The Expert Panel of Special Training Project on Pain Management of National Health Commission Capacity Building and Continuing Education Center.

Methods: We set up the Expert Panel of Special Training Project on Pain Management of National Health Commission Capacity Building and Continuing Education Center from various specialties and groups and performed the study of GC-related objectives and vital issues. The center reviewed the literature on the use, effectiveness, and adverse outcomes of GCs in accordance with evidence-based medicine principles, evaluated the quality of evidence by synthesizing existing literature, and utilized grading for recommendation.

Results: The grading recommendations for the application of GCs were formed to standardize said application. The center recommended that the principles of minimally invasive intervention of GCs be as follows: 1) Suspending GCs is not recommended for the cervical and thoracic epidural block or the radicular block if imaging monitoring is unavailable; 2) For drug compatibility, drugs other than normal saline, local anesthetics, and GCs are not recommended; 3) For treatment of epidural and selective radicular blocks within 6 months, intermediate- and long-acting GCs should not be used more than 3 times, while short-acting GCs should not be used more than 5 times; 4) GCs can be injected intraarticularly once every 3 months for up to 2 consecutive years. The frequency of intraarticular GC injections should be determined based on the severity of the patient's conditions and symptoms, as well as the preferences of the medical staff and patient; 5)GCs are not recommended for sympathetic blocks. In addition, the expert team made detailed grading recommendations for the indications, contraindications, minimally invasive interventional-administration routes, and specific operations of GCs.

Limitations: Lack of high-quality RCTs.

Conclusions: The expert consensus was established on the basis of comprehensive review of the literature and consensus among the panelists. Consequently, different minimally invasive routes of GC administration recommend different doses and courses to standard the use of GCs.

Background: Chronic axial spinal pain remains a leading cause of disability. Therapeutic interventional modalities for managing axial spinal pain of facet joint origin include intraarticular injections, facet joint nerve blocks, and radiofrequency neurotomy.Based on multiple randomized controlled trials (RCTs), systematic reviews, and clinical guidelines, the evidence supporting intraarticular facet joint injections is rated as Level III, with a weak to moderate recommendation for managing spinal facet joint pain.

Objective: To evaluate intraarticular facet joint injections as a therapeutic option for managing chronic axial spinal pain of facet joint origin.

Study design: A systematic review and meta-analysis of RCTs involving intraarticular facet joint injections, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

Methods: A comprehensive literature search was conducted across multiple databases from 1966 through February 2025, including manual searches of bibliographies from known review articles. The methodological quality and risk of bias for the included studies were assessed.Evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. The level of evidence was classified using a modified best evidence synthesis, ranging from Level I to Level V.

Outcome measures: The primary outcome measure was the proportion of patients achieving significant pain relief and functional improvement of more than 50% for a minimum of 3 months. Duration of relief was categorized as short-term (< 6 months) and long-term (> 6 months).

Results: This analysis identified 12 high-quality and 2 moderate-quality RCTs based on Cochrane review criteria, and 11 high-quality and 3 moderate-quality RCTs based on Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) criteria. Based on grade assessment, there were no high quality trials.Evidence synthesis using both qualitative and quantitative analyses, along with GRADE assessment, indicated Level IV (limited evidence), with low certainty and a low level of recommendation.

Limitations: The primary limitation is the continued paucity of high-quality literature.

Conclusion: Based on qualitative analysis and GRADE assessment, intraarticular facet joint injections are supported by Level IV evidence, with limited quality, low certainty, and a low strength of recommendation.

Background: Cervical interlaminar epidural injections are usually performed with the loss-of-resistance (LOR) technique. Therefore, no studies have evaluated or compared the hanging drop (HD) technique with the LOR technique in the administration of cervical interlaminar epidural injections (ILESIs).

Objectives: This study aimed to evaluate the success of the HD technique when used with the LOR technique in cervical ILESIs.

Study design: A prospective, randomized trial.

Setting: Department of Pain Medicine, Ege Hospital, Baku, Azerbaijan.

Methods: After obtaining ethical committee approval and initiating a randomization process, we allocated patients diagnosed with cervical herniated nucleus pulposus (CHNP) into LOR- and HD-method groups. The LOR group comprised 38 patients, and the HD group comprised 41 patients. All patients underwent interlaminar epidural steroid injections under C-arm fluoroscopy in contralateral oblique (CLO) safety view with an initial start angle of approximately 60 degrees. For the LOR group, the procedure was considered successful if there was a loss of pressure after slightly crossing the ventral spinolaminar line (VSLL) and the administered contrast material was in the epidural space. The procedure was considered successful if the saline in the needle's hub fell with negative pressure after slightly passing the VSLL and if the contrast administered was seen in the epidural space with fluoroscopy. In the HD group, there was no sensation of a drop in 3 patients, and the procedure was completed with LOR, so these patients were excluded from the study. Complications and pain scores on the VAS (visual analog scale) were questioned at the time of the procedure and at one hour and 3 weeks after the procedure, and successful injection ratios were recorded.

Results: The LOR and HD groups were similar in age, gender, body mass index (BMI), and side of ILESI. The successful injection ratio was higher in the right- and left-sided ILESI group than in the median ILESI group (P < 0.01). Therefore, no differences were found between the right and left ILESI groups. Binary logistic regression analysis found that age, gender, and BMI were not associated with successful injection in the HD group, while medial injection was associated with decreased successful injection risk (OR: 0.068, P = 0.034). The successful injection ratio was higher in the LOR group than in the HD group (P < 0.001).

Limitations: The study's limitations include the relatively small number of patients with CHNP  and the lack of mention of the level of CHNP.

Conclusions: The LOR technique was superior to the HD for cervical ILESIs. More studies with larger sample sizes may provide more precise and detailed information.

Background: The routine treatment for herpes zoster (HZ) focuses on symptom control, including the use of antiviral medication, anticonvulsants, and painkillers. However, the analgesic properties of these medical treatments have been reported to be less than highly effective in some HZ patients. The factors influencing the efficacy of medical treatments for HZ patients are not yet fully understood, warranting further investigation.

Objectives: This study aims to explore the factors influencing the efficacy of medical treatments in HZ patients and provide insights for clinical management of the condition.

Study design: A retrospective study.

Setting: This retrospective study included 76 individuals diagnosed with HZ who met specific inclusion criteria and were receiving treatments at Changde Hospital between February 2023 and December 2023.

Methods: The patients were divided into 2 groups. Data on age, gender, family history, comorbidities, prior use of antiviral drugs, rash location, skin lesion severity, HZ stage, visual analog scale (VAS) scores at admission and discharge, and responses to questionnaires were collected and statistically analyzed.

Results: The study revealed no significant differences in gender, family history, comorbidities, prior use of antiviral medication, rash location, or VAS scores between the 2  groups of patients. However, the results demonstrated a significant correlation between the analgesic effects of medical treatments and age, skin lesion severity, disease duration, and plasma adrenocorticotropic hormone (ACTH) and cortisol levels. Depression, anxiety, and sleep quality also influenced the treatment outcomes.

Limitations: The limitations of this study include the relatively small sample size and the lack of long-term follow-up data.

Conclusion: Age, skin lesion severity, disease duration, depression, sleep quality, and levels of anxiety and stress hormones are important factors influencing the efficacy of medical treatments for HZ patients.

Background: Spinal pain is a pervasive global health issue that poses significant challenges because of the disability and economic burden it causes. Despite the availability of various treatments for the condition, a definitive cure for spinal pain remains elusive, underscoring the need for innovative approaches. Artificial intelligence (AI) is considered a potential method for facilitating relief for patients suffering from spinal pain.

Objective: This study utilized a bibliometric analysis to explore the impact of AI on spinal pain research, examining publication trends, collaboration patterns, author contributions, and keyword clusters, to analyze research focus and trends in this field.

Study design: Bibliometric analysis.

Setting: Data were obtained from the Web of Science Core Collection (WoSCC).

Methods: The literature related to AI-assisted techniques in spinal pain treatment was collected from the WoSCC. The CiteSpace and R Bibliometrix software packages were used in the analysis.

Results: In total, 310 articles were included, with the number of publications and citations increasing progressively. The greatest number of publications and total citations came from the United States. The University of Washington was the institution associated with the most publications. Mork PJ was the byline that appeared most often in association with both publications and total citations. The European Spine Journal was the journal in which the most publications appeared, while Spine had the greatest number of citations. The literature with the most global citations was published by Jamalusin A in the European Spine Journal, while the literature with the most local citations was by Sandal LF on JMIR Research Protocols. The most frequent key words were "machine learning," "low back pain," "magnetic resonance imaging, etc. LIMITATIONS: Only the English-language articles in the WoSCC database were included, and proceeding papers, meeting abstracts, and book chapters were excluded. Furthermore, we included no research about wearable sensors, virtual reality, and so on. Additionally, the articles from the other databases were not included.

Conclusion: The research of applying AI as a treatment for spinal injury has appealed to interdisciplinary efforts, reflecting the potential for self-management, imaging processing, and clinical decision-making. An overall perspective is shown in our study, which facilitates understanding and provides research focuses and trends in this field.

Background: Several studies indicate that approximately two-thirds of individuals with mild traumatic brain injury (mTBI) will develop chronic pain, which is often debilitating and a primary factor in long-term disability. Patients with mTBI can suffer concurrently from multiple pain types, such as chronic neuropathic (central or peripheral), nociceptive, or nociplastic pain; however, the prevailing pain types in mTBI patients remain undetermined. This knowledge void limits the formulation of effective therapies for mTBI-related pain.

Objective: We aimed to identify the predominant pain mechanism in patients who had developed persistent post-concussive syndrome (PPCS) after the onset of their mTBI.

Study design: We conducted a retrospective observational study following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Our study focused on a cohort of mTBI patients with PPCS and chronic pain.

Setting: This study was conducted at an outpatient neurology clinic from January 2020 to December 2023.

Methods: The study included patients who met the criteria for post-mTBI PPCS. Exclusion criteria consisted of a history of chronic pain before the injury, being in the acute/subacute stage (fewer than 90 days after receiving the injury), or the presence of any other neurological comorbidities. We employed a range of diagnostic instruments, including a clinical research tool to measure the degree of central sensitization. Since patients with mTBI often show normal structural imaging, we used several neurophysiological techniques, including evoked potentials, videonystagmography, and quantitative electroencephalography, to confirm the presence of brain pathology objectively. The severity of the post-concussive symptoms was measured using the Rivermead Post-Concussion Symptoms Questionnaire. Central sensitization was assessed using the Widespread Pain Index and the Symptom Severity Index. The correlation between concussion severity and widespread pain was analyzed statistically.

Results: Out of 223 initial mTBI patients, 67 met the study criteria. The main reasons for exclusions included pre-existing chronic pain or other neurological diagnoses. Among the patients, 39 (58%) were male, averaging 45.7 years of age (range: 20-72). Ethnicity distribution was as follows: 26 (39%) Hispanic, 22 (33%) White, 12 (18%) Black or African American, and 7 (10%) Asian or Pacific Islander. We found that patients with PPCS exhibited high levels of central sensitization, highlighting its critical role in the pathophysiology of chronic pain post-mTBI. We observed a significant correlation between the extent of central sensitization and the presence of non-painful symptoms, suggesting shared neuropathological processes between chronic pain and other PPCS manifestations.

Limitations: