Sukriye Dadali, Seref Celik, Gulcin Babaoglu, Ulku Sabuncu, Ali Costu, Saziye Sahin, Erkan Yavuz Akcaboy
Background: Cervicogenic headache is a secondary headache disorder caused by cervical spine dysfunction, often associated with neck pain. Among the various treatment options, peripheral nerve blocks targeting the greater occipital nerve are commonly used, with pulsed radiofrequency emerging as a promising therapeutic intervention.
Objectives: Our study aimed to evaluate the clinical efficacy and safety of ultrasound-guided greater occipital nerve pulsed radiofrequency treatment at the second cervical vertebrae (C2) level in patients with cervicogenic headache. Specifically, we investigated changes in headache duration, intensity, frequency, analgesic use, and patient satisfaction.
Study design: Single-center, prospective, observational cohort study.
Setting: Tertiary referral center.
Methods: Our study included 43 patients diagnosed with cervicogenic headache according to the International Classification of Headache Disorders Third Edition criteria. A diagnostic greater occipital nerve block was performed on all patients; 34 exhibited a positive response and subsequently received greater occipital nerve pulsed radiofrequency treatment. Data were analyzed by comparing the pretreatment and posttreatment results.
Results: A total of 32 patients were included in our final analysis. Their mean (SD) age was 55.8 (10.9) years. Significant reductions in headache duration, intensity, and frequency were observed at both the first and third posttreatment months compared to baseline (P < 0.001). Visual Analog Scale scores and analgesic use also showed significant reductions. No statistically significant difference was observed between the first and third posttreatment months regarding these outcomes, and the Global Perceived Effect score remained stable during this period (P = 0.058).
Limitations: Our study has several limitations that should be considered when interpreting the findings. While the sample size was determined using G*Power (Heinrich-Heine-Universität Düsseldorf), our study population's relatively small size may affect the generalizability of the results. Furthermore, the inclusion of patients with a history of both cervicogenic headaches and migraines may have introduced diagnostic complexity. Lastly, the relatively short follow-up period may not fully capture the long-term effects of the intervention.
Conclusion: Our study demonstrates that, in patients who respond to a diagnostic block, ultrasound-guided greater occipital nerve pulsed radiofrequency treatment at the C2 level effectively reduces the duration, severity, and frequency of cervicogenic headaches, while decreasing analgesic use. These effects appear to persist for at least 3 months, though further research is required to evaluate long-term outcomes.
{"title":"Ultrasound-guided Pulsed Radiofrequency at the C2 Level for Cervicogenic Headache: Targeting the Greater Occipital Nerve.","authors":"Sukriye Dadali, Seref Celik, Gulcin Babaoglu, Ulku Sabuncu, Ali Costu, Saziye Sahin, Erkan Yavuz Akcaboy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cervicogenic headache is a secondary headache disorder caused by cervical spine dysfunction, often associated with neck pain. Among the various treatment options, peripheral nerve blocks targeting the greater occipital nerve are commonly used, with pulsed radiofrequency emerging as a promising therapeutic intervention.</p><p><strong>Objectives: </strong>Our study aimed to evaluate the clinical efficacy and safety of ultrasound-guided greater occipital nerve pulsed radiofrequency treatment at the second cervical vertebrae (C2) level in patients with cervicogenic headache. Specifically, we investigated changes in headache duration, intensity, frequency, analgesic use, and patient satisfaction.</p><p><strong>Study design: </strong>Single-center, prospective, observational cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Methods: </strong>Our study included 43 patients diagnosed with cervicogenic headache according to the International Classification of Headache Disorders Third Edition criteria. A diagnostic greater occipital nerve block was performed on all patients; 34 exhibited a positive response and subsequently received greater occipital nerve pulsed radiofrequency treatment. Data were analyzed by comparing the pretreatment and posttreatment results.</p><p><strong>Results: </strong>A total of 32 patients were included in our final analysis. Their mean (SD) age was 55.8 (10.9) years. Significant reductions in headache duration, intensity, and frequency were observed at both the first and third posttreatment months compared to baseline (P < 0.001). Visual Analog Scale scores and analgesic use also showed significant reductions. No statistically significant difference was observed between the first and third posttreatment months regarding these outcomes, and the Global Perceived Effect score remained stable during this period (P = 0.058).</p><p><strong>Limitations: </strong>Our study has several limitations that should be considered when interpreting the findings. While the sample size was determined using G*Power (Heinrich-Heine-Universität Düsseldorf), our study population's relatively small size may affect the generalizability of the results. Furthermore, the inclusion of patients with a history of both cervicogenic headaches and migraines may have introduced diagnostic complexity. Lastly, the relatively short follow-up period may not fully capture the long-term effects of the intervention.</p><p><strong>Conclusion: </strong>Our study demonstrates that, in patients who respond to a diagnostic block, ultrasound-guided greater occipital nerve pulsed radiofrequency treatment at the C2 level effectively reduces the duration, severity, and frequency of cervicogenic headaches, while decreasing analgesic use. These effects appear to persist for at least 3 months, though further research is required to evaluate long-term outcomes.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 1","pages":"55-64"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Subdural hematoma (SDH) is a frequent and serious complication of spontaneous intracranial hypotension (SIH), often requiring timely intervention. An epidural blood patch (EBP) is widely recognized as the preferred interventional treatment for SIH and its complications. However, treatment failure remains a concern, and predicting outcomes in patients with SIH and a concurrent SDH post EBP remains a clinical challenge.</p><p><strong>Objectives: </strong>Our study aimed to develop and validate a predictive nomogram for treatment failure following an EBP in patients with SIH complicated by an SDH, identifying key clinical and imaging predictors associated with poor prognosis.</p><p><strong>Study design: </strong>This was a retrospective cohort study conducted over a 7-year period.</p><p><strong>Setting: </strong>The study was conducted from January 2017 through December 2023 at a single tertiary care center, using electronic health records and radiologic databases.</p><p><strong>Methods: </strong>A total of 233 patients diagnosed with SIH and concurrent SDH and treated with an EBP were retrospectively enrolled. Patients were sequentially assigned to a development cohort (n = 175) and a validation cohort (n = 58) at a 3:1 ratio. Backward stepwise multivariable logistic regression was applied to the development cohort to identify independent treatment failure predictors. A nomogram was constructed based on the final regression model. The model's performance was assessed through discrimination (C-index), calibration plots, and decision curve analysis to evaluate clinical utility.</p><p><strong>Results: </strong>Treatment failure occurred in 86 of 233 patients (36.9%), with similar rates between development (36.6%) and validation (37.9%) cohorts (P = 0.977). Four independent predictors were identified: gender, the maximum SDH thickness, SDH density type (based on computed tomography brain imagery), and pontomesencephalic angle. Specifically, men (odds ratio [OR] = 2.63; 95% CI, 1.11-6.48; P = 0.030), greater SDH thickness (OR = 1.26 per mm increase; 95% CI, 1.13-1.43; P < 0.001), non-low-density SDH-including isodense, hyperdense, mixed-density, and layering patterns-(vs low-density; OR = 0.35; 95% CI, 0.14-0.88; P = 0.025), and smaller pontomesencephalic angle (OR = 0.95 per degree; 95% CI, 0.91-0.99; P = 0.030) were significantly associated with increased risk. The nomogram demonstrated strong discrimination in the development cohort (C-index = 0.87; 95% CI, 0.82-0.93) and maintained good performance in the validation cohort (C-index = 0.84; 95% CI, 0.73-0.94). Calibration was satisfactory in both cohorts, and a decision curve analysis confirmed the model's clinical value.</p><p><strong>Limitations: </strong>While the sample size is the largest among similar studies, it remains relatively modest. Our exclusion of iatrogenic SIH and cases with cerebrospinal fluid fistulas may limit generalizability. Additionally, relianc
{"title":"A Nomogram to Predict of Epidural Blood Patch Treatment Failure in Patients With Spontaneous Intracranial Hypotension and Subdural Hematoma.","authors":"Hua Huang, Fei-Fang He, Zhong-Feng Niu, TIng-Ting Wei","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Subdural hematoma (SDH) is a frequent and serious complication of spontaneous intracranial hypotension (SIH), often requiring timely intervention. An epidural blood patch (EBP) is widely recognized as the preferred interventional treatment for SIH and its complications. However, treatment failure remains a concern, and predicting outcomes in patients with SIH and a concurrent SDH post EBP remains a clinical challenge.</p><p><strong>Objectives: </strong>Our study aimed to develop and validate a predictive nomogram for treatment failure following an EBP in patients with SIH complicated by an SDH, identifying key clinical and imaging predictors associated with poor prognosis.</p><p><strong>Study design: </strong>This was a retrospective cohort study conducted over a 7-year period.</p><p><strong>Setting: </strong>The study was conducted from January 2017 through December 2023 at a single tertiary care center, using electronic health records and radiologic databases.</p><p><strong>Methods: </strong>A total of 233 patients diagnosed with SIH and concurrent SDH and treated with an EBP were retrospectively enrolled. Patients were sequentially assigned to a development cohort (n = 175) and a validation cohort (n = 58) at a 3:1 ratio. Backward stepwise multivariable logistic regression was applied to the development cohort to identify independent treatment failure predictors. A nomogram was constructed based on the final regression model. The model's performance was assessed through discrimination (C-index), calibration plots, and decision curve analysis to evaluate clinical utility.</p><p><strong>Results: </strong>Treatment failure occurred in 86 of 233 patients (36.9%), with similar rates between development (36.6%) and validation (37.9%) cohorts (P = 0.977). Four independent predictors were identified: gender, the maximum SDH thickness, SDH density type (based on computed tomography brain imagery), and pontomesencephalic angle. Specifically, men (odds ratio [OR] = 2.63; 95% CI, 1.11-6.48; P = 0.030), greater SDH thickness (OR = 1.26 per mm increase; 95% CI, 1.13-1.43; P < 0.001), non-low-density SDH-including isodense, hyperdense, mixed-density, and layering patterns-(vs low-density; OR = 0.35; 95% CI, 0.14-0.88; P = 0.025), and smaller pontomesencephalic angle (OR = 0.95 per degree; 95% CI, 0.91-0.99; P = 0.030) were significantly associated with increased risk. The nomogram demonstrated strong discrimination in the development cohort (C-index = 0.87; 95% CI, 0.82-0.93) and maintained good performance in the validation cohort (C-index = 0.84; 95% CI, 0.73-0.94). Calibration was satisfactory in both cohorts, and a decision curve analysis confirmed the model's clinical value.</p><p><strong>Limitations: </strong>While the sample size is the largest among similar studies, it remains relatively modest. Our exclusion of iatrogenic SIH and cases with cerebrospinal fluid fistulas may limit generalizability. Additionally, relianc","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 1","pages":"E29-E42"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laxmaiah Manchikanti, Mahendra Sanapati, Vidyasagar Pampati, Alan D Kaye, Nebojsa Nick Knezevic, Annu Navani, Devi Nampiaparampil, Joshua A Hirsch
<p><strong>Background: </strong>Recent analysis of epidural procedure utilization has demonstrated significant shifts over the past 25 years. Utilization increased substantially until 2004, continued with modest growth through 2011, and then gradually declined through 2019 among the Medicare population. Influences from the COVID-19 pandemic, the Affordable Care Act (ACA), and economic pressures have continued to contribute to declining utilization patterns.</p><p><strong>Objective: </strong>The present investigation provides an updated evaluation of epidural procedure utilization for chronic pain management in the U.S. Medicare population, focusing on the time periods of 2000 to 2010, 2010 to 2019, and 2019 to 2024.</p><p><strong>Study design: </strong>A retrospective cohort study evaluating utilization patterns and variables for epidural injections in the fee-for-service (FFS) traditional Medicare population in the U.S. from 2000 to 2024.</p><p><strong>Methods: </strong>A retrospective longitudinal analysis of Medicare Part B data from 2000 through 2024 was completed. Epidural injection services included cervical/thoracic and lumbar/caudal interlaminar injections, and cervical/thoracic and lumbar/sacral transforaminal injections, identified using procedure codes in the study database. A procedure or service represented all interventions performed during a treatment episode, incorporating add-on codes and bilateral services. Episodes were defined as one unit regardless of bilateral or additional services, reflecting the number of times patients received treatment. Utilization was assessed through counts, rates per 100,000 beneficiaries, geometric mean changes, and percent changes across key intervals (2000-2010, 2010-2019, 2019-2024). Trends by provider's specialty and place of service were also evaluated.</p><p><strong>Results: </strong>From 2000 to 2010, services, episodes, and rates per 100,000 beneficiaries increased 144.3%, 126.1%, and 103%. From 2010 to 2019, this pattern shifted to declining utilization, with reductions of 9.5% in services, 0.4% in episodes, and 9% in rates per 100,000. From 2019 to 2024, procedural rates declined 13%, episodes declined 22.6%, and episode rates declined 11.9%, corresponding to average annual reductions of 2.8%, 4.3%, and 2.6%.Comparative analysis showed that from 2000 to 2010, interlaminar epidural rates increased 43.8%, whereas transforaminal epidural rates increased 579.1%. From 2010 to 2019, interlaminar rates declined 18.4%, while transforaminal rates increased 5%. From 2019 to 2024, interlaminar rates declined 14.6% compared to 8.7% for transforaminal procedures. By 2024, interventional pain specialists performed over 92% of all epidural injections, while other specialties showed decreasing participation. A continued shift toward office settings and ambulatory surgery centers (ASCs) was also observed.</p><p><strong>Limitations: </strong>The study includes data only through 2024 and is limited to the F
{"title":"Updated Analysis of Declining Utilization Rate of 13% Epidural Procedures for Chronic Spinal Pain Management in the Traditional Medicare Population from 2019 to 2024.","authors":"Laxmaiah Manchikanti, Mahendra Sanapati, Vidyasagar Pampati, Alan D Kaye, Nebojsa Nick Knezevic, Annu Navani, Devi Nampiaparampil, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Recent analysis of epidural procedure utilization has demonstrated significant shifts over the past 25 years. Utilization increased substantially until 2004, continued with modest growth through 2011, and then gradually declined through 2019 among the Medicare population. Influences from the COVID-19 pandemic, the Affordable Care Act (ACA), and economic pressures have continued to contribute to declining utilization patterns.</p><p><strong>Objective: </strong>The present investigation provides an updated evaluation of epidural procedure utilization for chronic pain management in the U.S. Medicare population, focusing on the time periods of 2000 to 2010, 2010 to 2019, and 2019 to 2024.</p><p><strong>Study design: </strong>A retrospective cohort study evaluating utilization patterns and variables for epidural injections in the fee-for-service (FFS) traditional Medicare population in the U.S. from 2000 to 2024.</p><p><strong>Methods: </strong>A retrospective longitudinal analysis of Medicare Part B data from 2000 through 2024 was completed. Epidural injection services included cervical/thoracic and lumbar/caudal interlaminar injections, and cervical/thoracic and lumbar/sacral transforaminal injections, identified using procedure codes in the study database. A procedure or service represented all interventions performed during a treatment episode, incorporating add-on codes and bilateral services. Episodes were defined as one unit regardless of bilateral or additional services, reflecting the number of times patients received treatment. Utilization was assessed through counts, rates per 100,000 beneficiaries, geometric mean changes, and percent changes across key intervals (2000-2010, 2010-2019, 2019-2024). Trends by provider's specialty and place of service were also evaluated.</p><p><strong>Results: </strong>From 2000 to 2010, services, episodes, and rates per 100,000 beneficiaries increased 144.3%, 126.1%, and 103%. From 2010 to 2019, this pattern shifted to declining utilization, with reductions of 9.5% in services, 0.4% in episodes, and 9% in rates per 100,000. From 2019 to 2024, procedural rates declined 13%, episodes declined 22.6%, and episode rates declined 11.9%, corresponding to average annual reductions of 2.8%, 4.3%, and 2.6%.Comparative analysis showed that from 2000 to 2010, interlaminar epidural rates increased 43.8%, whereas transforaminal epidural rates increased 579.1%. From 2010 to 2019, interlaminar rates declined 18.4%, while transforaminal rates increased 5%. From 2019 to 2024, interlaminar rates declined 14.6% compared to 8.7% for transforaminal procedures. By 2024, interventional pain specialists performed over 92% of all epidural injections, while other specialties showed decreasing participation. A continued shift toward office settings and ambulatory surgery centers (ASCs) was also observed.</p><p><strong>Limitations: </strong>The study includes data only through 2024 and is limited to the F","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 1","pages":"1-16"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Douglas P Beall, Ty Ptacek, Ashley M Classen, Michael Jung, Matthew Skoblar, John Hatheway, Olivia A Beall, Matthew C Shonnard, Reade DeLeacy
<p><strong>Background: </strong>Low back pain (LBP) is a widespread and costly condition. Sacroiliac joint (SIJ) dysfunction accounts for 15-25% of chronic LBP cases and is especially common following lumbar spine fusion-affecting up to 75% of such patients within five years. Risk factors include prior spine surgery, pregnancy, obesity, trauma, and inflammatory diseases. For persistent cases, sacroiliac joint fusion (SIJF) is increasingly used, offering better outcomes than conservative treatments. Recent advancements in minimally invasive surgical (MIS) techniques and implant designs have improved the safety and effectiveness of SIJF, making it a reliable option for managing chronic SIJ dysfunction.</p><p><strong>Objectives: </strong>To examine the effectiveness of a minimally invasive sacroiliac joint approach and fusion device by means of clinical patient reported outcomes (PROs) and radiological outcomes.</p><p><strong>Study design: </strong>The design of this clinical trial is a multi-site, prospective, single arm feasibility study.</p><p><strong>Setting: </strong>The study was conducted in 7 sites located across the United States including both private practices and academic centers from September 19, 2022, to December 6, 2023.</p><p><strong>Methods: </strong>This study enrolled 37 patients aged 21-80 with chronic SIJ pain or degenerative sacroiliitis unresponsive to conservative care. All underwent SIJF and were followed for six months. PROs on pain, function, opioid use, work status, adverse events, and quality of life were collected via email at 1, 3, and 6 months postoperatively. Diagnostic inclusion required SIJ pain localization, ? 3 of 6 positive physical exam tests, 75% pain relief after anesthetic injection, and confirmatory imaging. Exclusions included alternative causes of back pain, trauma, infection, or conditions that could interfere with recovery. Radiologic outcomes were evaluated by a six-month CT. PROs included pain reporting via the Numeric Rating Scale (NRS), function via the Oswestry Disability Index (ODI), and quality of life via PROMIS-10.</p><p><strong>Results: </strong>The study measured outcomes using NRS, ODI, PROMIS-10, opioid use, pain interventions, work status, and SAEs. Pain scores (NRS) significantly decreased from 6.8 at baseline to 4.1, 4.8, and 4.2 at 1, 3, and 6 months (P < 0.01). Disability scores (ODI) also improved significantly from 50.3 to 41.7, 35.6, and 34.9 (P < 0.05). PROMIS-10 scores showed slight, non-significant improvements. Opioid use dropped from 26 to 13-16 patients over time, though not statistically significant. No SAEs occurred. CT scans at 6 months showed 96% implant bone apposition and no implant failures; 72% of patients had SIJ bridging.</p><p><strong>Limitations: </strong>This study is limited by a small sample size, short follow-up, and lack of control group.</p><p><strong>Conclusions: </strong>Laterally placed SIJ fusion titanium alloy implants are a safe and effective treatment
{"title":"Minimally Invasive Sacroiliac Joint Fusion Using 3D Printed Implants and a Lateral Approach: Safety and Effectiveness Assessments of Fusion Performed by Interventional Physicians in a Prospective Multicenter Single-Arm Clinical Study (The FICS Study).","authors":"Douglas P Beall, Ty Ptacek, Ashley M Classen, Michael Jung, Matthew Skoblar, John Hatheway, Olivia A Beall, Matthew C Shonnard, Reade DeLeacy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a widespread and costly condition. Sacroiliac joint (SIJ) dysfunction accounts for 15-25% of chronic LBP cases and is especially common following lumbar spine fusion-affecting up to 75% of such patients within five years. Risk factors include prior spine surgery, pregnancy, obesity, trauma, and inflammatory diseases. For persistent cases, sacroiliac joint fusion (SIJF) is increasingly used, offering better outcomes than conservative treatments. Recent advancements in minimally invasive surgical (MIS) techniques and implant designs have improved the safety and effectiveness of SIJF, making it a reliable option for managing chronic SIJ dysfunction.</p><p><strong>Objectives: </strong>To examine the effectiveness of a minimally invasive sacroiliac joint approach and fusion device by means of clinical patient reported outcomes (PROs) and radiological outcomes.</p><p><strong>Study design: </strong>The design of this clinical trial is a multi-site, prospective, single arm feasibility study.</p><p><strong>Setting: </strong>The study was conducted in 7 sites located across the United States including both private practices and academic centers from September 19, 2022, to December 6, 2023.</p><p><strong>Methods: </strong>This study enrolled 37 patients aged 21-80 with chronic SIJ pain or degenerative sacroiliitis unresponsive to conservative care. All underwent SIJF and were followed for six months. PROs on pain, function, opioid use, work status, adverse events, and quality of life were collected via email at 1, 3, and 6 months postoperatively. Diagnostic inclusion required SIJ pain localization, ? 3 of 6 positive physical exam tests, 75% pain relief after anesthetic injection, and confirmatory imaging. Exclusions included alternative causes of back pain, trauma, infection, or conditions that could interfere with recovery. Radiologic outcomes were evaluated by a six-month CT. PROs included pain reporting via the Numeric Rating Scale (NRS), function via the Oswestry Disability Index (ODI), and quality of life via PROMIS-10.</p><p><strong>Results: </strong>The study measured outcomes using NRS, ODI, PROMIS-10, opioid use, pain interventions, work status, and SAEs. Pain scores (NRS) significantly decreased from 6.8 at baseline to 4.1, 4.8, and 4.2 at 1, 3, and 6 months (P < 0.01). Disability scores (ODI) also improved significantly from 50.3 to 41.7, 35.6, and 34.9 (P < 0.05). PROMIS-10 scores showed slight, non-significant improvements. Opioid use dropped from 26 to 13-16 patients over time, though not statistically significant. No SAEs occurred. CT scans at 6 months showed 96% implant bone apposition and no implant failures; 72% of patients had SIJ bridging.</p><p><strong>Limitations: </strong>This study is limited by a small sample size, short follow-up, and lack of control group.</p><p><strong>Conclusions: </strong>Laterally placed SIJ fusion titanium alloy implants are a safe and effective treatment","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"29 1","pages":"83-94"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In Response to: Request for Withdrawal of Publication of \"Rapid Recommendations by Busse et al of Commonly Used Interventional Procedures for Non-Cancer Chronic Spine Pain: A Clinical Practice Guidelines\".","authors":"Helen Macdonald","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 S7","pages":"S219"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olivier Clerk-Lamalice, Alfonso Spath, Kimberly Carcary, Kasra Amirdelfan, Pierce D Nunley, Douglas P Beall
<p><strong>Background: </strong>Degenerative disc disease (DDD) is the most common cause of chronic low back pain (CLBP). In DDD, proteoglycans within the nucleus pulposus break down and lose their ability to retain water, thereby reducing the volume of intervertebral discs and decreasing their weight-bearing capacity. Mechanical loading shifts to the annulus fibrosus, creating fissures and tears that leak crucial factors in the pain to cascade into the intradiscal space and trigger inflammation. When conventional treatments for CLBP fail, surgical options may be required. These surgeries carry risks and require months to heal. For intervertebral discs requiring augmentation, an implant in the form of an injectable, polymer-based hydrogel was developed for the percutaneous treatment of CLBP secondary to lumbar DDD. We hypothesize that the implant's hydrophilic properties will increase water retention and hydration, improve biomechanics, distribute axial loading more evenly across the annulus fibrosus, and reduce some mechanical sources of discogenic disc pain.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of a novel, injectable hydrogel implant for the treatment of CLBP.</p><p><strong>Study design: </strong>Prospective, single-arm, multicenter feasibility and safety study.</p><p><strong>Methods: </strong>Patients with CLBP lasting for longer than 6 months, DDD (modified Pfirrmann grades 4-8), competent outer annuli, numeric rating scale (NRS) scores >= 4, and Oswestry Disability Index (ODI) scores >= 30 were enrolled in 3 outpatient clinics in Canada and Colombia. The hydrogel implant, melted and equilibrated to 65°C, was injected intradiscally with a 17G needle under local anesthesia, using fluoroscopic guidance. The hydrogel cooled to approximately 42°C as it exited the needle directly into the nucleus. Patients were discharged that day. Clinical assessments included ODI and NRS (taken at one, 3, 6, and 12 months), radiographs, computed tomography, and magnetic resonance imaging (MRI) scans. The primary outcome was the successful insertion of the implant in a lumbar disc nucleus.</p><p><strong>Results: </strong>Sixty patients (36 women, 24 men), 49.0 ± 9.3 years old, received 83 implants (one disc-level: n = 37; 2 disc-levels: n = 23). All patients were implanted successfully without complications during the procedure or at discharge. One patient died (for reasons unrelated to the device/procedure), and one patient was lost to follow-up, for n = 58 at the 12-month follow-up. Five patients (8.6%) experienced increased low back pain (LBP) or leg pain and/or leg paresthesia, due to what radiological procedures confirmed was partial implant migration. Migrated implant portions were removed endoscopically from those patients 2 weeks to 10 months after implantation, constituting a 6% (5/83) failure rate. Mean (standard error [SE]) ODI scores in the patients was 9.6 (1.7) at the final follow-up. In the full cohort, ODI scores
{"title":"Feasibility and Safety of Treatment of Painful Lumbar Degenerative Disc Disease with an Injectable Hydrogel Implant at One-year Follow-up.","authors":"Olivier Clerk-Lamalice, Alfonso Spath, Kimberly Carcary, Kasra Amirdelfan, Pierce D Nunley, Douglas P Beall","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Degenerative disc disease (DDD) is the most common cause of chronic low back pain (CLBP). In DDD, proteoglycans within the nucleus pulposus break down and lose their ability to retain water, thereby reducing the volume of intervertebral discs and decreasing their weight-bearing capacity. Mechanical loading shifts to the annulus fibrosus, creating fissures and tears that leak crucial factors in the pain to cascade into the intradiscal space and trigger inflammation. When conventional treatments for CLBP fail, surgical options may be required. These surgeries carry risks and require months to heal. For intervertebral discs requiring augmentation, an implant in the form of an injectable, polymer-based hydrogel was developed for the percutaneous treatment of CLBP secondary to lumbar DDD. We hypothesize that the implant's hydrophilic properties will increase water retention and hydration, improve biomechanics, distribute axial loading more evenly across the annulus fibrosus, and reduce some mechanical sources of discogenic disc pain.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of a novel, injectable hydrogel implant for the treatment of CLBP.</p><p><strong>Study design: </strong>Prospective, single-arm, multicenter feasibility and safety study.</p><p><strong>Methods: </strong>Patients with CLBP lasting for longer than 6 months, DDD (modified Pfirrmann grades 4-8), competent outer annuli, numeric rating scale (NRS) scores >= 4, and Oswestry Disability Index (ODI) scores >= 30 were enrolled in 3 outpatient clinics in Canada and Colombia. The hydrogel implant, melted and equilibrated to 65°C, was injected intradiscally with a 17G needle under local anesthesia, using fluoroscopic guidance. The hydrogel cooled to approximately 42°C as it exited the needle directly into the nucleus. Patients were discharged that day. Clinical assessments included ODI and NRS (taken at one, 3, 6, and 12 months), radiographs, computed tomography, and magnetic resonance imaging (MRI) scans. The primary outcome was the successful insertion of the implant in a lumbar disc nucleus.</p><p><strong>Results: </strong>Sixty patients (36 women, 24 men), 49.0 ± 9.3 years old, received 83 implants (one disc-level: n = 37; 2 disc-levels: n = 23). All patients were implanted successfully without complications during the procedure or at discharge. One patient died (for reasons unrelated to the device/procedure), and one patient was lost to follow-up, for n = 58 at the 12-month follow-up. Five patients (8.6%) experienced increased low back pain (LBP) or leg pain and/or leg paresthesia, due to what radiological procedures confirmed was partial implant migration. Migrated implant portions were removed endoscopically from those patients 2 weeks to 10 months after implantation, constituting a 6% (5/83) failure rate. Mean (standard error [SE]) ODI scores in the patients was 9.6 (1.7) at the final follow-up. In the full cohort, ODI scores ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 S7","pages":"S203-S213"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Request for Withdrawal of Publication of \"Rapid Recommendations by Busse et al of Commonly Used Interventional Procedures for Non-Cancer Chronic Spine Pain: A Clinical Practice Guidelines\".","authors":"Laxmaiah Manchikanti","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 S7","pages":"S215-S218"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annu Navani, Swarnima Vardhan, Abhinav Aggarwal, Riya Navani, Jose Fabio Lana, Sudhir A Diwan
<p><strong>Background: </strong>Low back pain (LBP) is a common and complex health issue with a multifactorial origin, involving structures such as the lumbar intervertebral discs (IVDs), facet joints, muscles, ligaments, and nerve roots. Typically, traditional pain management approaches target isolated pain generators. However, recent advancements, particularly regenerative injection techniques, have shifted the focus toward a more comprehensive treatment model that addresses the entire functional spinal unit (FSU), providing a disease-modifying approach.</p><p><strong>Objectives: </strong>The purpose of this narrative review is to provide a scoping overview of the concept of the FSU and evaluate the potential role of orthobiologics, such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs), in treating back pain associated with various spinal conditions.</p><p><strong>Study design: </strong>Narrative literature review.</p><p><strong>Methods: </strong>Relevant peer-reviewed manuscripts were identified through a comprehensive search of electronic databases, such as PubMed, Embase, and Google Scholar. Studies focusing on the anatomy, biomechanics, and pathology of the FSU, as well as those concerning the application of PRP and MSCs in spinal disorders, were included.</p><p><strong>Results: </strong>The FSU, the smallest structural unit of the spine, consists of 2 vertebrae, an IVD, facet joints, and associated supporting ligaments. The FSU is crucial for absorbing shock, distributing mechanical loads, protecting the spinal cord and nerve roots, and maintaining spinal stability and mobility. Orthobiologic therapies, including PRP and MSCs, have shown promise in modulating disease processes and promoting tissue repair in spinal conditions. Emerging evidence supports the efficacy of these therapies in reducing pain and improving functional outcomes by targeting multiple components of the FSU. A thorough understanding of the biomechanical processes and the dynamic distribution of mechanical load across its various structures is essential to recognizing that chronic LBP often arises from multiple pain generators rather than a single source. Therefore, an integrated treatment approach that addresses these multiple pain generators collectively, considering the FSU and the entire spine, is critical for optimizing patient outcomes.</p><p><strong>Limitations: </strong>Rather than being systematic, this narrative review is focused on providing an overview of the effects of orthobiologics in the treatment of chronic LBP using an FSU approach. The heterogeneity of study designs, variability in treatment protocols, and limited long-term data pose challenges in establishing standardized guidelines for orthobiologic therapies in LBP management.</p><p><strong>Conclusions: </strong>Orthobiologic treatments offer a promising disease-modifying approach by addressing the entire FSU rather than isolated pain generators. Future research should focus on optimi
{"title":"Functional Spinal Unit Approach for Orthobiologic Injections for Low Back Pain.","authors":"Annu Navani, Swarnima Vardhan, Abhinav Aggarwal, Riya Navani, Jose Fabio Lana, Sudhir A Diwan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a common and complex health issue with a multifactorial origin, involving structures such as the lumbar intervertebral discs (IVDs), facet joints, muscles, ligaments, and nerve roots. Typically, traditional pain management approaches target isolated pain generators. However, recent advancements, particularly regenerative injection techniques, have shifted the focus toward a more comprehensive treatment model that addresses the entire functional spinal unit (FSU), providing a disease-modifying approach.</p><p><strong>Objectives: </strong>The purpose of this narrative review is to provide a scoping overview of the concept of the FSU and evaluate the potential role of orthobiologics, such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs), in treating back pain associated with various spinal conditions.</p><p><strong>Study design: </strong>Narrative literature review.</p><p><strong>Methods: </strong>Relevant peer-reviewed manuscripts were identified through a comprehensive search of electronic databases, such as PubMed, Embase, and Google Scholar. Studies focusing on the anatomy, biomechanics, and pathology of the FSU, as well as those concerning the application of PRP and MSCs in spinal disorders, were included.</p><p><strong>Results: </strong>The FSU, the smallest structural unit of the spine, consists of 2 vertebrae, an IVD, facet joints, and associated supporting ligaments. The FSU is crucial for absorbing shock, distributing mechanical loads, protecting the spinal cord and nerve roots, and maintaining spinal stability and mobility. Orthobiologic therapies, including PRP and MSCs, have shown promise in modulating disease processes and promoting tissue repair in spinal conditions. Emerging evidence supports the efficacy of these therapies in reducing pain and improving functional outcomes by targeting multiple components of the FSU. A thorough understanding of the biomechanical processes and the dynamic distribution of mechanical load across its various structures is essential to recognizing that chronic LBP often arises from multiple pain generators rather than a single source. Therefore, an integrated treatment approach that addresses these multiple pain generators collectively, considering the FSU and the entire spine, is critical for optimizing patient outcomes.</p><p><strong>Limitations: </strong>Rather than being systematic, this narrative review is focused on providing an overview of the effects of orthobiologics in the treatment of chronic LBP using an FSU approach. The heterogeneity of study designs, variability in treatment protocols, and limited long-term data pose challenges in establishing standardized guidelines for orthobiologic therapies in LBP management.</p><p><strong>Conclusions: </strong>Orthobiologic treatments offer a promising disease-modifying approach by addressing the entire FSU rather than isolated pain generators. Future research should focus on optimi","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 S7","pages":"S145-S156"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Radiofrequency ablation (RFA) is a minimally invasive technique increasingly utilized in the treatment of musculoskeletal pain, particularly when pharmacological or rehabilitative approaches prove insufficient. However, the thematic evolution and research development of RFA over the past 2 decades have not been explored adequately.</p><p><strong>Objective: </strong>To conduct a comprehensive bibliometric analysis of the global literature on RFA for musculoskeletal pain, identifying publication trends, research focuses, leading contributors, and thematic transitions between 2000 and 2024.</p><p><strong>Study design: </strong>Bibliometric analysis.</p><p><strong>Setting: </strong>Data were retrieved from the Web of Science Core Collection (WoSCC).</p><p><strong>Methods: </strong>A total of 736 English-language articles published between January 1, 2000, and December 31, 2024, were included. Bibliometric tools such as VOSviewer, CiteSpace, and Biblioshiny were used to analyze annual publication trends, co-authorship networks, country/institutional productivity, keyword co-occurrences, co-citation patterns, and citation bursts.</p><p><strong>Results: </strong>A marked increase in publication volume was observed after 2010, with the peak occurring in 2023. The United States led in both publication output and international collaboration. The Johns Hopkins School of Medicine, University of Wisconsin, and University of Utah were among the most productive institutions. Steven P. Cohen and Laxmaiah Manchikanti emerged as the most influential authors, centrally positioned within international co-authorship networks. Meanwhile, Pain Physician, Pain Medicine, and Regional Anesthesia and Pain Medicine were identified as the journals that exerted the greatest impact. Co-citation analysis revealed a thematic shift from early spinal facet interventions and diagnostic blocks toward peripheral applications, especially genicular nerve ablation, and consensus-based clinical practices. Keyword co-occurrence and citation burst analyses identified 3 chronological research themes: firstly, early spinal interventions (2000-2010), secondly, the diagnostic standardization era (2010-2017), and thirdly, expansion into peripheral, imaging-guided, and multidisciplinary applications (2017-2024).</p><p><strong>Limitations: </strong>The analysis was limited to English-language articles indexed in the WoSCC. Conference proceedings, book chapters, and articles from other databases were excluded. Therefore, some relevant studies might not have been captured.</p><p><strong>Conclusion: </strong>This bibliometric analysis demonstrates a steady growth in RFA-related publications globally. While spinal interventions remain the primary focus, an interest in peripheral applications has seen a notable increase. The expansion of RFA reflects both technological advancements and evolving clinical demands. Future studies should focus on long-term outcomes, clinica
背景：射频消融（RFA）是一种微创技术，越来越多地用于治疗肌肉骨骼疼痛，特别是当药物或康复方法证明不足时。然而，近20年来RFA的主题演变和研究进展并没有得到充分的探讨。目的：对全球关于肌肉骨骼疼痛的RFA文献进行全面的文献计量分析，确定2000年至2024年间的出版趋势、研究重点、主要贡献者和主题转换。研究设计：文献计量学分析。设置：数据从Web of Science Core Collection （WoSCC）中检索。方法：纳入2000年1月1日至2024年12月31日发表的736篇英文文章。文献计量工具如VOSviewer、CiteSpace和Biblioshiny用于分析年度出版趋势、合著网络、国家/机构生产力、关键词共现率、共被引模式和引文爆发。结果：2010年以后论文发表量明显增加，2023年达到高峰。美国在出版物产量和国际合作方面都处于领先地位。约翰霍普金斯医学院、威斯康辛大学和犹他大学是最具生产力的机构。Steven P. Cohen和Laxmaiah Manchikanti成为最有影响力的作者，在国际合作网络中处于中心位置。同时，《疼痛医师》、《疼痛医学》和《区域麻醉与疼痛医学》被确定为影响最大的期刊。共引分析揭示了从早期脊柱小关节干预和诊断阻滞到外周应用的主题转变，特别是膝神经消融和基于共识的临床实践。关键词共现和引文爆发分析确定了3个按时间顺序排列的研究主题：第一，早期脊柱干预（2000-2010），第二，诊断标准化时代（2010-2017），第三，扩展到周边，成像引导和多学科应用（2017-2024）。局限性：该分析仅限于在wscc中索引的英文文章。会议记录、书籍章节和其他数据库中的文章被排除在外。因此，一些相关的研究可能没有被捕获。结论：文献计量学分析表明全球rfa相关出版物稳步增长。虽然脊柱干预仍然是主要焦点，但对周边应用的兴趣已经显著增加。射频消融的扩大反映了技术的进步和不断变化的临床需求。未来的研究应侧重于长期结果、临床应用以及基于证据的脊柱和周围适应症治疗算法优化。
{"title":"Radiofrequency Ablation for Musculoskeletal Pain: A Bibliometric Analysis of Global Research Trends (2000-2024).","authors":"Sahide Eda Artuc, Gizem Kilinc Kamaci","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) is a minimally invasive technique increasingly utilized in the treatment of musculoskeletal pain, particularly when pharmacological or rehabilitative approaches prove insufficient. However, the thematic evolution and research development of RFA over the past 2 decades have not been explored adequately.</p><p><strong>Objective: </strong>To conduct a comprehensive bibliometric analysis of the global literature on RFA for musculoskeletal pain, identifying publication trends, research focuses, leading contributors, and thematic transitions between 2000 and 2024.</p><p><strong>Study design: </strong>Bibliometric analysis.</p><p><strong>Setting: </strong>Data were retrieved from the Web of Science Core Collection (WoSCC).</p><p><strong>Methods: </strong>A total of 736 English-language articles published between January 1, 2000, and December 31, 2024, were included. Bibliometric tools such as VOSviewer, CiteSpace, and Biblioshiny were used to analyze annual publication trends, co-authorship networks, country/institutional productivity, keyword co-occurrences, co-citation patterns, and citation bursts.</p><p><strong>Results: </strong>A marked increase in publication volume was observed after 2010, with the peak occurring in 2023. The United States led in both publication output and international collaboration. The Johns Hopkins School of Medicine, University of Wisconsin, and University of Utah were among the most productive institutions. Steven P. Cohen and Laxmaiah Manchikanti emerged as the most influential authors, centrally positioned within international co-authorship networks. Meanwhile, Pain Physician, Pain Medicine, and Regional Anesthesia and Pain Medicine were identified as the journals that exerted the greatest impact. Co-citation analysis revealed a thematic shift from early spinal facet interventions and diagnostic blocks toward peripheral applications, especially genicular nerve ablation, and consensus-based clinical practices. Keyword co-occurrence and citation burst analyses identified 3 chronological research themes: firstly, early spinal interventions (2000-2010), secondly, the diagnostic standardization era (2010-2017), and thirdly, expansion into peripheral, imaging-guided, and multidisciplinary applications (2017-2024).</p><p><strong>Limitations: </strong>The analysis was limited to English-language articles indexed in the WoSCC. Conference proceedings, book chapters, and articles from other databases were excluded. Therefore, some relevant studies might not have been captured.</p><p><strong>Conclusion: </strong>This bibliometric analysis demonstrates a steady growth in RFA-related publications globally. While spinal interventions remain the primary focus, an interest in peripheral applications has seen a notable increase. The expansion of RFA reflects both technological advancements and evolving clinical demands. Future studies should focus on long-term outcomes, clinica","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 S7","pages":"S157-S168"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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