Pain physician最新文献

Background: Facetogenic pain accounts for 5-50% of chronic low back pain (CLBP) cases, and the prevalence of this pain increases with age. Because of poor imaging correlation, the diagnosis is challenging and relies on symptoms, exam findings, and "gold standard" diagnostic blocks, though optimal protocols remain debated. National societies have issued treatment recommendations for the condition, yet controversy persists. The present investigation focuses on medial branch block radiofrequency ablation (RFA) and highlights key factors for optimizing technique to improve patient outcomes.

Objectives: To demonstrate proper technique and factors that clinicians should consider to maximize the effectiveness of MBN RFA.

Study design: Development of methodology integrating ex vivo evidence and clinical approach.

Setting: An academic healthcare institution.

Methods: A PubMed review of article published between 2020 and 2025 was performed using the keywords "ex vivo," "radiofrequency ablation," and "lesion size." RFA of medial branch nerves (MBNs) relies on precise anatomical knowledge to ensure proper needle placement. Recent studies have demonstrated that there are multiple factors to consider in MBN RFA. When compared to muscle, adipose reduces lesion size in relation to lower thermal conductivity. Adipose around the needle decreases lesion size, which may explain the reduced efficacy of RFA in obese patients. Commonly used solutions impact lesion dimensions: 2% lidocaine increases lesional width, while iohexol 240 increases length. In addition, a probe's proximity to bone increases lesion size, as poor thermal conductance traps energy in adjacent tissues. Therefore, shape and size can be modified in accordance with medication selection and the active tip's juxtaposition to tissue.

Limitations: Despite advancements, significant knowledge gaps remain in understanding the effectiveness of RFA, since most studies focus on tumor ablation rather than neurolysis, and lack in-vivo data. To improve real-world clinical outcomes, future research should evaluate functional outcomes and pain relief in patients undergoing individualized procedures tailored to their unique anatomy.

Conclusions: RFA of MBNs is a valuable way to treat axial, facetogenic low back pain. The technique should be optimized to best account for the unique anatomy of each patient and thereby maximize the effectiveness of the procedure.

Background: In recent years, rising costs associated with managing spinal pain and other musculoskeletal disorders have been well documented. Prior to the COVID-19 pandemic, the use of interventional techniques to manage spinal pain and other musculoskeletal disorders had steadily increased. However, the pandemic disrupted chronic pain management, including interventional procedures and opioid use, reflecting a broader reduction in healthcare services.

Objectives: To provide an updated assessment of interventional technique utilization for chronic pain management in the U.S. Medicare population from 2000 to 2024.

Study design: Retrospective cohort study examining trends and factors influencing interventional technique use for chronic pain management within the traditional fee-for-service (FFS) Medicare population in the United States between 2000 and 2024.

Methods: Data were obtained from the Centers for Medicare & Medicaid Services (CMS) master database, specifically the physician/supplier procedure summary, covering the years 2000 through 2024.

Results: Service rates for interventional pain management per 100,000 Medicare beneficiaries significantly declined by 16.8% cumulatively from 2019 to 2024, corresponding to an average annual decrease of 3.6%. This contrasts with the 2010-2019 period, during which a cumulative increase of 14.5% was observed, along with an average annual growth rate of 1.5%. The steepest decline occurred between 2019 and 2020, with a 15.4% reduction coinciding with the onset of the COVID-19 pandemic.

Limitations: The analysis is limited to traditional (FFS) Medicare beneficiaries, excluding Medicare Advantage Plans, which represented nearly 54% of Medicare enrollment in 2024. Additionally, as with all retrospective claims-based studies, inherent limitations of coding accuracy and incomplete clinical detail apply.

Conclusion: From 2019 to 2024, the use of interventional pain management techniques declined significantly. Contributing factors likely include the lingering effects of COVID-19, economic pressures, the Affordable Care Act, and evolving local coverage determination (LCD) policies.