The Numerical Pain Rating Scale (NPRS) is routinely used to assess pain severity. A recently developed NPRS integrated the pain scale with an eye tracker (NPRS). As part of this study, we explored the NPRS's utility to d...The Numerical Pain Rating Scale (NPRS) is routinely used to assess pain severity. A recently developed NPRS integrated the pain scale with an eye tracker (NPRS). As part of this study, we explored the NPRS's utility to detect feigned pain, an ongoing challenge facing clinicians. To achieve this aim, chronic pain outpatients were randomly assigned to a simulation (i.e., requested to exaggerate their pain; n = 34) or a control condition (i.e., requested to genuinely report their pain severity; n = 35). They then rated their pain using the NPRS. Eye movement analyses indicated that simulators spent more time gazing at the higher NPRS pain ratings before providing their pain ratings and less time at the leftward ("No pain") anchor afterward. The discrimination capacities of these measures, however, were poor. In contrast, pain ratings using the NPRS showed excellent discriminative capacity, with a pain rating of 10 associated with 94.3% specificity and 26.5% sensitivity. Overall, the study's findings further indicate the feasibility of incorporating an eye tracker to evaluate the severity of pain. Though the findings at present do not support the utility of NPRS-based eye movement measures as validity indicators, pain ratings showed promise as a simple screen of feigned pain. The preliminary nature of the findings, however, calls for further research. Such research may aid in further developing effective indicators of feigned pain and hopefully clarify cognitive processes (e.g., experienced cognitive load) involved in pain deception. PERSPECTIVE: The NPRS enables pain ratings by patients with severe motor and speech impairments. While eye movements were not adequate in detecting feigned pain, participants' pain ratings showed initial promise. As this is a preliminary study, further research is recommended.
BACKGROUND: Ablative techniques, such as radiofrequency (RF) and cryoneurolysis (CN), are emerging as minimally invasive options for knee osteoarthritis (OA) pain management. However, inconsistencies in efficacy, techniq...BACKGROUND: Ablative techniques, such as radiofrequency (RF) and cryoneurolysis (CN), are emerging as minimally invasive options for knee osteoarthritis (OA) pain management. However, inconsistencies in efficacy, technique variations, and a lack of standardized protocols limit their clinical application. This study addresses these gaps through a comprehensive meta-analysis. OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the efficacy of ablative techniques in improving (1) pain, measured by the Visual Analog Scale (VAS), (2) functionality, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and (3) quality of life and patient perception/satisfaction at 4, 12, and 24 weeks after treatment in patients with OA. METHODS: A meta-analysis of randomized controlled trials (RCTs) was conducted using PubMed, Embase, Scopus, and the Cochrane Database up to October 2024. Studies were included evaluating genicular or saphenous nerve ablation in adults with OA-associated pain. Outcomes of interest comprised pain reduction (VAS), functional improvement (WOMAC), patient perception, and quality of life. The risk of bias was evaluated using the RoB 2 tool, and data were analyzed using fixed- or random-effects models based on the degree of heterogeneity. RESULTS: Seven studies involving a total of 437 patients were included. The meta-analysis demonstrated a significant reduction in pain in the ablation group at 4 weeks (MD = -1.60; 95% CI = -2.79 to -0.41), 12 weeks (MD = -1.97; 95% CI = -2.54 to -0.80), and 24 weeks (MD = -0.82; 95% CI = -1.41 to -0.23). CN consistently reduced pain (MD = -2.25 at 4 weeks, -1.12 at 12 weeks, and -1.28 at 24 weeks). Additionally, most evaluations did not show significant differences in patient perception and quality of life measures. CONCLUSION: Ablative techniques, particularly CN, show promise in reducing pain and enhancing function in patients with OA, offering a minimally invasive alternative for those with an inadequate response to conservative treatments. However, the observed outcome variability underscores the need for further research to standardize protocols and confirm long-term safety and efficacy.
INTRODUCTION: Chronic back pain is a significant global healthcare challenge, with a lifetime incidence affecting approximately 80% of people worldwide. Most patients respond positively to nonsurgical management, while a...INTRODUCTION: Chronic back pain is a significant global healthcare challenge, with a lifetime incidence affecting approximately 80% of people worldwide. Most patients respond positively to nonsurgical management, while a substantial proportion of the remainder obtain relief from surgical therapy. For the minority of patients with chronic back pain who do not respond to conventional medical management (CMM) and are not candidates for spine surgery, spinal cord stimulation (SCS) may be a viable treatment option. This Delphi consensus focused on identifying the thoughts and opinions of pain management and referral specialties on the use of SCS in patients with chronic back pain who are not suitable for spine surgery. METHODS: A steering group of US healthcare professionals specialized in spine surgery and chronic back pain management generated 35 statements across six main domains. Using a four-point Likert scale, the survey was created and shared with a wider panel of specialists. Results were analyzed to produce an aggregated agreement level for each statement. The consensus threshold was set at 75% agreement, which is defined as strong consensus, and ≥ 90% agreement was considered powerful consensus. RESULTS: A total of 211 responses were received from the following specialties: pain physician (18%; n = 38), physical therapist (18%; n = 38), orthopedic surgeon (18%; n = 37), neurosurgeon (17%; n = 36), primary care physician (15%; n = 32), and musculoskeletal radiologist (14%; n = 30). Of the 35 consensus statements developed for broader testing, 30/35 (86%) achieved consensus; 18 (51%) of which achieved ≥ 90% agreement. The remaining five (15%) statements failed to achieve consensus among the wider panel. CONCLUSION: Based on the agreement scores, the steering group agreed on seven key findings to consider for pain management in patients with chronic back pain who are not candidates for spine surgery. These findings are opinion-based and are meant to be a starting point to help identify appropriate patients who may benefit from SCS therapy and when an evaluation for SCS candidacy should be considered.
OBJECTIVES: Neck pain presents a multifactorial challenge with substantial personal and societal impact. Traditional classification approaches often overlook the variability among patients. This study aims to systematica...OBJECTIVES: Neck pain presents a multifactorial challenge with substantial personal and societal impact. Traditional classification approaches often overlook the variability among patients. This study aims to systematically collect and analyze data using a mobile health (m-health) application to explore the anatomical distribution of pain in neck pain patients, with particular attention to pain duration and socio-demographic characteristics. The aim of this study is to assess whether an m-health application can provide relevant insights into the anatomical pain distribution in neck pain patients based on pain duration and socio-demographic variables. METHODS: The retrospective cross-sectional study adhered to ethical guidelines, analyzing data from medicalmotion app users reporting neck pain between October 2018 and September 2022. Collected data encompassed movement frequency, work position, pain duration, quality, and intensity (NRS, 0-10). Statistical analyses investigated pain variations based on different pain durations and lifestyles. RESULTS: This study examined data from 1359 participants (mean age 42.7, 70.1% females). Chronic pain (70.7%) had an average intensity of 6.2 (1.7). Participants reported 3.9 pain areas on average, with 'pulling' (63.2%) and 'pressing' (36.8%) as primary descriptors. The chronic pain group reported more pain areas (4.3) compared to subacute (3) and acute (2.4) groups. Logistic regression revealed significant anatomical differences, consistently distinguishing chronic pain from subacute and acute groups. CONCLUSION: This study emphasizes notable differences in other painful areas of the body in people with chronic, subacute, and acute neck pain, underscoring the importance of considering pain duration. The moderate effect size and significant anatomical differences, identified through logistic regression, reveal the complexity of pain experiences in different neck pain groups. Accounting for confounding factors like age, sex, and sports frequency is crucial, aligning with research indicating an increased risk of persistent widespread neck pain in women. TRIAL REGISTRATION: https://doi.org/10.17605/OSF.IO/7XW23 (13.02.2023 via OSF Registries).
INTRODUCTION: Sacroiliac joint (SIJ) dysfunction is a significant contributor to chronic low back pain. Between 70% and 85% of people will suffer from low back pain (LBP) at some stage in their lives, and 15%-30% of thes...INTRODUCTION: Sacroiliac joint (SIJ) dysfunction is a significant contributor to chronic low back pain. Between 70% and 85% of people will suffer from low back pain (LBP) at some stage in their lives, and 15%-30% of these individuals will experience pain associated with the SIJ. With the limitations of conservative treatments in addressing the underlying pain and dysfunction, minimally invasive sacroiliac joint fusion has emerged as a promising intervention. Robust studies targeted towards examining complications associated with posterior approach SIJ fusions are rare; thus, this study aims to assess the incidence of adverse events (AEs) associated with posterior approach SIJ fusions using a cadaveric graft joint stabilization system in a clinical setting. METHODS: A retrospective single-site study was conducted reviewing 260 patients with chronic SIJ dysfunction refractory to conservative management. Patients underwent SIJ fusion using the almond-shaped bone allograft with bone window (LinQ system, Painteq, and Tampa Florida) and were monitored for AEs up to 6 months post procedure. Descriptive statistics and hierarchical generalized linear models were used to analyze the data. RESULTS: The cohort primarily consisted of females (70.27%) with a mean age of 65.21 years. The incidence of AEs was low, with 2.3% at 3 months and 1.9% at 6 months post intervention. No major serious adverse events occurred related to the surgery. Minor adverse events included superficial infection and limited hematoma. All events resolved without permanent harm. There were no device-related events. CONCLUSION: The posterior approach to minimally invasive SIJ fusion using a human bone allograft demonstrates a favorable safety profile with a low incidence of adverse events.
BACKGROUND: Diagnosing cLBP is complex due to its heterogeneity, lack of definitive biomarkers, and the subjective nature of pain. This study aims to analyze cLBP patients comprehensively, characterizing demographic and...BACKGROUND: Diagnosing cLBP is complex due to its heterogeneity, lack of definitive biomarkers, and the subjective nature of pain. This study aims to analyze cLBP patients comprehensively, characterizing demographic and clinical profiles of patients and evaluating the types and effectiveness of previous treatments. METHODS: From January 2022 to April 2024, we recruited 1262 participants aged between 18 and 72 years from the general population by advertisements and word-of-mouth propaganda. Collected data included a detailed medical history, standardized questionnaires (e.g., Von Korff) and a clinical examination. RESULTS: Our population included 471 (38%) with chronic back pain, 335 (27%) without back pain, and an additional group in between of 327 (26%) with intermittent back pain. The majority of participants experienced multifocal back pain, which was further subdivided based on the predominant pain localization. In patients with localized cLBP (median: 5 years, IQR: 1-10 years), the pain persisted for a shorter time than in the group with predominant back pain other than the lower back (median: 10 years, IQR: 5-15 years). The majority of participants did either use no pain medication at all (cLBP: 32%; iLBP: 37%; no-BP(2): 55%) or on-demand medication (cLBP: 56%; iLBP: 56%; no-BP(2): 39%). CONCLUSION: Our data show considerable heterogeneity underlying the widespread diagnosis "chronic back pain." Quantitative differentiation is difficult due to the low pain intensity on the day of the examination, and adequate treatment recommendations are challenging. To better understand chronic back pain, there is a strong need for a subclassification. TRIAL REGISTRATION: German Clinical Trial Register: DRKS-ID: DRKS00027907.
INTRODUCTION: There are many non-operative factors (patient specific and management strategies) that are ubiquitous across all surgeries, which may influence perioperative pain. Recognition of these factors and their ass...INTRODUCTION: There are many non-operative factors (patient specific and management strategies) that are ubiquitous across all surgeries, which may influence perioperative pain. Recognition of these factors and their association with pain and analgesia requirements could provide avenues for improved perioperative care. METHODS: All consecutive surgical patients admitted to six Australian tertiary hospitals (2017-2024) were included. The primary outcome was postoperative pain score (0 = no pain to 10 = unbearable pain). Additional outcomes included "Pain Crisis", quantity of postoperative and discharge analgesia. Pain scores were calculated using the median scores in the 5 days postoperatively. Postoperative analgesia was quantified by total morphine milligram equivalents (MME) in the 5 days postoperatively and discharge analgesia as MME provided on the discharge prescription. Multivariable binary logistic and linear regression models, with backward elimination, were employed with clinical characteristics and non-operative management factors included as predictors. RESULTS: A total of 37,278 patients were included. Of these, 92% were unplanned emergency procedures. Psychological factors, such as depression and anxiety, significantly influenced perioperative pain and opioid use. An increase in socio-economic status was associated with less postoperative analgesia but more discharge analgesia. Older patients generally experienced less pain and required fewer opioids. Contrastingly, increased frailty correlated with higher opioid usage. Patients speaking English as a primary language reported more postoperative pain, without higher opioid use. Patients who did not identify as a First Nations Australian received 30% more opioids on discharge, despite no relationship with pain. DISCUSSION/CONCLUSION: An integrated, anticipatory, patient-centric approach to perioperative pain and analgesia that considers not only the surgical factors but also the individual's psychological and socio-economic context is required.
INTRODUCTION: Discogenic low back pain can be severely disabling, clinically challenging to diagnose, and expensive to treat. Disc degeneration is characterized by disc dehydration, which diminishes the ability of the di...INTRODUCTION: Discogenic low back pain can be severely disabling, clinically challenging to diagnose, and expensive to treat. Disc degeneration is characterized by disc dehydration, which diminishes the ability of the disc to distribute pressure, making it more susceptible to damage, and leading to annular tears, fissures, and a higher incidence of herniation. Furthermore, the abnormal annular in-growth of nerves and inflammation of the disc increase the number and sensitivity of nociceptors, leading to chronic discogenic low back pain (CDLBP). The purpose of this article was to review the current literature. METHODS: In this narrative review, the literature on the diagnosis and treatment of discogenic low back pain was summarized. RESULTS: Symptoms and findings during physical examination may guide the diagnostic process but are not specific or sensitive regarding CDLBP. Magnetic resonance imaging (MRI) can rule out other pathology and provides a basis for the decision about whether to perform pressure-controlled provocative discography, the current diagnostic standard. Conservative care includes pain education programs, structured exercise therapies, psychological interventions, and pharmacological treatment. Various minimally invasive interventional treatment strategies for refractory CDLBP exist, of which biacuplasty or cooled radiofrequency can be used as therapeutic options. Promising new treatments include intradiscal injection of mesenchymal stem cells and platelet-rich plasma, radiofrequency ablation of the sinuvertebral and basivertebral nerves, dorsal root ganglion stimulation, and spinal cord stimulation. Future research regarding the safety and efficacy of these treatments should include large randomized controlled trials with strict inclusion criteria and longer follow-up periods. A primary focus should be on increasing the evidence base for diagnosing discogenic low back pain.
BACKGROUND AND AIM: Spinal cord injury (SCI) is a debilitating condition frequently associated with chronic symptoms such as central neuropathic pain (CNP) and its related complications. Gabapentinoids are often used in...BACKGROUND AND AIM: Spinal cord injury (SCI) is a debilitating condition frequently associated with chronic symptoms such as central neuropathic pain (CNP) and its related complications. Gabapentinoids are often used in the treatment of post-SCI CNP; however, the optimal management of this condition is still unclear. This study aimed to assess the efficacy and safety of gabapentinoids compared with placebo in post-SCI patients affected by CNP. METHODS: We systematically searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) comparing gabapentinoids (gabapentin, pregabalin, or mirogabalin) with placebo in post-SCI patients experiencing CNP. We calculated mean differences (MD) and risk ratios (RR) for continuous and dichotomous outcomes, respectively, with 95% confidence intervals (CI). Pain was measured on a 0 to 10 numerical rating scale. RESULTS: We included 5 RCTs comprising 682 patients. The mean age was 50.2 years, and 83.8% were male. When compared with placebo, patients treated with gabapentinoids experienced a significant decrease in average daily pain (MD -1.75; 95% CI: -3.23 to -0.28; p = 0.02) and pain-related sleep interference (MD -0.99; 95% CI: -1.38 to -0.60; p < 0.001). Additionally, there were higher proportions of individuals with pain intensity relief ≥ 50% (RR 2.19; 95% CI: 1.47 to 3.25; p < 0.001) and with at least some perceived improvement on the clinical global impression scale (RR 1.71; 95% CI: 1.34 to 2.18, p < 0.001) in the gabapentinoids group compared to the placebo group. However, treatment with gabapentinoids was associated with a significantly increased risk of blurred vision (RR 8.55; 95% CI: 1.53 to 47.7; p = 0.02), somnolence (RR 3.77; 95% CI: 2.44 to 5.84; p < 0.001), peripheral edema (RR 2.86; 95% CI: 1.37 to 5.99; p < 0.01), and dizziness (RR 2.83; 95% CI: 1.67 to 4.78; p < 0.001). CONCLUSION: In this meta-analysis of RCTs evaluating patients with CNP following SCI, gabapentinoids were associated with significant improvements in pain and pain-related sleep interference compared with placebo. Nonetheless, gabapentinoids significantly increased the risk of adverse events.
PURPOSE: To compare the efficacy and safety of a once-daily prolonged release (PR) pregabalin formulation to pregabalin immediate release (IR) in patients with diabetic peripheral neuropathy (DPN). PATIENTS AND METHODS:...PURPOSE: To compare the efficacy and safety of a once-daily prolonged release (PR) pregabalin formulation to pregabalin immediate release (IR) in patients with diabetic peripheral neuropathy (DPN). PATIENTS AND METHODS: This was a non-inferiority, randomized, double-blind, double-dummy, multiple-dose, multicenter, active and placebo controlled, three-arm, parallel study. Patients were randomly assigned in a 1:1:1 ratio to receive pregabalin PR tablet, pregabalin IR hard capsule (Lyrica) or placebo at an optimized dose based on individual subject's response and tolerability for 13 weeks. The primary efficacy outcome was the change in the mean weekly pain score from baseline to end of treatment. RESULTS: Overall, 453 patients were randomized. In the per protocol (PP) analysis set, the least square mean (LSM) difference between test and reference treatment for the change in weekly pain score from baseline to end of treatment was 0.06 (95% CI: -0.28, 0.41, p = 0.7121), indicating that pregabalin PR was non-inferior to pregabalin IR. In the Full Analysis Set (FAS), the LSM of change in mean weekly pain score from baseline to end of treatment for test, reference, and placebo groups were -3.43, -3.49, and -3.04, respectively. Test and reference products were superior to placebo (p = 0.0158 and 0.0047, respectively). CONCLUSION: The efficacy and safety of pregabalin PR was comparable to pregabalin IR for the treatment of pain in patients with DPN.
BACKGROUND: Spinal cord stimulation (SCS) is a nonpharmacological, minimally invasive intervention designed to ameliorate chronic low back pain. However, meta-analyses have not supported the use of SCS due to a lack of h...BACKGROUND: Spinal cord stimulation (SCS) is a nonpharmacological, minimally invasive intervention designed to ameliorate chronic low back pain. However, meta-analyses have not supported the use of SCS due to a lack of high-quality evidence. This work provides the necessary information to design better statistically powered clinical trials for SCS by providing estimates and variances for various patient-reported outcomes and biometrics across time in this population. METHODS: A cohort of 18 patients was followed across 7 months before and after SCS implantation. The patients were administered a monthly battery of patient-reported outcomes, and daily biometrics were obtained. Multilevel Bayesian distributional models quantified the median and variance change across time, both of which are necessary in sample size calculations. Secondary to estimating effects, we also determine the probability of a directional effect and equivalence. RESULTS: Scales for pain show sustained improvements and stable variance. There were no changes in quality-of-life medians or variance. Robust improvements were made in fatigue and reported sleep quality, despite an unclear effect on total hours slept as recorded by the daily wearable. Resting heart rate decreased after SCS and had low changes in variance; whereas pulse rate variability/heart rate variability exhibited no median change across time but wild swings in variance, indicating it is a poor biomarker in this population. CONCLUSIONS: This study reports many patient-reported outcomes and digital biomarkers used in SCS clinical research, including which ones have potential value and the exact information necessary to plan future high-quality clinical trials in the SCS population. SIGNIFICANCE: There is currently only low-quality evidence that spinal cord stimulation is effective for low back pain. This study supplies all the necessary information (effect estimates, variances and within-measure correlations across time) to better estimate sample sizes, a primary criticism of current evidence in this population. We also provide a preliminary indication as to which patient-reported outcomes and wearable measures are most effective in a spinal cord stimulation population.
BACKGROUND: Medication sources for prescription opioid misuse in US adolescents and young adults may have changed, particularly related to the COVID-19 pandemic. We examined how opioid sources vary across age groups and...BACKGROUND: Medication sources for prescription opioid misuse in US adolescents and young adults may have changed, particularly related to the COVID-19 pandemic. We examined how opioid sources vary across age groups and cohorts and whether links between sources and substance use or mental health vary between age groups. METHODS: Cross sectional nationally representative survey data from the 2015-2019 and 2021-2022 National Survey on Drug Use and Health were used. Respondents were interviewed in their homes (2015-19) or via mixed household and web-based survey methods (2021-2022). Participants were 6045 14-25-year-old reporting past-year prescription opioid misuse. Mutually exclusive opioid sources were physicians, purchases, theft, and friends/family for free. Cross-tabulations estimated source prevalence by age, and logistic and negative binomial regression models evaluated links between sources (independent variable) and substance use, mental health, and sociodemographics (individual dependent variables). RESULTS: Theft declined significantly with age in the 2015-2019 cohort (12.4% to 4.7%), with some evidence of opioid source differences between 2015-2019 and 2021-2022. Those using purchases had the most past-month prescription opioid misuse days and the highest prevalence of substance use disorder from misuse (e.g., 23.4% of 2015-2019 young adults), other substance use, and mental health concerns; those using theft typically had the second highest rates, with the lowest rates often in the physician source group. CONCLUSION: We found age- and cohort-based differences in sources, and mechanisms underlying these differences warrant further study. Adolescents and young adults using purchases or theft to obtain opioids are important targets for identification and intervention.
BACKGROUND: Sacroiliac joint dysfunction contributes to a significant proportion of lower back and leg pain and associated functional deficiencies. Following failure of conservative methods, lateral fusion approaches hav...BACKGROUND: Sacroiliac joint dysfunction contributes to a significant proportion of lower back and leg pain and associated functional deficiencies. Following failure of conservative methods, lateral fusion approaches have previously provided the mainstay for surgical stabilization of the joint. In recent years there are multiple devices available for sacroiliac fusion via posterior or posterolateral oblique approaches, thereby reducing neurovascular complications of the lateral approach. OBJECTIVES: To provide a comprehensive review of the evidence for pain and functional outcomes in patients treated with posterior or posterolateral oblique sacroiliac joint fusion devices. METHODS: The primary outcome was improvement in pain following posterior or posterolateral oblique sacroiliac joint fusion in publications between 2020 and 2024, with the authors' previous review conducted up to 2020. Three authors assessed studies identified from multiple databases (PubMed, SCOPUS, Embase, MEDLINE, Cochrane, and Google Scholar). RESULTS: Out of 740 initial publications, 12 studies fulfilled inclusion criteria. These peer-reviewed articles included two prospective and 10 retrospective observational studies, with two studies providing direct comparisons to lateral fusion approaches. Overall average improvement of VAS/NRS pain scores at final follow-up for intra-articular fusion via posterior approach and posterolateral oblique fusion ranged 35%-75% and 28%-89%, respectively. Cohort outcomes were nearly all statistically significant. Complications were minimal and typically resolved with revision fusion. The heterogeneity of studies prohibited proper meta-analysis. CONCLUSION: There is increasing evidence for the effectiveness and safety of posterior and posterolateral oblique sacroiliac joint fusion. Future randomized, controlled trials are needed to guide specific device and approach selection, and elucidation of patient long-term outcomes.
OBJECTIVES: Cervical neck pain is a significant public health issue due to its prevalence and profound impact on the quality of life of patients. The demand for treatments has surged in recent years. METHODS: The primary...OBJECTIVES: Cervical neck pain is a significant public health issue due to its prevalence and profound impact on the quality of life of patients. The demand for treatments has surged in recent years. METHODS: The primary aim of this study is to study our practice over the past two decades (2001-2021) regarding expert recommendations. Our secondary aims are documenting any complications encountered and attempting to identify predictors of positive outcomes following cervical medial branch block (CMBB) treatment. RESULTS: This single-centre retrospective study involved 729 patients who underwent CMBB or cervical medial branch denervation (CMBD) from 2001 to 2021. A total of 1031 procedures (729 CMBB and 302 CMBD) were performed, predominantly using a posterior approach (98.93%) and fluoroscopic guidance with a sentinel neurostimulator (98.84%). Corticosteroids were administered in 69.96% of CMBBs. Computed tomography (CT) scans and nuclear magnetic resonance imaging (NMR) were the most common preliminary investigations, performed in 60.72% and 53.93% of cases, respectively, with a minor complication rate of 0.49%. There were significant positive associations between successful CMBB outcomes and prior CT scans availability, physical medicine interventions, and a history of cervical trauma. Conversely, a prior NMR was associated with negative responses to CMBB. CONCLUSION: Our findings suggest that prior CT scans availability, prior management with physical medicine, and a history of cervical trauma are associated with favorable CMBB outcomes, whereas prior NMR correlates with poorer responses. There is potential for improvement in our use of corticosteroids in CMBB procedures. The complication rate in our study was under 0.5%, with all complications being minor. Further prospective studies are warranted to corroborate these findings.