Pain Pract [JOURNAL]
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200 papers
The effectiveness of liposomal bupivacaine in ultrasound-guided abdominal wall blocks after open abdominal surgery: A systematic review.
Vereen MS, Bidault VJ, Krabbendam E … +3 more , Hoeks SE, Stolker RJ, Dirckx M
Pain Pract · 2025 Mar · PMID 39968944 · Full text
BACKGROUND AND OBJECTIVE: Thoracic epidural analgesia has traditionally been used for pain management after open abdominal surgery, but its use has declined. The quest for efficient alternatives has resulted in the incre...
BACKGROUND AND OBJECTIVE: Thoracic epidural analgesia has traditionally been used for pain management after open abdominal surgery, but its use has declined. The quest for efficient alternatives has resulted in the increasing use of regional techniques. These can be applied as single-shot or continuous blocks using catheters. Long-acting liposomal bupivacaine could preclude the use of catheters. This review aimed to evaluate the effectiveness of ultrasound-guided abdominal wall blocks with liposomal bupivacaine for open abdominal surgery. DATABASES AND DATA TREATMENT: Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were systematically searched. Screening, data extraction, and quality assessment were done by two independent researchers. Inclusion criteria were (1) liposomal bupivacaine in ultrasound-guided abdominal wall blocks for open abdominal surgery, (2) outcome of pain and/or opioid consumption, (3) patients >18 years, and (4) reports published in English. RESULTS: Of the 1277 studies found, 22 met the inclusion criteria. The Cochrane Risk of Bias (Version 2) tool was used to assess randomized controlled trials. Studies were grouped for clarity. Transversus abdominis plane (TAP) blocks were mostly investigated. Data were heterogenic regarding types of surgery, approach to block placement, anesthetic solution injected, and use of intrathecal morphine (ITM). CONCLUSIONS: Patients undergoing cesarean section with neuraxial anesthesia and intrathecal morphine benefit from TAP blocks with liposomal bupivacaine, demonstrating reduced opioid consumption and comparable pain. Evidence for other open abdominal surgeries was inconclusive. Abdominal wall blocks with liposomal bupivacaine could be a viable alternative when epidural analgesia is contraindicated.
Feasibility of collecting objective data and exploring patient's experiences on physical activity in persistent spinal pain syndrome type 2 patients receiving spinal cord stimulation: A mixed feasibility study.
Hamm-Faber T, Arnts I, Henssen DJHA … +5 more , van Gorp EJAA, van Haren FGAM, van Dongen R, Engels Y, Vissers KCP
Pain Pract · 2025 Mar · PMID 39963711 · Publisher ↗
BACKGROUND: Patients with chronic pain due to persistent spinal pain syndrome Type 2 (PSPS Type 2) experience daily limitations in their physical activities. Physical, emotional, and social well-being changes are usually...
BACKGROUND: Patients with chronic pain due to persistent spinal pain syndrome Type 2 (PSPS Type 2) experience daily limitations in their physical activities. Physical, emotional, and social well-being changes are usually measured with standardized, validated self-reporting questionnaires. These reported data are subjective and are answered at a particular moment, which may not accurately reflect the patient's overall condition. Moreover, questionnaires could be misinterpreted, leading to potential inaccuracies in the reported data. This highlights the need for objective measurement tools that report longitudinal real-life data, which could be helpful in evaluating physical activity in spinal cord stimulation (SCS). However, objective measurement tools in SCS therapy are scarce. OBJECTIVE: We aimed to investigate the feasibility of collecting objective data from an activity tracker and a neurostimulator device to evaluate physical activity. As this is a feasibility study, we also aimed to evaluate the experiences of participating patients and healthcare professionals to explore the viability and practicality of future studies. METHODS: We performed a mixed-methods feasibility study with quantitative and qualitative data collection. Alongside the standardized questionnaires, we collected objective data on different bodily functions as measured by the activity tracker and on different body positions as measured with the neurostimulator device, starting 1 month before the trial spinal cord stimulation and with a follow-up of 3 months. Additionally, we performed face-to-face, in-depth interviews exploring patients' experiences of physical activity using the six dimensions of the diagram of positive health as a topic list. At the end of the study, patients and participating healthcare professionals were asked to evaluate their experiences on a five-point Likert scale expressing satisfaction. The study was performed in two Dutch hospitals. RESULTS: We included 20 patients with PSPS Type 2, of whom 17 (85%) completed the three-month follow-up with a nearly complete personalized real-time data set. Most of the missing data was due to the wear of the watch. One patient developed an allergic reaction to the watch strap. According to the interviews, patients mentioned feeling motivated to be physically active by wearing an activity tracker. The evaluation form showed that 84% of the patients and 75% of the healthcare professionals were very satisfied and would participate in a study with a similar design. The activity tracker remotely collected objective data on physical activity at baseline, trial, and three-month follow-up. CONCLUSION: Collecting objective data on physical activities and health status of PSPS Type 2 patients receiving SCS appeared feasible with a neuromodulation device and an activity tracker if the watch was correctly worn on the wrist or with clear instructions. The personalized data could add value to the standardized questionnaires evaluating holistic SCS outcomes. Participating patients and healthcare professionals supported a future prospective study with objective measurement tools in a similar design.
Permanent trials for spinal cord stimulation.
Bandlamuri S, Harland TA, Pilitsis JG … +1 more , Sukul VV
Pain Pract · 2025 Feb · PMID 39917964 · Publisher ↗
INTRODUCTION: Prior to the permanent implant of a spinal cord stimulator, patients typically undergo a screening trial using a percutaneously placed lead to ensure adequate response. However, due to several factors, pati...
INTRODUCTION: Prior to the permanent implant of a spinal cord stimulator, patients typically undergo a screening trial using a percutaneously placed lead to ensure adequate response. However, due to several factors, patients may not be candidates for this screening trial and therefore instead undergo a "permanent trial" where either a percutaneous lead or paddle lead is placed using a tunneled extension for the trial, with the intent of conversion to a permanent system. If these patients proceed with an implant, the epidural space is not re-accessed and only an impulse generator (IPG) is needed. Although this technique is commonly employed, there is a paucity of literature describing outcomes with the "permanent trial" methodology. We present here our clinical experience with this technique. METHODS: Participants who underwent permanent trials at a single institution between 2014 and 2020 were identified. Charts were reviewed to collect demographic information, numerical rating score (NRS) data, length of follow-up, revisions, complications, and removals. RESULTS: A total of 27 patients who underwent permanent trial placement were identified from a database of 762 patients who underwent SCS placement (3.54%). The permanent placement group included 7 paddle trials, 14 percutaneous trials, and 6 dorsal root ganglion (DRG) trials. The reasons for pursuing a permanent trial included previously aborted percutaneous trial (n = 8), inability to hold anticoagulation for a prolonged period (n = 4), previous thoracic spine surgery or presence of thoracic stenosis on MRI (n = 4), and significant medical comorbidities precluding typical percutaneous trial lead placement at a surgery center (n = 3). 24/27 (88.8%) proceeded to permanent implant, and 16/24 (66.7%) were considered responders (greater than 50% reduction in pain) after 3 months. Over an average follow-up of 28.7 months, complications included 1 peri-operative intracranial hemorrhage delaying IPG placement, 2 lead fractures, 1 lead migration, and 1 CSF leak. Three patients required revision surgery for lead migration, lead fracture, and CSF leak, respectively. One patient had his system explanted 25.9 months after initial placement due to increased pain from stimulation. CONCLUSION: This study aims to characterize our experience with permanent trials for SCS. Here we demonstrate a higher rate of trial-to-implant conversion than previously documented for traditional percutaneous trials. We show similar rates of revisions and complications, elucidating the important role of permanent SCS trials in high-risk patients.
An interdisciplinary virtual group program addressing the FINER points of chronic pain management: An exploratory analysis of functional outcomes.
Sarno DL, Gureck AE, Cardenas-Rojas A … +8 more , Eckley M, Vu K, Kurz J, Fu M, Isaac Z, Phillips E, Chin B, Barron DS
Pain Pract · 2025 Feb · PMID 39912505 · Full text
OBJECTIVES: Chronic pain is multifactorial and has large social and economic costs. Comprehensive pain management through an interdisciplinary approach addressing the biopsychosocial model of pain is beneficial. The purp...
OBJECTIVES: Chronic pain is multifactorial and has large social and economic costs. Comprehensive pain management through an interdisciplinary approach addressing the biopsychosocial model of pain is beneficial. The purpose of this study was to assess the feasibility and functional outcomes following participation in the 8-week virtual interdisciplinary Functional Integrative Restoration (FINER) program. DESIGN: Cohort study. SETTING: Virtual platform (Zoom) utilized by participants and clinicians within a large academic institution. SUBJECTS: 44 individuals with chronic pain meeting study criteria who participated in the virtual FINER program from September 2021 to April 2023 were included in final analysis. METHODS: Participants attended twice weekly seminars and group sessions focused on pain education, lifestyle medicine, integrative medicine, and psychological therapies virtually and completed pre- and post-program surveys. Outcomes included the Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29). Qualitative feedback was also obtained. RESULTS: From September 2021 to April 2023, 44 adult FINER participants with chronic low back and/or neck pain completed pre- and post-intervention surveys. We observed significant improvements in PCS, TSK, and various domains of the PROMIS-29, including pain interference, participation, physical function, and sleep, with modest effect sizes. CONCLUSIONS: The FINER program reduced self-reported functional outcomes related to the participants' chronic pain. Positive qualitative feedback from FINER participants suggested mental and physical health benefits. Future investigation will include a larger cohort and will deploy active (patient-reported outcomes) and passive (mobility and sociability) digital measures to further characterize functional changes.
Do patients with fibromyalgia syndrome and healthy people differ in their opinions on placebo effects in routine medical care?
van Lennep JPA, Meijer S, Karacaoglu M … +4 more , Rippe R, Peerdeman KJ, van Middendorp H, Evers AWM
Pain Pract · 2025 Feb · PMID 39868837 · Full text
OBJECTIVES: Placebo effects can relieve acute and chronic pain in both research and clinical treatments by learning mechanisms. However, the application of placebo-based treatment strategies in routine medical care is qu...
OBJECTIVES: Placebo effects can relieve acute and chronic pain in both research and clinical treatments by learning mechanisms. However, the application of placebo-based treatment strategies in routine medical care is questioned. The current study investigated the opinions of patients with fibromyalgia and healthy controls regarding learning of placebo effects and their practical applications. METHOD: An online survey asked 158 age- and sex-matched adult patients and controls (79 per group) to rate the perceived influence of various placebo learning mechanisms on pain relief, and the acceptability and perceived effectiveness of placebo-based strategies (open-label, closed-label, dose-extending, and treatment-enhancing strategies). Respondents' knowledge about placebo effects was obtained through a 7-item quiz. RESULTS: The groups did not differ in the perceived influence of placebo learning mechanisms on pain relief (p = 0.217). Controls considered closed-label and treatment-enhancing strategies more acceptable than patients (p = 0.003 and p < 0.001), whereas controls perceived all strategies more effective. In both groups, closed-label strategies were significantly less acceptable than any other strategy (p-values < 0.001), and treatment-enhancing or dose-extending strategies were most acceptable. Higher acceptability was predicted by higher perceived effectiveness ratings (p < 0.001). Also, increased placebo knowledge was related to higher acceptability (p = 0.03) and perceived effectiveness (p < 0.001). DISCUSSION: This survey suggests that both the medical history of patients and knowledge about placebo effects affect the acceptability and perceived effectiveness of placebo-based strategies. Furthermore, strategies that are transparent, assumed effective, or combined with existing medical treatments are deemed most acceptable. Keeping these factors in mind is essential for the clinical implementation of placebo-based strategies in routine medical care.
The efficacy of pulsed radiofrequency ablation of the dorsal root ganglion in the setting of failed spinal neuromodulation: A case report.
Rastogi A, Dastan K, Sunkara S … +1 more , LaRosa P
Pain Pract · 2025 Feb · PMID 39865364 · Publisher ↗
Radiofrequency ablation (RFA) is an interventional procedure that has been used to treat chronic back pain for over 50 years; this unique case report demonstrates the effectiveness of pulsed radiofrequency ablation (PRFA...
Radiofrequency ablation (RFA) is an interventional procedure that has been used to treat chronic back pain for over 50 years; this unique case report demonstrates the effectiveness of pulsed radiofrequency ablation (PRFA) on the dorsal root ganglion (DRG) in the treatment of chronic radicular pain (Russo et al., 2021, J Pain Res, 14, 3897). The RFA provides pain relief by using thermal energy to disrupt peripheral nerves carrying nociceptive signals back to the central nervous system (Abd-Elsayed et al. 2020, Pain Ther, 9, 709). However, there is a lack of literature about the safety and efficacy of PRFA of the DRG.
Objective, physiologic, biometrically driven spinal cord stimulation trialing is a necessity-The length of the trial is not.
Pope JE, Deer T, Goree JH … +1 more , Petersen EA
Pain Pract · 2025 Feb · PMID 39853937 · Publisher ↗
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7. Cervical facet pain: Degenerative alterations and whiplash-associated disorder.
Hellinga MD, van Eerd M, Stojanovic MP … +6 more , Cohen SP, de Andrès Ares J, Kallewaard JW, Van Boxem K, Van Zundert J, Niesters M
Pain Pract · 2025 Feb · PMID 39846460 · Full text
INTRODUCTION: Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. Here, we provide an overview of the literature on the...
INTRODUCTION: Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. Here, we provide an overview of the literature on the diagnosis and treatment of cervical facet-related pain with special emphasis on interventional treatment techniques. METHODS: A literature search on the diagnosis and treatment of cervical facet joint pain and whiplash-associated disorders (WAD) was performed using PubMed, Cochrane, and Embase databases. All relevant literature was retrieved and summarized. RESULTS: Facet-related pain is typically diagnosed based on history and physical examination of the patients, combined with a diagnostic block (eg, with local anesthetic) of the medial branches innervating the joints. There is no additive value for imaging techniques to diagnose cervical facet pain, but imaging may be used for procedure planning. First-line therapy for pain treatment includes focused exercise, graded activity, and range-of-motion training. Pharmacological treatment may be considered for acute facet joint pain; however, for chronic facet joint pain, evidence for pharmacological treatment is lacking. Considering the lack of evidence for treatment with botulinum toxin, intra-articular steroid injections, or surgery, these interventions are not recommended. Diagnostic blocks are not considered a viable treatment option, though some patients may experience a prolonged analgesic effect. Long-term analgesia (>6 months) has been observed for radiofrequency treatment of the medial branches. CONCLUSIONS: Cervical facet pain is diagnosed based on history, physical examination, and a diagnostic block of the medial branches innervating the painful joints. Conservative management, including exercise therapy, is the first line of treatment. When conservative management does not result in adequate improvement of pain, radiofrequency treatment of the medial branches should be considered, which often results in adequate pain relief.
A comparison of MRI and intraoperative measurements to determine interspinous spacer device size.
Nelson C, Liao C, Malik T
Pain Pract · 2025 Feb · PMID 39835417 · Full text
PURPOSE: To determine whether preoperative magnetic resonance imaging (MRI) can reliably determine intraoperative measurements in the Vertiflex Interspinous Spacer (ISS) procedure. METHODS: Patients who underwent Vertifl...
PURPOSE: To determine whether preoperative magnetic resonance imaging (MRI) can reliably determine intraoperative measurements in the Vertiflex Interspinous Spacer (ISS) procedure. METHODS: Patients who underwent Vertiflex ISS with Lumbar Spinal Stenosis (LSS) and a preoperative MRI available in picture archiving and communication system (PACS) between January 2013 to February 2023 were identified retrospectively from the University of Chicago Medical Center Database. An experienced board-certified pain specialist and well-trained 2nd-year medical student independently performed measurements of the interspinous space where Vertiflex ISSs of various sizes are inserted. MRI measurements were taken blinded to intraoperative measurement and ISS implant size used in the procedure. Pearson's correlation, paired T-test, intraclass correlation coefficients (ICC), absolute agreement, and 2-way random effects model were used to determine the relationships between MRI, intraoperative measurement, and ISS size. RESULTS: A total of 79 patients who underwent the Vertiflex ISS procedure were included in the study. Median Vertiflex ISS size was 10 mm (10-12), mean intraoperative measurement was 11.40 mm (±1.23), and mean MRI measurement was 11.24 mm (±1.44). Mean differences were not significant in intraoperative and MRI measurements (p = 0.271). Pearson's correlation between ISS size and intraoperative measurement was 0.807 (p < 0.001), representing the current best practice model. Pearson's correlation was 0.668 (p < 0.001) between MRI measurement and ISS size and 0.542 (p < 0.001) between MRI and intraoperative measurement. ICC showed good agreement and moderate reliability (0.698) between intraoperative and MRI measurements. Observer interrater ICC agreement of the MRI interspinous space measurement was 0.95 (p < 0.001). CONCLUSIONS: Measuring interspinous space on MRI yielded, on average, a value smaller than the intraoperative measurement in Vertiflex ISS procedures, but the mean differences were not significant. Good agreement and moderate reliability were found between observer MRI and surgeon intraoperative measurements, suggesting MRI can evaluate the intraoperative space for the Vertiflex ISS procedure. Preoperative MRI measurement may help decrease complications by aiding in surgical decision-making through providing a reference for intraoperative measurements. Further prospective study is necessary to determine if preoperative MRI measurement can predict and potentially replace the need for intraoperative measurement.
Anatomical and morphological variations in the dorsal root ganglion: Technical implications for chronic pain treatment with neuromodulation-A systematic review.
Acevedo-Gonzalez JC, Ariza-Piñeros CF, Vega-Corredor JM
Pain Pract · 2025 Feb · PMID 39831397 · Full text
OBJECTIVES: In the last 20 years, we have seen the flourishing of multiple treatments targeting the dorsal root ganglion (DRG) for pain. However, there is concern regarding the variation in the location of the DRG, which...
OBJECTIVES: In the last 20 years, we have seen the flourishing of multiple treatments targeting the dorsal root ganglion (DRG) for pain. However, there is concern regarding the variation in the location of the DRG, which could influence the long-term clinical outcomes. The aim of this work was to determine the exact position of the DRG in the spine and propose a pre-surgical planning. MATERIALS AND METHODS: A systematic search was conducted following the principles recommended by PRISMA. Search terms "ganglia," "DRG," "dorsal root ganglia, anatomy," "radiological," "neuromodulation," "dorsal root ganglion stimulation" (PubMed, Scopus, Medline, Web of Science, and Embase) were identified 177 articles and subjected to the selection criteria (inclusion/exclusion) based on the independent review of the abstracts. RESULTS: Eighteen articles were selected (seven anatomical dissections on cadavers, five radiological studies, and six narrative reviews). DISCUSSION: Percutaneous procedure targeting the DRG for the treatment of chronic pain requires preoperative planning independent to the study of the etiology of pain. The DRG should be typified using magnetic resonance imaging. We propose a preoperative evaluation scale based on four specific items: A-position in the vertebral canal, B-position of the DRG within the foramen, C-number of ganglia in the root, and D-ratio (proportion) of foramen/DRG. CONCLUSION: Percutaneous treatments for chronic pain directed at the DRG are effective. Clinical outcomes depend of good preoperative planning that allows for optimizing its effects. We propose a DRG morphology evaluation scale useful for the planning process prior to any treatment directed at the ganglion.
The comparison of spread of methylene blue after the Pericapsular Nerve Group block and a double injection selectively targeting the articular branches to the anterior hip capsule in human cadavers.
Smits RJH, Tan ECTH, van den Bersselaar LR … +5 more , de Bruijn A, Hendriksen E, Vissers KCP, Olde Dubbelink KTE, van der Wal SEI
Pain Pract · 2025 Feb · PMID 39831368 · Full text
OBJECTIVES: In this study, the spread of methylene blue was compared between an ultrasound-guided Pericapsular Nerve Group (PENG) block and a double injection technique, where the approach towards the inferomedial acetab...
OBJECTIVES: In this study, the spread of methylene blue was compared between an ultrasound-guided Pericapsular Nerve Group (PENG) block and a double injection technique, where the approach towards the inferomedial acetabulum was added to the latter. METHODS: The two techniques were performed in 11 fresh frozen cadavers. The spread was measured after anatomical dissection in which the supplying femoral and obturator nerves were identified. RESULTS AND CONCLUSION: Our study demonstrates adequate staining of the iliac bone with comparable distal and medial spread in both techniques, indicating that the PENG block with a single injection is adequate in blocking the hip capsule with 10 mL local anesthetics. Staining of the femoral nerve occurred in 2/6 specimens after the PENG block, and staining of the obturator nerve in 1 specimen in each group.
Comparative efficacy of closed-loop spinal cord stimulation and dorsal root ganglion stimulation through combination trialing for cancer pain - A retrospective case series.
Chung M, Abd-Elsayed A
Pain Pract · 2025 Feb · PMID 39831333 · Publisher ↗
OBJECTIVE: To compare the efficacy of closed-loop spinal cord stimulation (CL-SCS) and dorsal root ganglion (DRG) stimulation in managing chronic cancer-related pain. MATERIAL/METHODS: A retrospective review was conducte...
OBJECTIVE: To compare the efficacy of closed-loop spinal cord stimulation (CL-SCS) and dorsal root ganglion (DRG) stimulation in managing chronic cancer-related pain. MATERIAL/METHODS: A retrospective review was conducted with IRB exemption for four patients with cancer-related pain who underwent combination stimulator trials. Patients were trialed with both CL-SCS and DRG stimulation for 8-10 days, with assessments of pain relief, functional improvement, sleep improvement, pain medication changes, and overall satisfaction. RESULTS: All four patients reported significant relief and functional improvement with both CL-SCS and DRG stimulations. CL-SCS provided a range of 12.9-19.6 million adjustments during the trial period. Neural dose was delivered at a median dose ratio of 1.35 and median dose accuracy of 4.9 μV. Patients 1-3 preferred CL-SCS for paresthesia-based stimulation, having the potential to expand pain coverage, full-body MRI compatibility, and real-time automated adjustment features. Patient 4 favored DRG for its ability to provide slightly greater relief, over one aspect of his pain area, despite having comparable coverage with CL-SCS. CONCLUSIONS: The consistent and adaptable delivery of CL-SCS may bridge the gap in efficacy that DRG therapy has held over traditional dorsal column stimulation for historically complex and focal conditions that suggests further investigation.
Physical function estimates change in pain following IIPT among children with chronic pain.
Seth M, Bentley K, Hottinger K … +3 more , Vieni K, Reineke A, Dalal P
Pain Pract · 2025 Feb · PMID 39831301 · Full text
INTRODUCTION: Chronic pain can negatively impact a child's quality of life. Pediatric Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to improve overall functioning despite pain through various rehabilitat...
INTRODUCTION: Chronic pain can negatively impact a child's quality of life. Pediatric Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to improve overall functioning despite pain through various rehabilitative strategies. It is, however, unclear whether improved function corresponds to self-reported decrease in pain levels. Hence, the purpose of this study is to examine the relationship between changes in physical function and perceived pain among children with chronic pain who have undergone inpatient IIPT. MATERIALS AND METHODS: A secondary analysis of pre-existing databases of IIPT from two different inpatient acute rehabilitation programs was carried out. Children and adolescents (N = 309; age = 16.2 ± 2.6; 79% females) with chronic pain who attended on average 4-week inpatient IIPT from Nov 2011 to Jan 2023 were included. Participants completed pain intensity (Numerical Pain Rating Scale) and self-reported function measures (Lower Extremity Functional Scale [LEFS], Upper Extremity Functional Index [UEFI], Canadian Occupational Performance Measure [COPM]-Performance, and COPM-Satisfaction) at admission and discharge. RESULTS: Change in self-reported physical function was significantly associated with change in pain from admission to discharge. After covariate adjustment, self-reported physical function (per the LEFS, UEFI, COPM-Performance, and COPM-Satisfaction) explained 19.8%, 7.8%, 12.0%, and 8.6% of the variance in change in pain, respectively. These measures of self-reported physical function further distinguished between minimal (<30%) and moderate (≥30%) pain reduction. CONCLUSIONS: Self-reported functional gains during IIPT are associated with greater change in perceived pain. Moreover, measures of self-reported physical function can help identify children at risk of minimal pain reduction post-IIPT.
Wearable, noninvasive, pulsed shortwave (radiofrequency) therapy for postoperative analgesia: A randomized, double-masked, sham-controlled pilot study.
Ilfeld BM, Finneran JJ, Said ET … +9 more , Ball ST, Wallace AM, Broderick RC, Sandler BJ, Doucet JJ, Hu SR, Cha BJ, Murthy AN, Abdullah B
Pain Pract · 2025 Feb · PMID 39829429 · Full text
BACKGROUND: Nonthermal, pulsed shortwave (radiofrequency) therapy (PSWT) is a nonpharmacologic, noninvasive modality that limited evidence suggests provides analgesia. Its potential favorable risk-benefit ratio stems fro...
BACKGROUND: Nonthermal, pulsed shortwave (radiofrequency) therapy (PSWT) is a nonpharmacologic, noninvasive modality that limited evidence suggests provides analgesia. Its potential favorable risk-benefit ratio stems from its lack of side effects and significant medical risks, applicability to any anatomic location, long treatment duration, and ease of application by simply affixing it with tape. Even with a relatively small treatment effect, PSWT might contribute to a multimodal analgesic regimen, similar to acetaminophen. However, widespread clinical use is hindered by a lack of systematic evidence. The current randomized, controlled pilot study was undertaken to determine the feasibility and optimize the protocol for a subsequent definitive investigation and estimate the treatment effect of PSWT on postoperative pain and opioid consumption. METHODS: Within the recovery room following primary knee and hip arthroplasty, cholecystectomy, hernia repair, and non-mastectomy breast surgery, we applied 1-3 PSWT devices (Model 088, BioElectronics Corporation, Frederick, Maryland) over the surgical bandages. Participants were randomized to 28 days of either active or sham treatment in a double-masked fashion. The outcomes of primary interest were the cumulative opioid consumption and the mean of the "average" and "worst" daily pain measured with the Numeric Rating Scale over the first 7 postoperative days. RESULTS: During the first 7 postoperative days, oxycodone consumption in participants given active treatment (n = 55) was a mean (SD) of 21 mg (24) versus 17 mg (26) in patients given sham (n = 57): difference 4 (95% CI, -5 to 13), p = 0.376. During this same period, the "average" daily pain intensity in patients given active treatment was 2.4 (1.6) versus 2.6 (1.7) in sham: difference -0.2 (95% CI -0.8 to 0.5), p = 0.597. Concurrently, the worst/maximum pain for the active group was 4.6 (2.0) versus 4.7 (2.1) in sham: difference -0.1 (95% CI -0.8 to 0.7), p = 0.888. No device-related systemic side effects or serious adverse events were identified. CONCLUSIONS: Pulsed shortwave (radiofrequency) therapy did not reduce pain scores and opioid requirements to a statistically significant or clinically relevant degree during the initial postoperative week in this pilot study. These results must be replicated with a subsequent study before being considered definitive. Data from this preliminary study may be used to help plan future trials.
Signing your contract: What do you need to know.
Abd-Elsayed A, Gilligan C
Pain Pract · 2025 Feb · PMID 39828927 · Publisher ↗
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Factors associated with patient no-show rates in an academic pain management practice.
Burshtein A, Shekane P
Pain Pract · 2025 Feb · PMID 39825717 · Publisher ↗
OBJECTIVES: Chronic pain is a debilitating, multifactorial condition. The purpose of this study was to examine patient characteristics of those who did not show up for their scheduled first pain medicine appointment in o...
OBJECTIVES: Chronic pain is a debilitating, multifactorial condition. The purpose of this study was to examine patient characteristics of those who did not show up for their scheduled first pain medicine appointment in order to identify factors that may improve access to care. METHODS: This was a retrospective analysis of 810 patients from a single-center academic pain management clinic between January 1, 2022, and December 31, 2023. RESULTS: Overall no-show rate was 57%. There was a mean of 133 days (4.3 months) from scheduling to the appointment date. Patients age ≤ 30 years had the highest no-show rate (69%), and those ≥81 years had the lowest (49%). Hispanic and Caucasian patients had similar no-show rates (59% and 57%, respectively) and Asian patients had lower rate (41%). Referral from another specialty had a significantly lower no-show rate (36% vs. 89%, p < 0.001). The presence of referral (p < 0.001) was a significant predictor of lower no-show rates. Of the 191 patients with low back pain, internal medicine (38.7%) was the most referring specialty. DISCUSSION: High no-show rates were present particularly among younger patients. Having a referral from another specialty was an independent predictor of lower no-show rates.
Diagnosing persistent spinal pain syndrome type 2.
Abd-Elsayed A, Gilligan C
Pain Pract · 2025 Jan · PMID 39817636 · Publisher ↗
Abstract loading — click title to view on PubMed.
A consensus study on radiofrequency for chronic lumbosacral and cervical pain.
Abd-Elsayed A, Gilligan C
Pain Pract · 2025 Jan · PMID 39731221 · Publisher ↗
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Occipital nerve stimulation: A detailed description of a surgical approach and a discussion on implantation techniques.
Meier K, Fogh-Andersen IS, Sørensen JCH
Pain Pract · 2025 Jan · PMID 39607056 · Publisher ↗
OBJECTIVE: Occipital Nerve Stimulation (ONS) is increasingly used to treat a range of chronic, refractory headache conditions, most notably chronic cluster headache (CCH). Despite this, there is still no consensus on the...
OBJECTIVE: Occipital Nerve Stimulation (ONS) is increasingly used to treat a range of chronic, refractory headache conditions, most notably chronic cluster headache (CCH). Despite this, there is still no consensus on the optimal implantation technique. Clinical reports and reviews in the field have reported remarkably high complication rates of which several can be directly related to the surgical approach. We here describe a comprehensive and detailed surgical approach used at Aarhus University Hospital, Denmark, aiming to improve paresthesia coverage and minimize complications. METHODS: The implantation procedure described here is performed with a sleep-awake anesthetic regimen in a lateral position using anatomical landmarks and perioperative testing based on patient feedback. A single lead is subcutaneously implanted from behind the ear and across the back of the head, and the implantable pulse generator (IPG) is placed below the right clavicle. RESULTS: From March 2018 to June 2024, 45 CCH patients were implanted using this approach and followed up for a total of 86.3 patient years. A total of 22 adverse events (AEs) occurred in 17 patients, with nine AEs requiring revision surgery. Notably, no instances of lead migration, lead breakage, or muscle/neck stiffness were observed. Temporary occipital dysesthesia was the most frequent non-surgical AE, resolving spontaneously within weeks. The rate of serious adverse events (SAEs) was one per 9.6 patient years. Six patients had the ONS system explanted due to lack of efficacy. CONCLUSIONS: The surgical approach described here in detail offers several advantages, with a favorable complication profile, satisfactory paresthesia coverage, and good perioperative patient comfort. Advances in the surgical technique are vital to both patients and healthcare providers, and we believe this approach is a valuable contribution toward improved patient outcomes and procedural efficiency.
Artificial intelligence and pain medicine education: Benefits and pitfalls for the medical trainee.
Glicksman M, Wang S, Yellapragada S … +3 more , Robinson C, Orhurhu V, Emerick T
Pain Pract · 2025 Jan · PMID 39588809 · Full text
OBJECTIVES: Artificial intelligence (AI) represents an exciting and evolving technology that is increasingly being utilized across pain medicine. Large language models (LLMs) are one type of AI that has become particular...
OBJECTIVES: Artificial intelligence (AI) represents an exciting and evolving technology that is increasingly being utilized across pain medicine. Large language models (LLMs) are one type of AI that has become particularly popular. Currently, there is a paucity of literature analyzing the impact that AI may have on trainee education. As such, we sought to assess the benefits and pitfalls that AI may have on pain medicine trainee education. Given the rapidly increasing popularity of LLMs, we particularly assessed how these LLMs may promote and hinder trainee education through a pilot quality improvement project. MATERIALS AND METHODS: A comprehensive search of the existing literature regarding AI within medicine was performed to identify its potential benefits and pitfalls within pain medicine. The pilot project was approved by UPMC Quality Improvement Review Committee (#4547). Three of the most commonly utilized LLMs at the initiation of this pilot study - ChatGPT Plus, Google Bard, and Bing AI - were asked a series of multiple choice questions to evaluate their ability to assist in learner education within pain medicine. RESULTS: Potential benefits of AI within pain medicine trainee education include ease of use, imaging interpretation, procedural/surgical skills training, learner assessment, personalized learning experiences, ability to summarize vast amounts of knowledge, and preparation for the future of pain medicine. Potential pitfalls include discrepancies between AI devices and associated cost-differences, correlating radiographic findings to clinical significance, interpersonal/communication skills, educational disparities, bias/plagiarism/cheating concerns, lack of incorporation of private domain literature, and absence of training specifically for pain medicine education. Regarding the quality improvement project, ChatGPT Plus answered the highest percentage of all questions correctly (16/17). Lowest correctness scores by LLMs were in answering first-order questions, with Google Bard and Bing AI answering 4/9 and 3/9 first-order questions correctly, respectively. Qualitative evaluation of these LLM-provided explanations in answering second- and third-order questions revealed some reasoning inconsistencies (e.g., providing flawed information in selecting the correct answer). CONCLUSIONS: AI represents a continually evolving and promising modality to assist trainees pursuing a career in pain medicine. Still, limitations currently exist that may hinder their independent use in this setting. Future research exploring how AI may overcome these challenges is thus required. Until then, AI should be utilized as supplementary tool within pain medicine trainee education and with caution.
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