Interventions For Treatment Of Pain Research Articles

12. Vascular pain: Ischemic pain in the extremities and Raynaud's syndrome

Peripheral artery diseases (PAD) and Raynaud's syndrome are associated with substantial morbidity. PAD, through the restriction of blood flow to the extremities, may lead to critical limb ischemia with symptoms of pain at rest which may eventually progress to severe limb ischemia with gangrene. This serious and painful clinical condition requires extensive medical care, is limb-threatening and, in case of delayed or unsuccessful treatment, is associated with a high mortality rate. In Raynaud's syndrome, the blood supply to certain parts of the body, usually the fingers and toes and less frequently the nose or ears, is restricted because of vasculopathy of the smaller vessels at acral sites. Under certain circumstances, with cold as the most well-known provoking factor, blood flow restriction occurs, leading to demarcated color changes and symptoms such as pain, paresthesia, and numbness. In severe cases of Raynaud syndrome tissue ischemia may lead to necrosis and the need for amputation of the affected area. In this narrative review, the literature on the diagnosis and interventional pain treatment of PAD and Raynaud's syndrome was updated and summarized. This review focused on interventional pain treatment. In PAD, the effects of the intervention on limb salvage, ulcer healing, and ischemic pain were summarized. Additionally, results with respect to skin microcirculation and quality of life were reported if available. In Raynaud's syndrome, we focused on the effect of the intervention on peripheral blood flow metrics and pain intensity during attacks. In PAD, prevention and treatment of risk factors are important. Initially, conservative treatment and pharmacological therapy are preferred first-line therapies. However, when disease progression occurs, interventional management may be considered. The literature search yielded conflicting evidence for sympathectomy as a treatment for PAD. Spinal cord stimulation (SCS) as a treatment modality for advanced PAD had high-quality evidence for limb salvage in subgroups of patients but conflicting evidence for other outcome measures such as pain, wound healing, and quality of life. The literature search for interventional pain management in Raynaud's syndrome was limited to only one randomized controlled trial (RCT) studying the effect of thoracic sympathectomy. This study had several limitations and hence the level of evidence for this interventional treatment is very low. No RCTs studying SCS in patients with Raynaud's syndrome were found. In both PAD and Raynaud's syndrome, additional RCTs are needed to substantiate interventional (pain) management and bolster the evidence base for sympathectomy and SCS as treatment options.

The importance of the Association for Interventional Pain Treatment (AIPT) in the training of an outpatient neurosurgeon

One of the main goals of the Association for Interventional Pain Treatment (AIPT) is to expand the range of pain interventions and disseminate these skills among doctors of various specialties, incl. and neurosurgeons. The article describes the activities of AIPT and evaluates its significance in the training of outpatient neurosurgeons.

Association for Interventional Pain Treatment in Postgraduate Training of Neurosurgeons in Clinical Algology

Chronic pain syndrome (CPS) is an urgent and socially significant problem in modern medicine. This article is a review of the independent association (Association for Interventional Pain Treatment) in postgraduate education of specialists. The main tasks, activities and directions of this association are listed. Association for Interventional Pain Treatment conducts master classes for various specialists, which helps reduce technical errors in the treatment of patients with degenerative diseases of the spine.

Identification of group differences in predictive anticipatory biasing of pain during uncertainty: preparing for the worst but hoping for the best.

Pain anticipation during conditions of uncertainty can unveil intrinsic biases, and understanding these biases can guide pain treatment interventions. This study used machine learning and functional magnetic resonance imaging to predict anticipatory responses in a pain anticipation experiment. One hundred forty-seven participants that included healthy controls (n = 57) and individuals with current and/or past mental health diagnosis (n = 90) received cues indicating upcoming pain stimuli: 2 cues predicted high and low temperatures, while a third cue introduced uncertainty. Accurate differentiation of neural patterns associated with specific anticipatory conditions was observed, involving activation in the anterior short gyrus of the insula and the nucleus accumbens. Three distinct response profiles emerged: subjects with a negative bias towards high pain anticipation, those with a positive bias towards low pain anticipation, and individuals whose predictions during uncertainty were unbiased. These profiles remained stable over one year, were consistent across diagnosed psychopathologies, and correlated with cognitive coping styles and underlying insula anatomy. The findings suggest that individualized and stable pain anticipation occurs in uncertain conditions.

Cryoanalgesia of the ankle joint: clinical cases in the practice of a doctor of interventional pain treatment

BACKGROUND: Currently, with the advent of the cryoablation device, much attention is paid to cryoanalgesia of large joints, however, the pathology of smaller structures can also bring discomfort and reduce the patient’s quality of life. The article presents 3 cases of successful treatment of ankle arthrosis at the Multi-Specialty Center for Pain Treatment and Rehabilitation «Anesta» (Arkhangelsk), presenting the author’s method of joint denervation and its detailed description.
 CLINICAL CASES DESCRIPTION: Three patients were presented. The first with arthrosis of the knee and ankle joint, the second patient — after an accident with purulent-septic complications and violation of the anatomical integrity of the ankle joint, the third — with extensive concomitant pathology and severe arthrosis. All patients were satisfied with the procedure and its impact on the quality of life in the postoperative period. An anatomical rationale and a detailed description of the relevance of the ankle joint cryoanalgesia method are provided. Cryoanalgesia of the ankle joint was tested on cadaver by introducing liquid silicone into the places where the cryoprobe was installed, which confirmed the interest of the sensory branches going to the joint capsule. Due to the fact that the method is proprietary, and the use of cryoanalgesia is limited on the territory of the Russian Federation, there is very little literature data regarding the procedure for performing cryoanalgesia of the ankle joint, however, as experience is gained, we assume that this procedure will become a good alternative to surgery for arthrosis ankle joint.
 CONCLUSION: The presence of pain has an extremely negative impact on the general condition of patients. The presented author’s technique can significantly improve the quality of life of many patients, minimizing pain in both large and small joints.

Demographic Characteristics and Pain Treatments of Patients Applying to the Algology Polyclinic of Firat University Medical Faculty

Aim: The aim of this study is to retrospectively evaluate the patients who were admitted to the Algology polyclinic with pain, focusing on their sociodemographic characteristics, types of pain, and pain management. Materials and Methods: In this study, the pain assessment forms of patients who presented to our Algology polyclinic with pain complaints between January 2022 and December 2022 were examined. The sociodemographic characteristics of the patients, pain properties, and treatments administered were retrospectively evaluated. Results: Within one-year period, a total of 2001 patients have been admitted to our clinic. 75.5% of the patients were between the ages of 15 and 64. The average age of men was found to be significantly lower than the average age of women. 71.7% of the patients were overweight or obese, with obesity being more prevalent in women. Additionally, 69.8% of the patients had at least one comorbidity, with cardiovascular disease (CVD) and diabetes mellitus (DM) being the most common. The most common causes of pain were low back pain, neck pain, myofascial pain, and knee pain. The Visual Analog Scale (VAS) score was found to be 6.64. Interventional pain treatment was applied to 53.3% of the patients, with the most common methods were caudal epidural injection, cervical epidural injection, and ozone trigger point injection. Conclusion: Close examination of patients' responses to treatment and knowledge of sociodemographic characteristics are important. In addition to well-planned medical treatment for pain, we believe that interventional pain treatment can alleviate patients' pain, improve their quality of life, and potentially prevent work loss due to chronic pain.

Efficacy and Safety of Pulsed Radiofrequency of Dorsal Root Ganglion in Elderly Patient Population With Acute and Subacute Zoster-Related Pain.

Background: Herpes zoster (HZ) is typically characterized by a burning, stabbing pain, hyperalgesia, and allodynia. In some patients, despite the lesions resolving, the pain persists and becomes chronic. If the pain continues for more than 6 months after the onset of the pain phase, this condition is called postherpetic neuralgia (PHN). The frequency and severity of PHN increase with advancing age. The pain in PHN can be severe, sometimes resistant to medications, significantly impacting the patients' quality of life. The elderly patient population cannot tolerate the medications due to their side effects. In this situation, interventional pain treatment should be applied in the elderly patient group who have a high risk of developing PHN compared to other age groups. Method: We included patients over 65 years of age with HZ-related pain who underwent dorsal root ganglion (DRG) pulsed radiofrequency (PRF) within the first 6 months from the onset of pain. We divided these patients into 2 groups: patients who underwent intervention within the first 1 month from the onset of pain and patients who underwent intervention between 1 and 6 months. We recorded medication doses and Numeric Rating Scale (NRS) scores before the procedure and at 1 week, 1 month, 3 months, and 6 months after the procedure. Results: After the DRG PRF treatment, NRS scores improved significantly in both groups (p < 0.05). The mean NRS score in the early DRG PRF group was significantly lower than that in the late DRG PRF group (p < 0.05). The medication doses in the early DRG PRF group were significantly lower than those in the other group (p < 0.05). Conclusions: Interventional pain treatment should be applied as soon as possible in the elderly patient group who do not respond to first-line medical treatment or cannot tolerate medical treatment due to its side effects and who have a high risk of developing PHN compared to other age groups. DRG PRF, applied in the early period of medical treatment-resistant acute HZ, is safe and effective, preventing the progression to PHN.

Comparison of international medical costs for interventional pain treatment: a focus on Korea and Japan.

The rise in national health care costs has emerged as a global problem given the ever-aging population and rapid development of medical technology. The utilization of interventional pain management has, similarly, shown a continued rise worldwide. This study evaluates the differences in the medical costs in the field of interventional pain treatment (IPT) between two countries: Korea and Japan. Korean medical insurance costs for 2019 related to pain management focused on IPT were compared to those of Japan. Purchasing power parity (PPP) was used to adjust the exchange rate differences and to compare prices in consideration of the respective societies' economic power. The cost of trigger point injections in Japan was 1.06 times higher than that of Korea, whereas the perineural and intraarticular injection prices were lower in Japan. The cost of epidural blocks was higher in Japan compared to Korea in both cervical/thoracic and lumbar regions. As for blocks of peripheral branches of spinal nerves, the cost of scapular nerve blocks in Japan was lower than that in Korea, given a PPP ratio 0.09. For nerve blocks in which fluoroscopy guidance is mandatory, the costs of epidurography in Japan were greater than those in Korea, given a PPP ratio 1.04. This is the first comparative study focusing on the medical costs related to IPT between Korea and Japan, which reveals that the costs differed along various categories. Further comparisons reflecting more diverse countries and socio-economic aspects will be required.

ID: 217156 Lumbar-Sacral Transforaminal Nerve Root Stimulation: Applying Peripheral Nerve Stimulation Technology to Spinal Neurostimulation

The rationale and efficacy of spinal neurostimulation for treatment of neuropathic pain pathologies in lower extremities is well established. However, the presence of treatment failures, especially evident in long term follow up, justifies continued search for other ways of applying neuromodulation in spinal neurostimulation. Peripheral neurostimulation presents the advantages of increased specificity of stimulation targets and decreased risks of hardware implantation as it is performed outside the spinal axis. Lumbar-sacral transforaminal nerve root stimulation utilizes familiar transforaminal approach for placement of stimulation hardware directly inside the neural foramen, minimizing operative risks and allowing for immediate use and ease of programming of the implanted system. This approach is technically easier than the DRG stimulation placement technique previously described, as it utilizes the familiar transforaminal approach used in routine interventional pain treatment practice.

Anticoagulation and interventional pain treatment has anything changed?

Interventional pain management bears a significant risk of hemorrhagic complications. This risk increases in patientswith coagulation disorders and those taking anticoagulant therapy. The population of the latter is growing, and manynew drugs and new treatment regimens have become widespread in recent years. The latest guidelines on the periproceduraluse of anticoagulant therapy also apply to regional anaesthesia techniques for the treatment of chronicand acute pain. However, despite the existence of guidelines and recommendations, decision-making difficultiescan still be encountered in the practice of interventional pain management. The presentation includes a summaryof existing recommendations for the prophylactic use of anticoagulants and antiaggregants in clinical practice inthe periprocedural period. Also included is a discussion of selected concerns regarding their use in the practice ofinterventional pain management.

Management of low back pain: a survey of physical therapists’ adherence to clinical practice guidelines in the State of Kuwait

Background/Aims Physical therapy clinical practice guidelines for the management of low back pain are accessible to most physical therapists in the State of Kuwait. However, guideline adherence remains undocumented. The aims of this study were to describe the low back pain treatment interventions and adherence to clinical practice guidelines by physical therapists in the State of Kuwait. Methods A total of 200 questionnaires were distributed to a convenience sample of physical therapists working in governmental hospitals who treat a variety of neuro-musculoskeletal conditions. The questionnaire contained questions on patients and the treatments applied. Physical therapists with less than 1 year of clinical experience were excluded. Descriptive and inferential statistics (analysis of variance) were used. Results Overall, 132 physical therapists completed the questionnaire (response rate of 66.0%). One-third of physical therapists’ caseloads included 40-50% of patients with low back pain. Physical therapy treatments most commonly included non-evidence-based treatment, such as superficial heat, interferential therapy and transcutaneous electrical nerve stimulation. Evidence-based treatment, such as exercises and passive stretching techniques, were less frequently used. There was no significant difference between the physical therapists’ years of experience, education or place of work and their treatment of choice. Conclusions Some physical therapists in the State of Kuwait deviate from clinical practice guidelines and use non-evidence-based treatment instead of evidence-based treatment in the management of low back pain. Therefore, intensive training and revision to current treatment protocols are required.

Efficacy of Epidural Steroid Injection in Elderly Patients: Does Diagnosis Affect Treatment Success?

Introduction: Epidural steroid injections are a preferred interventional pain treatment for patients with low back pain. Our aim was to investigate the effectiveness of epidural steroid injections treatment in elderly patients and to examine the effect of patients’ diagnosis on the treatment success. Materials and Methods: Patients over the age of 65 who underwent epidural injections between January 2020 and January 2022 were retrospectively screened. The patients were divided into three groups according to their diagnosis: disc herniation, spinal stenosis, and failed back surgery syndrome. Numeric rating scale scores of all patients before the procedure, at three weeks, and at three months were noted. Results: A total of 234 patients were included in the study. Of these, 89 had disc herniation, 98 had spinal stenosis, and 47 had a history of failed back surgery. There were no significant differences between the groups in terms of age, gender, symptom duration, pre-procedural pain score, medical treatment, radiation dose, and procedure duration. Although a significant improvement was detected in pain scores at all follow-ups in all groups, these scores were found to be significantly lower in the disc herniation group than the spinal stenosis and failed back surgery groups at the three-week and month follow-ups. Conclusions: Epidural steroid injections has been found to be effective in back pain in elderly. In addition, elderly patients with disc herniation had a better response to treatment than those with spinal stenosis and failed back surgery. Further prospective and long-term follow-up studies are needed to support these results. Keywords: Aged; Low Back Pain; Injections, Epidural; Spinal Stenosis; Failed Back Surgery Syndrome.

Diagnostics and treatment of chronic pain in Siberia

This article is about I Russian scientific and practical conference with the international participation Actual questions of chronic pain management held on May 13-14 in Krasnoyarsk. The conference was organized by the Federal State Budgetary Institution of Healthcare of the Federal Scientific and Practical Center of the Federal Medical and Biological Agency of Russia, the KrasSMU, and the Association of Interventional Pain Treatment. Speakers from nine cities discussed wide and narrow questions of interventional and cancer pain treatment and other pain management directions. Additionally, two regional anesthesia under ultrasound control master classes were conducted. Approximately 360 people participated in the conference, both online and offline.

Effects of local anesthetics and contrast agents on musculoskeletal regenerative medicine procedures.

In regenerative medicine, cells, tissues and organs are often replaced, engineered or regrown in order to restore their function after they have been damaged or lost. Local anesthetics, corticosteroids and contrast agents are commonly employed for both diagnostic and therapeutic objectives in interventional pain and musculoskeletal treatments for regenerative medicine. There is growing evidence that routine injectables promote catabolism and disease processes. Thus, understanding the effects of these compounds on regenerative medicine injectates and target tissues such as tenocytes, chondrocytes, nucleus pulposus and ligamentous tissue is critical. This review includes the current research on the effects of local anesthetics and contrast agents, as well as their use and recommendations in regenerative medicine operations.

Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine-device use.

Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine-device use.

Peripheral Nerve Stimulation for Lower Extremity Pain.

Peripheral nerve stimulation (PNS) is rapidly increasing in use. This interventional pain treatment modality involves modulating peripheral nerves for a variety of chronic pain conditions. This review evaluated its use specifically in the context of chronic lower extremity pain. Studies continue to elucidate the utility of PNS and better define indications, contraindications, as well as short- and long-term benefits of the procedure for the lower extremity. While large, prospective evidence is still lacking, the best available evidence suggests that improvements may be seen in pain scores, functionality, and opioid consumption. Overall, evidence synthesis suggests that PNS for the lower extremities may be a viable option for patients with chronic lower extremity pain.

Motor-Sparing Neural Ablation with Modified Techniques for Knee Pain: Case Series on Knee Osteoarthritis and Updated Review of the Underlying Anatomy and Available Techniques.

Knee osteoarthritis (KOA) is ubiquitous. However, effective pain managements for patients with grades 3 or 4 KOA for whom conservative treatments are unsuccessful, but for whom surgery is not an option, remain lacking. This case series presented two motor-sparing interventional pain treatment modalities for five such patients. Three of the patients with a mean total WOMAC score of 41 underwent thermal radiofrequency (RF) ablation using a modified motor-sparing approach. One-week and four-week post-RF, the total score dropped to 27 (by 34%) and 19 (dropped 53.7%), respectively. Two other similar patients with a mean total WOMAC score 96 underwent chemical neurolysis using a motor-sparing approach with modified landmarks. The WOMAC score dropped to 58.5 (by 39.1%) and 49 (dropped by 49.0%), one-week and four-week postchemical neurolysis, respectively. A narrative review of the currently available approaches is also provided, with the conclusion that neural ablation using the modified landmarks approach may achieve better pain control and preserve the motor functions for patients with severe KOA for whom conservative treatment was unsuccessful and who are not candidates for surgery.

Periosteal Needling to the Cervical Articular Pillars as an Adjunct Intervention for Treatment of Chronic Neck Pain and Headache: A Case Report

(1) Background: Periosteal dry needling (PDN) involves clinicians using a solid filiform needle to stimulate bone for analgesic purposes. This case report presents the use of PDN to the cervical articular pillars (CAPs) in an 85-year-old female with chronic neck pain and headache. (2) Case description: PDN was applied to the right C2–C3 articular pillars, following trigger point dry needling (TrPDN) and manual therapy, in order to provide a direct sensory stimulus to the corresponding sclerotomes. PDN added over two treatments led to improved cervical range of motion and eliminated the patient’s neck pain and headache at 1 week follow-up. (3) Outcomes: At discharge, clinically relevant improvements were demonstrated on the numeric pain rating scale (NPRS), which improved from an 8/10 on intake to a 0/10 at rest and with all movements. In addition, the patient exceeded the risk adjusted predicted four-point score improvement and the minimal clinically important improvement (MCII) value of four points on the Focus on Therapeutic Outcomes (FOTO) Neck Functional Status (Neck FS). At one month post-discharge, the patient remained symptom-free. (4) Discussion: In the context of an evidence-informed approach for neck pain and headache, PDN led to marked improvements in pain and function. Patient outcomes exceeded predictive analytic expectations for functional gains and efficient utilization of visits and time in days. Combined with other interventions, PDN to the CAPs could be a viable technique to treat chronic neck pain with headache.

The efficacy of pulsed radiofrequency stimulation of the glenohumeral joint and suprascapular nerve for chronic shoulder pain and function compared to physiotherapy and exercise program without pain management

Background: Degenerative tendon diseases are primarily treated conservatively in primary health care and the most important treatment modality is physiotherapy-guided therapeutic rehabilitation. Method: In this prospective observational study, we investigated the effect of two different treatment approaches in patients with chronic shoulder pain. Physiotherapy-guided treatment was compared to interventional pain treatment with radiofrequency nerve stimulation (pRF) before exercise therapy. The primary outcomes were active shoulder mobility and shoulder function assessed by SPADI questionnaire at two and 6-month controls. Results: The results of this study show that pRF treatment combined to physiotherapy seem to effect shoulder function more than physiotherapy alone. With regard to patients with chronic pain and decreased shoulder mobility (65%), pRF treatment showed a significant greater effect in relieving pain and increasing functional outcome assessed by SPADI. Also short-term pain and impairment reduction for 8-12 weeks occurred in patients with chronic rotator cuff lesions. A direct comparison between the rehabilitation programs strengthened the assumption that effective pain management could be necessary to obtain optimal effect of physiotherapy and physical training in patients with chronic (&gt; 3 months) shoulder pain. Conclusion: PRF can be performed in an outpatient department and provides the clinician with an alternative or additional approach to oral drug treatment and intra-articular injection. Further, it may prove to be a useful treatment for patients who are unfit or unwilling to consider surgical intervention Level of evidence: IV.

The Needs and Experiences of Patients on Pain Education and the Clinical Reasoning of Physical Therapists Regarding Cancer-Related Pain. A Qualitative Study.

Objective: This study offers direction for interaction between physical therapists and patients about cancer-related pain during physical training. The study may increase awareness of rehabilitation strategies for cancer-related pain during and after cancer treatment.Methods: Qualitative study, evaluating results of two qualitative studies. Data has been collected using semi-structured interviews, in which topics were discussed with patients and physical therapists. Respondents were adult patients with cancer in the Northern Netherlands with moderate to severe pain who followed physical training with a (oncologic) physical therapist. The physical therapists were respondents specialized in oncology and working with patients with cancer in a primary care setting in in the Netherlands. Data were analyzed using thematic analysis.Results: Eighteen patients and fifteen physical therapists were interviewed. Data was categorized in statements regarding “patients' needs”, “patients' experiences” and “clinical reasoning of the physical therapist”. “Patients' needs” for education were personal and included needs for information about the cause, course and effect of pain in relation to cancer and/or medical treatment, needs for practical tools for reducing pain, needs for strategies dealing with pain in daily activities, and needs for information about additional treatment and care options. When discussing ‘patients’ experiences', patients mentioned that physical therapists are cautious to express their expectations of the progress of pain and to offer pain education with respect to the cause of pain, dealing with pain and limitations in daily life, exercising, posture, learning self-care and information about additional treatment and care options in cancer-related pain. Patients provided insight into their educational, mental, and social support relative to experiences with physical therapists. Additionally, when discussing the communication they experienced with physical therapists, patients used descriptors such as accessibility, empathy, trust, knowledge and eliminating uncertainties. Interviews with physical therapists regarding their clinical reasoning process in cancer-related pain described that they identified pain from anamnesis (medical history review) and performed screening and analysis for pain secondary to cancer (treatment), as type of pain and pain influencing factors. Thoughts and experiences about pain, the use of pain clinometry, the establishment of objectives and interventions for physical therapy and multidisciplinary treatment of cancer-related pain were also described.Conclusion: Patients with cancer-related pain during physical training have personal needs regarding pain education and experience that specialized oncologic physical therapists focus on patient-centered information and self-management support. Specialized oncologic physical therapists analyze pain in the anamnesis and keep in mind the origin and impact of pain for the patient during screening and treatment. Different methods of pain management are used. It is recommended that physical therapists who give physical training take the initiative to repeatedly discuss pain.