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Purpose: Exercise prescriptions for chronic low back pain (CLBP) often utilize reductionistic, trunk‐focused exercise aimed at addressing proposed pain mechanisms. It is unknown if the use of these trunk‐focused exercises imply beliefs to people with CLBP about the rationale for their use (e.g., etiology), even without concurrent biomedical narratives. This study aimed to explore people's perceptions of specific and general exercise without an accompanying narrative when experiencing CLBP. Methods: An anonymous online survey was distributed. Mixed methods were utilized for analysis. Six‐point Likert scales categorized people's beliefs about individual exercises. Open‐ended questions were used to gather further beliefs which were then coded into themes. Results: People with CLBP perceived specific exercise as more beneficial than general exercise. Eight themes and five subthemes were defined. A high volume of positive beliefs were centered around strengthening the low back and abdominal musculature, emphasizing the importance of correct technique. Negative beliefs were held against spinal flexion and external load. Both positive and negative beliefs were underpinned by spinal/pelvic stability being important as well as certain exercises being achievable or not. Conclusion: This study demonstrated that people with CLBP consider specific exercises to be more beneficial than general exercises for CLBP. Specific exercises irrespective of an accompanying narrative can imply meaning about the intent of an exercise. Understanding this requires practitioners to be mindful when prescribing and communicating exercise. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the effects of motor imagery (MI) on pain intensity and disability in individuals with complex regional pain syndrome (CRPS). Methods: A systematic search was conducted in various electronic databases to identify all relevant studies: PubMed, CINAHL, WOS, PEDro, CENTRAL, and Scopus. Randomized controlled trials assessing the effects of MI in individuals with CRPS were included. The risk of bias was assessed with the Cochrane Risk of Bias tool, the methodological quality was evaluated using PEDro scale, and the level of evidence was reported according to the GRADE. Between‐groups standardized mean differences (SMD) were calculated. Results: Six studies were included. The meta‐analysis found moderate‐quality evidence that MI improves pain intensity and related disability as immediate (pain: SMD −1.07, 95% CI: −1.53 to −0.60; disability: SMD 1.05, 95% CI: 0.59 to 1.51), short‐term (pain: SMD −1.28, 95% CI: −2.14 to −0.42; disability: SMD 1.37; 95% CI: 0.16 to 2.58), and long‐term effects (pain: SMD −1.18; 95% CI: −1.89 to −0.46; disability: SMD 1.18; 95% CI: 0.46 to 1.89), as compared with a comparison group. The risk of bias of the trials was relatively low, but the imprecision of the results downgraded the level of evidence. Conclusions: Moderate‐quality evidence suggests a positive effect of MI for improving pain intensity and disability immediately after and at short‐term in individuals with CRPS. [ABSTRACT FROM AUTHOR]

Introduction: The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high‐frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention. Materials and Methods: This was a retrospective single‐center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences. Results: The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self‐perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant. Conclusion: Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self‐perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre‐rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation. [ABSTRACT FROM AUTHOR]

Introduction: Spinal cord stimulation (SCS) is a well‐established treatment option for chronic pain. Pain over the implantable pulse generator, or pocket pain, is an incompletely understood risk of SCS implantation which may limit the efficacy of treatment and patient quality of life. The goal of this narrative review is to analyze the literature to gain a more thorough understanding of the incidence and risk factors for the development of pocket pain to help guide treatment options and minimize its occurrence in the future. Methods: A literature review was conducted investigating the development of pocket pain in patients with SCS for the management of a variety of pain conditions. Results: In total, 305 articles were included in the original database search and 50 met the criteria for inclusion. The highest level of evidence for papers that specifically investigated pocket pain was level III. Four retrospective, observational analyses included pocket pain as a primary outcome. The remainder of the included studies listed pocket pain as an adverse event of SCS implantation. Conclusions: There is a relative dearth of primary literature that examines the incidence, characteristics, and health economic implications of pocket pain in patients with SCS. This highlights the need for large‐scale, high‐quality prospective or randomized controlled trials examining pocket pain. This may ultimately help prevent and reduce pocket pain leading to improved efficacy of treatment and greater patient quality of life. [ABSTRACT FROM AUTHOR]

Background: One of the unique advances in neuromodulation for chronic pain has been spinal cord stimulators (SCS) and dorsal root ganglion stimulators (DRG‐S). These devices have aided in conditions such as neuropathic pain, complex regional pain syndromes, failed back surgery, and peripheral neuropathies. With these benefits, however, complications from implantable stimulators have included lead fractures and migration. The authors reviewed a lead migration, kinking, and subsequent fracture event involving a patient with complex regional pain syndrome (CRPS) II, who was treated with a DRG‐S. Case Presentation: The case report follows this patient, from their past medical history to assessment of appropriate qualifications for neuromodulation, to successful surgical placement, to follow‐up care. The authors further monitored assessment of inefficacy of pain relief, and identification of lead migration and kinking through imaging. In the process of removal, due to lead stress, lead fracturing occurred. After lead removal, the leads were fully replaced, and the patient was followed up and experienced improved pain relief. Conclusion: The case report assesses probable mechanisms of lead fracture and considerations for physicians for future assessment and triage of neuromodulation efficacy. [ABSTRACT FROM AUTHOR]

Objectives: To provide a systematic review of the literature on the effects of peripheral magnetic stimulation (PMS) in the treatment of chronic peripheral neuropathic pain. Methods: A systematic search of MEDLINE, EMBASE, CENTRAL, CINHAL, Web of Science, and ProQuest was conducted from inception to July 2023 to identify studies of any design published in English language that enrolled adult patients (≥18 years) that received PMS for treatment of a chronic peripheral neuropathic pain disorder (pain > 3 months). Results: Twenty‐three studies were identified which included 15 randomized controlled trials (RCTs), five case series, two case reports, and one non‐randomized trial. PMS regimens varied across studies and ranged from 5 to 240 min per session over 1 day to 1 year of treatment. Results across included studies were mixed, with some studies suggesting benefits while others showing no significant differences. Of nine placebo‐controlled RCTs, four reported statistically significant findings in favor of PMS use. In the meta‐analysis, PMS significantly reduced pain scores compared to control within 0–1 month of use (mean difference −1.64 on a 0–10 numeric rating scale, 95% confidence interval −2.73 to −0.56, p = 0.003, I2 = 94%, 7 studies [264 participants], very low quality of evidence), but not at the 1–3 months and >3 months of PMS use (very low and low quality of evidence, respectively). Minimal to no adverse effects were reported with PMS use. Discussion: There is limited and low‐quality evidence to make definitive recommendations on PMS usage, however, the available data is encouraging, especially for short‐term applications of this novel modality. Large high‐quality randomized controlled trials are required to establish definitive efficacy and safety effects of PMS. [ABSTRACT FROM AUTHOR]

Objective: The combined use of spinal cord stimulation (SCS) and muscle stimulation, in the treatment of chronic pain, using the same probe, could improve the clinical results. However, this technique has not been established as yet. It was our hypothesis that it is possible to generate muscle stimulation by using low frequencies with SCS electrodes and use it to additionally treat chronic back pain. Methods: We generated muscle stimulation in patients with previously implanted SCS electrodes, for the treatment of lower back pain, by using low frequencies (2, 4, 6, and 8 Hz) and different contact combinations of the electrodes. The results were evaluated by using visual inspection (videos), haptic control, surface electromyography (EMG), and sonographic recordings. Results: This pilot study (17 patients, seven females, age 36–87 years, 11 percutaneous paddle leads, and 6 octrodes) was performed at the Neurosurgical Department of the University of Tuebingen. The most preferred frequencies were 6 Hz (45.5% of percutaneous paddle leads) and 8 Hz (50% of octrodes) at contacts 3&4 or 5&6. The preference of frequencies differed significantly among genders (p = 0.023). Simultaneous EMG and ultrasonic recordings demonstrated the generation of muscle potentials and the stimulation of deeper muscle groups. Conclusion: In this study, it has been shown that with low‐frequency SCS stimulation, pleasant and pain‐relieving muscle contractions of the lower and upper back can also be generated. This combined method has been coined by us as "MuscleSCS" technique. Clinical trials are necessary to establish the value of this combined technique and its subtypes. [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 pandemic has had substantial impacts for both people using pain services and healthcare professionals delivering them. While the effects on service users have been studied, less is known about the effects for service providers. This study aimed to assess the impact of the pandemic on providers and the evolving role of telemedicine in treatment. Design & Methods: An electronic survey was distributed to the professional membership of the European Pain Federation (EFIC). The survey evaluated impact and adjustment to the COVID‐19 pandemic separately across two pandemic years (March 2020–February 2021 and March 2021 to February 2022) and assessed worry about COVID‐19, disruption and adjustment of pain services, and use of telehealth services. The change between the first and second pandemic years and the degree to which telehealth services were adopted was evaluated. Results: From 149 respondents, 131 (88%) participants provided sufficient data to be included in the analysis. Both providers worry about the pandemic and service disruption decreased significantly from the first to the second year of the pandemic. Prior to the pandemic, only 30% of providers offered telehealth appointments but this increased to 64% and 83%, respectively, in the first and second years of the pandemic. Conclusions: Although provider worry and disruption to delivery of pain services decreased during the second year of COVID‐19 pandemic, waiting times for appointments continued to lengthen. The pandemic has hastened the adoption of telemedicine in pain services and plans to continue telehealth services seem common. [ABSTRACT FROM AUTHOR]

Introduction: Neuromodulation has emerged as a promising therapy for the management of chronic pain, movement disorders, and other neurological conditions. Spinal cord stimulation (SCS) is a widely used form of neuromodulation that involves the delivery of electrical impulses to the spinal cord to modulate the transmission of pain signals to the brain. In recent years, there has been increasing interest in the use of automation systems to improve the efficacy and safety of SCS. This narrative review summarizes the status of Food and Drug Administration‐approved autonomous neuromodulation devices including closed loop, feedforward, and feedback systems. The review discusses the advantages and disadvantages of each system and focuses specifically on the use of these systems for SCS. It is important for clinicians to understand the expanding role of automation in neuromodulation in order to select appropriate therapies founded on automation systems to the specific needs of the patient and the underlying condition. Conclusion: The review also provides insights into the current state of the art in neuromodulation automation systems and discusses potential future directions for research in this field. [ABSTRACT FROM AUTHOR]

Background: A better insight in how the biopsychosocial factors influence patient outcome(s) may provide information that helps selecting the optimal pain management for a specific group. Methods: Categorization was made in the prospective DATAPAIN registry, in which patients with pain severity (Numeric Rating Scale [NRS]: 7–10), depression or anxiety (Hospital Anxiety and Depression Scale: > 10), and pain catastrophizing (Pain Catastrophizing Scale: > 31) were identified as complex cases. Patient outcomes; treatment satisfaction on the Patient Global Impression of Change (PGIC), pain relief (NRS), pain interference on the Brief Pain Inventory (BPI) and quality of life indicator General Perceived Health (GPH) were evaluated. Logistic regression analyzed if belonging to the complex cases showed modification in the outcome of the PGIC and GPH. Linear regression was observed if complex cases differed in average reduction in pain relief and interference compared to non‐complex cases. Results: 1637 patients were included, of which 345 (21.08%) were considered complex cases. The changes in scores of pain relief and BPI active subscale were not significantly different between groups. The BPI affective subscale had a different change in score (−0.509; p: 0.002). The complex cases had an odds ratio (OR) of 0.59 (95% confidence interval [CI]: 0.36–0.77) on treatment satisfaction compared to non‐complex cases, and an OR of 0.28 (95% CI: 0.11–0.56) on the GPH. Conclusion: When treating patients with complex cases, desired treatment outcome(s) should be recognized by specialists and patients, as these may be less likely to occur. [ABSTRACT FROM AUTHOR]

Introduction: Spinal cord stimulation is an important therapy option for the treatment of chronic neuropathic pain of spinal or peripheral etiology. As with any implantable device, complications may arise. These must be promptly identified and managed to maintain patients in successful therapy. Case Report: We report an unusual case of cephalad and extraspinal lead migration requiring surgical intervention in order to salvage therapy. Conclusion: Lead migration is one of the most common complications of spinal cord stimulation, and left untreated can lead to loss of therapy and possible device explant. A strategy for correcting this issue is needed, and we present an unusual case to consider when faced with a loss of therapy from lead migration. [ABSTRACT FROM AUTHOR]

Introduction: The potential benefits of electroconvulsive therapy (ECT) in chronic pain and several theories for its mechanism have been reported in the past, but mixed findings have also been reported. In the current systematic review and case series, our primary aim was to assess whether pain and functional outcomes are improved after ECT in patients with chronic pain. Secondary objectives included examining whether psychiatric improvement, specific pain diagnoses, and demographic or medical characteristics were associated with differences in pain treatment response. Methods: We performed a retrospective chart review to identify patients with chronic pain diagnoses for more than 3 months prior to the initiation of ECT and a systematic literature search on electronic databases for studies on chronic pain outcomes after ECT. Results: Eleven patients with various chronic pain diagnoses and comorbid psychiatric conditions were identified in the case series. Six patients reported improvement in pain while 10 patients reported improvement in mood following ECT. Systematic review identified 22 articles reporting a total of 109 cases. Eighty‐five (78%) of cases reported reduction in pain while 96.3% of the patients with a comorbid psychiatric diagnosis reported improvement in mood symptoms post‐ECT. While there was an association between improvement in mood and pain in studies with numeric ratings in both outcomes (r = 0.61; p < 0.001), some patients reported pain improvement without improvement in mood in both the case series and the pooled analysis of cases in the review. Certain pain diagnoses such as CRPS, phantom limb pain, neuropathic pain, and low back pain have consistently reported benefits and should be further studied in future studies with matched case controls. Conclusion: ECT may be offered to patients with certain pain conditions who have not responded sufficiently to conventional therapies, particularly when comorbid mood symptoms are present. Improved documentation practices on the outcomes in chronic pain patients receiving ECT will help generate more studies that are needed on this topic. [ABSTRACT FROM AUTHOR]

Objectives: Spinal cord stimulation (SCS) is conventionally placed at either cervical or thoracic spinal regions to treat chronic pain. However, for patients with multiarea pain, concomitant cervical and thoracic SCS (ctSCS) may be necessary to provide sufficient coverage. It remains unknown whether ctSCS is effective and safe. Thus, we aimed to survey the existing literature and assess the efficacy and safety of ctSCS. Methods: A systematic review of the literature was performed according to the 2020 PRISMA guidelines to investigate pain, functional, and safety outcomes related to ctSCS. Articles between 1990 and 2022 available through PubMed, Web of Science, Scopus, and Cochrane Library databases were included if they assessed these outcomes in the context of ctSCS. Data extracted from articles included study type, number of ctSCS implantations, stimulation parameters, indications for implantation, complications, and frequency. The Newcastle–Ottawa scale was used to assess risk of bias. Results: Three primary studies met our inclusion criteria. Overall, ctSCS was effective in providing analgesia. Pain severity was captured with patient‐reported pain scales and changes in analgesic requirements. Various metrics were used to quantify quality of life and functional outcomes. Failed back surgery syndrome was the most common indication for ctSCS implantation. Implanted pulse generator pocket pain was the most common postoperative adverse event. Conclusions: Despite the limited evidence available, ctSCS seems to be effective and generally well tolerated. The dearth of relevant primary literature illustrates a knowledge gap, and future studies are needed to better clarify the efficacy and safety profile of this SCS variant. [ABSTRACT FROM AUTHOR]

Background: Chronic pelvic pain (CPP) is a difficult condition to treat. Due to complex pelvic innervation, dorsal column spinal cord stimulation (SCS) has not been shown to produce the same effect as dorsal root ganglion stimulation (DRGS) given emerging evidence suggesting that applying DRGS may result in favorable outcomes for individuals with CPP. The aim of this systematic review is to investigate the clinical use and effectiveness of DRGS for patients with CPP. Materials and Methods: A systematic review of clinical studies demonstrating the use of DRGS for CPP. Searches were conducted using four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) across August and September 2022. Results: A total of nine studies comprising 65 total patients with variable pelvic pain etiologies met the inclusion criteria. The majority of subjects implanted with DRGS reported >50% mean pain reduction at variable times of follow‐up. Secondary outcomes reported throughout studies including quality of life (QOL) and pain medication consumption were reported to be significantly improved. Conclusions: Dorsal root ganglion stimulation for CPP continues to lack supportive evidence from well‐designed, high‐quality studies and recommendations from consensus committee experts. However, we present consistent evidence from level IV studies showing success with the use of DRGS for CPP in reducing pain symptoms along with reports of improved QOL through periods as short as 2 months to as long as 3 years. Because the available studies at this time are of low quality with a high risk of bias, we strongly recommend the facilitation of high‐quality studies with larger sample sizes in order to better ascertain the utility of DRGS for this specific patient population. At the same time, from a clinical perspective, it may be reasonable and appropriate to evaluate patients for DRGS candidacy on a case‐by‐case basis, especially those patients who report CPP symptoms that are refractory to noninterventional measures and who may not be ideal candidates for other forms of neuromodulation. [ABSTRACT FROM AUTHOR]

Background: Chronic neuropathic dental pain has a poor prognosis with a low chance of significant spontaneous improvement. Local or oral therapies may be efficient, however short in terms of duration with potential side effects. Cryoneurolysis has been described to prevent acute postoperative pain or to treat some chronic pain conditions; however, application to dental orofacial pain has not been reported so far. Case Series: Following a positive diagnostic block on the corresponding alveolar nerve, neuroablation was performed using a cryoprobe on three patients suffering from persistent pain after a dental extraction and 1 after multiple tooth surgeries. The effect of treatment was assessed using a Pain Numeric Rating Scale (NRS) and determined by changes in medication dosage and quality of life at day 7 and 3 months. Two patients experienced more than 50% of pain relief at 3 months, 2 by 50%. One patient was able to wean off pregabalin medication, one decreased amitriptyline by 50%, and one decreased tapentadol by 50%. No direct complications were reported. All of them mentioned improvement in sleep and quality of life. Conclusion: Cryoneurolysis on alveolar nerves is a safe and easy‐to‐use technique allowing prolonged neuropathic pain relief after dental surgery. [ABSTRACT FROM AUTHOR]

Objective: People from minority ethnicities often have a greater impact of chronic pain, are underrepresented at pain services, and may not benefit from treatment to the same extent as dominant cultures. The aim of this study was to review Indian and Chinese cultural views of pain and pain management, as a basis for improving management of chronic pain in migrant populations from these ethnicities. Methods: A systematic review of qualitative studies addressing pain beliefs and experiences involving Indian and Chinese participants was conducted. Thematic synthesis was used to identify themes across the studies, and the quality of the articles was appraised. Results: Twenty‐six articles were included, most of which were appraised as high quality. Five themes were identified: Making meaning of pain described the holistic interpretation of the meaning of pain; Pain is disabling and distressing described the marked physical, psychological, and spiritual impact of pain; Pain should be endured described the cultural expectation to suppress responses to pain and not be a burden; Pain brings strength and spiritual growth described the enrichment and empowerment some people experienced through living with pain, and Management of pain goes beyond a traditional or Western approach described the factors that guided people in their use of healthcare. Discussion: The review identified a holistic interpretation and impact of pain in Indian and Chinese populations, with pain management guided by multiple factors that transcended a single cultural framework. Several strength‐based management strategies are recommended based on preferences for traditional treatments and respect for Western healthcare. [ABSTRACT FROM AUTHOR]

Objective: To determine, using the Delphi method, standardized recommendations for the follow‐up of patients undergoing an interventional procedure for the treatment of chronic pain in Spain. Methods: First, a systematic literature review was performed to identify the literature on the management of patients with chronic pain undergoing interventional techniques; subsequently, a two‐round Delphi survey with 108 questions was conducted. The questionnaire was validated by a Scientific Committee (5 experts) and sent to 47 experts specialized in chronic pain. "Consensus" or "intermediate consensus" was determined when ≥ 75% or < 75% to ≥ 65% of the experts selected the same answer for each item, respectively. Then, a face‐to‐face deliberation process was held with the Scientific Committee to analyze and discuss the results. Results: The questionnaire was completed by 24 panelists (51%). Consensus was reached on 88.4% of the questions. The panelists identified pain, drug consumption, and quality of life as essential variables in the follow‐up of patients with chronic pain. Consensus was reached on most of the scales/questionnaires to be used in measuring outcomes during follow‐up, except for psychological status. Regarding the follow‐up frequency, in radicular spinal chronic pain, a consensus was reached on the first visit 1–2 months after the intervention, during the first year, at 1, 3, 6, and 12 months, and then every 6 months thereafter. For non‐radicular spinal chronic pain, the first visit 1–2 months after surgery was agreed upon, however, there was no consensus on follow‐up during the first year. For non‐spinal chronic pain, consensus was reached regarding the first visit at 1–2 months after surgery and during the first year at 1, 3, 6, and 12 months. No consensus was reached on follow‐up frequency for oncological chronic pain. After receiving a permanent neurostimulator implant for chronic pain, the first visit was agreed upon at 1–3 weeks, during the first year, at 2 weeks, 1, 3, 6, and 12 months, and after, every 6 months. For intrathecal infusion, it was agreed that the first visit should occur during the first month, and thereafter whenever the pump requires a refill. Conclusions: These findings provide recommendations in relation to the frequency of follow‐up and the scales to be used with chronic pain patients undergoing interventional techniques in Spain. [ABSTRACT FROM AUTHOR]

Background: Chronic flank pain can pose a therapeutic challenge. Current management centres on visceral pathology affecting the renal system. Acute exacerbations can be severe, requiring emergency admission. Patients usually have well‐established visceral pathology including polycystic kidney disease, Fowler's syndrome, and renal calculi disease that often cause recurrent urinary tract infections. However, in many cases, despite negative investigations including imaging, biochemistry and urine analysis, flank pain persists. Abdominal myofascial pain syndrome is a poorly recognized pathology in this cohort. The report describes the underlying pathophysiology and a novel interventional management pathway for patients presenting with refractory flank pain secondary to abdominal myofascial pain syndrome. Methods: Adult patients with refractory chronic flank pain at a tertiary renal unit were included as a part of an on‐going prospective longitudinal audit. Patients refractory to standard management were offered the interventional pathway. The pathway included two interventions: quadratus lumborum block with steroid and pulsed radio frequency treatment. Patients completed brief pain inventory and hospital anxiety and depression scale questionnaires at baseline, 3 and 6 months postprocedure. Outcomes collected included ability to maintain employment, change in opioid consumption at 6 months and impact on emergency hospital admissions at 12 months after initiation of the pathway. Results: Forty‐five patients were referred to the pain medicine clinic over a seven‐year period between 2014 and 2021. All patients were offered the interventions. Four patients refused due to needle phobia. Forty‐one patients received transmuscular quadratus lumborum plane block with steroids. Twenty‐seven patients (27/41, 66%) reported durable benefit at 6 months and six patients (6/41, 15%) had clinically significant relief at 3 months. Fifteen patients received pulsed radiofrequency to quadratus lumborum plane and 11 patients (73%) reported > 50% analgesia at 6 months. Treatment failure rate was 10% (4/41). Opioid consumption at 6 months and emergency admission at 12 months were reduced post intervention. Conclusion: Abdominal myofascial pain syndrome is a poorly recognized cause of chronic flank pain syndrome. The interventional management pathway could be an effective solution in this cohort. [ABSTRACT FROM AUTHOR]

The article critiques a study by Dhruva et al. in JAMA Neurology comparing spinal cord stimulation (SCS) to conventional medical therapy, emphasizing issues with study design, patient cohort selection, and conflicts of interest. Topics include inappropriate patient inclusion criteria, the assumption about SCS recipients receiving spinal injections, the inadequacy of using medication management as a comparative therapy, and the undisclosed conflicts of interest among the authors.

Background: Current evidence favors a multidisciplinary biopsychosocial approach to the management of chronic non‐specific low back pain (CLBP). However, it is unclear whether such an approach is facilitated by current clinical guidelines. This rapid review set out to examine the extent to which clinical guideline recommendations for managing CLBP address domains of the biopsychosocial approach. Methods: MEDLINE, EMBASE, CINAHL, and the gray literature were searched for any clinical guidelines targeting the management of CLBP, published within the last 6 years. Title/abstract and full‐text screening were undertaken by two reviewers using the accelerated approach. Data extraction and critical appraisal were completed by two reviewers, independently. Extracted data were synthesized in narrative form. Results: Fifteen guidelines met the review inclusion criteria. One‐half of the guidelines were considered to be of medium quality. All guidelines provided management recommendations addressing the biological domain of the biopsychosocial approach; 13 (87%) guidelines reported recommendations addressing the psychological domain, and 8 (53%) guidelines presented recommendations addressing the social domain. Only 53% (8/15) of guidelines reported recommendations addressing all three domains of the biopsychosocial approach. Guideline recommendations both across and within the biopsychosocial domains were varied and inconsistent. Conclusions: The CLBP clinical guidelines included in this review provided detailed guidance on the biological domain, yet limited attention and detail were afforded to the psychological and social domains. Several recommendations are presented on how to improve the quality of future CLBP guidelines, and to help foster the provision of a biopsychosocial approach to CLBP management. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of low‐dosed outpatient biopsychosocial interventions versus active physical interventions on pain intensity and disability in adults with nonspecific chronic low back pain. Introduction: Research has shown that primary care biopsychosocial interventions (PCBI) can reduce pain intensity and disability. While scattered studies support low‐dosed (≤ 15 treatment hours) PCBI, no systematic review exists comparing the effectiveness of low‐dosed PCBI treatment with traditional physical activity interventions in adults with nonspecific chronic low back pain (CLBP). Inclusion Criteria: Randomized controlled trials that evaluate low‐dosed PCBI compared to physical treatment with an active component such as exercise, physical activity or usual physiotherapy treatment for adult participants (18 years or older), who suffer from CLBP were included. Not recommended interventions that feature only passive therapies, spinal surgery or pharmacological treatment, and studies with inpatient multidisciplinary‐based rehabilitation (MBR) were excluded. Methods: Databases were searched from inception to December 31, 2021. Language was restricted to English or German. Keywords and derivatives of "chronic back pain", "exercise intervention", "cognitive‐behavioral therapy", "primary care" and "randomized controlled trials" were used. Sources were CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science. Search was finished on March 08, 2022. Data appraisal, extraction and synthesis followed JBI guidance for systematic reviews of effectiveness. Risk of Bias was assessed using JBI 13‐item checklist for randomized controlled trials. The GRADE approach for grading the certainty of evidence was followed. Systematic Review Registration Number: PROSPERO 2022 CRD42022302771. Results: Eighteen RCTs were found eligible and 15 trials comprising a total of 1531 participants suffering from CLBP were entered in the meta‐analyses. Risk of Bias was low. Overall evidence was moderate. Significant effects in favor of PCBI were found for pain intensity post‐treatment (standardized mean difference (SMD) = −1.09, 95% confidence interval (CI) = −1.84 to −0.34, I2 = 97%, p = 0.004) as well as at short‐term (SMD = −0.23, 95% CI = −0.39 to −0.08, I2 = 0%, p = 0.004), long term (SMD = −0.79, 95% CI = −1.42 to −0.17, I2 = 96%, p = 0.01) and very long‐term (SMD = −1.13, 95% CI = −1.93 to −0.33, I2 = 94%, p = 0.005) follow‐up. Significant effects in favor of PCBI for physical function were found post‐treatment (SMD = −1.33, 95% CI = −2.17 to −0.49, I2 = 97%, p = 0.002) at short‐term (SMD = −0.20, 95% CI = −0.36 to −0.04, I2 = 0%, p = 0.01) and at long‐term follow‐up (SMD = −1.17, 95% CI = −2.06 to −0.28, I2 = 98%, p = 0.01). The results were characterized by high heterogeneity due to different types (cognitive behavioral therapy, pain‐neuroscience education, mindfulness, and motivation), delivery modes (individual and/or group), durations (3–12 weeks) and contact times (2–15 h) of PCBI. In sensitivity analysis outliers were removed to reduce heterogeneity. The results remained significant for pain intensity at short‐term (SMD = −0.23, 95% CI = −0.39 to −0.08, I2 = 0%, p = 0.004) and long‐term follow‐up (SMD = −0.22, 95% CI = −0.41 to −0.03, I2 = 39%, p = 0.02). Conclusions: This meta‐analysis suggests that low‐dosed PCBI has favorable effects in terms of disability and pain intensity compared to active physical treatments alone. All conducted meta‐analyses indicate that biopsychosocial interventions produce better outcomes than active physical treatment alone. Therefore, we strongly recommend decision makers and clinical practitioners to analyze how psychosocial elements can be introduced into outpatient (low‐dosed) CLBP interventions. [ABSTRACT FROM AUTHOR]

Objective: Cognitive behavioral therapy for chronic pain (CBT‐CP) is an evidence‐based treatment for improving functioning and pain intensity for people with chronic pain with extensive evidence of effectiveness. However, there has been relatively little investigation of the factors associated with successful implementation and uptake of CBT‐CP, particularly clinician and system level factors. This formative evaluation examined barriers and facilitators to the successful implementation and uptake of CBT‐CP from the perspective of CBT‐CP clinicians and referring primary care clinicians. Methods: Qualitative interviews guided by the Consolidated Framework for Implementation Research were conducted at nine geographically diverse Veterans Affairs sites as part of a pragmatic clinical trial comparing synchronous, clinician‐delivered CBT‐CP and remotely delivered, technology‐assisted CBT‐CP. Analysis was informed by a grounded theory approach. Results: Twenty‐six clinicians (CBT‐CP clinicians = 17, primary care clinicians = 9) from nine VA medical centers participated in individual qualitative interviews conducted by telephone from April 2019 to August 2020. Four themes emerged in the qualitative interviews: (1) the complexity and variability of referral pathways across sites, (2) referring clinician's lack of knowledge about CBT‐CP, (3) referring clinician's difficulty identifying suitable candidates for CBT‐CP, and (4) preference for interventions that can be completed from home. Conclusions: This formative evaluation identified clinician and system barriers to widespread implementation of CBT‐CP and allowed for refinement of the subsequent implementation of two forms of CBT‐CP in an ongoing pragmatic trial. Identification of relative difference in barriers and facilitators in the two forms of CBT‐CP may emerge more clearly in a pragmatic trial that evaluates how treatments perform in real‐world settings and may provide important information to guide future system‐wide implementation efforts. [ABSTRACT FROM AUTHOR]

Introduction: Traditional spinal cord stimulation (t‐SCS) has been used to treat chronic pain for over 50 years. However, up to 30% of patients undergo explant, with the main indication being loss of efficacy (LoE), and few alternative treatment options exist for these patients. Strategies to mitigate LoE commonly include conversion to another type of SCS (termed 'salvage' or 'rescue'). This review summarizes the existing literature concerning the efficacy and safety of 10 kHz SCS as a salvage therapy. Methods: We searched PubMed, the Cochrane Library, ClinicalTrials.gov, and other sources between January 2009 and April 2021. Records were retained if the authors reported clinical outcomes with a minimum of ≥ 3 months of follow‐up in patients implanted with a Senza® 10 kHz SCS system in an effort to treat t‐SCS LoE. Results: Ten articles were eligible for inclusion, reporting 3 prospective studies and 7 retrospective reviews. In the single study that salvaged patients without a repeat trial prior to surgery, 81% of patients were responders (≥ 50% pain relief from baseline), with mean pain relief of 60%. Among repeat‐trial studies, the responder rate ranged from 46% to 80%, and mean pain relief from 47% to 68%. No unanticipated therapy‐related safety issues were reported among the included articles. Conclusion: Preliminary data suggest that chronic back and/or leg pain patients with t‐SCS LoE can experience improved and durable pain relief after conversion to 10 kHz SCS. However, additional research is needed to define predictors of success and establish whether salvage without a repeat trial is a viable conversion method. [ABSTRACT FROM AUTHOR]

Introduction: Exercise is the most recommended treatment for chronic low back pain (CLBP) and is effective in reducing pain, but the mechanisms underlying its effects remain poorly understood. Exercise‐induced hypoalgesia (EIH) may play a role and is thought to be driven by central pain modulation mechanisms. However, EIH appears to be disrupted in many chronic pain conditions and its presence in people with CLBP remains unclear. As people suffering from chronic pain often exhibit psychological factors and central sensitization symptoms influencing pain perception, EIH might be associated with these factors. Objective: The aim of this study is to compare the level of EIH between participants with and without CLBP following back and wrist exercises and to assess the associations between EIH, psychological factors, and symptoms of central sensitization (using the central sensitization inventory ‐ CSI) in CLBP. Method: Twenty‐eight participants with CLBP and 23 without pain were recruited. Pressure pain thresholds (PPT) were measured at 4 sites (2 bony sites = capitate, S1|2 muscle sites = wrist flexors, lumbar erector spinae) before and after each of two exercises (wrist flexion and lumbar extension). Exercise‐induced hypoalgesia was defined as percent change in PPT from pre‐ to post‐exercise. Participants with CLBP also completed questionnaires to measure psychological factors (e.g., kinesiophobia, catastrophizing, anxiety, and self‐efficacy) and symptoms of central sensitization (CSI), and correlations with EIH were calculated. Results: After wrist exercise, EIH measured at the muscle sites was lower in the CLBP group compared with the pain‐free group (p = 0.047) but no differences were found at bony sites (p = 0.49). No significant differences for EIH were observed following back exercise at muscle sites (p = 0.14) or at bony sites (p = 0.65). Exercise‐induced hypoalgesia was not correlated with any psychological factors or with the CSI score. Conclusion: The lower EIH following wrist exercises may represent an alteration in pain modulation control in CLBP. However, psychological factors and central sensitization symptoms may not explain the differences observed. [ABSTRACT FROM AUTHOR]

Introduction: Dorsal root ganglion stimulation (DRG‐S) has recently emerged as a novel therapy in neuromodulation that demonstrated a higher rate of success than spinal cord stimulation (SCS) in a prospective, head‐to‐head randomized comparative trial to treat complex regional pain syndrome (CRPS) and causalgia. In contrast to SCS, DRG‐S also shows promise in treating conditions that are not purely neuropathic such as axial low back pain, which has a prominent nociplastic pain component. It is not known to what extent the effectiveness of DRG‐S for such indications is due to effective treatment of the neuropathic pain component versus the effects of DRG‐S on mechanical pain. Although rarely studied, reporting outcomes of DRG‐S to treat predominantly mechanical/nociceptive pain may help point toward expanding the utility of this therapy. Here, we present five cases of refractory mechanical pain treated with DRG‐S. Methods: A retrospective analysis of all patients who underwent a successful DRG‐S trial and implant between September 2017 and September 2021 at our institute was performed. Patients who had intractable joint pain without strong evidence of neuropathic pain were included in this case series. The Budapest criteria for CRPS, the Douleur Neuropathique 4 Questions (DN4) survey, or a definable nerve injury were used to determine the presence of neuropathic pain. Baseline assessments for pain (Numeric Rating Scale [NRS]), function (Oswestry Disability Index [ODI]), quality of life (EuroQol‐5 Dimension [EQ‐5D]), and other applicable joint surveys were extracted from pre‐trial baseline and follow‐up appointments. Results: Five patients were identified and included. Patient diagnoses consisted of refractory joint pain of the hip, knee, or ankle. Mean NRS pain scores improved by 74% from 9.2 at baseline to 2.4 at the last follow‐up (mean = 28 months post‐implant). From baseline to the last follow‐up, mean ODI scores improved by 65% from 66 to 23 and EQ‐5D scores more than doubled from an average of 0.371 to 0.797. Conclusion: This clinical report illustrates the potential utility DRG‐S has in treating pain that clinically presents as predominantly refractory mechanical joint pain without a significant neuropathic component. The physiological reasons for our observations may be that DRG‐S is able to directly influence the conduction of nociceptive signaling at the DRG and within the spinal cord. Further investigations are warranted to determine if DRG‐S is a potential treatment option for chronic mechanical pain. [ABSTRACT FROM AUTHOR]

The article discusses on comparing the effectiveness of low-dosed outpatient biopsychosocial interventions with active physical interventions for adults with chronic low back pain. The systematic review and meta-analysis of 15 clinical trials found that low-dosed outpatient biopsychosocial interventions were more effective in reducing pain severity at various follow-up periods compared to physical treatment alone, indicating their favorable effects.

Rationale, aims, and objectives: Chronic pain is a global public health problem that negatively impacts individuals' quality of life and imposes a substantial economic burden on societies. The use of medicinal cannabis (MC) is often considered by patients to help manage chronic pain as an alternative or supplement to more conventional treatments, given enabling legalization in a number of countries. However, healthcare professionals involved in providing guidance for patients related to MC are often doing so in the absence of strong evidence and clinical guidelines. Therefore, it is crucial to understand their perspectives regarding the clinical use and relevance of MC for chronic pain. As little is known about attitudes of HCPs with regard to MC use for chronic pain specifically, the aim of this review was to identify and synthesize the published evidence on this topic. Methods: A systematic search was conducted across six databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PubMed from 2001 to March 26, 2021. Three authors independently performed the study selection and data extraction. Thematic analysis was undertaken to identify key themes. Results: A total of 26 studies were included, involving the United States, Israel, Canada, Australia, Ireland, and Norway, and the perspectives of physicians, nurses, and pharmacists. Seven key themes were identified: MC as a treatment option for chronic pain, and perceived indicated uses; willingness to prescribe MC; legal issues; low perceived knowledge and the need for education; comparative safety of MC versus opioids; addiction and abuse; and perceived adverse effects; Conclusion: To support best practice in the use of MC for chronic pain, healthcare professionals require education and training, as well as clinical guidelines that provide evidence‐based information about efficacy, safety, and appropriate dosage of products for this indication. Until these gaps are addressed, healthcare professionals will be limited in their capacity to make treatment recommendations about MC for people/patients with chronic pain. [ABSTRACT FROM AUTHOR]

The article focuses on serious concerns regarding a randomized clinical trial by Hara et al. that compared burst-wave spinal cord stimulation (SCS) with sham, highlighting issues in study design, implementation, and conclusions, as outlined by Eldabe et al.

There is an urgent need for safe and effective nonpharmacologic approaches to treat chronic knee pain in older adults. Although virtual reality (VR) has shown some effectiveness for acute pain, there is limited evidence on the effects of VR on chronic pain particularly with older adult populations. This single application, within‐subject pilot study evaluated the feasibility and effectiveness of VR as a clinical treatment for older adults with chronic osteoarthritis knee pain. Nineteen participants aged 60+ years old participated in a 10‐min VR meditation program. Data on pain and affect were collected immediately prior to, post, and 24–48 h after the VR. Results suggest that VR meditation had significant moderate to large analgesic effects on knee pain intensity, primarily during VR (d = 1.10) and post VR (d = 0.99), with some lasting effects into next day (d = 0.58). The findings also suggest VR meditation intervention had a positive effect on affect, with a significant large decrease in negative affect scores pre‐ to post‐VR (d = 1.14). The significant moderate to large decreases in pain interference for normal work (d = 0.71), mood (d = 0.53), sleep (d = 0.67), and enjoyment of life (d = 0.72) suggest that older adults may have a higher ability to participate in meaningful daily activities up to 24–48 h after VR meditation. VR appears to be a feasible and effective nonpharmacological tool for older adults to treat chronic overall and knee‐specific pain. [ABSTRACT FROM AUTHOR]

Objective: To assess long‐term outcomes of cooled radiofrequency ablation (CRFA) of genicular nerves for chronic knee pain due to osteoarthritis (OA). Methods: A prospective, observational extension of a randomized, controlled trial was conducted on adults randomized to CRFA. Subjects were part of a 12‐month clinical trial comparing CRFA of genicular nerves to a single hyaluronic injection for treatment of chronic OA knee pain, who then agreed to visits at 18‐ and 24‐months post CRFA and had not undergone another knee procedure since. The subjects were evaluated for pain using the Numeric Rating Scale (NRS) function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), subjective benefit using the Global Perceived Effect (GPE) scale, quality of life using the EuroQol‐5‐Dimensions‐5 Level (EQ‐5D‐5L) questionnaire, and safety. Results: Of 57 subjects eligible, 36 enrolled; 32 completed the 18‐month visit with a mean NRS score of 2.4 and 22 (69%) reporting ≥50% reduction in pain from baseline (primary endpoint); 27 completed the 24‐month visit, with a mean NRS of 3.4 and 17 (63%) reporting ≥50% pain relief. Functional and quality of life improvements persisted similarly, with mean changes from baseline of 53.5% and 34.9% in WOMAC total scores, and 24.8% and 10.7% in EQ‐5D‐5L Index scores, at 18‐ and 24‐months, respectively. There were no identified safety concerns in this patient cohort. Conclusion: In this subset of subjects, CRFA of genicular nerves provided durable pain relief, improved function, and improved quality of life extending to 24 months post procedure, with no significant safety concerns. [ABSTRACT FROM AUTHOR]

Spinal cord stimulation (SCS) is effective for the treatment of chronic intractable pain of the trunk and limbs. The mechanism of action may be based, at least in part, upon the gate control theory; however, new waveforms may suggest other mechanisms. Although benefits of the SCS technology generally outweigh the complications associated with SCS, some complications such as infection and skin erosion over the implant can result in device removal. Additional reasons for device removal, such as pocket pain and battery depletion, have driven technological innovations including battery‐free implants and device miniaturization. The neurostimulation system described here was specifically designed to address complications commonly associated with implantable batteries and/or larger implantable devices. The benefits of the small size are further augmented by a minimally invasive implant procedure. Usability data show that patients found this novel neurostimulation system to be easy to use and comfortable to wear. What is more, clinical data demonstrate that the use of this system provides statistically significant reduction in pain scores with responder rates (defined as ≥50% reduction in pain) of 78% in the low back and 83% in the leg(s). Advances in miniaturization technology arose from the considerable shrinkage of the integrated circuit, with an increase in performance, according to Moore's law (1965). However, commensurate improvements in battery technology have not maintained a similar pace. This has prompted some manufacturers to place the battery outside, against the skin, thereby allowing a massive reduction in the implant volume, with the hopes of fewer device‐related complications. [ABSTRACT FROM AUTHOR]

Aim: Novel minimally invasive short‐term and long‐term peripheral nerve stimulation (PNS) systems have revolutionized targeted treatment of chronic neuropathic pain. We present an international survey of PNS‐implanting pain physicians to assess what factors they consider when offering permanent PNS. Methods: This cross‐sectional study consisted of a survey (Qualtrics) that was distributed to PNS‐implanting physicians in a device supplier's entire email database on November 13, 2020, with 3 weeks of response time. Physicians' contact information in the form of their email addresses had been previously collected by the supplier upon device distribution with permission to use survey responses for research. Results: Of 2032 database physicians, 40 physicians representing 37 institutions responded to the survey. The most common application of PNS was mononeuropathic pain (57%). The most frequently targeted nerve was the suprascapular nerve (29%). 14% of physicians reported 81–100% of their implants were dual‐lead. The representative physicians ranged broadly in their most frequently targeted nerves. Although mononeuropathic pain was the most common indication for PNS, there was still varied response regarding other indications such as CRPS and post‐surgical chronic pain. Conclusion: In context of a low response rate, identifying such factors can help update the prevailing treatment algorithm for interventional therapies, assist pain physicians in better identifying which patients are the best candidates for PNS, and inform future clinical trial design on PNS efficacy. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the impact of chronic low back pain (CLBP) on patients' personal and professional lives, and management strategies applied to treat CLBP. Methods: A 60‐question survey was developed, and respondents from 16 countries with a self‐reported physician's diagnosis of CLBP were recruited via an online market research survey panel. Respondents were stratified as having mild, moderate, or severe pain. Target sample sizes per country and for pain severity were set. Data were weighted according to the known population and prevalence of CLBP in each country and the number of respondents from that country. Results: Results from 9642 CLBP patients indicated that almost a quarter of patients with severe CLBP report a psychological comorbidity. Prescription pain medications were more commonly used by patients with severe CLBP (56%) than those with mild (20%) or moderate (34%) CLBP. Among those with severe CLBP who had been prescribed pain medication, 58% were prescribed opioids, with 1 in 4 patients using opioids for more than 5 years. Patients were primarily managed by general practitioners/primary care physicians, physiotherapists, neurologists, or orthopedic surgeons. CLBP negatively impacted patients' daily activities, social lives, and work productivity. Conclusion: Chronic low back pain has pronounced effects on patients' personal relationships, ability to work, and daily living. Almost 1 in four patients with severe CLBP reported a psychological comorbidity. Adherence to guidelines appears inconsistent, which is noteworthy as a substantial subgroup of patients with severe CLBP had been prescribed opioid medication for more than 5 years. Improved education is required to support healthcare professionals (HCPs) in identifying and understanding the complex biopsychosocial needs of CLBP patients to optimize pain management and to encourage referral of CLBP patients to physiotherapists and psychologists. [ABSTRACT FROM AUTHOR]

Background: Spinal cord stimulation (SCS) continues to gain increasing popularity in the pain management field for the treatment of different painful conditions; however, to‐date, the correlation between the SCS effectiveness and biological sex has not been fully established. We aimed to investigate the correlation between the biological sex and SCS outcomes. Methods: Following Institutional Review Board approval, a retrospective cohort study was performed by collecting data for patients treated with SCS at a tertiary academic center between the years 2002 and 2019. Data was assessed with multivariable linear regression to investigate the association between biological sex and pain scores at baseline, 6‐, and 12‐ months following SCS implantation. Propensity score matching (PSM) was performed based on a set of covariates including age, duration of pain, time since implant, BMI, opioid medications use, smoking, depression and history of alcohol, or substance abuse. Results: Of the patients treated with SCS implants, 418 patients fit the inclusion and exclusion criteria, out of which the majority were females (272, 65%). The pre‐matching data reported a significant difference in history of diabetes and depression and was also significant for greater opioid use in male patients at baseline, 6‐, and 12‐months post‐SCS implant. Propensity score matching (PSM) was performed based on the above mentioned covariant. After matching, no statistical difference was found among the variables, in both groups. Furthermore, after matching no significant differences in the pain scores at baseline, 6‐, and 12‐months post‐SCS implant were observed. Conclusion: No biological sex‐based differences in the analgesic response to SCS therapy was detected at 6‐ and 12‐months post‐SCS implant between groups with similar demographics, biomedical, and psychological values. [ABSTRACT FROM AUTHOR]

Introduction: Radiofrequency (RF) treatment of the genicular nerves is a promising treatment for chronic osteoarthritic and persistent postsurgical knee pain (PPSP), refractory to conventional medical management. Methods: The RECORGEN study is a retrospective single‐center cohort study of patients treated with ultrasound‐guided conventional RF of the genicular nerves for chronic knee pain in Hospital Oost‐Limburg, Genk from September 2017 to June 2020. Subgroup analysis based on etiology of pain (PPSP and degenerative knee pain) was performed in addition to the total study population analysis. Outcome parameters were global perceived effect (GPE), Numeric Rating Scale for pain, consumption of strong opioids, and safety of the treatment at 6 weeks and cross‐sectionally at a variable time point. Treatment success was defined as GPE≥50%. Results: Sixty‐eight cases were screened of which 59 (46 diagnosed with PPSP and 13 with degenerative knee pain) were included in the study. Treatment success at 6 weeks was achieved in 19 of 59 interventions (32.2%) and was similar in both groups. Seventeen responders were evaluated at follow‐up. 45.1% (8/17) continued to have a positive effect at the second time point. The mean duration of effect of the RF treatment was 8.3 months. Safety analysis at 6 weeks and at the second time point showed a good safety profile of the treatment. Conclusion: Conventional RF of the genicular nerves was clinically successful in more than 30% of the study population refractory to conventional medical management. Overall, the treatment was well tolerated. The mean duration of effect was 8.3 months. [ABSTRACT FROM AUTHOR]

Background: Change on the Numeric Rating Scale (NRS) is based on subjective pain experience, hampering the establishment of clinically important improvement. An anchor‐based method, the Patients' Global Impression of Change (PGIC), is often added to determine whether a patient has improved. A two‐point change on the NRS has been shown to be equivalent to a moderate clinically important improvement in randomized controlled trials (RCT's) on medication effects. We contemplated whether these findings could be reproduced in cohort and data and in non‐drug interventional RCT's. Methods: The NRS change was quantified by subtracting the NRS of baseline from the NRS at 6‐month follow‐up. Categorization of success/nonsuccess was applied on the PGIC, and their average NRS raw changes were calculated. The Spearman correlation coefficient quantified the overall relationship, while the discriminative ability was explored through the receiver operating characteristic curve. Data were stratified on design, sex, and pain intensity at baseline. Besides, the cohort evaluated treatment status at follow‐up. Results: The records of 1661 patients were examined. Overall, the observed NRS change needed for moderate clinically important improvement was larger than the average two points. Yet, the changes in the cohort were smaller compared with the RCT's. Moreover, it modified with pain intensity at baseline and treatment statuses indicated differences in mean clinical importance of −4.15 (2.70) when finalized at 6 months and −2.16 (2.48) when treatment was ongoing. Conclusion: The moderate clinically important improvement varied substantially, representing heterogeneity in pain relief and its relation to treatment success in chronic pain patients. [ABSTRACT FROM AUTHOR]

Background: The use of ultrasound (US)‐guided intradiscal injection has been described in the literature with the patient lying in the prone position; however, many patients are unable to lie in the prone position. Therefore, we describe an innovative technique of US‐guided platelet‐rich plasma (PRP) administration in the lumbar intervertebral disc (IVD) of 3 patients with chronic lower back pain who failed to improve with conservative management. Case Series: For all the 3 patients, magnetic resonance imaging showed annular tears of the L5/S1 IVD with broad‐based central posterior protrusions. PRP injection was performed with the patients in the lateral decubitus position or modified recovery position. With the transducer initially placed in the short axis to the lumbar spine, the needle was inserted in‐plane to the IVD, with the needle trajectory clearly visualized. Once the needle entered the annulus fibrosus, placement of the needle was confirmed by turning the transducer along the long axis of the spine to validate the location of the needle tip inside the IVD. Discus stimulation was performed with contrast administered to elicit each patient's usual pain, and spread of the contrast was confirmed under fluoroscopy. Upon confirmation of the intradiscal location, 3 ml of PRP was administered. Conclusions: This report described a novel technique demonstrating that US‐guided lumbar intradiscal needle placement for PRP administration in patients lying in the lateral decubitus position is feasible. [ABSTRACT FROM AUTHOR]

Objectives: Musculoskeletal disorders often lead to chronic pain in Veterans. Chronic pain puts sufferers at risk for substance misuse, and early intervention is needed for both conditions. This pilot study tested the feasibility and acceptability of a Screening, Brief Intervention, and Referral to Treatment for Pain Management intervention (SBIRT‐PM) to help engage Veterans seeking disability compensation for painful musculoskeletal disorders in multimodal pain treatment and to reduce risky substance use, when indicated. Methods: This pilot study enrolled 40 Veterans from 8 medical centers across New England in up to 4 sessions of telephone‐based counseling using a motivational interviewing framework. Counseling provided education about, and facilitated engagement in, multimodal pain treatments. Study eligibility required Veterans be engaged in no more than 2 Veteran Affairs (VA) pain treatment modalities, and study participation involved a 12‐week postassessment and semistructured interview about the counseling process. Results: Majorities of enrolled Veterans screened positive for comorbid depression and problematic substance use. Regarding the offered counseling, 80% of participants engaged in at least one session, with a mean of 3 sessions completed. Ninety percent of participants completed the postassessment. Numerically, most measures improved slightly from baseline to week 12. In semistructured interviews, participants described satisfaction with learning about new pain care services, obtaining assistance connecting to services, and receiving support from their counselors. Discussion: It was feasible to deliver SBIRT‐PM to Veterans across New England to promote engagement in multimodal pain treatment and to track study outcomes over 12 weeks. Preliminary results suggest SBIRT‐PM was well‐received and has promise for the targeted outcomes. [ABSTRACT FROM AUTHOR]

Background: Spinal cord stimulation (SCS) is a well‐established treatment for chronic intractable pain of the trunk and/or limbs; however, low back pain (LBP) is difficult to treat using traditional SCS. Differential Target Multiplexed spinal cord stimulation (DTM SCS) is an advanced approach inspired from animal studies demonstrating improved pain‐related behavior and pain‐relevant biological processes. Objective: The purpose of this study was to compare the effectiveness of DTM SCS and traditional SCS in treating chronic LBP and leg pain (LP). Methods: This prospective, postmarket randomized controlled trial compared DTM SCS to traditional SCS in patients with chronic LBP and LP. Primary end point was LBP responder rate (percentage of subjects with ≥ 50% relief) at 3 months. Noninferiority and superiority were assessed. Other outcomes included mean change in back and leg pain, responder rates, disability, global health, satisfaction, and safety profile throughout the 12‐month follow‐up. Results: One hundred twenty‐eight subjects were randomized across 12 centers (67 DTM SCS and 61 traditional SCS). Of the 94 patients implanted, 46 subjects in each group completed the 3‐month assessment. LBP responder rate of 80.1% with DTM SCS was superior to 51.2% with traditional SCS (p = 0.0010). Mean LBP reduction (5.36 cm) with DTM SCS was greater than reduction (3.37 cm) with traditional SCS (p < 0.0001). These results were sustained at 6 months and 12 months. Safety profiles were similar between treatment groups. Conclusion: Superiority of DTM SCS compared with traditional SCS for chronic LBP was demonstrated. Clinical improvements provided by DTM SCS were sustained over 12 months and are expected to significantly impact the management of chronic LBP. [ABSTRACT FROM AUTHOR]

Background: The objective of this prospective, multicenter study is to characterize responses to percutaneous medial branch peripheral nerve stimulation (PNS) to determine if results from earlier, smaller single‐center studies and reports were generalizable when performed at a larger number and wider variety of centers in patients recalcitrant to nonsurgical treatments. Materials & Methods: Participants with chronic axial low back pain (LBP) were implanted with percutaneous PNS leads targeting the lumbar medial branch nerves for up to 60 days, after which the leads were removed. Participants were followed long‐term for 12 months after the 2‐month PNS treatment. Data collection is complete for visits through end of treatment with PNS (primary end point) and 6 months after lead removal (8 months after start of treatment), with some participant follow‐up visits thereafter in progress. Results: Clinically and statistically significant reductions in pain intensity, disability, and pain interference were reported by a majority of participants. Seventy‐three percent of participants were successes for the primary end point, reporting clinically significant (≥30%) reductions in back pain intensity after the 2‐month percutaneous PNS treatment (n = 54/74). Whereas prospective follow‐up is ongoing, among those who had already completed the long‐term follow‐up visits (n = 51), reductions in pain intensity, disability, and pain interference were sustained in a majority of participants through 14 months after the start of treatment. Conclusion: Given the minimally invasive, nondestructive nature of percutaneous PNS and the significant benefits experienced by participants who were recalcitrant to nonsurgical treatments, percutaneous PNS may provide a promising first‐line neurostimulation treatment option for patients with chronic axial back pain. [ABSTRACT FROM AUTHOR]

Background: Spinal cord stimulation is a well‐established modality for the treatment of chronic intractable pain. The safety and efficacy of various stimulation therapy designs have been demonstrated in multiple randomized controlled studies, oftentimes comparing an investigational device to an existing commercial therapy. In the real‐world setting, data are lacking regarding selection of spinal cord stimulation (SCS) therapy, as waveform, pulse trains, and programming are not interchangeable among the devices. The purpose of this study is to help dissect a methodology for a patient centric multisystem trialing. Methods: We conducted a single center, retrospective, open label observational chart review. Between June 2017 and June 2019, 83 patients underwent SCS trials. Devices from four commercially available systems were trialed. Patients were given the opportunity to trial up to three systems. If the patient reported 50% or more pain relief/functional improvement with the trial, they were able to choose which system they liked best and proceed with implantation. Results: There were 82% (68/83) of patients who proceeded to permanent implant, with 72 patients electing to trial more than one stimulation paradigm. Of those, 62 trialed 2 SCS systems, whereas 11 trialed 3. During the SCS trials, loss of efficacy due to lead migration was 1.2% (1/83) and no infections occurred. The average pain score measured on the numeric pain rating scale (NRS), improved from 6.8 at baseline to 2.9 after implantation. Conclusions: Multisystem trialing is safe and effective in providing patients increased exposure to multiple commercially available SCS systems. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain is a major public health concern, as is the associated use of opioid medications, highlighting the importance of alternative treatments, such as spinal cord stimulation (SCS). Here, we present the final 24‐month results of the Avalon study, which investigated the use of the first closed‐loop SCS system in patients with chronic pain. The system measures the evoked compound action potentials (ECAPs) elicited by each stimulus pulse and drives a feedback loop to maintain the ECAP amplitude near constant. Methods: Fifty patients were implanted with the Evoke system (Saluda Medical) and followed over 24‐months. Pain, quality of life (QOL), function, sleep, and medication use were collected at baseline and each scheduled visit. ECAP amplitudes and programming adjustments were also monitored. Results: At 24 months, responder rates (≥ 50% pain reduction) and high responder rates (≥ 80% pain reduction) for overall pain were 89.5% and 68.4%, respectively, the latter up from 42.2% at 3 months. Significant improvements from baseline were observed in QOL, function, and sleep over the 24 months, including ≥ 80% experiencing a minimally important difference in QOL and > 50% experiencing a clinically significant improvement in sleep. At 24 months, 82.8% of patients with baseline opioid use eliminated or reduced their opioid intake. Over the course of the study, reprogramming need fell to an average of less than once a year. Conclusion: Over a 24‐month period, the Evoke closed‐loop SCS maintained its therapeutic efficacy despite a marked reduction in opioid use and steady decrease in the need for reprogramming. [ABSTRACT FROM AUTHOR]

Objective: Providing sustained and effective treatment via the peripheral nervous system for the management of chronic pain is challenging. Application of noninvasive high‐frequency stimulation at or near the painful area may benefit those with chronic pain. This open‐label pilot survey examined the impact of this stimulation on pain intensity, activities of daily living, functional capacity, and medication consumption after 2 weeks of treatment. Methods: Stimulation was administered at home using the summation of two high‐frequency sinusoidal alternating signals at 3858 and 3980 Hz delivered between two electrodes placed directly over one or two locations of pain. Individuals completed a survey after 2 weeks to assess pain, activities of daily living (ADL), pain medication consumption, quality of life (QoL), mood, sleep, functional outcomes, and satisfaction. Results: 463 individuals (372 males; 91 females) retuned the completed survey after 2 weeks of treatment. Pain and ADL scores significantly improved at follow‐up compared with baseline (pain mean difference: 3.05; 95% confidence interval [CI]: 2.86, 3.24; ADL mean difference: 1.82; 95% CI: 1.60, 2.04). Corresponding improvements in QoL, sleep, mood, functional outcomes, and satisfaction were noted. On average, 8.00 ± 11.11 hours of pain relief were reported with 54% experiencing reductions in pain medication consumption. 98% would use the stimulation in the future. Conclusion: Two weeks of noninvasive high‐frequency peripheral nerve fiber stimulation appeared to confer positive effects in individuals with chronic pain. Future research employing a control group/arm is needed to establish the long‐term impact of this bioelectric technique in specific pain cohorts. [ABSTRACT FROM AUTHOR]

Background: Low‐back pain (LBP) is one of the most frequently reported symptoms of patients who visit pain clinics, and a significant proportion of them have discogenic pain. Pulsed radiofrequency (PRF) stimulation is an effective treatment for various types of pain. Purpose: We reviewed articles which investigated the effectiveness of intradiscal PRF for controlling discogenic LBP. Methods and Materials: We searched PubMed for papers published prior to August 7, 2020, in which intradiscal PRF was used for treating discogenic LBP. The key search phrase was (intradiscal PRF) for identifying potentially relevant articles. We included articles in which intradiscal PRF was used for controlling LBP. Review articles were excluded. Results: Nine publications were included in this review. Except for one study, all other studies showed positive therapeutic outcomes after treating discogenic LBP using intradiscal PRF. However, the quality of these studies was not high. Conclusions: This review showed that intradiscal PRF appears to be a helpful treatment method for patients with discogenic LBP. Our review provides insights into the degree of evidence of the therapeutic effects of intradiscal PRF for alleviating discogenic LBP. For confirmation of the effectiveness of intradiscal PRF on discogenic LBP, more high‐quality studies are necessary. We reviewed the literature on the efficacy of pulsed radiofrequency (PRF) for controlling discogenic lower‐back pain (LBP). PRF appears to be a helpful treatment method for patients with discogenic LBP. For confirmation of the effectiveness of intradiscal PRF on discogenic LBP, more high‐quality studies are necessary. [ABSTRACT FROM AUTHOR]

Purpose: Peripheral nerve stimulation (PNS) is a rapidly expanding field within neuromodulation; however, there is limited data on therapeutic efficacy. This study describes the indications and clinical outcomes for patients undergoing PNS for chronic pain states. Patients and Methods: This is a retrospective case series of adults undergoing PNS implantation from 2004 to 2017 at an academic medical center. The primary outcomes were changes in numeric rating scale (NRS) pain scores, opioid utilization in oral morphine milligram equivalent (MME), and self‐reported patient functioning at 6 months postoperatively. Infectious and device‐related complications were also assessed. Results: A total of 72 patients underwent PNS implantation, including 59 patients that received a preceding PNS trial (59/78; 76% progression rate) and 13 that did not receive a PNS trial. The most common indication for stimulation was occipital neuralgia (47%) followed by lower‐extremity neuropathies (17%). PNS implantation was associated with 6‐month reductions in pain scores (7 [6, 8] baseline vs. 4 [2, 5] 6 months; P < 0.001) and opioid utilization (eg, median 60 [31, 104] vs. 18 [0, 52] MME among those with baseline opioid use; P < 0.001). Median functional improvement was 73% (50%, 88%). Seven patients (10%) suffered a postoperative surgical site infection at a median of 50 (30, 124) days, of which five devices were removed. Conclusion: Peripheral nerve stimulation was associated with reduced pain scores, lower opioid utilization, and improved patient function at 6 months. These data support PNS as a potentially effective nonopioid analgesic modality in chronic pain, though prospective multicenter evaluation is warranted to evaluate longer‐term outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on examining the efficacy of dorsal root ganglion (DRG) stimulation in treating chronic pelvic pain (CPP). Topics discussed include the inclusion of studies with a total of 65 patients in the review, consistent results demonstrating significant pain improvement and reduction in pain medications among patients, and the recommendation for higher quality studies to validate these findings.

Background: Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group‐based interventions has yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) plus motor control exercise (MCE) with group‐based exercise (GE) in patients with CLBP. Methods: Seventy‐three patients with CLBP were randomly assigned into the PNE plus MCE group (n = 37) and GE group (n = 36). Both PNE plus MCE and GE were administered twice weekly for 8 weeks. Pain intensity (as measured using the VAS), disability (as measured using the Roland‐Morris Disability Questionnaire), fear‐avoidance beliefs (as measured using the Fear‐Avoidance Beliefs Questionnaire), and self‐efficacy (as measured using the Pain Self‐Efficacy Questionnaire) were assessed at baseline and 8 weeks post‐intervention. A 2 × 2 variance analysis (treatment group × time) with a mixed‐model design was applied to statistically analyze the data. Results: Both groups showed significant improvements in all the outcome measures, with a large effect size (P < 0.001, partial eta squared [ηp2] = 0.66 to 0.81) after the intervention. The PNE plus MCE group showed greater improvements, with a moderate effect size in pain intensity (P = 0.041, ηp2 = 0.06) and disability (P = 0.021, ηp2 = 0.07) compared to the GE group. No significant difference was found in fear‐avoidance beliefs during physical activity and work, and self‐efficacy (P > 0.05) between the 2 groups. Conclusion: PNE and MCE seem to be better at reducing pain intensity and disability compared to GE, while no significant differences were observed for fear‐avoidance beliefs and self‐efficacy between the 2 groups in patients with CLBP. With regard to the superiority of individualized interventions over group‐based ones, more studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Chronic pain, the leading cause of disability in the world, imposes limitations on activities of daily living and diminishes quality of life leading to unnecessary patient suffering. The personal and socioeconomic costs of chronic pain cannot be overstated. Physicians are at the crux of the pandemic and must attempt to limit the spread of the virus while maintaining their professional responsibility to their patients and staff members. Objective: The aim of this review is to analyze the existing literature to develop consensus recommendations for treating pain during the current COVID‐19 pandemic. Methods: Relevant literature was located via computer‐generated citations between the months of March and May of 2020. Online computer searches of multiple databases including Google Scholar, CINAHL, PubMed, and Cochrane Review were conducted in conjunction with a thorough review of local, state, national, and international governmental and organizational websites to locate research on the area of interest. Results: The guidelines in this review are meant to offer a framework to pain practitioners and organizations for providing highly effective, ethical, and safe care to patients while maintaining their commitment to mitigating the spread of the COVID‐19 pandemic. Specific areas addressed include general and interventional‐specific treatment and mitigation recommendations. Conclusions: We believe that the recommendations in this review, if used in conjunction with evolving recommendations of Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and federal, state, and local governing bodies, provides a path to not only mitigate the spread of the pandemic but also limit the adverse impact of pain and suffering in chronic pain patients. [ABSTRACT FROM AUTHOR]

Objectives: Spinal cord stimulation (SCS) therapies are used in the management of patients with complex regional pain syndrome I (CRPS I) and failed back surgery syndrome (FBSS). The purpose of this study was to investigate the racial and health insurance inequalities with SCS therapy in patients with chronic pain who had CRPS I and FBSS. Methods: Patients with chronic pain who had a discharge diagnosis of FBSS and CRPS I were identified using the National Inpatient Sample database. Our primary outcome was defined as the history of SCS utilization by race/ethnicity, income quartile, and insurance status. Multivariable logistic regression was used to determine the variables associated with utilization of SCS therapy. Results: Between 2011 and 2015, 40,858 patients who were hospitalized with a primary diagnosis of FBSS and/or CRPS I were identified. Of these patients, 1,082 (2.7%) had a history of SCS therapy. Multivariable regression analysis revealed that compared to White patients, Black and Hispanic patients had higher odds of having SCS therapy (Black patients: odds ratio [OR] = 1.41; 95% confidence interval [CI], 1.12 to 1.77; P = 0.003; Hispanic patients: OR = 1.41; 95% CI, 1.10 to 1.81; P = 0.007). Patients with private insurance had significantly higher odds of having SCS therapy compared with those with Medicare (OR = 1.24; 95% CI, 1.08 to 1.43; P = 0.003). Compared to patients with Medicare, Medicaid patients had lower odds of having SCS therapy (OR = 0.50; 95% CI, 0.36 to 0.70; P < 0.001). Conclusions: Our study suggests that socioeconomic disparities may exist in the utilization of SCS among hospitalized patients with CRPS I and FBSS the United States. However, confirming these data from other administrative databases, in the outpatient setting, may shed more insight. [ABSTRACT FROM AUTHOR]

Background: Chronic pelvic pain (CPP) is a debilitating condition that often leads to disability and does not respond to conventional treatments. This study was conducted to evaluate the effects of paresthesia‐independent 10‐kHz spinal cord stimulation (SCS) in subjects with CPP. Methods: This prospective, single‐arm pilot study enrolled subjects with clinical diagnoses of CPP and mean pain scores of ≥ 5.0 cm on a 10‐cm VAS. Subjects underwent trial stimulations with 10‐kHz SCS, and those who had successful trial stimulations (≥40% pain relief) received permanently implanted devices and were followed for 12 months. Results: Of the 21 subjects who underwent the 10‐kHz SCS trial, 17 were successful and 14 subjects received permanent implants. No neurological deficits were observed in any subjects and all adverse events (AEs) were resolved without sequelae during the study period. Over 12 months, mean VAS scores decreased by 72% from baseline, and 10 of 13 subjects (77%) were responders (≥50% pain relief). Pain remission (VAS score ≤ 3.0 cm) was reported by 8 of 13 subjects (62%), and mean pain scores on the short‐form McGill Pain Questionnaire 2 decreased as well. Pain Disability Index scores declined by 29 points, and 85% of the subjects reported satisfaction. Conclusions: Paresthesia‐independent stimulation with 10‐kHz SCS reduced pelvic pain in subjects with CPP and was not associated with any unexpected AEs. While larger, controlled studies are needed, results of this study suggest that this therapeutic modality could potentially treat patients with CPP while improving their quality of life. [ABSTRACT FROM AUTHOR]