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Matthew Slitzky,1 R Jason Yong,2 Giuliano Lo Bianco,3 Trent Emerick,4 Michael E Schatman,5,6 Christopher L Robinson2 1Burke Rehabilitation, Montefiore Health System, White Plains, NY, USA; 2Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA; 3Anesthesiology and Pain Department, Fondazione Istituto G. Giglio Cefalù, Palermo, Italy; 4Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 5Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 6Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Christopher L Robinson, Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street Boston, Boston, MA, 02118, USA, Email crobinson48@bwh.harvard.edu

Matthew Slitzky,1 R Jason Yong,2 Giuliano Lo Bianco,3 Trent Emerick,4 Michael E Schatman,5,6 Christopher L Robinson2 1Burke Rehabilitation, Montefiore Health System, White Plains, NY, USA; 2Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA; 3Anesthesiology and Pain Department, Fondazione Istituto G. Giglio Cefalù, Palermo, Italy; 4Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 5Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 6Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Christopher L Robinson, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02118, USA, Email crobinson48@bwh.harvard.edu

Giuliano Lo Bianco,1 Sean Li,2 Miles Day,3 Michael E Schatman4,5 1Anesthesiology and Pain Department, Fondazione Istituto ”G. Giglio”, Cefalù, Palermo, Italy; 2National Spine and Pain Centers, Shrewsbury, NJ, USA; 3Pain Research, The Pain Center at Grace Clinic, Department of Anesthesiology, Texas Tech University HSC, Lubbock, TX, USA; 4Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 5Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Michael E Schatman, Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA, Tel +1 425-647-4880, Email Michael.Schatman@NYULangone.org

Giuliano Lo Bianco,1 Michael E Schatman2,3 1Anesthesiology and Pain Department, Fondazione Istituto “G. Giglio”, Cefalù, Palermo, Italy; 2Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 3Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Michael E Schatman, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA, Tel +1 425-647-4880, Email Michael.Schatman@NYULangone.org

Giuliano Lo Bianco,1,2 Andrea Tinnirello,3 Alfonso Papa,4 Vito Torrano,5 Gianluca Russo,6 Agnes Stogicza,7 Sebastiano Mercadante,8 Andrea Cortegiani,9 Silvia Mazzoleni,3 Michael E Schatman10,11 1Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; 2Department of Anesthesiology and Pain, Fondazione Istituto G. Giglio, Cefalù, Italy; 3Department of Anesthesiology and Pain Medicine, ASST Franciacorta, Ospedale di Iseo, Iseo, Italy; 4Department of Pain Management– AO “Ospedali dei Colli” – Monaldi Hospital, Naples, Italy; 5Department of Anesthesia, Critical Care and Pain Medicine, Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy; 6Department of Anesthesia, Postoperative Intensive Care and Pain Therapy, Lodi Hospital, Lodi, Italy; 7Department of Anesthesiology Saint Magdolna Hospital, Budapest, Hungary; 8Department of Pain Relief and Supportive Care, Private Hospital La Maddalena, Palermo, Sicilia, Italy; 9Department of Anesthesiology and Intensive Care, Università degli Studi di Palermo, Palermo, Italy; 10Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA; 11Department of Population Health – Division of Medical Ethics, NYU School of Medicine, New York, NY, USACorrespondence: Andrea Tinnirello, Department of Anesthesiology and Pain Medicine, ASST Franciacorta, Ospedale di Iseo, Via Giardini Garibaldi 4, Iseo, 25049, Italy, Tel +393392599568, Email andreatinny@libero.itAbstract: In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic- or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.Keywords: chronic pain, pain management, analgesics, opioid, epidural injection, facet joints

Giuliano Lo Bianco,1,2 Giovanni Misseri,2 Agnes R Stogicza,3 Gregoretti Cesare,2,4 Sean Li,5 Miles Day,6 David J Kennedy,7 Michael E Schatman8,9 1Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; 2Anesthesiology and Pain Department, Fondazione Istituto “G. Giglio”, Cefalù, Palermo, Italy; 3Anesthesia and Pain, Saint Magdolna Private Hospital, Budapest, Hungary; 4Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy; 5National Spine and Pain Centers, Shrewsbury, NJ, USA; 6Pain Research, The Pain Center at Grace Clinic, Texas Tech University HSC, Lubbock, TX, USA; 7Department of PM&R, Vanderbilt University Medical Center, Nashville, TN, USA; 8Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 9Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Giuliano Lo Bianco, Anesthesia and Pain Medicine Department, Fondazione Giglio Cefalù, Contrada Pietrapollastra, Via Pisciotto, Cefalù, Palermo, 90015, Italy, Tel +393289682219, Email giulianolobianco@gmail.comBackground: Lumbar zygapophyseal joint dysfunction represents one of the major sources of chronic low back pain. Radiofrequency ablation (RFA) using a V-shaped active tip needle may offer a larger lesion of the medial branch nerves, improving clinical outcome. The aim of our study is to evaluate the efficacy and the feasibility of RFA using V-shaped active tip needles.Methods: This is a single-center observational retrospective study. Clinical records were screened and analyzed if they met the following inclusion criteria: adult patients (> 18 years), diagnosis of chronic lumbar zygapophyseal joint pain, failure of conservative treatments, ability to provide informed consent for data analysis and publication. Exclusion criteria: lumbar pain not related to zygapophyseal joints, previous spinal/lumbar surgery, incomplete data, absence or withdrawal of informed consent. The primary outcome of the study was a change in pain intensity at follow-up. The secondary outcomes were the evaluation of quality-of-life improvement, the occurrence of adverse events and the impact on post-procedural analgesic consumption. For these purposes, pre- and post-treatment numeric rating scale (NRS), neuropathic pain 4 questions (DN4), EuroQoL - EQ-5D-3L, EQ-VAS, EQ-index and North American Spine Society (NASS) index were retrieved and analysed.Results: Sixty-four patients were included. 7.8% of patients at 1-month (CI95% 0.026, 0.173), 37.5% at 3-month (CI95% 0.257, 0.505), 40.6% at 6-month (CI95% 0.285, 0.536) and 35.9% at 9-month (CI95% 0.243, 0.489) follow-up reported a reduction of more than 80% in NRS Statistical analysis indicated a significant change in NRS, DN4, EQ-index and EQ-5D-VAS (p-value < 0.001) at the different time-points.Conclusion: RFA using a V-shaped active tip needle might be a feasible and effective treatment for chronic lumbar zygapophyseal joint pain.Keywords: arthralgia, chronic pain, zygapophyseal joint, pain management, radiofrequency ablation, neuromodulation, lumbar facet joint

Giuliano Lo Bianco,1,2 Andrea Tinnirello,3 Alfonso Papa,4 Maurizio Marchesini,5 Miles Day,6 Gaetano Joseph Palumbo,7 Gaetano Terranova,8 Maria Teresa Di Dato,4 Simon J Thomson,9 Michael E Schatman10,11 1Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; 2Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy; 3Anesthesiology and Pain Medicine Department, ASST Franciacorta, Ospedale di Iseo, Iseo, 25049, Italy; 4Pain Department, AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy; 5Mininvasive Surgery Department, Unit of Pain Medicine IRCCS Maugeri Pavia, Pavia, 27100, Italy; 6Pain Research, The Pain Center at Grace Clinic, Texas Tech University HSC, Lubbock, TX, USA; 7Azienda Ospedale - Università Padova, Department of Anesthesia and Intensive Care, Padova, Italy; 8Anaesthesia and Intensive Care Department, Asst Gaetano Pini, Milano, Italy; 9Pain Management, Mid and South Essex University Hospitals NHSFT, Basildon, SS16 5NL, UK; 10Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA; 11Department of Population Health – Division of Medical Ethics, NYU School of Medicine, New York, NY, USACorrespondence: Giuliano Lo Bianco, Email giulianolobianco@gmail.comAbstract: In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasound-guided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.Keywords: chronic pain, pain management procedures, complications, spinal cord stimulation, intrathecal drug delivery, low back pain

Objetivos: Relatar a experiência da implementação da grade de onco-hematologia em uma liga de oncologia. Relato de experiência: Ligas acadêmicas são de extrema relevância aos estudantes de medicina, pois por meio dela amplia-se a visão de assuntos, como também proporciona um maior contato com a realidade da área através das práticas. Sendo assim, para o funcionamento ideal de todos os pilares dentre da liga, faz-se necessário a organização de um cronograma da gestão anual por meio dos diretores desta. Dessa forma, a Liga Acadêmica de Oncologia do Pará (LAOPA) na gestão de Setembro de 2021 a Outubro de 2022, desempenhou diversas atividades, mas de inovador houve a implementação de uma grade de onco-hematologia, não tão visualizada anteriormente. Com isso, a primeira aula inaugural da liga, para recepção dos novos ligantes contou com uma aula sobre “panorama geral da onco-hematologia”, ministrada por uma hematologista. Além disso, posteriormente ministrou-se uma aula sobre mieloma múltiplo. Concomitantemente ocorria estágios extracurriculares voluntários na especialidade de onco-hematologia em uma clínica, visualizando a rotina dos hematologistas, as doenças mais comuns e seus principais tratamentos. Além do mais, aulas sobre doação de sangue foi ministrada, e campanhas internas para doação de sangue foram iniciadas, estimulando os participantes da liga a se tornarem doadores. Ademais, na finalização da gestão, realizou-se um congresso aberto para os interessados de fora da liga, onde se abordaria temáticas importantes, e 2 das 5 palestras eram sobre Leucemias e outra sobre linfomas. Diante do exposto, deu-se uma atenção redobrada a área, jamais abordada amplamente em gestões passadas. Discussão: Entende-se que o papel das ligas acadêmicas são de suma importância para o maior contato com áreas não tão observadas durante a faculdade de medicina, sendo assim, a implementação de uma grade/módulo de onco-hematologia proporcionou o aprendizado continuo com essa especialidade nova para os ligantes que nunca tinham tido contato. Por isso, a diretoria selecionou temas mais que necessários para serem abordados além da busca pelo estágio na área, proporcionando experiências únicas e construtivas na área. Conclusão: Diante do exposto, observa-se apenas vantagens positividades da participação em ligas acadêmicas e da implementação de uma grade de onco-hematologia nela, pois assim, a temática passa a se tornar foco de palestras, estágios e ações de extensão. Muitos avanços foram obtidos na gestão de 2021 a 2022 na LAOPA, e um deles foi o feedback positivo por parte dos ligantes ao conhecerem temáticas jamais estudadas e vistas anteriormente. A experiência só foi obtida por meio do comprometimento dos diretores e presidentes da liga em organizarem um calendário para as atividades além de colocarem em prática suas idealizações envolvendo a especialidade citada.

Objetivos: Descrever o intuito e a experiência de organizar o I Simpósio de Onco-hematologia que ocorreu de forma online. Relato da experiência: O evento de cunho acadêmico foi idealizado pelos diretores da Liga Acadêmica de Oncologia do Pará (LAOPA) ao perceberem que havia uma precariedade de debate sobre a temática nas faculdades de medicina. Buscou-se assim parceria com a Liga Acadêmica de Hematologia (LAHEPA), a qual se interessou pelo propósito de difundir os conhecimentos sobre os assuntos da onco-hematologia. Sendo assim, selecionou-se temáticas importantes e profissionais competentes na área, divulgando o evento nas redes sociais das ligas. Como obtiveram uma grande demanda de inscrição, totalizando em 300 acadêmicos de medicina e de outras áreas do Brasil, optou-se por fazer o evento de forma online, em 2 dias, em live remota do Youtube, para assim sanar as dúvidas eprorcionar maior interação entre os médicos e os interessados pelos assuntos. O primeiro dia de evento contou com aula sobre linfoma de hodgkin e mieloma múltiplo. Já o segundo dia contou com aula sobre linfoma não Hodgkin e hemoterapia dos pacientes oncológicos. Nos momentos finais, pós palestras, as médicas hematologistas se disponibilizaram de sanar as dúvidas postadas no chat do Youtube. Houve bastante interação e interesse por parte dos acadêmicos, além da disposição das médicas de respondê-los. Dessa forma, o evento proporcionou boa interação entre acadêmicos e médicos, além de um amplo debate de uma temática não explorada nas faculdades, gerando assim interesse nos participantes. Discussão: Sabe-se que os aprendizados são obtidos por meio do aprofundamento dos assuntos e visualização deles na prática, seja na medicina ou em outra área da saúde. Porém a Onco-hematologia não faz parte da grade curricular da maioria das faculdades de medicina, fazendo com que muitos estudantes desconheçam pontos importantes sobre o diagnóstico das doenças onco-hematológicas. Com isso, as ligas acadêmicas tem por objetivo de aproximar os acadêmicos de tais especialidades e promover maior visualização do cenário. Sendo assim, foi promovido esse evento, o qual unia a especialidade de ambas as ligas, aproximando não só os ligantes da temática, como também alunos do Brasil inteiro que demonstraram interesse pelo assunto. Conclusão: Diante disso, é de suma importância os conhecimentos de onco-hematologia para os futuros profissionais médicos e não médicos, tornando de fundamental importância maiores debates sobre a temática, já que nas faculdades médicas o assunto não é explorado. A partir disso as ligas surgem e tem por objetivo promover um contato maior dos participantes com a temática. E assim foi feito com a parceria da Liga Acadêmica de Oncologia do Pará (LAOPA) com a Liga Acadêmica de Hematologia (LAHEPA), as quais promoveram a I Jornada de Onco-hematologia, que teve grande número de inscrições, além de elogios pela temática explorada. Conclui-se assim a importância do debate acerca das patologias onco-hematológica para a boa formação dos futuros profissionais que exercerão não somente a medicina.

Alfonso Papa,1 Maria Teresa Di Dato,1 Giuliano Lo Bianco,1– 3 Giuseppe Gazzerro,1 Anna Maria Salzano,1 Emilio Di Costanzo,1 Dario Tammaro,1 Michael E Schatman,4,5 Giustino Varrassi6 1Pain Department AO “Ospedali dei Colli”, Monaldi Hospital, Naples, Italy; 2Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Catania, Italy; 3Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy; 4Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA; 5School of Social Work, North Carolina State University, Raleigh, NC, USA; 6Paolo Procacci Foundation, Rome, ItalyCorrespondence: Giuliano Lo Bianco Tel +393289682219Email giulianolobianco@gmail.comObjective: Osteoarthritis (OA) is the most common cause of chronic knee pain, often a debilitating condition that can cause a significant reduction in functional capacity. Radiofrequency is a form of neuromodulation that modulates pain signal transmission and has become progressively more common as a treatment for knee pain. This retrospective study aims to evaluate the efficacy of intraarticular radiofrequency in patients with chronic knee OA pain.Materials and Methods: In this retrospective study, we included 129 patients undergoing intraarticular pulsed radiofrequency using the Poisson curve for energy distribution (Sluijter-Teixeira Poisson radiofrequency) (STP) from March 2018 to November 2019. Knee osteoarthritis severity was assessed prior to the procedure using the Lequesne Index, classifying patients into six groups based on level of severity. Pain intensity was assessed through a 10-cm visual analog scale (VAS), and level of patient satisfaction was assessed through a questionnaire.Results: In the sample, pain reduction as measured by VAS compared to baseline prior to the procedure was statistically significant immediately following the procedure, at 30 days and at 90 days (p< 0.001); this difference was less significant at 180 days (p< 0.005). Efficacy in patients with moderate to severe disability was considerably greater than in patients with very severe to extremely severe disability. 57.36% reported that they were very satisfied, 29.46% satisfied, 9.3% neither satisfied nor dissatisfied, 2.33% dissatisfied, and 1.55% very dissatisfied.Conclusion: Our results suggest that STP radiofrequency may be a safe and effective procedure for knee OA, able to signi&filig;cantly reduce VAS scores at 1 month and 3 months compared to baseline. Based on our results, a key factor to consider when treating knee OA with STP radiofrequency is that it is more effective among patients with a lower level of disability. Due to the retrospective observational study design, prospective longitudinal investigation is required to further support the recommendation of STP radiofrequency for knee OA.Keywords: pulsed radiofrequency treatment, knee joint, osteoarthritis, knee, chronic pain

Matteo Luigi Giuseppe Leoni,1 Michael E Schatman,2,3 Laura Demartini,4 Giuliano Lo Bianco,5– 7 Gaetano Terranova8 1Unit of Interventional Pain Management, Guglielmo da Saliceto Hospital, Piacenza, Italy; 2Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 3Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 4Pain Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy; 5Basildon and Thurrock University Hospital, Essex, London, Orsett Hospital, Pain Management and Neuromodulation, London, Essex, UK; 6IRCCS Centro Regionale Oncologico Basilicata, Rionero in Vulture, Italy; 7Department of Biomedical and Biotechnological Sciences (Biometec), Università di Catania, Catania, Italy; 8Anaesthesia and Intensive Care Department, Asst Gaetano Pini, Milano, ItalyCorrespondence: Matteo Luigi Giuseppe LeoniUnit of Interventional Pain Management, G. da Saliceto Hospital, via Taverna 49, 29121, Piacenza, ItalyEmail matteolg.leoni@gmail.comBackground: Chronic knee osteoarthritic (OA) pain is a common and debilitating complaint in elderly patients. Despite numerous pharmaceutical options, the majority of patients still experience long-term pain. Genicular nerve (GN) radiofrequency has become increasingly popular as a treatment for knee pain. This retrospective study aimed to evaluate the effects of pulse dose radiofrequency (PDRF) in patients with chronic knee OA pain.Patients and Methods: Propensity score matching analysis was performed in a retrospective cohort of 78 patients with moderate-severe knee OA pain unresponsive to conservative treatment who underwent PDRF GN or intra-articular (IA) and PDRF GN. Pain relief was measured using the numeric rating scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient Global Impression of Change (PGIC) at 3 and 6 months post-intervention.Results: A significant reduction in NRS scores was reported at 3 (p< 0.001) and 6 months (p< 0.001) after PDRF in both groups. NRS was lower in PDRF IA + GN than PDRF GN (p< 0.0001). WOMAC pain was significantly reduced at 3 months in PDRF IA + GN group (baseline: 10.12± 3.14, 3 months: 6.25± 2.44, p=0.0001). WOMAC stiffness and function were improved only at 3 months in PDRF IA + GN compared to baseline (p=0.007 and p=0.006, respectively). A longer period of pain relief was reported after PDRF IA + GN (6.75± 2.42 months) compared to PDRF GN (4.31± 2.85 months, p< 0.001) in association with higher PGIC scores.Conclusion: This is the first study that compared two different PDRF techniques. PDRF GN and PDRF IA + GN were both effective in reducing pain at 3 and 6 months follow-up. However, only PDRF IA + GN was able to improve WOMAC scores at 3 months after the treatment with a longer period of efficacy compared to PDRF GN alone.Keywords: knee pain, pulse dose radiofrequency; PDRF, radiofrequency; genicular nerve, osteoarthritis, chronic pain, WOMAC, interventional pain management

Giuliano Lo Bianco, 1–3 Simon Thomson, 3 Simone Vigneri, 4 Hannah Shapiro, 5 Michael E Schatman 6, 7 1Università di Catania, Dipartimento di Scienze Biomediche e Biotecnologiche (BIOMETEC), Catania, Italy; 2I.R.C.C.S. CROB Centro di Riferimento Oncologico Basilicata, Rionero in Vulture, Potenza, Italy; 3Basildon and Thurrock University Hospitals NHSFT, Orsett Hospital, Pain Management and Neuromodulation, London, Essex, UK; 4Pain Medicine Department, Santa Maria Maddalena Hospital, Occhiobello, Rovigo, Italy; 5Department of Biopsychology, Tufts University, Medford, MA, USA; 6Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 7Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USACorrespondence: Michael E Schatman Tel +1425647-4880Email Michael.Schatman@tufts.edu Abdominal pain is a nonspecific symptom which can be caused by myriad pathologies, resulting in frequent misdiagnosis. 1 Some pathological conditions can cause paroxysmal gastrointestinal symptoms, such as porphyria, cyclical vomiting, intestinal malrotation, peritoneal bands, and abdominal migraine. 2 Furthermore, emotional and psychological factors may also play an important role in the presentation of certain patients with gastrointestinal disorders, and accurate diagnosis can be confounded by these. An accurate diagnosis may be delayed or even abandoned due to the attribution of “functional” or “psychogenic” causality. 3 Physicians in numerous fields of practice too often respond in such a fashion when the more common causes of pain conditions are ruled out, 4 which potentially puts patients with rare pain disorders that are challenging to diagnose at considerable risk for needless, prolonged suffering. Further, the stigma associated with being diagnosed with a Somatoform Disorder or a Medically Unexplained Symptom (MUS) should not be understated. 5

Marco Ceresoli,1,2 Giulia Lo Bianco,1,2 Luca Gianotti,1,2 Luca Nespoli1,2 1Department of General Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; 2School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy Abstract: The pathogenesis of diverticular disease and acute diverticulitis is still unclear and many different hypotheses have been formulated. Seemingly, there are several related factors such as chronic inflammation, gut microbiome, obesity and the immunogenic properties of fat tissue and diet. Inflammation plays a pivotal role in diverticular disease and acute diverticulitis. The aim of the present review is to investigate the role of inflammation in diverticular disease as well as in mild and complicated acute diverticulitis with a focus on current research and treatment perspectives. Keywords: acute diverticulitis, inflammation, diverticular disease.