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Marcin Karcz,1 Alaa Abd-Elsayed,2 Krishnan Chakravarthy,3 Aman Mansoor,4 Natalie Strand,5 Mark N Malinowski,6 Usman Latif,7 David Dickerson,8 Tolga Suvar,9 Timothy Lubenow,9 Evan Peskin,10 Ryan D’Souza,5 Eric Cornidez,11 Andrew Dudas,12 Christopher Lam,7 Michael Farrell II,13 Geum Yeon Sim,14 Mohamad Sebai,15 Rosa Garcia,16 Lucas Bracero,1 Yussr Ibrahim,17 Syed Jafar Mahmood,18 Marco Lawandy,19 Daniel Jimenez,20 Leili Shahgholi,15 Kamil Sochacki,21 Mohamed Ehab Ramadan,15 Vinny Francio,22 Dawood Syed,7 Timothy Deer1 1The Spine and Nerve Centers of the Virginias, Charleston, WV, USA; 2Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; 3Innovative Pain Treatment Solutions, San Diego, CA, USA; 4Aurora Pain Management, Aurora Health Care, Oshkosh, WI, USA; 5Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA; 6Department of Anesthesiology, Ohio Health System, Columbus, OH, USA; 7Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA; 8Department of Pain Medicine, Northshore University Health System, Skokie, IL, USA; 9Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Oak Park, IL, USA; 10Department of Pain Management, Insight Institute of Neurosurgery & Neuroscience, Flint, MI, USA; 11Pain Institute of Southern Arizona, Tucson, AZ, USA; 12Mays and Schnapp Neurospine and Pain, Memphis, TN, USA; 13Department of Pain Management, Erie County Medical Center, Buffalo, NY, USA; 14Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA; 15Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 16Department of Physical Medicine & Rehabilitation, Larkin Hospital Health System, Miami, FL, USA; 17Department of Pain Management at Northern Light Health – Eastern Maine Medical Center, Bangor, ME, USA; 18Department of Pain Medicine, University of California Davis Health System, Sacramento, CA, USA; 19Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, Bronx, NY, USA; 20Department of Physical Medicine & Rehabilitation, Michigan State University, Lansing, MI, USA; 21Department of Anesthesiology and Perioperative Medicine, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA; 22Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USACorrespondence: Marcin Karcz, The Spine and Nerve Centers of the Virginias, Charleston, WV, USA, Email drmarcinkarcz@gmail.comAbstract: Pain serves as a vital innate defense mechanism that can significantly impact an individual’s quality of life. Understanding the physiological effects of pain well plays an important role in developing novel pain treatments. Nociceptor neurons play a key role in pain and inflammation. Interactions between nociceptors and the immune system occur both at the site of injury and within the central nervous system. Modulating chemical mediators and nociceptor activity offers promising new approaches to pain management. Essentially, the sensory nervous system is essential for modulating the body’s protective response, making it critical to understand these interactions to discover new pain treatment strategies. New innovations in neuromodulation have led to alternatives to opioids individuals with chronic pain with consequent improvement in disease-based treatment and nerve targeting. New neural targets from cellular and structural perspectives have revolutionized the field of neuromodulation. This narrative review aims to elucidate the mechanisms of pain transmission and processing, examine the characteristics and properties of nociceptors, and explore how the immune system influences pain perception. It further provides an updated overview of the physiology of pain and neuromodulatory mechanisms essential for managing acute and chronic pain. We assess the current understanding of different pain types, focusing on key molecules involved in each type and their physiological effects. Additionally, we compare painful and painless neuropathies and discuss the neuroimmune interactions involved in pain manifestation.Keywords: neurons, nociceptive pain, neuropathic pain, nociplastic pain, physiological effects, pain pathways, sensitization

Anthony Giuffrida,1 Christy Saia-Owenby,2 Chris Andriano,3,* Douglas Beall,4,* Ashley Bailey-Classen,5,* Patrick Buchanan,6,* Ryan Budwany,7,* Mehul J Desai,8,* Ashley Comer,9,* Andrew Dudas,10,* Vinicius Tieppo Francio,11,* Warren Grace,12,* Benjamin Gill,13,* Betsy Grunch,14,* Andrew Goldblum,13,* Rosa A Garcia,15,* David W Lee,16,* Chad Lavender,17,* Marco Lawandy,18,* Lyric Mandell,2,* Robin Mata,19,* Morteza Rabii,20,* Kiran Patel,21,* Raj G Patel,22,* Ankur A Patel,23,* Dawood Sayed,24,* Gurtej Singh,25,* Natalie Strand,26,* Jordan Tate,27,* Michael E Schatman,28 Timothy Deer29 1Cantor Spine Center, Paley Orthopedic and Spine Institute, Fort Lauderdale, FL, USA; 2MOXY Company, Covington, LA, USA; 3Georgia Pain Care, Stockbridge, GA, USA; 4Oklahoma Spine Hospital, Oklahoma City, OK, USA; 5Trinity Pain Medicine Associates, Fort Worth, TX, USA; 6Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA; 7Center for Pain Relief, Charleston Area Medical Center, Charleston, WV, USA; 8International Spine, Pain, and Performance Center, Washington, DC, USA; 9The Spine and Nerve Centers of the Virginias, Charleston, WV, USA; 10Maya & Schnapp, Neurospine and Pain, Memphis, TN, USA; 11Anesthesiology and Pain Medicine, University of Kansas, Kansas City, KS, USA; 12Redefine Healthcare, Orthopedic Pain and Spine Center, Edison, NJ, USA; 13Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA; 14Longstreet Clinic, Gainesville, GA, USA; 15Larkin Hospital Health Systems, Miami, FL, USA; 16Interventional Pain and Spine, Fullerton Orthopedics, Yorba Linda, CA, USA; 17Department of Orthopaedics, Marshall University, Huntington, WV, USA; 18Physical Medicine and Rehabilitation, Montefiore Medical Center, New York, NY, USA; 19Department of Physical Medicine and Rehabilitation, University of Miami, Miami, FL, USA; 20Crimson Pain Management, Overland Park, KS, USA; 21Pain Medicine and Anesthesiology, Northwell Health, New York, NY, USA; 22Central Texas Interventional Pain Doctor, Capitol Pain Institute, Austin, TX, USA; 23Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA; 24Department of Pain Medicine and Neurology, University of Kansas Health System, Kansas City, KS, USA; 25Department of Pain Medicine, Rehabilitation, and Pain Medicine, the Center for Advance Orthopaedics, Cantonsville, MD, USA; 26Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA; 27Department of Pain Medicine and Physical Medicine and Rehabilitation, Southern Pain and Spine, Jasper, GA, USA; 28Department of Anesthesiology, Perioperative Care, and Pain Medicine at NYU Grossman School of Medicine, New York, NY, USA; 29Department of Pain Management, Spine and Nerve Centers of the Virginias, Charleston, WV, USA*These authors contributed equally to this workCorrespondence: Lyric Mandell, MOXY Company, Covington, LA, USA, Email lyric@moxycompany.comPurpose: The American Society of Pain and Neuroscience (ASPN) identified a significant gap in resources and guidelines that aim to educate healthcare providers for best practices when engaging on social media. As part of the broader initiatives on Spine and Nerve practice, the executive board of ASPN has decided it would be beneficial to include comprehensive guidance for healthcare providers when engaging on social media.Methods: A panel of experts was chosen based on expertise, publications, diversity, and their social media presence. Along with expert guidance, the committee conducted an extensive analysis of peer-reviewed literature in communication and medical journals to determine best practices for healthcare practitioners on social media.Results: Social media messages significantly impact patients’ and colleagues’ perceptions and actions regarding medical issues. As such, providers and their teams must be aware of legal and ethical considerations in healthcare while maintaining a consistent, educational, and digestible persona online.Conclusion: The advancement of communication and medical technologies and systems necessitates continued education and resources to adapt to our rapidly changing media and medical landscape.Keywords: digital communication, social networking sites, healthcare providers, best practices, physician communication, social media, medical marketing, spine