A Review of Pathophysiology, Molecular Mechanisms, and Omics Approaches of Spinal Cord Injury.

Spinal cord injuries are often devastating and result in severe functional limitations. Our review breaks down the pathophysiology, molecular mechanisms, and omics approaches regarding spinal cord injuries. The pathophysiology can be divided into two main phases, with the secondary phase being of greater interest.

Evaluation of Landmark-Based and Fluoroscopic-Guided Sacroiliac Joint Injections-A Pilot Series.

Background: Sacroiliac joint (SIJ) dysfunction is a frequently underdiagnosed contributor to chronic low back pain. Although fluoroscopic-guided SIJ injections remain the gold standard for both diagnostic and therapeutic purposes, their availability may be limited by insurance barriers or logistical constraints. In such cases, alternative approaches such as ultrasound-guided or landmark-based injections may offer practical, rapid solutions in outpatient settings.

60-Day Peripheral Nerve Stimulation in Chronic Knee Pain: A Retrospective Analysis.

Introduction: Chronic knee pain has seen a significant rise over the past two decades, leading to increased functional limitations, mobility challenges, and decreased quality of life. Peripheral nerve stimulation (PNS) is an alternative management approach for chronic knee pain across various conditions. PNS involves implanting an electrode near a targeted nerve to deliver electrical stimulation, which interrupts pain signals, providing pain relief.

Evaluating Bilateral Symptom Relief Following Parasagittal Interlaminar Epidural Steroid Injections.

Introduction: Interlaminar epidural steroid injections (ILESIs) using a parasagittal approach are frequently employed to manage lumbar radicular pain. The degree of contralateral symptom relief achieved with parasagittal ILESIs remains underexplored. This study aims to evaluate the short-term effectiveness of parasagittal ILESIs in providing ipsilateral and contralateral symptom relief in patients with bilateral lumbar radiculopathy and unilateral contrast spread.

Stellate Ganglion Block for Management of Nicolau's Syndrome Following Intravenous Ibuprofen Injection: a Case Report and Literature Review.

Purpose Of The Review: Nicolau's syndrome (NS) is a rare but serious drug reaction that occurs after administration of many drugs through various routes, with a broad spectrum of manifestations ranging from severe pain up to skin necrosis. In this review, we reported a case of advanced-grade NS following intravenous injection of ibuprofen. Moreover, we reviewed the existing knowledge and current practice to present in-depth any possible pathogeneses involved in this condition and highlight the specific pharmacological properties of the offending drugs that may play a role in the development of this syndrome.

Methadone Prescribing Patterns at a Single Institution: A Retrospective Study and Clinical Implications.

Background: Methadone is a long-acting opioid utilized in the management of chronic pain and opioid dependency. Given its unique pharmacokinetics and potential for both therapeutic benefit and risk, understanding prescribing patterns is essential. This study aimed to evaluate methadone utilization at a single academic university over a one-year period as well as discuss important considerations of methadone pharmacology.

Prevalence of THC-Positive Urine Drug Screens in Patients Receiving Chronic Opioid Therapy: A Retrospective Review.

Purpose Of Study: This retrospective review aimed to evaluate the prevalence of tetrahydrocannabinol (THC)-positive urine drug screens (UDS) in patients undergoing chronic opioid therapy (COT) for chronic pain at a single academic institution. With a growing national trend toward cannabis legalization and increased public access to marijuana for medical and recreational purposes, understanding the intersection between THC use and opioid prescribing practices is essential. The presence of THC on UDS has clinical, legal, and ethical implications, especially in regions where cannabis remains illegal.

Comparison of Clinical Outcomes Between Fluoroscopic and Computer Tomographic Guidance in Concurrent Use of Radiofrequency Ablation and Vertebral Augmentation in Spinal Metastases: A Scoping Review.

: The image guidance of choice for the combination therapy of radiofrequency ablation (RFA) and vertebral augmentation (VA) in the context of vertebral disease from spinal metastases are fluoroscopy and computer tomography (CT). Here, we aimed to assess the roles of both imaging modalities and if adoption of either would influence clinical outcomes of pain, physical function, and quality of life (QoL). RFA has been favored as a minimally invasive option for managing painful spinal metastases, and it is often coupled with VA to treat underlying osseous structural instability.

The Impact of Chronic Pain on Cognitive Function.

: Chronic pain affects a significant proportion of the population in the United States and poses a significant public health concern. Beyond physical discomfort, chronic pain has been increasingly linked to cognitive dysfunction, including impairments in memory, attention, executive function, and decision-making. The relationship is particularly pronounced in older adults and may contribute to the onset or progression of neurodegenerative diseases.

Understanding the Landscape of Lumbar Epidural Steroid Injections: A Review of Interlaminar, Transforaminal, and Caudal Approaches.

Purpose Of The Review: Lumbar epidural steroid injections (ESIs) have been used for decades for managing lumbosacral pain, particularly in patients with radiculopathy and chronic low back pain. Despite frequent use, there remains debate regarding their overall effectiveness, fueled by variability in physician technique and differing opinions on the optimal approach. This narrative review examines the three primary methods of lumbar ESI administration-transforaminal, interlaminar, and caudal-to evaluate their respective advantages, limitations, and clinical applications.

Notalgia Paresthetica: An Updated Review of Pathophysiology, Diagnosis, and Treatment Approaches.

Purpose Of Review: Notalgia paresthetica (NP) is a chronic sensory neuropathy characterized by localized pruritus and dysesthesia, most commonly affecting the upper back. Despite being a relatively common condition, it remains underdiagnosed and frequently mismanaged. This review covers the pathophysiology, clinical presentation, diagnostic evaluation, and treatment approaches for NP.

Safety of Catheter-Based Cervical Epidural Steroid Injections: A Retrospective Review.

Background: Cervical epidural steroid injections (CESIs) are frequently utilized for the treatment of cervical radiculopathy and axial neck pain. Given the anatomical complexity of the cervical spine, techniques that enhance precision while maintaining safety are essential. This case series evaluates the safety of a catheter-based approach for CESI, allowing targeted medication delivery to the affected spinal level.

Lumbar Multifidus Dysfunction and Chronic Low Back Pain: Overview, Therapies, and an Update on the Evidence.

Background: Chronic low back pain (CLBP) is a common and harmful medical condition, and in many cases, no specific radiographic cause is identified. Many cases of CLBP are refractory to treatment and will recur after the initial episode. Dysfunction of the lumbar multifidus muscle (LMM) has been increasingly identified as a possible cause of non-specific CLBP (NSCLP).

Trends in Celecoxib Prescribing: A Single Institution 16-Month Review.

Celecoxib, a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID), is widely prescribed for pain management due to its efficacy and improved gastrointestinal safety profile compared to traditional NSAIDs. Understanding prescription trends and their comparison to other NSAIDs provides valuable insight into prescribing behaviors in clinical settings. This retrospective study analyzed celecoxib prescriptions written by three pain management physicians in a single institution over a 16-month period from 1 January 2023 to 30 April 2024.

Caudal Epidural Steroid Injections: A Retrospective Pilot Study of Safety and Patient-Reported Outcomes.

Background: Caudal epidural steroid injections (ESIs) are commonly used to manage lumbosacral radicular pain and axial low back pain. While they are generally considered safe, real-world data on complication rates and patient-reported outcomes remain limited. This study aimed to evaluate the safety profile and short-term effectiveness of caudal ESIs by reviewing a series of randomly selected cases performed over a six-month period.

Challenges in Transitioning from Methadone to Buprenorphine-Naloxone for Chronic Pain Management: Two Cases.

Background: Methadone is frequently used for chronic pain management due to its long half-life and NMDA receptor activity, making it an effective option for opioid-tolerant patients. Buprenorphine-naloxone is increasingly explored as an alternative for chronic pain and opioid use disorder, offering partial opioid agonism with a ceiling effect on respiratory depression. The transition from methadone to buprenorphine-naloxone remains clinically challenging, requiring careful management to prevent withdrawal and ensure adequate pain control.

Trends in Outpatient Buprenorphine Prescribing for Chronic Pain: A Retrospective Analysis Over 18 Months.

Background: Buprenorphine, a partial opioid agonist, has gained attention for its use in chronic pain management due to its lower risk of abuse and respiratory depression compared to traditional opioids. The utilization of buprenorphine for chronic pain has increased in recent years. This study aimed to analyze trends in buprenorphine prescribing for chronic pain in an outpatient setting over an 18-month period, excluding buprenorphine-naloxone combinations used for opioid use disorder and opioid dependence.

The Use of Tricyclic Antidepressants for Postherpetic Neuralgia - A Case Series.

Postherpetic neuralgia (PHN) is one of the most debilitating forms of neuropathic pain that can occur after a herpes zoster infection. PHN can significantly impair patients' quality of life due to persistent neuropathic pain. Current first-line treatments for PHN include anticonvulsants like gabapentin and pregabalin, topical agents such as lidocaine patches, and opioids in severe cases.

Regional Anesthesia for Orthopedic Surgeries: A Guide for Upper and Lower Extremity Procedures.

Purpose Of The Review: Regional anesthesia has become a cornerstone in orthopedic surgeries due to its ability to provide precise, localized pain relief while minimizing the systemic risks associated with general anesthesia and opioid use. This review aims to provide a compact guide for anesthesia trainees and practicing anesthesiologists on the use of regional anesthesia techniques for upper and lower extremity procedures.

Summary: This guide outlines the main regional block options for orthopedic surgeries, detailing the targeted anatomy, common surgical indications, important adjacent structures, and potential complications for each technique.

Risks and Benefits of Cervical Transforaminal Epidural Steroid Injections: A Comprehensive Review.

Purpose Of Review: Cervical transforaminal epidural steroid injections (CTFESIs) are widely used for the treatment of radicular pain caused by cervical spine pathology, including disc herniations and foraminal stenosis. This review aims to analyze the risks and benefits of CTFESIs, address their efficacy and safety profile, improve clinical decision-making, and educate interventional pain medicine physicians.

Recent Findings: CTFESIs have demonstrated benefits such as pain relief, functional improvement, and the potential to avoid surgical interventions.

Preprocedural Imaging Review Before Performing Epidural Steroid Injections: Analysis of Physician Practice Parameters.

Epidural steroid injections (ESIs) are a common interventional treatment for managing spinal pain complaints. Despite their widespread use, practice patterns among physicians performing ESIs vary significantly. This study aimed to evaluate preprocedural imaging review by pain physicians who perform ESIs in the cervical, thoracic, and lumbar spine.

Enhanced Pain Relief with Catheter-Guided Caudal Epidural Steroid Injections: A Case Series of Patients with Unilateral Lumbar Radicular Pain.

Background: Caudal epidural steroid injections (ESIs) are a common intervention for lumbar radicular pain, but responses can be variable. When initial injections provide suboptimal relief, targeted approaches using an epidural catheter may enhance efficacy.

Case Series: We describe three patients with unilateral lumbar radicular pain who underwent caudal ESIs using a 22-gauge spinal needle.

Patient Outcomes Following Parasagittal Interlaminar Epidural Steroid Injections for Bilateral Lumbar Radicular Symptoms: Correlation of Contrast Spread With Symptom Relief.

Introduction Bilateral lumbar radicular symptoms are commonly treated with interlaminar epidural steroid injections (ILESIs). The parasagittal approach often results in unilateral contrast spread, which may influence the degree of bilateral symptom relief. This study evaluates whether unilateral contrast spread correlates with symptom improvement in both ipsilateral and contralateral symptoms.

Superior Vena Cava Stenting Complicated by Perforation and Cardiac Tamponade.

Superior vena cava (SVC) syndrome is a clinical condition characterized by impaired venous return from the upper body due to intrinsic or extrinsic obstruction of the SVC. Endovascular stenting has become an effective intervention for symptomatic relief. However, the procedure carries a rare risk of life-threatening complications, including SVC perforation and cardiac tamponade.