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Lancet 2021 Jun 8. Epub 2021 Jun 8.

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Neurology, Physical Medicine and Rehabilitation, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA.

Low back pain covers a spectrum of different types of pain (eg, nociceptive, neuropathic and nociplastic, or non-specific) that frequently overlap. The elements comprising the lumbar spine (eg, soft tissue, vertebrae, zygapophyseal and sacroiliac joints, intervertebral discs, and neurovascular structures) are prone to different stressors, and each of these, alone or in combination, can contribute to low back pain. Due to numerous factors related to low back pain, and the low specificity of imaging and diagnostic injections, diagnostic methods for this condition continue to be a subject of controversy. Read More

Osteoporos Int 2021 Jun 4. Epub 2021 Jun 4.

Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.

This literature review summarized studies that evaluated the effects of epidural steroid injections (ESIs) on skeletal health. While evidence is limited, studies suggest that ESIs may cause bone loss. Better understanding of these skeletal consequences will help foster strategies to prevent bone loss in the growing population of patients receiving ESIs. Read More

Pain Med 2021 Jun 4. Epub 2021 Jun 4.

Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.

Incorporating indicated interventions in a multimodal approach to manage musculoskeletal pain has become standard of care. For example, in patients with radicular pain associated with intervertebral disc herniation or lumbar spinal stenosis, epidural steroid injections (ESI) are commonly used and often improve pain and function while avoiding more invasive surgical approaches. Recently, the coronavirus disease 2019 (COVID-19) pandemic has allowed remote evaluations to mitigate COVID-19 transmission using telemedicine. Read More

J Pain Res 2021 27;14:1495-1504. Epub 2021 May 27.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Purpose: Particulate steroids used in epidural steroid injections have been suspected as a cause of post-procedural embolic events. Some particulate steroids have been suspended only when the transforaminal approach is used for an epidural block of the spine. In contrast, non-particulate steroids are generally accepted for safety during epidural steroid injections. Read More

Reg Anesth Pain Med 2021 May 26. Epub 2021 May 26.

Department of Anesthesiology and Pain Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)

Background: Transforaminal epidural steroid injection is widely used in clinical practice to effectively deliver injectate into the ventral epidural space. Complications associated with intravascular injection such as spinal cord infarction and paraplegia can occur during transforaminal epidural steroid injection. To improve the safety of the procedure, avoidance of intravascular injection is crucial, for which appropriate needle selection is important. Read More

Spine J 2021 May 22. Epub 2021 May 22.

Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA. Electronic address:

Background Context: Despite established guidelines, long-term management of surgically-treated low back pain (LBP) and lower extremity pain (LEP) remains heterogeneous. Understanding care heterogeneity could inform future approaches for standardization of practices.

Purpose: To describe treatment heterogeneity in surgically-managed LBP and LEP. Read More

Spine (Phila Pa 1976) 2021 Jun;46(12):E701-E702

Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Rothman Orthopedics Philadelphia, PA.

J Pain Res 2021 5;14:1231-1239. Epub 2021 May 5.

Global Research and Development, Scilex Pharmaceuticals Inc, Palo Alto, CA, USA.

Purpose: SP-102 is a novel epidural steroid injection (ESI) formulation of 10 mg dexamethasone sodium phosphate in a viscous gel solution. Repeat dosing of ESIs is possible if required for pain relief, but with consideration of hypothalamic-pituitary-adrenal (HPA) axis suppression from prolonged systemic exposure. This phase I/II study investigated the effect of initial and repeat SP-102 injections on HPA suppression and analgesia. Read More

Eur Spine J 2021 May 11. Epub 2021 May 11.

Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.

Purpose: The purpose of this systematic review and meta-analysis was to determine whether epidural steroid injections (ESI) are superior to epidural or non-epidural placebo injections in sciatica patients.

Methods: The PubMed, Embase, Cochrane Library, and Web of science databases were searched for trials comparing ESI to epidural or non-epidural placebo. Risk of bias was assessed using the Cochrane RoB 2 tool. Read More

Agri 2021 Apr;33(2):84-88

Division of Algology, Department of Anesthesiology and Reanimation, Adnan Menderes University Faculty of Medicine, Aydın, Turkey.

Objectives: Demonstrate of accidental intravascular injection during lumbar transforaminal anterior epidural steroid injection (TAESI) performed with three-dimensional imaging angiography (3DIA) and fluoroscopy.

Methods: We assessed 20 (9 males and 11 females) patients (with a total of 40 levels) whose images were received with simultaneously 3DIA and fluoroscopy-guided TAESI between January 2016 and September 2016 as retrospective. Injections were carried out in the lumbar fourth intervertebral space bilaterally and performed in the same way all of the cases. Read More

J Cutan Aesthet Surg 2020 Oct-Dec;13(4):265-274

Director & Senior Consultant Dermatologist, SKINNOCENCE: The Skin Clinic, Gurgaon, India.

Background: Post-herpetic neuralgia (PHN) is usually a constant or intermittent burning, stabbing, or sharp shooting pain with hyperalgesia or allodynia, persisting beyond the healing of herpetic skin lesions. This review was carried out in concordance to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We used PICOS (Population, Intervention, Control, and Outcome Study) design for inclusion of potential studies into this review. Read More

Eur Neurol 2021 Apr 26:1-11. Epub 2021 Apr 26.

Department of Neurology, OLVG Teaching Hospital, Amsterdam, The Netherlands.

Background: This study aimed to assess how Dutch neurologists and anesthesiologists diagnose and treat people with sciatica in secondary care and to evaluate their adherence to the newest guidelines.

Methods: We conducted a cross-sectional survey. Respondents were asked about their current clinical practice related to sciatica. Read More

BMJ Case Rep 2021 Apr 23;14(4). Epub 2021 Apr 23.

Department of Anesthesiology, University of Florida, Gainesville, Florida, USA

We report the case of a 70-year-old man who presented to the clinic with back pain and presumed chronic kidney pain from renal keratinising desquamative squamous metaplasia, in which he would intermittently pass keratin plugs in urine. The pain had a visceral-sounding component that was inconsistent with renal colic. MRI of the spine revealed anterolateral disc bulges, which were likely irritating the anterolateral sympathetic nerves of the intervertebral disc, mimicking visceral pain. Read More

Spine J 2021 Apr 17. Epub 2021 Apr 17.

Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, USA. Electronic address:

Background Context: The complication profile and higher cost of care associated with preoperative opioid use and spinal fusion is well described. However, the burden of opioid use and its impact in patients undergoing lumbar discectomy is not known. Knowledge of this, especially for a relatively benign and predictable procedure will be important in bundled and value-based payment models. Read More

Clin J Pain 2021 Jul;37(7):524-537

Department Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam.

Objectives: Epidural steroid injections (ESIs) can be used to reduce lumbosacral radicular syndrome (LRS) related pain. The clinical relevance of ESIs are currently unknown. This systematic review and meta-analyses aims to assess whether ESIs are clinically relevant for patients with LRS. Read More

Health Technol Assess 2021 Apr;25(24):1-86

Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK.

Background: Sciatica is a common condition reported to affect > 3% of the UK population at any time and is most often caused by a prolapsed intervertebral disc. Currently, there is no uniformly adopted treatment strategy. Invasive treatments, such as surgery (i. Read More

BMC Musculoskelet Disord 2021 Apr 12;22(1):347. Epub 2021 Apr 12.

The Key Laboratory of Biomedical Information Engineering of Ministry of Education, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, and Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, P. R. China.

Background: To assess the therapeutic efficacy of transforaminal epidural steroid injection (TFESI) combined with radio frequency (RF) for the treatment of lumbar disc herniation (LDH).

Methods: A total of 230 patients participated in the study: TFESI (Group T, n = 110), TFESI combined with RF (Group TR, n = 120). Visual analogue scale (VAS), Oswestry disability index (ODI) and Global perceived effect (GPE) scale were measured pre-operation, 1, 3, 6, 12 and 24 months after the operation. Read More

Curr Pain Headache Rep 2021 Apr 6;25(6):38. Epub 2021 Apr 6.

Department of Anesthesiology and Pain Medicine, Yale University School of Medicine, 333 Cedar Street TMP3, New Haven, CT, 06510, USA.

Purpose Of Review: Pain management in dermatologic conditions can be complicated by the primary disease burden and associated decreased quality of life, disability, and psychosocial issues. This review focuses on pain management strategies in some of the more painful dermatologic conditions.

Recent Findings: Pain management in painful dermatologic conditions such as pyoderma gangrenosum, postherpetic neuralgia, lower limb ulcers, and hidradenitis suppurativa revolves around treatment of the underlying disease process. Read More

Spine J 2021 Mar 27. Epub 2021 Mar 27.

Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA, 15213 USA.

Background Context: Psychological comorbidities are important prognostic factors for low back pain (LBP). To develop improved treatment paradigms, it is first necessary to characterize and determine current patterns of treatment in this population.

Purpose: Identify how comorbid depression or anxiety in patients with LBP is related to use of healthcare resources. Read More

J Clin Neurosci 2021 Apr 30;86:71-78. Epub 2021 Jan 30.

Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address:

Identifying an optimal composition of nonoperative therapies to trial in patients suffering from degenerative lumbar spine conditions prior to surgical management remains challenging. Contrasting successful versus failed nonoperative treatment approaches may provide clinicians with valuable insight. The purpose of this study was to compare the nonoperative therapy regimens in degenerative lumbar spine disorder patients successfully managed conservatively versus patients who failed primary treatment and opted for lumbar fusion surgery. Read More

PM R 2021 Mar 26. Epub 2021 Mar 26.

Department of Orthopaedic Surgery, Stanford University, Virginia Beach, Virginia, USA.

Background: Few studies have evaluated the effect of final needle position on contrast flow patterns during the performance of cervical transforaminal epidural steroid injections (TFESIs).

Objective: To analyze fluoroscopically guided cervical TFESI contrast flow patterns based upon final needle tip position.

Design: Retrospective, observational in vivo study. Read More

Pain Physician 2021 Mar;24(2):117-125

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Cervical epidural steroid injections (ESI) are performed either by interlaminar (IL) or transforaminal (TF) approaches; however, there is controversy over which is better for safety and efficacy.

Objectives: This clinical trial aimed to compare the effectiveness of the parasagittal IL and TF approaches for cervical ESI in patients who were suffering from cervical radicular pain.

Study Design: A prospective randomized assessor-blind study. Read More

Pain Physician 2021 Mar;24(2):101-116

Department of Physiatry, Hospital for Special Surgery, New York, NY; Regenerative SportsCare Institute, New York, NY.

Background: Interventional spine procedures, such as discography, epidural steroid injections (ESIs), facet joint procedures, and intradiscal therapies, are commonly used to treat pain and improve function in patients with spine conditions. Although infections are known to occur following these procedures, there is a lack of comprehensive studies on this topic in recent years.

Objectives: To assess and characterize infections following interventional spine procedures. Read More

Eurasian J Med 2021 Feb;53(1):48-52

Department of Anaesthesiology and Reanimation, Dr Ersin Arslan Training and Research Hospital, Gaziantep, Turkey.

Objective: A successful interlaminar epidural injection relies on correct epidural space needle placement. Most interlaminar epidural steroid injection (ESI) procedures are performed with a blind technique known as loss-of-resistance (LOR) without an imaging guide. This study aims to evaluate the success rate of the LOR technique in interlaminar epidural steroid injection under fluoroscopic control. Read More

J Pain Res 2021 5;14:623-629. Epub 2021 Mar 5.

Department of Pain Medicine, The Spine and Nerve Center of the Virginias, Charleston, WV, USA.

To date, COVID-19 has spread to more than 108 million people globally, with a death toll surpassing 2 1/2 million. With the United States Food and Drug Administration (FDA) approval of two highly effective COVID-19 vaccines from Pfizer-BioNtech and Moderna, we now have a novel approach to contain COVID-19 related morbidity and mortality. Chronic pain care has faced unprecedented challenges for patients and providers in this ever-changing climate. Read More

Spine J 2021 Mar 6. Epub 2021 Mar 6.

Medical College of Wisconsin, Milwaukee, WI, USA.

Background Context: Outcomes of treatment in care of patients with spinal disorders are directly related to patient selection and treatment indications. However, for many disorders, there is absence of consensus for precise indications. With the increasing emphasis on quality and value in spine care, it is essential that treatment recommendations and decisions are optimized. Read More

Spine (Phila Pa 1976) 2021 Mar 4. Epub 2021 Mar 4.

Institute of Pain Medicine, Division of Anesthesiology, Tel Aviv Sourasky Medical Center, Israel Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel Department of Anesthesia Móstoles University Hospital, Móstoles, Madrid, Spain Department of Neurosurgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Orthopaedic Surgery, The Spine Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel Department of Anesthesia and Chronic Pain Unit.Hospital Quirónsalud de Tenerife. Santa Cruz de Tenerife, Spain.

Study Design: Prospective clinical pilot study and cadaveric study.

Objective: evaluate the spread of an Ultrasound guided interfascial plane blocks (UGIPB) and its potential efficacy for Cervical radiculopathy.

Summary Of Background Data: Cervical radiculopathy is a common disorder, potentially leading to severe pain and disability. Read More

Medicine (Baltimore) 2021 Mar;100(9):e25012

Department of Physical Medicine and Rehabilitation, Pain Medicine Section, School of Medicine, Marmara University, Istanbul, Turkey.

Abstract: Epidural steroid injections (ESI) are commonly performed for the treatment of chronic cervical disc herniation (CDH). Although they are considered to be effective for both nociceptive and neuropathic types of pain, there is a lack of data regarding the impact of neuropathic pain (NP) and nociceptive pain components on treatment outcomes. The aim of this study is to compare the effectiveness of interlaminar epidural steroid injection (ILESI) between patients with predominantly NP and nociceptive pain due to CDH. Read More

Pain Med 2021 Feb 24. Epub 2021 Feb 24.

Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.

Objective: Examine how interventional pain physicians navigated the early phase of reopening practices during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: In June/July 2020, Spine Intervention Society members were queried about practice demographics, perception of COVID-19 prevalence, financial impact, and implementation of new tools and procedures when re-opening practices.

Results: Of the 2,295 members approached, 195 (8%) completed the survey. Read More

Support Care Cancer 2021 Feb 24. Epub 2021 Feb 24.

Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA.

Purpose: To examine the incidence of bleeding and infectious adverse events (AEs) in patients undergoing interventional, fluoroscopic-guided axial spine procedures to modulate pain.

Methods: Retrospective data of patients undergoing fluoroscopically guided axial spine injections at a single tertiary care medical center Cancer Rehabilitation program in the USA were reviewed. AEs, type of chemotherapy, type of tumor, age, platelet and absolute neutrophil counts (ANC) prior to the procedure, and relevant past medical history were collected. Read More