Comparison of tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation in the treatment of painful calcaneal spur and plantar fasciitis: A randomized clinical trial.

OBJECTIVE: Ultrasound-guided tibial nerve pulsed radiofrequency (US-TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur (PCS) and plantar fasciitis (PF). This study aimed to compare the effectiveness of the two procedures. DESIGN: A prospective, randomized, single-blind study. SETTING: Single-center pain clinic. SUBJECTS: Forty-nine patients who met the inclusion criteria were randomized into two groups. METHODS: 25 patients (group U) received US-TN PRF at 42 °C for 240 s, while 24 patients (group F) received intralesional FL-RFT at 80 °C for 90 s. The most severe Numeric Rating Scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness using the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. RESULTS: NRS and AOFAS scores significantly improved in groups U and F at 1 and 3 months compared to baseline (p < 0.05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in group U and 75% in group F. No significant difference was observed in the incidence of mild adverse events between the groups. CONCLUSIONS: US-TN PRF and intralesional FL-RFT have shown significant effectiveness in the treatment of PCS and PF. Larger randomized controlled trials are needed.

Comparison of Selective Nerve Root Pulsed Radiofrequency Vs Paramedian Interlaminar Epidural Steroid Injection for the Treatment of Painful Cervical Radiculopathy.

BACKGROUND: Although there are studies evaluating ultrasound-guided selective nerve root pulsed radiofrequency (ULSD-SNRPRF) and fluoroscopy-guided paramedian cervical interlaminar epidural steroid injection (FL-CIESI) for the treatment of chronic cervical radicular pain, no study has compared the efficacy of these 2 methods. OBJECTIVES: This study aimed to compare the efficacy of these 2 methods, their superiority to each other, and the incidence of adverse events. STUDY DESIGN: A prospective, randomized controlled trial. SETTING: Outpatient department of a single-center pain clinic. METHODS: Sixty patients who did not respond to conservative treatments for lower cervical radicular pain were randomly divided into 2 groups. One group underwent ULSD-SNRPRF (Group U), and the other underwent paramedian FL-CIESI (Group F). Patients were evaluated pretreatment, and 3 and 6 months posttreatment. The Numeric Rating Scale (NRS-11) was used to assess clinical improvement, The Neck Disability Index (NDI) to assess improvement in functional disability, and the Self-Leeds Assessment of Neuropathic Symptoms and Signs Pain Score (S-LANSS) to assess the treatment's effect on neuropathic pain. Clinically significant pain relief was defined as a 50% or more pain reduction in the NRS-11. The posttreatment reduction in medication consumption was assessed using the Medication Quantification Scale Version III (MQS III). We also evaluated whether there was a difference in treatment-related characteristics, such as procedure time and adverse events. RESULTS: The procedure time was significantly longer in Group U. Blood aspiration was observed in 2 patients in Group U and vascular spread in one patient in Group F, with no significant difference. At 3 and 6 months posttreatment, NRS-11 and NDI scores showed a significant decrease compared to the pretreatment scores in both groups; there was no difference between the groups. Both treatments effectively improved neuropathic pain, with no significant difference between the S-LANSS scores. There was no difference in the reduction of medication consumption between the groups. LIMITATIONS: There was no sham or control group, and the follow-up period was limited to 6 months. CONCLUSIONS: Pain relief, functional improvement, and safety were similar between groups. ULSD-SNRPRF and paramedian FL-CIESI are 2 different effective techniques for chronic cervical radicular pain. The choice of method should depend on various factors, such as patient preference, operator experience, and availability of resources. An advantage of ULSD over fluoroscopy is that patients and physicians are not exposed to radiation.

Neuromodulation of the median nerve in carpal tunnel syndrome, a single-blind, randomized controlled study.

Background: This study aimed to evaluate the efficacy of pulsed radiofrequency applied using transcutaneous electrodes in carpal tunnel syndrome (CTS). Methods: After randomization, the patients received two cycles of noninvasive pulsed radiofrequency (NiPRF), once weekly, or splinting (the control group) for three months. Clinical evaluations were recorded at baseline and weeks 4 and 8. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the functional status and symptom severity. Results: Sixty-two patients were followed up for three months. There was no difference between the groups in the BCTQ scores before and after treatment. The NiPRF group found a significant difference between the BCTQ measurements at all time intervals (paired sample t -test; P < 0.001). In the splint group, there was a significant difference only between the basal-1st month and basal-3rd month (paired samples t -test; P < 0.001). The main effect of the time variable was statistically significant (ANOVA; P < 0.001), but the group variable was not. There was no correlation between the BCTQ results measured at any time and the electroneuromyelogragphy findings in either group. Conclusions: NiPRF effectively improves symptoms and functionality in patients with CTS for up to 3 months. Thus, NiPRF can be considered an easy, safe, and useful alternative treatment modality for CTS.

Ultrasound-Guided Coccygeal Nerve Radiofrequency Ablation and Steroid Injection: Combination Therapy for Coccydynia.

OBJECTIVES: Coccydynia is characterized by pain in tailbone region, which affects the quality of life. Various interventional procedures are performed for coccydynia that is unresponsive to conservative treatment. This study aimed to evaluate the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) and steroid injection of the coccygeal nerve in patients with idiopathic and traumatic coccydynia. METHODS: In this prospective study, 32 patients with coccydynia unresponsive to conservative treatments underwent US-guided RFA of the coccygeal nerve. Coccygeal nerves were visualized at the level of the coccygeal cornua with US, 1 mL lidocaine 2% was injected into both areas and radiofrequency ablation was performed at 90°C for 60 seconds. After RFA, 2 mL dexamethasone and 2 mL bupivacaine 0.5% were injected. Visual Analog Scale (VAS) and Paris scales were used to evaluate the effect of treatment on pain and functionality before and at 1, 4, and 12 weeks after treatment. RESULTS: We found that 54% of the patients had a >50% reduction in VAS score and 66% of the patients had a >50% reduction in Paris scores measured between baseline and week 12. Additionally, the main effect of time on the VAS and Paris scores was statistically significant (P < .001) in all measurements. Baseline P and VAS scores were higher than the post-treatment measurements (P < .001). CONCLUSIONS: Our study showed that US-guided steroid injection and RFA of the coccygeal nerve for chronic coccydynia significantly improved pain and function scores at weeks 1, 4, and 12. RFA also results in a lower rate of adverse events. This study is the first clinical trial of ultrasound-guided coccygeal nerve RFA in patients with coccydynia. We believe that this new less invasive method may be an alternative to other interventional treatments.

Parasagittal Interlaminar and Transforaminal Epidural Steroid Injections for Radicular Low Back Pain; Which is More Comfortable?

Objective: This study aimed to compare parasagittal interlaminar (PS) and transforaminal (TF) epidural steroid injections for unilateral L5 and S1 radicular lower back pain in terms of patient comfort, efficacy, safety, contrast enhancement, and radiation exposure. Methods: This was a prospective randomized single-blind study. A total of 59 participants were included in this study. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were obtained. A comfort questionnaire was administered to all participants. The total fluoroscopy time and contrast distribution levels were recorded. Results: Pre- and post-treatment VAS scores were similar between the groups. The ODI scores increased in favor of the PS group at week 2 (P < 0.041); however, there was no difference between the two groups at other times. The VAS and ODI scores improved significantly with treatment in both the groups (P < 0.001). Total fluoroscopy time was shorter in the PS group (P < 0.001). PS application was more comfortable (P < 0.001). While no complications were observed in the PS group, three complications occurred in the TF group. Anterior epidural contrast spread to three or more levels was observed in 57% of the participants in the PS group, whereas no spread to more than two levels was observed in the TF group. Conclusion: The PS epidural approach is superior to the TF approach in terms of a low incidence of side effects, less radiation exposure, better patient comfort, higher epidural contrast spread, and single-level needle access.

A new neuromodulation method in chronic migraine; non-invasive pulsed radiofrequency, a single-blinded, randomised, controlled trial.

OBJECTIVE: Non-invasive pulsed radiofrequency (NipRF) therapy, a neuromodulation method for peripheral nerves, is a new treatment modality for pain. We aimed to show the changes in pain severity and frequency per month in chronic migraine with NipRF treatment. METHODS: We treated patients diagnosed with chronic migraine according to the International Classification of Headache Disorders III beta diagnostic criteria. In half of the patients, we applied pulsed radiofrequency (pRF) treatment with transcutaneous electrodes to the greater occipital nerve (GON) trace. In the other half, we applied the GON block under ultrasound guidance. The Migraine Disability Assessment Scale (MIDAS) was administered to the participants, and those with scores > 2 were included in the study. Pain intensity and frequency were evaluated using the visual analog scale (VAS) and a headache diary completed before and 4 weeks after treatment. RESULTS: When both groups were compared, the pre- and post-treatment VAS scores and headache frequencies were similar. Comparing the pre-treatment and post-treatment values within the groups, VAS scores and headache frequency decreased significantly after treatment in both groups (p < 0.001). CONCLUSION: In this study, we observed that NipRF treatment is safe and effective for treating chronic migraine. Pain intensity and frequency decreased with NipRF treatment, similar to that in the GON block group. CLINICAL TRIALS REGISTRATION NUMBER: NCT05499689, Date: 08/11/2022.

Predictive Factors Associated with Successful Response to Percutaneous Adhesiolysis in Chronic Lumbar Radicular Pain.

Percutaneous adhesiolysis (PEA) is of interest in the treatment of lumbar radicular pain. This study aimed to assess the effectiveness of PEA in patients with chronic lumbar radicular pain refractory to epidural steroid injections and to determine predictive factors, including demographic, clinical, and procedural data, to provide superior treatment efficacy. One hundred and ninety-three patients were reviewed. Successful treatment outcome was described as a 50% reduction in the visual analog scale score. Among the 193 patients, 109 (56.2%) exhibited a positive treatment response at 12 months. In multivariate logistic regression analysis, no depression (OR, 3.105; 95% CI, 1.127-8.547; p = 0.028), no spondylolisthesis (OR, 2.976; 95% CI, 1.246-7.092; p = 0.014), no previous lumbar surgery (OR, 2.242; 95% CI, 1.067-4.716; p = 0.033), mild foraminal stenosis (OR, 3.460; 95% CI, 1.436-8.333; p = 0.006), no opioid use (OR, 1.782; 95% CI, 0.854-3.717; p = 0.123), and baseline pain scores (OR, 0.787; 95% CI, 0.583-1.064; p = 0.120) were the predictive factors significantly associated with unsuccessful treatment outcome. PEA is a useful treatment option for patients with chronic lumbar radicular pain refractory to epidural steroid injections. A history of lumbar surgery, spondylolisthesis, depression, and severe foraminal stenosis could be associated with a poor prognosis.

Comparison of the efficacy of genicular nerve phenol neurolysis and radiofrequency ablation for pain management in patients with knee osteoarthritis.

Background: : Genicular nerve neurolysis with phenol and radiofrequency ablation (RFA) are two interventional techniques for treating chronic refractory knee osteoarthritis (KOA) pain. This study aimed to compare the efficacy and adverse effects of both techniques. Methods: : Sixty-four patients responding to diagnostic blockade of the superior medial, superior lateral, and inferior medial genicular nerve under ultrasound guidance were randomly divided into two groups: Group P (2 mL phenol for each genicular nerve) and Group R (RFA 80°C for 60 seconds for each genicular nerve). The numeric rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the effectiveness of the interventions. Results: : RFA and phenol neurolysis of the genicular nerves provided effective analgesia within groups at 1 week, 1 month, and 3 months compared to baseline. There was no significant difference between the groups in terms of NRS and WOMAC scores at all measurement times. At the 3rd month follow-up, 50% or more pain relief was observed in 53.1% of patients in Group P and 50% of patients in Group R. The rate of transient paresthesia was 34.4% in Group P and 6.3% in Group R, and this was significantly higher in Group P. Conclusions: : Neurolysis of the genicular nerves with both RFA and phenol is effective in the management of KOA pain. Phenol may be a good alternative to RFA. Further studies are needed on issues such as dose adjustment to prevent transient paresthesia response.

Comparison of the Effectiveness of Ultrasound-Guided Proximal, Mid, or Distal Adductor Canal Block after Knee Arthroscopy.

OBJECTIVE: Adductor canal block has been used for effective post-operative analgesia; however, the optimal location of adductor canal block placement is still controversial. We aimed to assess the opioid consumption and pain intensity in patients undergoing proximal, mid, and distal adductor canal block after knee arthroscopy. METHODS: A total of 90 patients who had undergone an arthroscopic knee surgery and proximal, mid, or distal adductor canal block for postoperative analgesia were examined. All groups received 20 mL of bupivacaine (0.375%) to the adductor canal. Post-operative pain scores, tramadol consumption, Bromage scores, additional analgesic need, and other complications were recorded. RESULTS: Our results demonstrated that proximal adductor canal block group significantly reduced opioid consumption compared to the midadductor canal block group (P < .001), and mid-adductor canal block group provided significantly decreased opioid consumption than the distal adductor canal block group (P = .004). The visual analog scale values were significantly lower in the proximal adductor canal block group compared to the mid-adductor canal block group at 0, 2, 4, 8, 12, and 24 hours, except in resting visual analog scale values at 24 hours. When the proximal and distal groups were compared, visual analog scale values were significantly lower in the proximal adductor canal block group. The Bromage score was 0 in all groups at each follow-up point. Post-operative nausea was observed in only 3 (3.3%) patients, all of these patients were in the distal adductor canal block group. CONCLUSION: Ultrasound-guided adductor canal block can be applied reliably at proximal, mid, and distal locations. The proximal adductor canal block approach provides significantly lower tramadol consumption and post-operative visual analog scale values than the mid- and distal adductor canal block groups.

Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol.

OBJECTIVES: Genicular nerve radiofrequency procedures increasingly are being performed to treat chronic pain due to knee osteoarthritis. Targeting additional sensory nerves and improving target identification by using ultrasound guidance could improve treatment success. The aim of this study was to compare the effectiveness of targeting only the traditional genicular nerves versus targeting the traditional genicular nerves plus 2 additional sensory nerves in ultrasound-guided genicular nerve radiofrequency procedures in patients with chronic knee osteoarthritis. METHODS: A total of 80 patients were randomized into 2 groups. Patients in the 3-nerve-targeted group received a genicular radiofrequency procedure in which the traditional genicular nerves were targeted: the superior lateral, superior medial, and inferior medial nerves. The 5-nerve-targeted group received a genicular radiofrequency procedure in which the recurrent fibular and infrapatellar branches of the saphenous nerve were targeted in addition to the traditional genicular nerves. The numeric rating scale, Short Form-36, Western Ontario and McMaster Universities Arthritis Index, Quantitative Analgesic Questionnaire, and patient satisfaction were evaluated before treatment, at week 1 after treatment, and at months 1, 3, and 6 after treatment. RESULTS: Both techniques provided significant pain reduction and functional improvement up to 6 months after the procedure (P < .05). The 5-nerve-targeted group showed significant improvement with regard to the numeric rating scale, Western Ontario and McMaster Universities Arthritis Index total, and Short Form-36 score compared with the 3-nerve-targeted group at each follow-up point. No differences in the Quantitative Analgesic Questionnaire or patient satisfaction scores were observed between the groups. CONCLUSIONS: The ultrasound-guided 5-nerve-targeted technique is a safe method and a more effective therapeutic procedure than the traditional 3-nerve-targeted technique for chronic knee osteoarthritis. TRIAL REGISTRATION: www.ClinicalTrials.gov ID: NCT05073887.

Fluoroscopy-Guided Versus Fluoroscopy-Confirmed Ultrasound-Guided S1 Transforaminal Epidural Injection with Pulsed Radiofrequency: A Prospective, Randomized Trial.

OBJECTIVE: The aim of this prospective randomized controlled study was to compare the effectiveness and accuracy of the ultrasound- and fluoroscopy-guided S1 transforaminal epidural injection combined with pulsed radiofrequency in patients with lumbosacral radicular pain caused by S1 nerve involvement. MATERIALS AND METHODS: A total of 60 patients were randomized into 2 groups. Patients received S1 transforaminal epidural injection combined with pulsed radiofrequency under either ultrasound or fluoroscopy guidance. Primary outcomes were estimated with Visual Analog Scale scores at 6 months. Secondary outcomes included Oswestry Disability Index, Quantitative Analgesic Questionnaire, and patient satisfaction scores during the 6-month follow-up period and procedure-related variables including procedure time and accuracy of the needle replacement. RESULTS: Both techniques provided significant pain reduction and functional improvement for 6 months compared to baseline (P < .001), without statistical significance between groups at each follow-up point. There was no significant difference in pain medication consumption (P=.441) and patient satisfaction scores (P=.673) between groups. The fluoroscopy guidance for combined transforaminal epidural injection with pulsed radiofrequency at S1 provided a greater accuracy for the cannula replacement (100%) than the ultrasound (93.3%), without significant difference between groups (P=.491). CONCLUSION: The ultrasound-guided combined transforaminal epidural injection with pulsed radiofrequency at S1 level is a feasible alternative to fluoroscopy guidance. In this study, we reported that the ultrasoundguided technique resulted in similar treatment benefits including improvement in pain intensity and functionality and reduction in pain medication consumption as those in the fluoroscopy group, while reducing the risk for radiation exposure.

Ultrasound-guided PENG block versus intraarticular corticosteroid injection in hip osteoarthritis: a randomised controlled study.

Background: This study aimed to compare the effectiveness of the pericapsular nerve group (PENG) block and intra-articular injection (IAI) of steroid-bupivacaine in the treatment of hip osteoarthritis (OA). Methods: After randomization, patients received either a PENG block or IAI under ultrasound-guidance. Clinical evaluations were recorded at baseline, day 1, and weeks 1, 4, and 8 post-intervention. The numerical rating scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Scale (HHS) scores, pain medication use determined by a quantitative analgesic questionnaire, and patient satisfaction were evaluated. Results: Sixty patients were included in this study. NRS scores improved significantly for both groups during the follow-up compared to pretreatment (P < 0.001), with better pain scores for the PENG group (P < 0.001) at day 1 with larger effect size (Cohen's d = 4.62), and IAI group at 4 (Cohen's d = 5.15) and 8 (Cohen's d = 4.33) weeks (P < 0.001). There was no significant difference in pain medication consumption (P = 0.499) and patient satisfaction (P = 0.138) between groups. Patients in the IAI group experienced significant improvement in HHS (Cohen's d = 2.16, P = 0.007) and WOMAC (Cohen's d = 1.02, P = 0.036) scores at 8 weeks compared to the PENG group. Conclusions: The ultrasound-guided PENG block provides effective pain relief which improves functionality and quality of life in hip OA patients up to 2 months. The PENG block can be considered an easy, safe, and useful alternative treatment modality for hip OA.

Ultrasound-guided rhomboid intercostal block for myofascial pain syndrome: a prospective clinical study.

BACKGROUND: Myofascial pain syndrome (MPS) is a common chronic pain syndrome that may affect quality of life, daily living activities, and psychological status. Ultrasound (US)-guided rhomboid intercostal block (RIB) is a recently defined plane block and used for chronic pain such as postmastectomy syndrome and MPS. Our aim was to evaluate the efficacy of US-guided RIB for the management of pain, quality of life, physical disability, and patient satisfaction in MPS. METHODS: In this prospective study, between February and March 2021, a total of 30 patients who applied with the diagnosis of MPS, were included. The patients received US-guided RIB. Pain intensity was evaluated using a numerical rating scale (NRS) at pretreatment, and just after the intervention, at day 1, and 1, 2, 4, and 6 weeks after the intervention. At pretreatment and 6 weeks after treatment, Short Form-36 Health Survey (SF-36) for health-related quality of life, Neck Disability Index (NDI), and patient satisfaction were evaluated. RESULTS: There was a statistically significant decrease in average NRS immediately after treatment, at day 1 and week 1,2,4, and 6 compared to the pretreatment (p < 0.0001). The average SF-36 scores advanced at 6 weeks after treatment. There was a statistically significant reduction in mean NDI scores throughout the follow-up period (p < 0.001). DISCUSSION: Our study demonstrated that RIB had improved neck function, physical and mental quality of life, and patient satisfaction in MPS. Therefore, we think US-guided RIB could be an alternative treatment modality in patients suffering from MPS.

Predictive factors associated with successful response to utrasound guided genicular radiofrequency ablation.

Background: Ultrasound-guided genicular nerve radiofrequency (RF) procedures are of interest in the management of chronic knee pain. A wide variety of demographic, clinical, and procedural characteristics can affect treatment success. This study aimed to determine predictive factors to provide superior treatment outcomes. Methods: The demographic, clinical, and technical data of patients who received genicular nerve RF for knee pain between September 2016 and September 2021 were evaluated. A positive outcome was defined as at least 50% pain relief on a pain score for at least 6 months. Logistic regression analysis was performed to determine the factors associated with a successful response to genicular RF. Results: Among 206 patients who underwent genicular RF, 62% of the patients reported successful outcomes at 6 months. In the multivariate model, targeting 5 nerves (odds ratio [OR], 6.184; 95% confidence interval [CI], 2.291-16.690; P < 0.001) was the most significant predictor of successful outcomes. Multivariable logistic regression analysis showed that prognostic genicular nerve block with a 50% cut-off value (OR, 2.109; 95% CI, 1.038-4.287; P = 0.039), no opioid use (OR, 2.753; 95% CI, 1.405-5.393; P = 0.003), and depression (OR, 0.297; 95% CI, 0.124-0.713; P = 0.007) were the predictive factors significantly associated with response to genicular RF. Conclusions: Clinical and technical factors associated with better treatment outcomes were ultimately targeting more nerves, performing prognostic block, no opioid use, and no depression. These results are expected to be considered when selecting patients for genicular RF.

Easy to treat when the diagnosis is made: Three cases of clunealgia and the advantage of ultrasonography.

In this article, we present three cases of clunealgia admitted with low back pain. Their pain relieved with superior cluneal nerve block. The posterior side of the iliac crest, which is the location where the superior cluneal nerve passes, was identified using a high-frequency linear transducer. The drug injected separates the erector spinae muscle and thoracolumbar fascia and accumulates between these two structures. All patients were discharged with a complete pain relief. This report highlights the fact that superior cluneal nerve entrapment should be kept in mind in patients with low back pain and that ultrasound guidance can correctly identify the infiltration and eliminate anesthetization of other surrounding structures.

Ultrasound-Guided Erector Spinae Plane Block and Trapezius Muscle Injection for Myofascial Pain Syndrome.

OBJECTIVE: There were two goals to this study: the first goal was to research the analgesic effectiveness of erector spinae plane block (ESPB) added to the treatment after trapezius muscle injection (TMI) and the second was to investigate whether repeated TMI increases the analgesic effect in myofascial pain syndrome (MPS). METHODS: Sixty patients with a diagnosis of MPS were randomized into two groups. The TMI group (n = 30) received ultrasound-guided (USG) TMI with 5 mL of 0.25% bupivacaine two times, with a 1-week interval in between. The ESPB group (n = 30) received USG TMI with 5 mL of 0.25% bupivacaine in the first week and USG ESPB with 20 mL of 0.125% bupivacaine in the second week. The pain severity of the patients was evaluated using the visual analog scale (VAS). The data obtained before (week 0) and after (weeks 1, 2, 3, and 4) the injections were statistically compared between the groups. RESULTS: In both groups, the mean VAS score decreased in the first week compared to the mean pretreatment score (p < .001). When the VAS scores were compared between the first and second weeks, a decrease was observed in both groups (p < .001), but it was more evident in the ESPB group. Compared to previous weeks, there was no significant difference in VAS scores at the third and fourth weeks. CONCLUSIONS: The analgesic effect of repeated TMI for MPS was superior to a single injection, but ESPB combined with TMI provided more effective analgesia than repeated TMI.

Chronic Pain: An Update of Clinical Practices and Advances in Chronic Pain Management.

Chronic pain affects a significant amount of the population and represents a heavy personal and socioeconomic burden. Chronic pain mechanisms can be categorized as nociceptive, neuropathic, or nociplastic. Although mechanism-based pain treatment is optimal, different types of pain mechanisms may overlap in patients. Recently, the biopsychosocial model with the multidisciplinary pain management program is widely accepted as one of the most effective methods to assess and manage chronic pain. The treatment of chronic pain consists of a personalized, stepwise, and multimodal approach that includes pharmacotherapy, psychotherapy, integrative treatments, and interventional procedures. Somatic and peripheral nerve blocks for the treatment of chronic pain are often deferred. With the increasing use of ultrasound in pain medicine, newly defined interfascial plane blocks, which may be performed alone or as an adjuvant to multimodal management, have gained popularity. Adequate pain management can improve physical functioning, mental health and quality of life indicators, and reduce pain chronification. The aim of this current article is to perform a comprehensive and updated review of existing treatment options, particularly interfascial plane blocks in chronic pain syndromes.