Abstract Hip pain from bone metastases is often severe, refractory, and difficult to control with systemic analgesics due to its complex innervation. The pericapsular nerve group (PENG) block is an interfascial technique targeting articular branches of the femoral, obturator, and accessory obturator nerves, which supply the anterior hip capsule. This technique provides effective analgesia while preserving motor function. Ethanol neurolysis via the PENG approach has been used perioperatively for hip fracture pain. In this case series, we evaluated the efficacy and safety of PENG ethanol neurolysis for metastatic hip pain in patients with advanced cancer. Five patients with confirmed lytic hip metastases and predominantly anterior hip capsular pain were enrolled. All patients fulfilled predefined inclusion criteria, including refractory pain despite optimized systemic analgesia and a positive diagnostic PENG block. The procedure resulted in significant and sustained pain relief, reduced opioid requirements, and improved functional mobility in activities of daily living, with no major adverse events. Functional outcomes were assessed using the Karnofsky Performance Scale. An institutional ethics committee waiver was obtained for this retrospective case series.
Abstract Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that may follow herpes zoster infection and is often difficult to treat with conventional medical therapy. Elderly patients are particularly vulnerable and may experience severe functional and psychological impairment. We report the case of a 73-year-old male with refractory PHN involving the upper thoracic dermatomes, who achieved significant pain relief following fluoroscopy-guided T2–T3 thoracic radiofrequency (RF) sympathectomy. This case highlights the role of interventional pain management (MIPSI) in patients with PHN unresponsive to pharmacological treatment. Despite receiving treatment with gabapentin, nortriptyline, topical medications, antivirals, and oral corticosteroids, the patient’s acute neuropathic pain persisted for 10 months. The Visual Analog Scale was used to measure baseline pain level (Visual Analog Scale [VAS]: 8/10), and the DN4 questionnaire was used to screen for neuropathic pain (DN4 score: 6/10). The Patient Health Questionnaire (PHQ)-9 was used to measure psychological discomfort (14/27). The patient reported improved sleep and everyday functioning after RF sympathectomy, along with a considerable reduction in pain (VAS: 3/10 after 24 h). At follow-up appointments at 1 week, 1 month, 3 months, and 6 months, sustained effect was observed, with decreased analgesic needs and an improved PHQ-9 score (6/27 at 6 months). No major complications were observed. The present case implies that some patients with refractory PHN affecting upper thoracic dermatomes may benefit from thoracic RF sympathectomy. However, additional controlled studies are needed to determine its effectiveness, safety, and comparative relevance among interventional modalities due to the limits of a single-case observation and the existence of potential confounding factors.
Abstract Eagle syndrome is a rare cause of glossopharyngeal neuralgia that results from an elongated styloid process impinging on cranial nerve IX. While surgical resection of the styloid process remains the definitive treatment, minimally invasive procedures such as glossopharyngeal nerve blocks are often used to provide symptomatic relief. We describe a patient with Eagle syndrome who underwent an ultrasound-guided glossopharyngeal nerve block for pain management. Immediately following the procedure, the patient developed transient peripheral facial nerve palsy. The facial weakness resolved spontaneously within a few hours without requiring any intervention. This case highlights a rare complication of glossopharyngeal nerve block in the setting of Eagle syndrome. Awareness of potential anatomical variations and inadvertent local anesthetic spread is essential. Clinicians should recognize this possibility, counsel patients beforehand, and adopt strategies to reduce the risk of such adverse effects.
Abstract Herpes zoster ophthalmicus (HZO) frequently results in severe neuropathic pain that is often refractory to conventional pharmacological management. Peripheral nerve cryoablation represents an emerging minimally invasive intervention for targeted pain relief in selected patients. A 73-year-old male presented with severe HZO-related pain involving the supraorbital, supratrochlear, and infraorbital nerve distributions, refractory to duloxetine and pregabalin therapy. Under ultrasound guidance, percutaneous cryoablation was performed targeting the supraorbital, supratrochlear, and infraorbital nerves using a cryoprobe at − 78°C with single freeze–thaw cycles lasting 2 min 45 s per nerve. The patient was monitored for immediate complications, including chemosis, ptosis, acute pain exacerbation, and localized inflammation. The procedure was technically successful with immediate pain relief and no acute complications. The technique demonstrated reproducibility and safety in this challenging clinical scenario. Ultrasound-guided cryoablation of trigeminal nerve branches represents a feasible and potentially effective intervention for HZO-related pain refractory to medical management, warranting consideration as an early interventional option in selected patients.
Interventional pain management plays a pivotal role in addressing distressing symptoms, notably pain, in palliative care patients with locally advanced rectal cancer. Ganglionic impar block and caudal epidural block have emerged as promising approaches for refractory pain relief. This case report discusses a 61-year-old female with locally advanced rectal cancer experiencing severe perianal pain, unresponsive to high-dose opioids. The patient underwent ganglion impar and caudal epidural block, resulting in a significant reduction in pain intensity. However, she developed transient confusion postprocedure, which resolved spontaneously within 2 h. This unusual complication underscores the importance of meticulous technique and patient monitoring in interventional pain management. While rare, transient neurological symptoms following such procedures necessitate understanding their potential etiologies and effective management strategies. This case highlights the efficacy of interventional pain management in rectal cancer-associated pain and emphasizes the need for continued research to optimize patient outcomes in cancer pain management.
Chronic osteoarthritis (OA) pain can profoundly affect the quality of life, especially for individuals with preexisting mobility issues related to Parkinson’s disease. Parkinsonism impairs movement, balance, and gait control, while OA in weight-bearing joints such as the knees and hips exacerbates disability and limits mobility. Treatment becomes challenging and imposes safety issues in patients with advanced Parkinson’s disease having implantable pulse generator. This case report highlights the potential of a minimally invasive technique, genicular nerve bipolar radiofrequency ablation, to safely and effectively alleviate pain, improving functional ability and quality of life in this complex patient demographic, where conventional treatments may carry greater risks.
Background: Plantar fasciitis is a common cause (11.0%–15.0%) of heel pain in adults, often becoming chronic and unresponsive to conservative management. Platelet-rich plasma (PRP), due to its regenerative properties, has emerged as a promising treatment modality. Objectives: To evaluate the effectiveness of ultrasound-guided PRP therapy/minimally invasive pain and spine intervention in the management of chronic plantar fasciitis in terms of pain relief, functional improvement, and ultrasonographic changes. Materials and Methods: This prospective observational study was conducted at a tertiary care center over 18 months. A total of 25 patients with chronic plantar fasciitis unresponsive to conservative measures were included. Autologous PRP was prepared and injected under ultrasound guidance using the peppering technique. Pain intensity (visual analog scale [VAS]), function (American Orthopedic Foot and Ankle Society [AOFAS] score), and plantar fascia thickness (ultrasound) were assessed at baseline, immediately postinjection, and at 1 week, 1 month, 3 months, and 6 months. Results: The mean VAS score significantly reduced from 7.6 ± 0.9 to 1.4 ± 0.7 over a period of 6 months (P < 0.001). AOFAS scores improved significantly from 63.9 ± 13.2 to 90.6 ± 4.2 (P < 0.001). Plantar fascia thickness also decreased significantly from 6.45 ± 0.6 mm to 4.1 ± 0.4 mm (P < 0.001). No adverse effects were reported. Conclusion: Ultrasound-guided PRP injection is a safe, effective, and well-tolerated modality for chronic plantar fasciitis. It offers significant long-term pain relief, improved functional outcomes, and a measurable reduction in plantar fascia thickness.
The dorsal root ganglia (DRG) serve as a pivotal relay in the transmission of sensory information, particularly nociception, from the periphery to the central nervous system. Situated in the intervertebral foramina, these pseudounipolar neurons integrate peripheral inputs and regulate excitability through a complex interplay of ion channels, neurotransmitters, and glial interactions. Alterations in sodium, potassium, and calcium channel dynamics contribute to abnormal action potential generation, sensitization, and spontaneous discharges—hallmarks of chronic pain states. This makes the DRG a central player in neuropathic pain, complex regional pain syndrome, radiculopathy, and post-herpetic neuralgia. Recent advances in interventional pain medicine have harnessed the DRG as a therapeutic target. Radiofrequency techniques, both thermal and pulsed, disrupt or modulate pain transmission with variable durations of relief. DRG neuromodulation has shown promise in refractory neuropathic pain, offering dermatomal specificity and targeted analgesia where conventional spinal cord stimulation may fail. Emerging evidence also supports novel therapies such as ozone injection at the DRG for post-herpetic neuralgia, leveraging its anti-inflammatory and neuromodulatory properties. This review outlines the anatomy and physiology of the DRG, with emphasis on the mechanisms of action potential generation, its role in chronic pain pathophysiology, and current interventional strategies. By bridging fundamental neurobiology with clinical applications, we highlight the DRG not only as a passive conduit of sensory signals but as an active, dynamic therapeutic target in modern pain medicine.
Atypical facial pain is diagnosed when clinical features do not fulfill any of the available diagnostic criteria, and it is known to be a sympathetically mediated pain. Therefore, cervical sympathetic ganglion block is effective in the management of pain. A middle-aged female with features of migraine headache on treatment for a considerable duration without significant pain relief, considered it as atypical facial pain. Cervical sympathetic ganglion block was performed which gave significant pain relief. Since the block gave temporary pain relief, to provide a long-term relief pulsed radiofrequency (PRF) neuromodulation of cervical sympathetic ganglion was performed. Cervical sympathetic ganglion block is an effective intervention for atypical facial pain which provides diagnosis and temporary pain relief. Pulsed radiofrequency (PRF) neuromodulation of the ganglion provides long-term relief.
Chronic facial pain is a complex clinical entity, particularly when traditional treatments fail to provide relief. This case report presents a 36-year-old male with persistent right-sided facial and nasal pain for 3 years. Despite initial diagnoses of maxillary sinusitis and a deviated nasal septum, surgical intervention and conservative therapies were ineffective. The use of diagnostic and therapeutic sphenopalatine blocks, followed by radiofrequency ablation (RFA), offered significant pain relief, emphasizing the importance of considering neural involvement in chronic nasal and facial pain syndromes. Ultimately, RFA delivered long-term relief, significantly improving the patient’s quality of life.
Background: Knee osteoarthritis (KOA) is a degenerative joint disorder leading to pain and functional impairment. Intra-articular growth factor concentrate (GFC), a refined derivative of platelet-rich plasma, is emerging as a regenerative treatment modality with potential chondroprotective and analgesic effects. Objectives: The objective of this study was to evaluate the efficacy and safety of intra-articular GFC in reducing pain, improving function, and promoting cartilage thickness in patients with moderate KOA living in hilly regions of Uttarakhand. Methodology: A retrospective observational study was conducted at a tertiary care center in Uttarakhand. Fifty patients aged 40–75 years with Kellgren–Lawrence Grade II–III KOA and Numerical Rating Scale (NRS) ≥4 were included. Patients received GFC injections and were assessed at baseline, 3 weeks, 6 weeks, and 3 months. Primary outcome was pain relief (NRS); secondary outcomes included cartilage thickness (ultrasound), WOMAC score, and adverse events. Statistical analysis was performed using repeated measures analysis of variance. Results: The mean NRS scores significantly decreased from 7.2 to 2.5 at 3 months (P = 0.007). Cartilage thickness improved from 2.57 mm to 2.88 mm (P = 0.002). WOMAC score showed significant improvement (23.06% reduction; P < 0.01). Only one patient (1.96%) reported mild local soreness, indicating a favorable safety profile. Conclusions: Intra-articular GFC demonstrated significant pain relief, functional improvement, and increased cartilage thickness over 3 months in moderate KOA patients living in hilly regions of Uttarakhand with minimal adverse effects. These findings support GFC as a viable regenerative therapy in conservative osteoarthritis management. Prospective, long-term studies are warranted.
Background and Aim: Pectoral nerve blocks have emerged as a promising technique for postoperative pain management following breast surgery. The addition of dexamethasone to local anesthetics has been shown to prolong the duration of nerve blocks, enhancing analgesic efficacy. This study investigates the efficacy of PECS-1 and PECS-2 blocks with dexamethasone for postoperative pain management and preventing chronic postmastectomy pain (CPM) syndrome. We evaluated time to first rescue analgesia, pain intensity (Numerical Rating Scale), analgesic consumption, and adverse effects. The findings may provide valuable insights into optimizing pain management strategies for breast surgery patients. Materials and Methods: This prospective, double-blind, randomized trial included 60 patients undergoing elective modified radical mastectomy (MRM). The participants were randomly allocated to one of two groups: Group B – patients in this group received an ultrasound-guided PECS block with 0.25% bupivacaine (28 mL) combined with 2 mL of saline. Group BD: Patients in this group received an ultrasound-guided PECS block with 0.25% bupivacaine (28 mL) combined with dexamethasone 8 mg (2 mL). Results: Group BD exhibited a statistically significant reduction in 24-h analgesic consumption compared to Group B (P < 0.001). The duration to first rescue analgesia was notably longer in Group BD (462.33 ± 22.23 min) versus Group B (378.67 ± 50.36 min), with P < 0.001. Group BD demonstrated significantly lower Numeric Rating Scale compared to Group B (P < 0.001). Adverse effects were comparable across the study groups. Conclusion: This study concludes that PECS blocks with bupivacaine and dexamethasone provide effective postoperative pain relief, reduce opioid use, and prolong pain relief duration in breast cancer surgery patients. By minimizing intense pain, this approach may reduce the risk of CPM syndrome, improving patient outcomes. Integrating PECS blocks with dexamethasone into perioperative care may enhance patient care and reduce long-term pain risks.
In cancer pain management, neurolysis of the peripheral nerves is used when pain is not controlled with pharmacological means and other interventions. We report a case of diffuse large B-cell lymphoma suffering with severe pain in the left upper limb and was managed successfully by alcohol neurolysis of the brachial plexus. Brachial plexus neurolysis is still a sparsely used technique, and only a few cases have been reported in the literature. The present case report highlighted the usefulness and safety of alcohol neurolysis of the brachial plexus when conservative measures failed to provide adequate pain relief.
For more than 75 years, different types of biological markers have evolved and are helping disease management better. The role of biological markers in the management of patients with chronic pain is remarkably noncontributory. Among different conditions of chronic pain, degenerative pain affecting various major and minor joints and spinal columns does not produce contributory markers in body fluids, which can be used for diagnostic and/or prognostic purposes. Of late, with the advent of various digital biomarkers originating from the introduction of sensor-based devices empowered with artificial intelligence and machine-based learning, there have been inflows of newer ways of management and guidance to patients who are with chronic pain. This narrative review has focused on the development of digital biomarkers in medical sciences over the last 25 years in the backdrop of the presence of biomarkers in medical science over almost four decades, with final view to look into the presence and role of digital biomarkers in the field of pain management. Recent studies highlight that digital input-based feedback from sensor-based immersive technology (IT) having the ability to create augmented and virtual reality environment for patients with chronic pain can be a boon for guiding them with a better spectrum of self-motivated rehabilitation therapy. It is expected that the field of pain medicine is in the process of having its own digital biomarkers from this newer IT-based therapy which has the ability to receive inputs from patients, analyze them using deep learning methods, and provide feedback for better healthcare management.
Causalgia, or complex regional pain syndrome (CRPS) type II, is a challenging neuropathic pain condition often resistant to conventional treatments. Pulsed radiofrequency (PRF) has emerged as a minimally invasive intervention for managing such pain. This case report details the successful use of PRF on the C5 remnant nerve root in a patient with CRPS type II following C5 nerve sheath tumor excision. A 50-year-old woman developed severe left upper limb pain, characterized by burning, allodynia, hyperalgesia, intermittent swelling, and motor weakness after the excision of a C5 nerve sheath tumor. Conservative treatments, including medications and physiotherapy, offered minimal relief. A diagnostic block of the left C5 remnant nerve root with ropivacaine and dexamethasone resulted in a 70% temporary pain reduction, confirming the nerve root as the primary pain generator, while a stellate ganglion block was ineffective. PRF was performed on the left C5 remnant nerve root under ultrasound guidance, at 42°C for 120 s. The patient reported a 50% reduction in pain intensity, from Numeric Pain Rating Scale score 8/10–4/10, and improvement in Douleur Neuropathique 4 score 7/10–2/10 for over 12 weeks, significantly improving her quality of life and function. This case shows us that PRF of the C5 remnant nerve root successfully reduced pain, highlighting the importance of diagnostic nerve blocks for proper patient selection. By modulating pain pathways without nerve destruction, PRF offers a promising alternative when traditional therapies fail.
Neuropathic pain, a chronic condition caused by nervous system damage, is often linked to trauma, surgery, or chemotherapy. Recently, iron deficiency has been explored as a contributing factor in cases resistant to standard treatments. Iron is essential for adenosine triphosphate production and neurotransmitter synthesis, both critical for nerve function and pain regulation. This case report involves a 61-year-old woman with severe vaginal pain following breast cancer treatment. Despite multiple interventions, including nerve blocks and neuropathic medications, her pain persisted. On discovering severe iron deficiency, intravenous iron and Vitamin B12 therapy were administered, leading to a significant and satisfactory pain reduction, sustained for 9 months. This case highlights the often-overlooked role of iron deficiency in neuropathic pain and emphasizes the need to assess iron and B12 levels in chronic pain management. Further research is needed to understand the underlying mechanisms and develop treatment guidelines.
In knee osteoarthritis (KOA), intra-articular bone marrow aspirate concentrate (IA-BMAC) and platelet-rich plasma (IA-PRP) are widely studied orthobiologic therapies, yet comparative evidence regarding their efficacy remains inconsistent. A meta-analysis was conducted to compare the efficacy and safety of IA-BMAC versus IA-PRP in KOA. PubMed, Cochrane Library, and Google Scholar were searched up to May 2025. Two randomized controlled trials and one comparative retrospective study involving 186 patients treated with IA-BMAC and 88 with IA-PRP were included. The primary outcome was change in pain score, while secondary outcomes included changes in the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Pooled mean differences with 95% confidence intervals were calculated. Both IA-BMAC and IA-PRP demonstrated comparable reductions in pain and WOMAC scores at 1, 3, 6, 9, and 12 months (P > 0.05), although heterogeneity was significant. IA-BMAC resulted in significantly greater improvements in IKDC at 3 months (MD = 6.88, 95% CI = 3.14–10.62; P < 0.001), 6 months (MD = 4.13, 95% CI = 0.01–8.25; P = 0.04), and 12 months (MD = 4.48, 95% CI = 0.23–8.74; P = 0.03), with no significant difference at 1 and 9 months. KOOS improvement favored IA-BMAC at 1 month (MD = 7.10, 95% CI = 2.47–11.72; P = 0.002) but not at later time points. Sensitivity analysis excluding the retrospective study reduced heterogeneity and revealed significantly greater WOMAC improvement with IA-BMAC at 3 months (MD = −4.81, 95% CI = −8.75 to −0.86; P = 0.01). Both IA-BMAC and IA-PRP are effective in KOA, with IA-BMAC demonstrating modest functional advantages. Larger, high-quality randomized trials are required to confirm these findings.
This case report details the occurrence of a greater auricular neuroma following the excision of a soft tissue tumor of the left side of the neck. The neuroma was successfully managed using an ultrasound-guided hydro-dissection technique, involving a mixture of 20 ml of 0.125% Ropivacaine and 8 mg Dexamethasone, resulting in significant pain relief. The patient’s symptoms, diagnostic approach, treatment procedure, and outcomes are discussed. To our knowledge, this is the first case report describing ultrasound guided hydro-dissection of greater auricular neuroma. Clinical evaluation is of utmost importance in diagnosis of Greater auricular neuroma and ultrasound guided hydro-dissection provides quick diagnostic and therapeutic possibility in the management of them.
Background and Objective: Low back pain (LBP) is prevalent in India, adversely affecting quality of life and contributing to economic burdens. Current guidelines recommend weak opioids like tramadol for symptomatic relief, but side effects limit their use. Flupirtine, a nonopioid analgesic, may provide a better alternative. This meta-analysis evaluates the efficacy and tolerability of flupirtine compared to tramadol and nonsteroidal anti-inflammatory drugs (NSAIDs) in LBP management. Methods: A systematic search of Evidence-Based Medicine Reviews, Cochrane Library, and PubMed identified relevant randomized controlled trials (RCTs) using keywords related to flupirtine, tramadol, NSAIDs, and LBP. Results: A total of 186 studies were identified out of which, 6 RCTs involving a total of 869 patients were eligible for analysis. In comparison to tramadol, flupirtine resulted in a significantly more reduction in the pain intensity on both Numerical Rating Scale (NRS) (mean difference [MD] = −0.42; 95% confidence interval [CI]: −0.67 to −0.17, P < 0.0001) and visual Analog Scale (VAS) score (MD = −0.23; 95% CI: −0.32 to −0.14, P < 0.0001). Flupirtine was found to be significantly better tolerated than tramadol in terms of total adverse events (AEs) (odds ratio [OR] = 0.49; 95% CI: 0.35–0.68, P < 0.0001), nausea (OR = 0.20; 95% CI: 0.12–0.33, P < 0.0001), vomiting (OR = 0.17; 95% CI: 0.08–0.37, P < 0.0001), and constipation (OR = 0.37; 95% CI: 0.17 to 0.83, P = 0.02) and had significantly lower treatment discontinuations (OR = 0.28; 95% CI: 0.14–0.60, P = 0.0009). When compared with NSAIDs, flupirtine resulted in significantly more reduction in the pain intensity on VAS (MD = −0.76; 95% CI: −0.82 to −0.70, P < 0.00001), and it was better tolerated than NSAIDs in terms of total AEs (OR = 0.40; 95% CI: 0.19–0.85, P = 0.27) and upper gastrointestinal pain and nausea (OR = 0.21; 95% CI: 0.09–0.48, P < 0.0003). Conclusion: Flupirtine offers better pain relief and fewer adverse effects than tramadol and NSAIDs in LBP management, making it a viable alternative for patients intolerant to opioids or NSAIDs.
