Background: Chronic upper back myofascial pain usually does not respond well to conventional treatments. This study evaluates the effectiveness of fascial plane interventions targeting spinal accessory and dorsal scapular (SADS) nerves using ultrasound (US) in alleviating pain and reducing analgesic usage. Materials and Methods: Twenty participants who were suffering from chronic upper thoracic myofascial pain were included in this prospective observational study. Participants underwent a US-guided SADS nerve fascial plane intervention. This procedure was categorized as a minimally invasive pain and spine intervention. Pain levels (numerical rating scale [NRS]), functional recovery (Global Perceived Effect [GPE]), and the level of prescribed drugs (Medication Quantification Scale [MQS]) were evaluated before the procedure, immediately after, and at 1 and 3 months postoperatively. Results: Mean NRS values demonstrated a statistically significant decrease from 6.9 ± 0.91 preoperative value to 2.2 ± 1.15 postoperative, 2.3 ± 2.51 at 1 month, and 2.55 ± 2.52 at 3 months (P < 0.001). The greater part of the patients (70%) reported “very much” or “much improved” at 3 months according to GPE scores. Moreover, MQS showed a decline from 22.6 ± 2.01 to 6.95 ± 9.60 at the 3-month follow-up. There were no serious complications noted. Conclusion: Fascial plane interventions targeting SADS nerves under US guidance appear to provide significant reduction of pain, improvement of functional outcome, and reduction of analgesic consumption in chronic upper back myofascial pain patients. Further randomized controlled trials are needed to validate these findings.

Background and Aims:Rotator cuff (RC) disorders have a varied range of treatment. Multiple interventional, non-surgical treatments are often opted for by patients. This study evaluates the effectiveness of dextrose prolotherapy in treating RC pathologies.Methods:A comprehensive review of databases (PubMed, Google Scholar, Embase, Scopus, and Cochrane databases) from 2000 to June 2025 identified 13 relevant studies involving 936 patients. The randomised clinical trials, which compared dextrose prolotherapy with interventions such as platelet-rich plasma, steroids, physiotherapy, or placebos, were included in the systematic review. A risk-of-bias analysis was conducted using the Risk of Bias Visualisation Tool. It indicated that seven studies had low bias. Studies with a high risk of bias were excluded from the meta-analysis. The protocol was registered beforehand (PROSPERO ID: CRD42024520747).Results:Review Manager software was used to analyse the data and generate the plots. The analysis showed that prolotherapy significantly reduced pain (MD = -0.76; 95% CI: -1.26, -0.27; P = 0.003), improved functional outcomes (shoulder pain and disability index (MD = -8.58; 95% confidence interval (CI): -13.00, -4.17; P = 0.0001)), and enhanced ultrasonography features. No major adverse effects were reported, indicating that the treatment is safe.Conclusions:This systematic review and meta-analysis suggests that dextrose prolotherapy may be a feasible and effective alternative for RC disorders, and it can be considered for patients with limited treatment options. However, to reach the required information size, further trials are required. Uniformity in protocols, intervention strategies, and outcome reporting is necessary for longer follow-up periods to facilitate more effective evidence synthesis. This study received no external funding.

Background: Substance P (SP), a neuropeptide identified in 1931, is ubiquitously present in both the central (CNS) and peripheral (PNS) nervous systems, playing a pivotal role in nociceptive signal transmission and immune system responses. Aims and Objectives: This research aims to explore the correlation of SP levels with chronic pain in various syndromes, specifically focusing on osteoarthritis (OA), rheumatoid arthritis (RA), widespread pain (WSP), and fibromyalgia (FM). Materials and Methods: This cross-sectional study involved 60 participants aged 18-65 years with chronic pain persisting for at least 180 days. Patient selection criteria included evaluation of pain severity using the Visual Analogue Scale (VAS). Substance P concentration was measured in both serum and cerebrospinal fluid (CSF). Statistical analysis methodologies employed included the t-test, ANOVA, and Pearson's correlation coefficient. All participants provided informed consent prior to their inclusion in the study. Results: The study population's features included a mean age of 42.08±10.57 years, with a gender distribution of 38 females and 22 males. Mean VAS scores were 73.5±13.0, while mean serumSP concentrations were 477.52±288.39 pg/mL and mean CSF SP concentrations were 653.95±262.23 pg/mL. Among the 60 patients classified with severe pain, 32 were diagnosed with osteoarthritis, 26 with rheumatoid arthritis, and 2 with widespread pain syndrome. Correlation analysis revealed a weak positive correlation between cerebrospinal fluid SP levels and chronic pain syndromes, and a moderate positive correlation with VAS scores. Weaker associations were observed between serum SP levels and both pain syndromes and VAS scores. These findings suggest potential influences of biomarkers on pain states and diagnostic categories. Conclusion: The study concludes that Substance P levels positively correlate with chronic pain perception across various pain syndromes. While SP levels do not appear to vary significantly with the specific underlying cause of chronic pain, these findings support the need for a larger, multi-centric trial to comprehensively assess SP's role in a more diverse patient population.

BackgroundPhantom limb pain (PLP) is the most common type of pain experienced by amputees and is chronic and complex, with manifestations including pain in a limb that no longer exists. To date, treatments that are pharmaceutical or surgical in nature are relatively ineffective at bringing much relief as the pathophysiology of PLP is somewhat obscure. Chronic pain syndromes such as PLP may benefit from sympathetic nervous system modulation through the stellate ganglion.Case Ten refractory PLP patients treated with ultrasound-guided stellate ganglion pulsed radiofrequency ablation (SG PRF) after a diagnostic stellate ganglion block took effect: A case series Patients were assessed before and after the treatment at 1 week, 1 month, and 3 months. Significant reductions in pain as measured using a numerical rating scale; Pain Disability Indexwas improved, and Medication Quantification Scale also was improved. Minimal side effects.ConclusionsUltrasound-guided SG PRF has provided promising results for PLP by giving the patient with sustained pain relief and functional improvement without much side effects. Further studies need to be done to validate this finding.

Background: Stellate ganglion block (SGB) is effectively utilized in various sympathetically mediated pain conditions of head and neck, upper limb such as complex regional pain syndrome, postherpetic neuralgias, but there has been a paucity of evidence of SGB for the management of phantom limb pain (PLP). Methods: Ten upper extremity PLP patients underwent ultrasound-guided SGB block. Under real-time needle tip visualization and after ensuring negative aspiration, 5 mL of 1% lignocaine and 4 mg of dexamethasone were injected. Postprocedure pain score (numerical rating scale [NRS]) and patient satisfaction score (Likert scale) were noted, and patients were followed-up for the next 60 days. Results: The baseline NRS score (Mean [standard deviation]) of 7.8 (0.748) showed significant reduction ( P < 0.001) to 2.8 (0.748) at immediate postinjection, to 2.6 (0.663) at day 7, at day 30 (2.9 [0.7]), and at day 60 (30.775). Most of the patients (80%–90%) were somewhat to very much satisfied with the treatment response (score 4–5 on Likert scale) at all the follow-up intervals. Only mild and transient adverse events were demonstrated in two patients who developed hoarseness of voice. Conclusion: Ultrasound-guided SGB effectively reduces pain and improves patient satisfaction in postamputee patients who developed PLP, over 2 months of the follow-up period. Further prospective randomized controlled trials over a larger duration with more sample size are needed to provide more concrete evidence.