OBJECTIVE:To evaluate whether lesion duration, aka "burn time" is associated with clinical outcomes following basivertebral nerve ablation (BVNA). DESIGN:Multicenter retrospective cohort study. SETTING:Seven United States pain management and spine care centers including academic, community, and private practice settings. SUBJECTS:: 359 adults with vertebrogenic low back pain (LBP) of at least 6 months' duration with magnetic resonance imaging evidence of Modic Type I or Type II vertebral endplate changes who underwent BVNA between 2022 and 2025. METHODS:Patients were categorized into 3 groups according to radiofrequency lesion duration: Uniform 7-minute lesions (n = 202), uniform 15-minute lesions (n = 59), or mixed-duration lesions combining 7- and 15-minute applications (n = 98). Pain intensity was assessed using the Numeric Rating Scale at baseline and at 1, 3, and 6 months. The primary outcome was ≥50% pain reduction at 6 months. Secondary outcomes included ≥30% and ≥80% improvement and continuous pain change. Multivariable analyses incorporated propensity score-based inverse probability of treatment weighting (IPTW) to adjust for baseline demographic, clinical, and anatomical covariates. Sensitivity analyses included complete-case and worst-case scenarios, as well as alternative IMMPACT-aligned responder thresholds. RESULTS:Responder rates differed across groups, with 54.0% in the 7-minute group, 59.3% in the 15-minute group, and 73.5% in the mixed-duration group (P = .005). In propensity-weighted analyses, mixed-duration lesioning showed higher odds of ≥50% response compared with uniform 15-minute lesions, but this difference did not reach statistical significance (OR 2.01; 95% CI, 0.88-4.59; P = .098), while 15-minute lesioning showed no clear advantage over 7-minute lesions. Continuous measures of pain improvement did not differ across groups. Male sex was associated with lower response, whereas baseline pain severity, symptom duration, and number of treated levels were not. Findings were consistent across sensitivity analyses and alternative responder thresholds. CONCLUSIONS:In this multicenter cohort, mixed-duration BVNA was associated with higher responder rates than uniform lesion strategies, but no statistically significant differences in outcomes were observed across 7-, 15-minutes, or mixed duration strategies after adjustment. The observed variation in lesion strategies underscores the need for prospective studies to evaluate tailored lesioning approaches. CLINICAL TRIAL REGISTRATION:This study was a retrospective observational cohort study and was not registered in a clinical trials registry.

Background: Peripheral nerve stimulation (PNS) is increasingly used in selected patients with neuropathic pain, and many individuals seek supplemental online information to clarify procedural expectations and postoperative care. Large language models such as ChatGPT may provide scalable patient education; however, their performance for PNS-related questions has not been evaluated. This study assessed the reliability, accuracy, and comprehensibility of ChatGPT-5.0 responses to common PNS patient questions. Methods: We conducted a cross-sectional evaluation of ChatGPT-5.0 responses to 21 standardized questions derived through expert consensus, spanning pre-implantation, implantation, and post-implantation domains. Sixteen board-certified interventional pain specialists and a nurse educator independently rated each response using validated scales for reliability (1-6), accuracy (1-3), and comprehensibility (1-3). Descriptive statistics were calculated, and domain-level patterns were examined. Results: Clinician ratings demonstrated generally strong performance across all domains. Mean reliability was 4.7 ± 1.4, mean accuracy 2.6 ± 0.6, and mean comprehensibility 2.8 ± 0.5. Foundational questions addressing mechanisms, expectations, and postoperative care received the highest ratings. Lower ratings were observed for implantation-focused items requiring procedural nuance. No response fell below predefined acceptability thresholds, and sensitivity analyses confirmed that including one partial evaluator did not alter the observed trends. Conclusions: ChatGPT-5.0 generated responses to PNS-related patient questions that clinicians rated as generally reliable, accurate, and understandable, particularly for foundational and postoperative topics. Performance was more variable for procedural questions, underscoring the need for clinician oversight and verification. These findings provide a benchmark of current LLM capabilities and highlight the importance of ongoing evaluation as models evolve and as patients access versions with differing functionalities.

Background:Basivertebral nerve ablation (BVNA) is an established treatment for vertebrogenic low back pain, but the relationship between early post-procedural response and longer-term outcomes remains unclear. Objective:To evaluate whether early pain-response trajectories following BVNA were associated with 12-month clinical outcomes and to identify a clinically useful time point for reassessment. Methods:This prospective multicenter observational cohort study included 140 patients with MRI-confirmed Modic type 1 or 2 changes treated with BVNA between April 2024 and April 2025. Patients reported weekly percent pain relief through 8 weeks, followed by assessments at 3, 6, and 12 months. The primary outcome was ≥50% pain relief at 12 months. Discriminative performance of Week 3 and Week 6 responses was assessed using sensitivity, specificity, likelihood ratios, and receiver operating characteristic analysis. Time to first ≥50% relief was evaluated using Kaplan-Meier methods. Secondary outcomes included changes in Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Patient Global Impression of Change (PGIC), and post-procedural healthcare utilization. Results:At 12 months, 82.1% achieved ≥50% pain relief. The mean NRS improved by 4.3 points and the mean ODI improved by 34 points, with 84.3% and 94.3% achieving Minimally Clinically Important Difference (MCID) thresholds, respectively. The Week 3 response was linked to increased likelihood of 12-month success (LR+ 2.13; LR- 0.25). Discrimination of long-term outcomes was greater at Week 6 when analyzed continuously (AUC 0.96), with an optimal threshold of approximately 38% pain relief. All patients who achieved ≥30% pain relief by Week 6 also achieved clinically meaningful improvement at 12 months, whereas only 50% of those without early improvement achieved this threshold. Most 12-month responders achieved ≥50% relief within 4-6 weeks. Early improvement also corresponded to greater functional recovery and reduced subsequent spine-related interventions. Conclusion:Early pain-response trajectories following BVNA were associated with 12-month outcomes. Clinically meaningful submaximal improvement (≥30%) identified patients who attained durable benefit, whereas absence of early improvement was linked to a lower likelihood of long-term success. These findings suggest that meaningful response signals may emerge before conventional ≥50% responder thresholds are reached, providing a more nuanced framework for interpreting early post-procedural response.

Introduction:Greater trochanteric pain syndrome (GTPS) is a common cause of chronic lateral hip pain and may remain refractory despite pharmacologic therapy, physical therapy, and injection-based interventions. While radiofrequency ablation targeting the trochanteric branch of the femoral nerve has been described as a potential treatment, the use of peripheral nerve stimulation targeting this sensory branch remains limited. Case report:We report a case of refractory GTPS in a 40-year-old woman treated with peripheral nerve stimulation (PNS) followed by dorsal root ganglion stimulation (DRG). Intervention and outcome:A temporary 60-day PNS system targeting the trochanteric branch of the femoral nerve resulted in complete resolution of hip pain during the treatment period. Following recurrence of lateral hip pain after lead removal, persistent longstanding low back and buttock pain prompted DRG stimulation to address the patient's broader preexisting pain distribution. Permanent implantation of right L1-L2 and bilateral S1 DRG leads resulted in approximately 75% reduction in both residual lumbosacral pain and recurrent lateral hip pain, with durable functional improvement. Conclusion:This case highlights the trochanteric branch of the femoral nerve as a potential neuromodulation target for refractory GTPS. Peripheral nerve stimulation may provide a minimally invasive, targeted approach for lateral hip pain, while DRG stimulation may offer broader dermatomal coverage in patients with overlapping pain distributions. Further study is warranted.

Introduction Peripheral nerve stimulation (PNS) delivered for 60 days has emerged as a promising short-term neuromodulation therapy for chronic pain, with early outcomes showing favorable results. However, the ability to predict which patients will sustain long-term benefit remains limited, given existing predictive models have not fully integrated psychosocial and behavioral factors that are increasingly recognized as key modulators of response in chronic pain management. To address this gap, we aimed to identify psychosocial predictors of sustained pain relief at 12 months after 60-day PNS and develop clinically relevant nomograms to guide patient selection and prognostication. Materials and Methods This prospective, multisite observational cohort study enrolled 110 patients who underwent temporary PNS therapy for chronic trunk and/or limb pain. Baseline assessments included demographics, clinical characteristics, and validated psychosocial instruments including the Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, Oswestry Disability Index, and Physical Activity Vital Sign. The primary outcome was ≥50% pain reduction at 12 months. Predictors were evaluated using univariate logistic regression, and two nomograms were developed: one incorporating core clinical features and another integrating psychosocial factors. Model performance was assessed using the area under the curve (AUC), internal validation with 1000 bootstrapped samples, and penalized regression through Least Absolute Shrinkage and Selection Operator. Results A total of 110 participants completed follow-up. Initial 60-day response (odds ratio [OR] 11.09), high physical activity (OR 7.71), and high pain self-efficacy (OR 6.67) were strong positive predictors, whereas pain catastrophizing, insomnia, anxiety, and high baseline disability predicted nonresponse. The clinical nomogram achieved excellent discrimination (AUC = 0.91), whereas the psychosocial-enhanced model showed robust performance (AUC = 0.97). Adverse events were rare and mild, and supplemental treatments were more common in nonresponders. Conclusion Treatment response at 60 days, functional capacity, and psychosocial context meaningfully influence long-term outcomes after temporary PNS. The resulting nomogram models show promise for supporting individualized patient selection and hypothesis generation in future predictive neuromodulation research. However, these findings should be considered preliminary pending external validation in independent cohorts.

OBJECTIVES:To evaluate the impact of health-service (payor type and authorization delays), clinical, and psychosocial domains on outcomes at 6 months following 60-day peripheral nerve stimulation (PNS). DESIGN:Prospective, single-center observational cohort study. SETTING:Academic health system-based outpatient pain clinics. SUBJECTS:In total, 121 adult patients with chronic pain treated with temporary PNS between December 1, 2023, through December 1, 2024. METHODS:Baseline assessments included demographic characteristics, pain, and disability scores. The primary outcome was response to PNS characterized as responders (≥50% relief) and high responders (≥80% relief) at 60-days and 6-month follow-up. Insurance delays were categorized as no delay, short (1-14 days), or long (≥15-day) delay. Multivariate logistic regression identified predictors of response with sensitivity analyses. RESULTS:At 60 days, 66.9% achieved ≥50% relief and 28.9% ≥80%. At 6 months, 78.5% and 44.6% met these thresholds, respectively. Insurance delay and high baseline disability predicted worse outcomes. Each 10-day delay reduced the odds of ≥50% and ≥80% relief by 89% and ≥80%, respectively. The 60-day response strongly predicted 6-month benefit. Psychological and health service factors predominated at 60 days, whereas clinical (opioid use) and demographic variables (including morbid obesity) emerged at 6 months. Delayed response trajectories were observed: 62.5% of 60-day non-responders achieved ≥50% relief and 45.3% reached ≥80% relief at 6 months. CONCLUSIONS:Insurance-related delays, high opioid burden, baseline disability and morbid obesity negatively influenced PNS outcomes, while psychological resilience conferred benefit. Delayed onset responders/high responders highlight the need for longitudinal follow-up and caution against premature discontinuation of PNS therapy.

Abstract Introduction Large language models are increasingly being used in healthcare. In interventional pain medicine, clinical reasoning is essential for procedural planning. Prior studies show that simplified prompts reduce clinical detail in AI-generated responses. It remains unclear whether this reflects knowledge loss or simply prompt-driven suppression of information. Methods We performed a controlled comparative study using 15 standardized low back pain questions representing common interventional pain questions. Each question was submitted to ChatGPT under three conditions, professional-level prompt (DP), fourth-grade reading-level prompt (D4), and clinician-directed rewriting of the D4 response to a medical level (U4→MD). No follow-up prompting was allowed. Three physicians independently rated responses for accuracy using a 0–2 ordinal scale. Clinical completeness was determined by consensus. Word count and Flesch–Kincaid Grade Level (FKGL) were also measured. Paired t-tests compared conditions. Results Accuracy was highest with professional prompting (1.76). Accuracy declined with the fourth-grade prompt (1.33; p = 0.00086). When simplified responses were rewritten for clinicians, accuracy returned to baseline (1.76; p ≈ 1.00 vs DP). Clinical completeness followed the same pattern showing DP 80.0%, D4 6.7%, U4→MD 73.3%. Fourth-grade responses were shorter and less complex. Upscaled responses were more complex and similar in length to professional responses. Inter-rater reliability was low (Fleiss’ κ = 0.17), but trends were consistent across conditions. Conclusions Reduced clinical detail under simplified prompts appears to reflect constrained output rather than loss of knowledge. Clinician-directed reframing restores omitted content. LLM performance in interventional pain depends strongly on prompt design and intended audience.

Cannabis sativa contains more than 120 phytocannabinoids, with Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) being the best characterized. This review synthesizes preclinical and clinical evidence on hemp-derived extracts, cannabinoids, and active compounds. THC primarily acts as a partial agonist at cannabinoid receptor type 1 (CB1) and type 2 (CB2), producing psychoactive, appetite-stimulating, antiemetic, and analgesic effects. CBD is non-intoxicating and has a multimodal profile involving CB1 negative allosteric modulation, CB2 inverse agonism or antagonism, inhibition of anandamide inactivation, and activity at 5-HT1A receptors, transient receptor potential channels, GPR55, and peroxisome proliferator-activated receptor gamma. Preclinical models of Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, epilepsy, and pain support anti-inflammatory, antioxidant, anti-excitotoxic, and glial-modulating mechanisms, but clinical translation remains uneven. The strongest evidence supports FDA-approved cannabidiol for Lennox–Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex, and THC-based agents for refractory chemotherapy-induced nausea and vomiting and AIDS-related anorexia. Moderate-certainty evidence supports nabiximols for multiple sclerosis spasticity and small benefits in selected chronic neuropathic pain populations. Evidence remains insufficient or negative for acute pain, insomnia, most psychiatric disorders, and many promoted indications. Key risks include cannabis use disorder, cognitive and psychiatric effects, cardiovascular events, sedation, high-dose CBD hepatotoxicity, and drug interactions. Rigorous, long-term, product-standardized trials are needed.

Schroth therapy improves outcomes in mild degenerative scoliosis but may be insufficient for patients with vertebrogenic pain linked to vertebral endplate changes. Basivertebral nerve ablation (BVNA) is a novel intervention that may provide additional benefit in these cases. This retrospective, propensity score-matched cohort study included adults aged ≥ 18 years with idiopathic or degenerative scoliosis (Cobb angle ≥ 20°) and vertebrogenic pain, treated between January 1, 2020 and January 31, 2024, across two major healthcare systems. A subset received BVNA between December 5, 2022 and December 5, 2024. Propensity score matching was performed 1:1 for age, sex, body mass index, baseline disability and pain scores, and prior therapy sessions, yielding 44 matched patients (22 per group). The primary outcome was ≥ 15-point improvement in Oswestry Disability Index (ODI) at 12 months. Secondary outcomes included ≥ 3-point pain reduction, opioid and health-resource utilization, and complications. Among 76 patients (mean [standard deviation] age 68.8 [14.8] years; 82.9

Background:Clinical predictors of pain relief with 60-day peripheral nerve stimulation (PNS) remained undefined. Identifying the factors associated with treatment outcomes may improve patient selection and optimize results. Objective:This study examined baseline physical activity, pain, disability, and psychological factors influencing early versus delayed response and non-response to a 60-day PNS. Methods:A prospective, multicenter, observational cohort study was conducted on 73 patients who consecutively received a 60-day PNS. Baseline assessments included pain (numeric rating scale [NRS]), disability (Oswestry Disability Index [ODI]), psychological profiles (Pain Self-Efficacy Questionnaire, PSEQ; Pain Catastrophizing Scale, PCS), and physical activity (physical activity vital signs [PAVS]). Logistic regression and principal component analysis were used to identify the predictors of response phenotypes. Results:Early (≥50% pain relief within 7-14 days of PNS implant that is sustained through the entire 60-day period) and delayed (<50% pain relief in the first 14 days but eventually reaching ≥50% before the end of the 60 days) responder rates were 26% and 43%, respectively. Non-responders (<50% pain relief at the end of the 60-day treatment period) comprised 30.1% of the group. Predictors of early response included high physical activity (OR=4.22, p=0.0006, Area Under the Curve [AUC] =0.81), high pain self-efficacy (OR=1.12, p=0.0004, AUC=0.86), and low catastrophizing (OR=0.88, p=0.0003, AUC=0.86). A delayed response was associated with a longer chronic pain duration (OR=0.83, p=0.027) and high baseline ODI (OR=0.43, p=0.002; AUC=0.79). Nonresponse was linked to psychological distress (eigenvalue =3.23, 40.3% variance), opioid dependency, and morbid obesity (eigenvalue =1.63, 20.4% variance). Conclusion:This real-world study showed that baseline physical activity, psychological resilience, and pain behaviors predicted response to a 60-day PNS. Non-responders presented with psychological distress, morbid obesity, and opioid dependence. These findings may refine patient selection and help to set treatment expectations for 60-day PNS.

Background:ChatGPT and other Large Language Models (LLMs) are not only being more readily integrated into healthcare but are also being utilized more frequently by patients to answer health-related questions. Given the increased utilization for this purpose, it is essential to evaluate and study the consistency and reliability of artificial intelligence (AI) responses. Low back pain (LBP) remains one of the most frequently seen chief complaints in primary care and interventional pain management offices. Objective:This study assesses the readability, accuracy, and overall utility of ChatGPT's ability to address patients' questions concerning low back pain. Our aim is to use clinician feedback to analyze ChatGPT's responses to these common low back pain related questions, as in the future, AI will undoubtedly play a role in triaging patients prior to seeing a physician. Methods:To assess AI responses, we generated a standardized list of 25 questions concerning low back pain that were split into five categories including diagnosis, seeking a medical professional, treatment, self-treatment, and physical therapy. We explored the influence of how a prompt is worded on ChatGPT by asking questions from a 4th grader to a college/reference level. One board certified interventional pain specialist, one interventional pain fellow, and one emergency medicine resident reviewed ChatGPT's generated answers to assess accuracy and clinical utility. Readability and comprehensibility were evaluated using the Flesch-Kincaid Grade Level Scale. Statistical analysis was performed to analyze differences in readability scores, word count, and response complexity. Results:How a question is phrased influences accuracy in statistically significant ways. Over-simplification of queries (e.g. to a 4th grade level) degrades ChatGPT's ability to return clinically complete responses. In contrast, reference and neutral queries preserve accuracy without additional engineering. Regardless of how the question is phrased, ChatGPT's default register trends towards technical language. Readability remains substantially misaligned with health literacy standards. Verbosity correlates with prompt type, but not necessarily accuracy. Word count is an unreliable proxy for informational completeness or clinical correctness in AI outputs and most errors stem from omission, not commission. Importantly, ChatGPT does not frequently generate false claims. Conclusion:This analysis complicates the assumption that "simpler is better" in prompting LLMs for clinical education. Whereas earlier work in structured conditions suggested that plain-language prompts improved accuracy, our findings indicate that a moderate reading level, not maximal simplicity, yields the most reliable outputs in complex domains like pain. This study further supports that AI LLMs can be integrated into a clinical workflow, possibly through electronic health record (EHR) software.

Background:Basivertebral nerve ablation (BVNA) is an FDA-cleared treatment for vertebrogenic low back pain. However, limited data exist detailing the specific timing and durability of patient-reported relief. Objective:To characterize the weekly temporal trajectory of patient-reported ≥50 % pain relief and evaluate the predictive value for short-term and sustained response. Methods:This prospective observational cohort study included 86 consecutive patients with MRI-confirmed Modic Type 1 or 2 changes treated with intraosseous BVNA between April 2024 and April 2025 at an academic center. Patients reported weekly pain relief for 8 weeks, then again at 12 and 24 weeks. Primary outcomes were time to first ≥50 % relief and the positive and negative likelihood ratios (LR+, LR-) of early improvement for predicting response. Secondary outcomes included changes in Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and adjunctive spine interventions. Results:Pain reduction was rapid and durable: By Week 1, 34 % of patients achieved ≥50 % relief, increasing to 76 % by Week 3 and 91 % by Week 6. These improvements plateaued through Week 12 and persisted at 24 weeks. Median time to first ≥50 % relief was 3 weeks. Early responders (Week 3) were 6.6 times more likely to maintain relief at Week 12 (LR+ = 6.56, 95 % CI 2.50-17.0); predictive utility peaked at Weeks 4-6 (LR+ 7.1-9.0; LR- ≤ 0.13). Mean ODI improved from 66.5 ± 13.5 to 32.3 ± 15.8 and NRS from 8.3 ± 1.5 to 3.0 ± 2.6 (p < 0.0001 for both). Nearly 90 % achieved ≥15-point ODI and ≥2-point NRS improvement; 21 % were pain-free by Week 12. Use of adjunctive spine injections declined from 86 % pre-procedure to 22 % post-procedure (p < 0.0001). Conclusion:This is the first study to prospectively characterize the weekly time course of response following BVNA and demonstrates early, substantial, and durable improvements in pain and function. Most patients experienced meaningful relief within 3-6 weeks, and early response was sustained through 24 weeks. These findings support BVNA as a robust real-world intervention for vertebrogenic pain and highlight the prognostic value of early pain trajectory monitoring in predicting sustained outcomes.

Background:This meta-analysis is an update to a seminal meta-analysis on racial/ethnic disparities in pain treatment in the United States (US) published in 2012. Since then, literature has accumulated on the topic and important policy changes were made. Objective:Examining racial/ethnic disparities in pain management and investigating key moderators of the association between race/ethnicity and pain outcomes in the US. Methods:We performed a systematic search of publications (between January 2011 and February 2021) from the Scopus database. Search terms included: race, racial, racialized, ethnic, ethnicity, minority, minorities, minoritized, pain treatment, pain management, and analgesia. All studies were observational, examining differences in receipt of pain prescription medication in various settings, across racial or ethnic categories in US adult patient populations. Two binary analgesic outcomes were extracted: 1) prescription of "any" analgesia, and 2) prescription of "opioid" analgesia. We analyzed these outcomes in two populations: 1) Black patients, with White patients as a reference; and 2) Hispanic patients, with non-Hispanic White patients as a reference. Results:The meta-analysis included twelve studies, and the systematic review included forty-three studies. Meta-analysis showed that, compared to White patients, Black patients were less likely to receive opioid analgesia (OR 0.83, 95% CI [0.73-0.94]). Compared to non-Hispanic White patients, Hispanic patients were less likely to receive opioid analgesia (OR 0.80, 95% CI [0.72-0.88]). Conclusion:Despite a decade's gap, the findings indicate persistent disparities in prescription of, and access to opioid analgesics for pain among Black and Hispanic populations in the US.

Stroke is a disease of disparities, with tremendous racial and ethnic inequities in incidence, prevalence, treatment, and outcomes. The accumulating literature on the relationship between stroke and social determinants of health (ie, the structural conditions of the places where people live, learn, work, and play) contributes to our understanding of stroke inequities. Several interventions have been tested concurrently to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factor control. It is regrettable that no common theoretical framework has been used to facilitate comparison of interventions. In this scientific statement, we summarize, across the stroke continuum of care, trials of interventions addressing racial and ethnic inequities in stroke care and outcomes. We reviewed the literature on interventions to address racial and ethnic inequities to identify gaps and areas for future research. Although numerous trials tested interventions aimed at reducing inequities in prehospital, acute care, transitions in care, and poststroke risk factor control, few addressed inequities in rehabilitation, recovery, and social reintegration. Most studies addressed proximate determinants (eg, medication adherence, health literacy, and health behaviors), but upstream determinants (eg, structural racism, housing, income, food security, access to care) were not addressed. A common theoretical model of social determinants can help researchers understand the heterogeneity of social determinants, inform future directions in stroke inequities research, support research in understudied areas within the continuum of care, catalyze implementation of successful interventions in additional settings, allow for comparison across studies, and provide insight into whether addressing upstream or downstream social determinants has the strongest effect on reducing inequities in stroke care and outcomes.

Introduction:Pain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS.Methods and materials:We convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice.Results:Thirteen assessment and treatment recommendations were produced regarding pain in children with MS.Discussion:Future studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting.

Introduction The peripheral nervous system is an increasingly popular target for chronic pain treatment modalities. Noninvasive neuromodulation has shown promise at providing significant chronic pain relief with a much safer side effect profile. This retrospective pilot study is shaped around a noninvasive neuromodulation system over a 2-week treatment timeline. Methods Open-label survey of chronic pain patients recruited from Veteran Affairs, orthopedic, and pain health systems. If a noninvasive neuromodulation system was prescribed the patients were then offered a 2-week follow-up survey. This voluntary survey did not affect their therapy duration or quality. This survey was designed to address similar metrics as smaller noninvasive neuromodulation studies to allow a quality comparison while giving more power with a large population size of 1511 patients. Overall pain scores (including before and after scores), satisfaction level, desire to continue therapy, medication use, effect on functional metrics (mood, sleep, sit, stand, walk, and lift), and activities of daily living (ADL) scores were assessed. Results The results demonstrated an overall pain reduction of 46%. All functional metrics were improved throughout with the largest improvements reported in mood and sleep at over 47%. Medication use was reported as decreased or eliminated in 42% of patients. There were no adverse reactions or complications reported over the 1511 patients. Conclusion This survey is amongst the largest population sizes every studied for noninvasive neuromodulation. Within just 2 weeks patients can see a reduction in overall pain and medication needs. Although survey studies have inherent limitations such as duration and compliance biases with such an overwhelming benefit in every category we believe that noninvasive neuromodulation therapy is a promising, safe, and cost-effective therapy. Future studies should focus on long-term follow-ups and post-therapy pain scores with a placebo group.

Mobility impairments are a common symptom of age-related degenerative diseases. Gait features can discriminate those with mobility disorders from healthy individuals, yet phenotyping specific pathologies remains challenging. This study aims to identify if gait parameters derived from two foot-mounted inertial measurement units (IMU) during the 6 min walk test (6MWT) can phenotype mobility impairment from different pathologies (Lumbar spinal stenosis (LSS)-neurogenic diseases, and knee osteoarthritis (KOA)-structural joint disease). Bilateral foot-mounted IMU data during the 6MWT were collected from patients with LSS and KOA and matched healthy controls (N = 30, 10 for each group). Eleven gait parameters representing four domains (pace, rhythm, asymmetry, variability) were derived for each minute of the 6MWT. In the entire 6MWT, gait parameters in all four domains distinguished between controls and both disease groups; however, the disease groups demonstrated no statistical differences, with a trend toward higher stride length variability in the LSS group (p = 0.057). Additional minute-by-minute comparisons identified stride length variability as a statistically significant marker between disease groups during the middle portion of 6WMT (3rd min: p ≤ 0.05; 4th min: p = 0.06). These findings demonstrate that gait variability measures are a potential biomarker to phenotype mobility impairment from different pathologies. Increased gait variability indicates loss of gait rhythmicity, a common feature in neurologic impairment of locomotor control, thus reflecting the underlying mechanism for the gait impairment in LSS. Findings from this work also identify the middle portion of the 6MWT as a potential window to detect subtle gait differences between individuals with different origins of gait impairment.

IMPORTANCE Identifying gaps in inclusivity of Indigenous individuals is key to diversifying academic medical programs, increasing American Indian and Alaska Native representation, and improving disparate morbidity and mortality outcomes in American Indian and Alaska Native populations. OBJECTIVE To examine representation of American Indian and Alaska Native individuals at different stages in the 2018-2019 academic medical training continuum and trends (2011-2020) of American Indian and Alaska Native representation in residency specialties. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, population-based analysis was conducted using self-reported race and ethnicity data on trainees from the Association of American Medical Colleges (2018), the Accreditation Council for Graduate Medical Education (2011-2018), and the US Census (2018). Data were analyzed between February 18, 2020, and March 4, 2021. EXPOSURES Enrolled trainees at specific stages of medical training. MAIN OUTCOMES AND MEASURES The primary outcome was the odds of representation of American Indian and Alaska Native individuals at successive academic medical stages in 2018-2019 compared with White individuals. Secondary outcomes comprised specialty-specific proportions of American Indian and Alaska Native residents from 2011 to 2020 and medical specialty-specific proportions of American Indian and Alaska Native physicians in 2018. Fisher exact tests were performed to calculate the odds of American Indian and Alaska Native representation at successive stages of medical training. Simple linear regressions were performed to assess trends across residency specialties. RESULTS The study data contained a total of 238 974 607 White and American Indian and Alaska Native US citizens, 24 795 US medical school applicants, 11 242 US medical school acceptees, 10 822 US medical school matriculants, 10 917 US medical school graduates, 59 635 residents, 518 874 active physicians, and 113 168 US medical school faculty. American Indian and Alaska Native individuals had a 63% lower odds of applying to medical school (odds ratio [OR], 0.37; 95% CI, 0.31-0.45) and 48% lower odds of holding a full-time faculty position (OR, 0.52; 95% CI, 0.44-0.62) compared with their White counterparts, yet had 54% higher odds ofworking in a residency specialty deemed as a priority by the Indian Health Service (OR, 1.54; 95% CI, 1.09-2.16). Of the 33 physician specialties analyzed, family medicine (0.55%) and pain medicine (0.46%) had more than an average proportion (0.41%) of American Indian and Alaska Native physicians compared with their representation across all specialties. CONCLUSIONS AND RELEVANCE This cross-sectional study noted 2 distinct stages in medical training with significantly lower representation of American Indian and Alaska Native compared with White individuals. An actionable framework to guide academic medical institutions on their Indigenous diversification and inclusivity efforts is proposed.