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Clinical Advances in Pain Management
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Clinical Advances in Pain Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 29 August 2025 | Viewed by 3409

Special Issue Editors

Dr. Jamal Hasoon

E-Mail Website
Guest Editor
McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
Interests: peripheral nerve stimulation; spinal cord stimulation; interventional pain procedures; prescription patterns in pain medicine; practice patterns in pain medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Omar Viswanath

E-Mail Website
Guest Editor
Department of Anesthesiology, Creighton University School of Medicine, Phoenix, AZ, USA
Interests: pain management; acute pain; chronic pain; neuralgia; anesthesiology

Special Issue Information

Dear Colleagues,

Chronic pain remains a global health challenge, affecting millions and significantly impacting quality of life. The field of pain management has seen remarkable advancements in recent years, driven by innovative interventional procedures, emerging pharmacological therapies, and a deeper understanding of the complex mechanisms underlying pain. This Special Issue, Clinical Advances in Pain Management, aims to showcase cutting-edge research and clinical strategies that are shaping the future of pain care.

This Special Issue covers a broad spectrum of cutting-edge topics in pain management. Among them are innovative minimally invasive therapies for conditions like spinal stenosis, advancements in neuromodulation techniques such as spinal cord and peripheral nerve stimulation, and significant breakthroughs in regenerative medicine approaches. This Special Issue also explores the use of ultrasound-guided regional blocks for acute and chronic pain, highlighting their efficacy and growing role in clinical practice. Additionally, it emphasizes evidence-based strategies for pharmacological management, focusing on optimizing opioid use.

With contributions from leading experts in pain medicine, this Special Issue seeks to provide clinicians, researchers, and healthcare professionals with actionable insights and practical updates to enhance patient care. By bridging the gap between research and clinical practice, this compilation emphasizes innovation, safety, and patient-centered approaches to tackling acute and chronic pain.

We invite you to explore these transformative advancements that continue to redefine pain management and improve patient outcomes.

Dr. Jamal Hasoon
Dr. Omar Viswanath
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • postoperative pain
  • acute pain
  • chronic pain
  • nociceptive
  • analgesia
  • analgesics
  • interventional pain procedures

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Published Papers (5 papers)

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Research

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10 pages, 204 KiB  
Article
Repeat Genicular Nerve Cooled Radiofrequency Ablation: Retained Efficacy or Diminishing Returns?
by James N. Nitz, Barnabas T. Shiferaw, Michael J. Bartley, Jarod R. Moyer, Kylie K. Ruprecht, Andrew Y. Matta and Alaa Abd-Elsayed
J. Clin. Med. 2025, 14(12), 4194; https://doi.org/10.3390/jcm14124194 - 12 Jun 2025
Viewed by 306
Abstract
Introduction: Radiofrequency ablation (RFA) of the genicular nerve is an increasingly common treatment for chronic knee pain, refractory to conservative measures. However, RFA often provides significant but temporary relief, and patients return for repeat RFAs for the treatment of their pain. This study [...] Read more.
Introduction: Radiofrequency ablation (RFA) of the genicular nerve is an increasingly common treatment for chronic knee pain, refractory to conservative measures. However, RFA often provides significant but temporary relief, and patients return for repeat RFAs for the treatment of their pain. This study investigates the efficacy of repeat RFAs compared to the initial RFA for patients who receive repeat RFAs for chronic knee pain. Methods: This study is a retrospective chart review and analysis that was conducted between 2015 and 2023. Groups were determined by the number of RFA procedures that patients received, and a one-tailed ANOVA test was performed to assess the statistical significance of the initial RFA and the three repeat RFA groups. A one-way ANOVA was performed to analyze statistical differences between percent improvement, preoperative pain scores, and the duration of improvement using the visual analog scale (VAS). A p-value of statistical significance was set at p < 0.05. A paired two-tailed T-test was carried out, individually comparing the initial RFA to the three repeat groups for percent improvement. A paired t-test was also carried out to compare initial and first repeat RFAs for preoperative pain score and duration of improvement. Results: A total of 42 patients underwent repeat RFA procedures, with 8 receiving bilateral treatments, totaling 50 knees and 116 procedures. The original RFA group demonstrated a mean percent improvement of 75% ± 25% (mean ± SD) and a duration of improvement of 9.46 ± 5.45 months. The first repeat group had a mean percent improvement of 66% ± 29% and a duration of improvement of 8.77 ± 7.32 months. The second repeat group had a mean percent improvement of 67% ± 24% and a duration of improvement of 10.00 ± 2.45 months. The third repeat group had a mean percent improvement of 85% ± 20% and a duration of improvement of 4.00 months. ANOVA revealed no statistically significant differences among the groups in preoperative scores (p = 0.40), percent improvement (p = 0.25), or duration of improvement (p = 0.79). Paired t-tests showed a significant decrease in percent improvement in the first repeat RFA compared to the original RFA (p = 0.04), but no significant differences were observed in preoperative scores (p = 0.057) or duration of improvement (p = 0.175). No significant differences were found in percent improvement via paired T-test between the original RFA and the second (p = 0.75) or third repeats (p = 0.21). Conclusions: The repeat RFA of genicular nerves retains a clinically significant level of pain reduction for chronic knee pain. However, this study demonstrated decreased pain relief following the first repeat RFA compared to the initial RFA when analyzing individual knees sequentially via a paired T-test. An analysis of initial, first, second, and third repeat groups via ANOVA showed no difference in percent improvement, duration of pain relief, or preoperative pain scores. Full article
(This article belongs to the Special Issue Clinical Advances in Pain Management)
13 pages, 870 KiB  
Article
Retrospective Analysis of Cement Extravasation Rates in Vertebroplasty, Kyphoplasty, and Bone Tumor Radiofrequency Ablation
by Soun Sheen, Prit Hasan, Xiaowen Sun, Jian Wang, Claudio Tatsui, Kent Nouri and Saba Javed
J. Clin. Med. 2025, 14(9), 2908; https://doi.org/10.3390/jcm14092908 - 23 Apr 2025
Viewed by 626
Abstract
Background: Percutaneous vertebral augmentation techniques, including vertebroplasty, kyphoplasty, and bone tumor radiofrequency ablation (BT-RFA), are commonly used to treat painful vertebral compression fractures (VCFs). While generally safe and effective, they carry risks, including cement extravasation, which can lead to pulmonary embolism or spinal [...] Read more.
Background: Percutaneous vertebral augmentation techniques, including vertebroplasty, kyphoplasty, and bone tumor radiofrequency ablation (BT-RFA), are commonly used to treat painful vertebral compression fractures (VCFs). While generally safe and effective, they carry risks, including cement extravasation, which can lead to pulmonary embolism or spinal cord compression. This study aims to compare the rate of cement extravasation across different vertebral augmentation techniques and identify potential risk factors. Methods: A retrospective cohort study was conducted at a comprehensive cancer center on 1002 procedure encounters in 888 patients who underwent vertebral augmentation for painful VCFs. Data were collected on patient demographics, fracture pathology, procedure type, imaging guidance, and pain scores. Intraoperative and postoperative imaging were manually reviewed to assess cement extravasation. Statistical analyses were performed using pairwise comparisons with Tukey’s Honest Significant Difference adjustment to compare cement extravasation rates across the procedure groups and generalized linear mixed models to assess the association between the cement extravasation with other variables. Results: Cement extravasation occurred in 573 (57.2%) encounters. Kyphoplasty had the lowest rate of cement extravasation (46.2%) with significantly lower odds compared to vertebroplasty (OR: 0.42, 95% CI: 0.30–0.58; p < 0.0001) and BT-RFA (OR: 0.57, 95% CI: 0.42–0.77; p = 0.0009). Pathologic fractures and multilevel augmentations were linked to a 64% (p = 0.001) and 63% (p = 0.0003) increased odds of cement extravasation, respectively. Male sex and older age were protective factors. Conclusions: Cement extravasation is a common but largely asymptomatic complication of percutaneous vertebral augmentation. It is crucial to consider patient-specific risk factors when selecting an augmentation technique to optimize outcomes. Kyphoplasty may be the optimal choice for patients at increased risk of cement extravasation. Full article
(This article belongs to the Special Issue Clinical Advances in Pain Management)
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13 pages, 933 KiB  
Article
Trends in Celecoxib Prescribing: A Single Institution 16-Month Review
by Ivo H. Cerda, Helen Jung, Maria C. Guerrero, Rodrigo Diez Tafur, Robert Jason Yong, Christopher L. Robinson and Jamal J. Hasoon
J. Clin. Med. 2025, 14(8), 2823; https://doi.org/10.3390/jcm14082823 - 19 Apr 2025
Viewed by 955
Abstract
Background/Objectives: Celecoxib, a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID), is widely prescribed for pain management due to its efficacy and improved gastrointestinal safety profile compared to traditional NSAIDs. Understanding prescription trends and their comparison to other NSAIDs provides valuable insight into prescribing behaviors [...] Read more.
Background/Objectives: Celecoxib, a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID), is widely prescribed for pain management due to its efficacy and improved gastrointestinal safety profile compared to traditional NSAIDs. Understanding prescription trends and their comparison to other NSAIDs provides valuable insight into prescribing behaviors in clinical settings. Methods: This retrospective study analyzed celecoxib prescriptions written by three pain management physicians in a single institution over a 16-month period from 1 January 2023 to 30 April 2024. Prescription data were collected and grouped into four 4-month intervals to assess temporal trends. Additionally, we compared celecoxib prescriptions to other commonly prescribed NSAIDs, including ibuprofen, meloxicam, naproxen, and diclofenac. Results: A total of 143 celecoxib prescriptions were identified during the study period, with a steady increase observed across consecutive intervals: 8 prescriptions from January–April 2023, 22 from May–August 2023, 46 from September–December 2023, and 67 from January–April 2024. In comparison, a total of 165 prescriptions were written for other NSAIDs over the same period, with 26 prescriptions from January–April 2023, 41 from May–August 2023, 45 from September–December 2023, and 53 from January–April 2024. While prescriptions for both celecoxib and other NSAIDs increased over time, the rate of celecoxib prescriptions showed a steeper rise. Conclusions: The findings demonstrate a notable increase in celecoxib prescriptions in this pain management clinic, outpacing the growth of other NSAIDs. This trend may reflect increasing provider preference for COX-2 selective inhibitors due to their favorable safety profile and efficacy. Further research is warranted to explore the underlying factors driving these prescribing patterns. Full article
(This article belongs to the Special Issue Clinical Advances in Pain Management)
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Review

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12 pages, 655 KiB  
Review
Supra Inguinal Fascia Iliac Versus PENG Block for Post-Operative Pain Management of Hip Arthroplasty: A Narrative Review
by Shahab Ahmadzadeh, Megan S. Walker, Mary O’Dell Duplechin, Drake P. Duplechin, Charles J. Fox, Sahar Shekoohi and Alan D. Kaye
J. Clin. Med. 2025, 14(12), 4050; https://doi.org/10.3390/jcm14124050 - 7 Jun 2025
Viewed by 470
Abstract
Effective post-operative pain management following hip arthroplasty is critical to improving recovery, reducing opioid consumption, enhancing mobility, and reducing the risk of complications for patients. Multimodal anesthesia strategies, including the supra inguinal fascia iliac block (SIFIB) and the periarticular nerve group (PENG) block [...] Read more.
Effective post-operative pain management following hip arthroplasty is critical to improving recovery, reducing opioid consumption, enhancing mobility, and reducing the risk of complications for patients. Multimodal anesthesia strategies, including the supra inguinal fascia iliac block (SIFIB) and the periarticular nerve group (PENG) block have become the new point of focus as opposed to traditional methods previously used. This narrative review compares the SIFIB and the PENG block in their efficacy to treat post-operative pain management. Mechanism of action, safety, patient outcomes, and clinical applications are compared between the two blocks for evaluation. Clinical studies have indicated that both blocks reduce post-operative pain and reduce opioid use. In contrast, SIFIB has shown to be more preferred in more complex procedures such as total hip arthroplasty, which requires extensive nerve coverage despite its longer onset time. The SIFIB has been shown to carry a higher risk of impairing motor function, making the PENG highly preferred in patients where quick mobility improvement is prioritized. The PENG block also showed slightly higher efficacy in reducing pain associated with post-operative passive limb movements, and a slight decrease in opioid consumption in comparison to SIFIB in the early post-operative time frame. Although the PENG shows more benefits in the early stages of post-operative recovery, the SIFIB shows similar outcomes to PENG over longer durations of recovery. Future studies can aid in establishing a framework for tailoring block selection to individual patient needs to optimize clinical outcomes. Full article
(This article belongs to the Special Issue Clinical Advances in Pain Management)
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Other

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14 pages, 2103 KiB  
Case Report
Patient-Reported Outcomes with Peripheral Nerve Stimulation for Low Back Pain from Vertebral Plana Deformities: A Case Series
by Saba Javed, Loc Lam, Angela Nwankwo and Zaur Komachkov
J. Clin. Med. 2025, 14(11), 3964; https://doi.org/10.3390/jcm14113964 - 4 Jun 2025
Viewed by 502
Abstract
Objectives: This study evaluated peripheral nerve stimulation (PNS) as a treatment for vertebra plana fractures, focusing on its impact on pain intensity, physical function, anxiety, depression, fatigue, social role participation, and pain interference. The goal was to assess whether PNS could serve as [...] Read more.
Objectives: This study evaluated peripheral nerve stimulation (PNS) as a treatment for vertebra plana fractures, focusing on its impact on pain intensity, physical function, anxiety, depression, fatigue, social role participation, and pain interference. The goal was to assess whether PNS could serve as a minimally invasive alternative for managing pain in patients with severe vertebral fractures. Methods: Four patients with lumbar vertebra plana fractures received PNS implants for 60 days. Pain scores and PROMIS-29 domains (physical function, anxiety, depression, fatigue, social participation, and pain interference) were assessed at 30, 60, 90, 180, and 365 days post-implantation. Data analysis included mean and standard deviation calculations. Results: PNS led to marked improvements in pain-related outcomes. The average pain intensity scores dropped from 8.5 at baseline to 4.25 at one year, and pain interference scores declined from 61.75 to 54.75. Physical function initially decreased but improved from 38.5 at three months to 46.75 at one year. Changes in depression, anxiety, fatigue, and social participation were minimal, reflecting their multifactorial nature and limited response to pain relief alone. Conclusions: This case series suggests that PNS may significantly reduce pain and pain interference while enhancing physical function in patients with vertebra plana fractures. Its sustained benefits highlight PNS as a promising minimally invasive treatment, especially for those ineligible for traditional procedures. However, the limited improvement in psychological and social domains underscores the need for comprehensive care strategies. Further research is warranted to explore the broader role of PNS in managing vertebral fracture pain. Full article
(This article belongs to the Special Issue Clinical Advances in Pain Management)
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