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Background: Chronic pain is a major issue affecting more than 50% of the older population and up to 80% of nursing homes residents. Research on pain in the elderly focuses mainly on the development of clinical tools to assess pain in patients with dementia and cognitive impairment or on the efficacy and tolerability of medications. In this review, we searched for evidence of specific pain mechanisms or modifications in pain signals processing either at the cellular level or in the central nervous system. Methods: Narrative review. Results: Investigation on pain sensitivity led to conflicting results, with some studies indicating a modest decrease in age-related pain sensitivity, while other researchers found a reduced pain threshold for pressure stimuli. Areas of the brain involved in pain perception and analgesia are susceptible to pathological changes such as gliosis and neuronal death and the effectiveness of descending pain inhibitory mechanisms, particularly their endogenous opioid component, also appears to deteriorate with advancing age. Hyperalgesia is more common at older age and recovery from peripheral nerve injury appears to be delayed. In addition, peripheral nociceptors may contribute minimally to pain sensation at either acute or chronic time points in aged populations. Conclusions: Elderly subjects appear to be more susceptible to prolonged pain development, and medications acting on peripheral sensitization are less efficient. Pathologic changes in the central nervous system are responsible for different pain processing and response to treatment. Specific guidelines focusing on specific pathophysiological changes in the elderly are needed to ensure adequate treatment of chronic pain conditions.

Background and Objectives: Chronic pain is a significant global health issue, with conventional treatment strategies often proving insufficient or causing undesirable side effects. Interventional pain management techniques, including neuromodulation, have gained increasing interest as alternative therapeutic options. Cryoneurolysis, a technique leveraging extreme cold to modulate pain pathways, has emerged as a promising tool in chronic pain management. However, its efficacy and role within current clinical practice remain under evaluation. Methods: A narrative review was conducted by searching PubMed, Scopus, Embase, and Web of Science databases for studies published between 2010 and 2024 using the keywords “Cryoneurolysis”, “Cryoanalgesia”, “Cryoablation”, and “Chronic pain.” Only English-language studies were included. Studies that examined intraoperative cryoablation or lacked statistical analyses (except case reports) were excluded. Results: A total of 55 studies were included: 4 randomized controlled trials (RCTs), 16 retrospective studies, 4 prospective observational studies, and 31 case reports or small case series. The studies displayed significant heterogeneity in patient selection, targeted nerves, procedural protocols, and follow-up durations. While two RCTs demonstrated a significant pain reduction compared to control groups, other RCTs reported no significant improvement. Observational studies and case reports frequently report positive outcomes, with some achieving complete pain relief. Cryoneurolysis appears to be most effective in treating neuropathic pain, particularly in patients with peripheral nerve involvement. Conclusions: Cryoneurolysis is a safe technique for chronic pain management, which has been successfully applied, particularly for selected neuropathic pain conditions. However, the current evidence is limited by study heterogeneity and a lack of high-quality comparative trials. Further well-designed randomized studies are necessary to define its long-term efficacy and its potential role relative to other interventional pain therapies, such as radiofrequency ablation.

Radiofrequency ablation has been used to treat chronic shoulder pain with mixed results. Thanks to recent anatomical studies, the precise location of articular branches of the suprascapular, lateropectoral and axillary nerves has been determined. Cooled radiofrequency is a neuroablative modality of treatment which has been demonstrated as efficient in different anatomical locations, and targeting the aforementioned nerves could result in a complete and efficient denervation of the shoulder. The aim of this study is to assess the efficacy of a fluoroscopic guided cooled radiofrequency technique for chronic shoulder pain. This is a retrospective observational study performed in two hospital in Wales and Italy (Wrexham NHS trust and Iseo Hospital). Forty-four patients were treated between December 2019 and January 2023. Follow-up was provided at 1-, 6- and 12-months post-procedure. Pain intensity was measured with a 0-10-point Numerical Rating Scale (NRS), and was assessed at rest and during movement. Disability was assessed with the Oxford Shoulder Score (OSS). All patients were treated with cooled radiofrequency under fluoroscopic guidance targeting the articular branches of the suprascapular, axillary and lateropectoral nerves. In the 44 patients treated, the mean NRS significantly decreased at all follow ups, pain relief of >50% was obtained in 70.4%, 61% and 51% of the patients at 1.6 and 12 month follow-ups, respectively. Disability improved significantly, with a mean OSS at 12 months follow up of 30 ±17.5, compared to 15 ± 3 at baseline. Medication intake (non-steroidal anti-inflammatory drugs (NSAIDS) and/or opioids) significantly decreased at all follow ups. Cooled radiofrequency denervation can be an effective procedure to manage chronic shoulder pain, providing sustained pain relief and functional improvement in more than 50% of the patients.

In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasound-guided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.

In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic- or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.

Abstract Objective. To compare two radiofrequency (RF) devices, Simplicity III (conventional RF), and SInergy (cooled RF), which are specifically designed to denervate the sacroiliac joint (SIJ). Design. Retrospective observational study. Setting. Italian National Health Service Public Hospital. Subjects. Forty-three patients with SIJ-derived pain refractory to conservative treatment; 21 and 22 patients, respectively, received Simplicity III or SInergy to denervate the SIJ. Methods. Mean numerical rating scale (NRS) and Oswestry Disability Index (ODI) scores were determined for each study group up to 12 months postprocedure. Secondary outcomes included the average amount of time required to complete each RF procedure and the adverse events associated with each technique. Results. Average SInergy group NRS and ODI scores were consistently less than those in the Simplicity III cohort at each post-RF denervation follow-up, and such differences were statistically significant at six and 12 months. The Simplicity III procedure was completed approximately 2.5 times faster than the SInergy procedure, and one minor adverse event was reported in the SInergy group. Conclusions. The study results suggest that SInergy safely afforded patients with greater and more durable analgesia and disability relief than Simplicity III for SIJ-derived pain. The Simplicity III procedure may be more conducive than SInergy for bilateral procedures and for patients who have limited tolerance to be in an RF procedure–required prone position. Randomized controlled trials are needed to confirm the implication made in this study that SInergy is the preferred RF denervation option for treating SIJ-derived pain and the disability associated with it.

Background: Osteoarthritis of the hip joint is a common cause of pain and disability. Patients not responding to conservative management often cannot undergo joint replacement due to the presence of multiple comorbidities, while some other patients prefer to postpone surgery as long as possible. Radiofrequency denervation of articular branches of the femoral and obturator nerves, which supply innervation of the joint, is a novel technique to reduce hip joint pain. Previous studies reported positive results after application of continuous radiofrequency to the target nerves; however, this approach carries the potential risk of neuritis and neuroma formation. Pulsed radiofrequency (PRF) is a safer alternative to continuous radiofrequency not creating necrosis but a complex neuromodulatory effect on target nerves. There is no published evidence of PRF efficacy after 3 month follow-up. Objectives: This single-center study objective was to evaluate the short and medium term effectiveness of PRF on the femoral articular branches and obturator nerves in patients with chronic hip pain. Study Design: Retrospective single-center study. Setting: Italian National Health Service Public Hospital. Methods: Retrospective analysis of 14 patients treated with PRF for severe hip joint pain (mean numeric rating scale (NRS) 7.7 ± 1.2 mean Oxford Hip Score (OHS) 20 ± 8.4). Mean pain and disability scores were evaluated with NRS and OHS respectively at 1, 3, 6, and 12-month follow-up. All patients were treated with pulsed radiofrequency applied under fluoroscopy on the articular branches of the femoral and obturator nerves for 300 seconds each. Results: Eight patients out of 14 (57%) reported an NRS reduction > 50% at 1 month post procedure. Overall, both pain and disability scores were significantly (P < 0.01) lower at all follow-up until 6 months, mean NRS at 1, 3, and 6 months was 3.6 ± 3; 4.1 ± 3.3; 4.8 ± 2.9 while OHS was 37.6 ± 17.7; 35.8 ± 17.7; 35.8 ± 14 respectively. At 12 months, NRS was 5.8 ± 2.4 while OHS 23.3 ± 12.7, it must be pointed out that even if both scores are significantly (P < 0.01) lower than basal, only 3 patients out of 14 (21%) maintained a NRS reduction > 50% from basal at 12 months post procedure. We reported 2 femoral artery punctures without any significant complication. Limitations: Retrospective study, small sample size. Conclusions: Pulsed radiofrequency is a safe and effective modality to treat hip joint pain in the short and medium term. Definition of positive outcome predictors is required to reserve radiofrequency treatment only for those patients who can benefit from this procedure. Key words: Hip joint pain, pulsed radiofrequency, obturator nerve, femoral nerve, interventional pain management, radiofrequency

Subjects. Forty-three patients with SIJ-derived pain refractory to conservative treatment; 21 and 22 patients, respectively, received Simplicity III or Slnergy to dener-vate the SIJ.

Background: Radiofrequency ablation (RFA) and cryoanalgesia are minimally invasive procedures used when conservative medical management fails and there are positive diagnostic blocks. Although both radiofrequency ablation (RFA) and cryoanalgesia are straightforward techniques, the increasing workload of physicians is leading to less time available for patient interaction, including addressing questions about indications, feasibility, long-term effectiveness, and potential complications. Generative artificial intelligence (AI) chatbots, such as ChatGPT, have the potential to reduce physician burden and enhance patient education. Methods: An expert panel compiled thirteen frequently asked questions about RFA and cryoanalgesia, which were subsequently submitted to ChatGPT-4.0. The AI-generated responses were evaluated by 41 participants, including pain physicians, healthcare professionals, and non-healthcare individuals. The Likert scale was used for evaluating the responses, focusing on reliability, accuracy, and comprehensibility using predefined acceptability thresholds. Results: Across all 13 questions, ChatGPT’s responses demonstrated high overall reliability, with a mean score of 4.9 ± 0.7. The mean accuracy score was 2.6 ± 0.3, suggesting alignment with evidence-based standards. Comprehensibility was rated at 2.7 ± 0.2 on average. Pre-procedural questions achieved the highest scores, while post-procedural questions posed more challenges for ChatGPT. Conclusions: ChatGPT demonstrated potential as an adjunct tool for patient education on RFA and cryoanalgesia. Improvements in procedural specificity and medical accuracy are needed before routine clinical implementation.

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