bluuebunny/crossref_metadata_2025 huggingface dataset:
Image Caption Generator
Authors:   Department. of Computer science and Engineering Delhi Technical Campus GGSIPU, Delhi, India., Panicker Megha J , Upadhayay Vikas ,   Department. of Computer science and Engineering Delhi Technical Campus GGSIPU, Delhi, India., Sethi Gunjan ,   Department. of Computer science and Engineering Delhi Technical Campus GGSIPU, Delhi, India., Mathur Vrinda ,   Department. of Computer science and Engineering Delhi Technical Campus GGSIPU, Delhi, India.
Published: February 2021

In the modern era, image captioning has become one of the most widely required tools. Moreover, there are inbuilt applications that generate and provide a caption for a certain image, all these things are done with the help of deep neural network models. The process of generating a description of an image is called image captioning. It requires recognizing the important objects, their attributes, and the relationships among the objects in an image. It generates syntactically and semantically correct sentences. In this paper, we present a deep learning model to describe images and generate captions using computer vision and machine translation. This paper aims to detect different objects found in an image, recognize the relationships between those objects and generate captions. The dataset used is Flickr8k and the programming language used was Python3, and an ML technique called Transfer Learning will be implemented with the help of the Xception model, to demonstrate the proposed experiment. This paper will also elaborate on the functions and structure of the various Neural networks involved. Generating image captions is an important aspect of Computer Vision and Natural language processing. Image caption generators can find applications in Image segmentation as used by Facebook and Google Photos, and even more so, its use can be extended to video frames. They will easily automate the job of a person who has to interpret images. Not to mention it has immense scope in helping visually impaired people.
Using ANP to Evaluate Factors Affecting Construction Project s Performance
Authors:   Structural Engineering Department, Arab Academy for Science Technology and Maritime Transport – Cairo Campus., M.S Shided , Rashid I Abdel ,   Professor, Faculty of Engineering, Ain Shams University, Egypt., O.D EL Monayeri ,   Associate Professor, Faculty of Engineering, Arab Academy for Science Technology and Maritime Transport – Cairo Campus., Sayad EL ,   M . A, Ph.D., Faculty of Engineering, Arab Academy for Science Technology and Maritime Transport – Cairo Campus.
Published: February 2021

The Analytic Network Process (ANP) approach was applied to evaluate the overall project performance. The interdependencies between the performance factors in sanitation infrastructure projects have been modeled, and their cumulative influences were simulated and quantified. This model focuses on the planning and construction phase of projects under unit price contracts and is intended for use by owners, supervision consulting firms (Owner’s representative) and/or contractors as well. The proposed model assist both owners, consultants and contractors in controlling projects during the different phases and can also be used as a basis for simulation of various managerial scenarios/interventions to explore the best solution to correct the negative effect of poor performance. The proposed model is generic and may be applicable to almost any project in the construction industry, since all projects, regardless of size or type, follow a broadly similar pattern of development. This model focuses on the two phases; planning phase and construction phase of a project and is intended for implementation by both owners and contractors. Although the proposed evaluation model reflects to a great extent the contractors’ preferences, most contractors perceive performance according to project objectives and contractual aspects. The model also reflects to some extent the owner’s and or its consultant’s interventions within the different project cycle. Therefore, the objective of this research is not to standardize the priorities of performance factors, but rather to establish a systematic framework for consistent and quantitative evaluation process for performance of planning and construction of sanitation infrastructure projects in Egypt that take into consideration the interdependencies between multi dimensional performance factors.
Selección de participantes en la investigación: ejemplificación para un contexto intergeneracional
Authors:   Universidad de La Rioja, Sáenz de Jubera Ocón Magdalena , Sanz Arazuri Eva ,   Universidad de La Rioja, Valdemoros San Emeterio M.ª Ángeles ,   Universidad de La Rioja, Ponce de León Elizondo Ana ,   Universidad de La Rioja, Alonso Ruiz Rosa Ana ,   Universidad de La Rioja
Published: February 2021

La selección de participantes es una de las fases fundamentales en la investigación educativa y social, independientemente de que el enfoque del estudio sea cualitativo, cuantitativo o mixto. El análisis objetivo y riguroso de la realidad exige de los investigadores una clara delimitación de la población objeto de estudio, de manera que se han de establecer los criterios para selección de los casos, dado que serán el referente para configurar de forma minuciosa el subconjunto de la población a examen, que se conoce como muestra. En la investigación cuantitativa es deseable que la muestra sea representativa, para lo cual se ha de atender exhaustivamente a la definición y selección del tipo de muestreo y del tamaño muestral, de modo que permita hacer inferencias sobre la población. A la hora de calcular el tamaño muestral representativo, el investigador tomará decisiones relativas a tres factores: nivel de confianza, error de muestreo y proporción en la que se da la característica de estudio en la población. En la investigación cualitativa suelen utilizarse muestras pequeñas no aleatorias, seleccionadas según los criterios que establece el investigador, ya que no suele ser elegida para representar a la población y su intención suele focalizarse en profundizar en el problema de investigación. Por ello, el diseño muestral está íntimamente vinculado al objeto de estudio, que tendrá su muestra específica, intencional y estructural. La triangulación de técnicas cuantitativas y cualitativas en un estudio podría consolidar la descripción, comprensión y explicación de los fenómenos sociales.
Análisis del contexto y posibilidades socioeducativas
Authors:   Universidad Autónoma de Madrid, Rodrigo Moriche María Pilar , Del Pozo Serrano Francisco José ,   Universidad Complutense de Madrid, de Valenzuela Bandín Ángela L. ,   Universidad de Santiago de Compostela
Published: February 2021

La intervención socioeducativa se vincula con un conjunto de dimensiones, factores y relaciones que acontecen en un contexto. Un análisis pertinente de la realidad va a condicionar la planificación del proceso, así como la eficacia de los resultados. Estudiar un contexto determinado requiere de estrategias analíticas que permitan evaluar la realidad y detectar sus problemas y características y, a su vez, valerse de estrategias creativas y fundamentadas que proyecten posibilidades de acción. Iniciamos este capítulo mostrando la importancia de la rigurosidad de las fuentes, así como de la sistematización en el análisis y la adopción de una perspectiva sistémica y holística para analizar cualquier organización o territorio. A continuación, presentamos como esencial e indispensable para el interés de cualquier profesional de este ámbito un procedimiento metodológico que evalúa las necesidades y las capacidades a través de tres fases: preevaluativa, evaluativa y posevaluativa. Por último, exponemos algunos principios para el análisis de redes socioeducativas, entendidos como herramienta que permite analizar la complejidad de las organizaciones, los territorios o las poblaciones desde las alianzas y la corresponsabilidad que establecen con su entorno.
Posture Influences the Extent of Spread
of Contrast Medium During Thoracic
Epidurography: A Prospective Randomized Trial
Authors: Hong Ji Hee
Published: February 2021

Background: Various factors influencing the distribution of sensory blockade in epidural
anesthesia have been identified; however, reports on the effects of gravity and different postures in
thoracic epidural anesthesia have been rare. Medications may be injected with the lateral decubitus
or the neutral position; however, it is unclear whether the distribution range of medication is
similar or significantly different between these 2 postures.
Objective: We focused on identifying the effect of different postures on the distribution of local
anesthetics using epidurography at the thoracic level.
Study Design: Prospective randomized trial.
Setting: An interventional pain management practice in South Korea.
Methods: A total of 68 patients were randomized to either the L group (n = 34, lateral decubitus
with neck and hip flexion) or the P group (n = 34, prone position). After completing the insertion
of the epidural catheter, the location of the catheter tip was adjusted between T7 and T8 and
the patients were asked to change their posture according to their allocated group. Three mL of
contrast medium was injected and the total number of segments, including the most cranial and
caudal ends of the vertebra, was identified.
Results: The total number of vertebral segments confirmed by contrast medium spread was
7.4 ± 2.2 in group P and 9.2 ± 1.8 in group L. The total number and the number of vertebral
segments covered in the caudad direction were higher in group L compared to
group P and this was statistically significant (P < 0.001).
Limitations: We made every effort to make the posture of group L like crouchback, we
think that slight differences would present in the flexion angles of the neck and hip among the
patients of group L.
Conclusion: Group L demonstrated a more extensive distribution of contrast medium for both
the cranial and caudad directions compared to group P.
Repeated Ganglion Impar Block in a Cohort of
83 Patients with Chronic Pelvic and Perineal
Pain
Authors: Jérôme Rigaud
Published: February 2021

Background: The ganglion impar is the first pelvic ganglion of the efferent sympathetic trunk
that relays pelvic and perineal nociceptive messages and therefore constitutes a therapeutic target.
Objective: The objective of this single-center study was to evaluate the effectiveness of 3 repeated
ganglion impar blocks in patients with chronic pelvic and perineal pain on intention-to-treat.
Study Design: Retrospective single-center study.
Setting: We reviewed the medical records of 83 patients with chronic refractory pelvic and
perineal pain. On intention-to-treat analysis, 62 (74.7%) of the patients received 3 ganglion impar
blocks.
Methods: Ganglion impar block was performed with 0.75% ropivacaine via a lateral approach
over the Co1-Co2 coccygeal joint with computed tomography (CT) guidance. The effectiveness of
ganglion impar blocks was evaluated by visual analogue scale (VAS) before and 30 minutes after
the blocks. Evaluation at least one month after the block was also performed by Patient Global
Impression of Change (PGI-C).
Results: A total of 220 blocks were performed, 193 (87.7%) of which were considered to be
positive with immediate but transient improvement of pain by more than 50% and complete but
transient pain relief after the procedure in 119 (54.1%) procedures. The variation of the VAS score
before and after each block was statistically significant (P < 0.001). Similarly, the VAS score before
repeated blocks was significantly improved with decreased pain intensity over time (P = 0.001).
Analysis of the PGI-C one month after the block demonstrated improvement in 41% of cases in
the overall population and in 43.6% of cases in the subgroup of 62 patients treated by 3 blocks.
Limitations: Retrospective study, short term follow-up.
Conclusions: Repeated ganglion impar blocks allowed short-term reduction of pain intensity
with a moderate intermediate-term effect. Ganglion impar appears to be a useful therapeutic
target to block the nociceptive message by acting on sensitization phenomena.
Lack of Gender and Age Differences in Pain
Measurements Following Exercise in People
with Chronic Whiplash-Associated Disorders
Authors: Ickmans Kelly
Published: February 2021

Background: Individuals with chronic whiplash associated disorders (WAD) present persistent
pain in the absence of structural pathology. In these people, altered central pain processing
and central sensitization are observed. The role of personal factors, such as gender and age,
on pain processing mechanisms in chronic WAD, however, is still unclear.
Objectives: This study investigated possible gender- and age-related differences in selfreported and experimental pain measurements in people with chronic WAD. Besides the
exercise-induced response on pain measurements between gender and age subgroups was
recorded.
Study Design: Case-control study.
Setting: University Hospital, Brussels.
Methods: Self-reported pain and experimental pain measurements (pressure pain thresholds
[PPT], occlusion cuff pressure, temporal summation, and conditioned pain modulation) were
performed in 52 individuals (26 chronic WAD patients and 26 healthy controls), before and
after a submaximal cycle exercise.
Results: Lower PPTs and occlusion cuff pressures were shown in chronic WAD in comparison
with healthy controls. No gender and age differences regarding PPTs, occlusion cuff pressures
and conditioned pain modulation were found in chronic WAD.
Within the chronic WAD group, men showed higher self-reported pain compared to women
and younger adults showed enhanced generalized pain facilitation compared to older adults.
In addition, chronic WAD patients are able to inhibit exercise-induced hyperalgesia, but no
gender and age differences in pain response following exercise were found.
Limitations: This study was sufficiently powered to detect differences between the chronic
WAD and control group. However, a sufficient power was not reached when patients were
divided in age and gender groups. Furthermore, only mechanical stimuli were included in the
experimental pain measurements. Besides, psychosocial factors were not taken into account.
Conclusion: Some alterations of altered pain processing are present in chronic WAD patients,
however not in response to exercise. No gender and age differences in pain measurements
were observed in people with chronic WAD.
Decompressive L5 Transverse Processectomy
for Bertolotti’s Syndrome: A Preliminary Study
Authors: Ju Chang il
Published: February 2021

Background: Bertolotti’s syndrome is a spinal disorder characterized by abnormal enlargement of
the transverse process of the most caudal lumbar vertebra. The L5 transverse process may be enlarged
either unilaterally or bilaterally and may articulate or fuse with the sacrum or ilium. Pseudoarticulation
between the transverse process of the L5 and the alar of the sacrum can cause buttock pain and leg
pain. In addition, the L4 exiting nerve root could be compressed by an enlarged L5 transverse process.
The authors could have obtained satisfactory results from the selected cases of Bertolotti’s syndrome
by applying a selective transverse processectomy of the L5.
Objective: The objective of this study is to determine the effectiveness of L5 transverse processectomy
for symptomatic Bertolotti’s syndrome.
Study Design: A retrospective study.
Methods: A total of 256 patients with Bertolotti’s syndrome who had severe buttock pain and
unilateral or bilateral radiating leg pain were selected. The correct diagnosis was made based on
imaging studies which included computed tomography (CT), plain x-rays, and magnetic resonance
imaging (MRI). The final diagnosis was made by confirming pain relief from anesthetic block. A total
of 87 patients were classified into 2 groups: group A included 50 patients whose pain was relieved by
block into the pseudoarticulation and group B included 37 patients whose pain was relieved by block
into the L4 exiting nerve root. A total of 61 cases (group A: 39 cases, group B: 22 cases) were selected
as pure L5 transverse processectomy.
Outcome Measures: The primary outcome measures were reduction in pain scores and improvement
in quality of life.
Results: Among 61 patients, there were 19 men and 42 women. The mean age of the patients was
53.2 ± 12 years (group A: 57.8 ± 14 years [16 – 86 years], group B: 53.4 ± 14 years [27 – 77 years]).
The mean follow-up period was 6.5 months. The patients’ mean visual analog scale (VAS) prior to
surgery was 7.54 ± 0.81 (group A: 7.59 ± 0.93, group B: 7.50 ± 0.86), and the mean postoperative
VAS was 2.86 ± 1.67 (group A: 3.82 ± 1.59, group B: 2.05 ± 1.00). According to Macnab’s criteria,
12 patients showed excellent results (group A: 3, group B: 9), 41 patients showed good results (group
A: 11, group B: 30), 6 patients showed fair results (group A: 5, group B: 1), and 2 patients showed
poor results (group A: 2, group B: 0). Thus, satisfactory results were achieved in 86.89% of the cases.
Conclusion: In patients with Bertolotti’s syndrome, pseudoarticulation as well as L4 nerve root
compression can be the source of buttock pain and lower extremity pain. Bisectional cutting of the
L5 transverse process and decompression of the L4 nerve root could be an optimal treatment for
Bertolotti’s syndrome, and it may be easily approached by the paraspinal approach
Percutaneous Endoscopic Debridement and
Drainage with Four Different Approach
Methods for the Treatment of Spinal Infection
Authors: Kim Kyung-Hoon
Published: February 2021

Background: The incidence of spinal infection seems to be increasing in recent years.
Percutaneous endoscopic debridement and drainage (PEDD) has become an effective alternative
to extensive open surgery.
Objective: This study reviewed the charter of patients who received PEDD using 4 different
approach methods to evaluate the clinical results.
Study Design: An Institutional Review Board (IRB)-approved retrospective chart review.
Setting: University hospital inpatient referred to our pain clinic.
Methods: A retrospective patient chart analysis of PEDD procedures in spinal infections over a
7-year period was done for the evaluation of structural location, symptoms and signs, etiologic
agents, and outcomes.
Results: Seventeen patients (11 men and 6 women, mean age 70.4 ± 11.1 years) with spinal
infections received PEDD. According to the structural localization of the spinal infections, 6
cases of spondylodiscitis alone, 5 cases of spondylodiscitis with a psoas abscess, one case of
spondylodiscitis with an epidural abscess, 4 cases of spondylodiscitis with epidural and psoas
abscesses, and one case of spondylodiscitis with a facet joint abscess were found. All patients
had preoperative symptoms of unremitting backache and febrile sensation, and signs of
paravertebral muscle tenderness and limitation of spine motion. The most common etiologic
bacteria were Staphylococcus aureus. Most patients (14/17) improved; the 2 failed patients
received a second PEDD after recurrence, and the other received open surgery without re-PEDD.
Both the numeric rating scale and Oswestry disability index scores were significantly reduced
after PEDD. No complications related to PEDD were found.
Limitation: This study is limited by its retrospective design.
Conclusions: PEDD using 4 different routes brought immediate pain relief and reduced
disability in treating spinal infections, especially in elderly patients with comorbid underlying
disorders.
Clinical Course of Cervical Percutaneous
Epidural Neuroplasty in Single-Level Cervical
Disc Disease with 12-Month Follow-up
Authors: Shin Dong Ah
Published: February 2021

Background: Cervical disc disease is a common and occasionally disabling condition, occurring
as a natural consequence of aging in the vast majority of the adult population. Percutaneous
epidural neuroplasty (PEN) has been used to deliver highly concentrated drugs for chronic neck
pain and to prevent scarring in cases refractory to conventional epidural blocks. However, the
clinical course after PEN in cervical disc disease is not well-documented.
Objective: The purpose of this study was to evaluate the efficacy of cervical PEN for single-level
cervical disc disease.
Study Design: A retrospective observational study.
Methods: A consecutive series of 100 patients who underwent cervical PEN for single-level disc
disease (bulging or protrusion) were included in this study. Preoperatively, all patients underwent
magnetic resonance imaging (MRI), and visual analog scale (VAS) scores as well as Odom’s criteria
were measured preoperatively and at post-operative follow-up visits (one, 3, 6, and 12 months).
Limitations: The results of this study are limited by the lack of a control group that did not
undergo treatment with PEN.
Results: Additional block therapy was performed in 58 patients (58.0%). Subsequent surgery
was performed in 10 patients (10.0%, excluded from data of clinical follow-up). Mean neck pain
and VAS arm pain scores for all follow-up patients decreased from 6.82 and 4.74 preoperatively to
2.18 and 1.87 at 12 months after PEN (P < 0.001). More than 80% and 40% of all patients with
and without additional block therapy after cervical PEN, respectively, showed good and excellent
outcomes according to Odom’s Criteria during 12 months of follow-up. During this follow-up
period, no severe complications related to the procedure were observed.
Conclusion: Cervical PEN was shown to be a safe and effective treatment for neck and arm pain
in single-level disc disease during 12 months of follow-up.
Utilization Patterns of Sacroiliac Joint Injections
from 2000 to 2018 in Fee-for-Service Medicare
Population
Authors: Manchikanti Laxmaiah
Published: February 2021

Background: Sacroiliac joint is one of the proven causes of low back and lower extremity pain.
Prevalence estimates of sacroiliac joint pain range from 10% to 25% in patients with persistent axial
low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic
studies and systematic reviews. Over the years, utilization patterns of sacroiliac joint injections
have been increasing in comparison to other interventional techniques. Further, the development
of new current procedural terminology (CPT) codes and coverage policies for sacroiliac joint nerve
blocks, sacroiliac joint radiofrequency neurotomy, and evolving evidence for sacroiliac joint fusion
will further increase the utilization patterns.
Study Design: Analysis of growth patterns of sacroiliac joint injections from 2000 to 2018 with
comparative analysis of 2000 to 2009 and 2009 to 2018.
Objectives: To assess utilization patterns of sacroiliac joint injections from 2000 to 2018.
Methods The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure
Summary (PSPS) Master dataset was utilized in this analysis.
Results: The results of the evaluation from 2009 to 2018 showed an increase of 11.3% and
an annual increase of 1.2% per 100,000 Medicare population. However, from 2000 to 2009, an
increase of 299.8% from 2000 to 2009 with an annual increase of 16.6% per 100,000 Medicare
population.
Limitations: The limitations of this study included a lack of data on the new sacroiliac joint nerve
block and radiofrequency neurotomy codes. Further, this data did not include utilization patterns
of sacroiliac joint fusions. In addition, Medicare Advantage patients were not included, which
constitute approximately 30% of overall Medicare population. Further, there is also a possibility
that state claims data may include claims from other states. As with all claims-based data analyses,
this study is retrospective and thus potentially limited by bias. Finally, patients who are self or
commercially insured are not part of the dataset.
Conclusions: This study shows increases in utilization patterns of sacroiliac joint injections;
however, at a significantly lower rate with an annual increase of 16.6% prior to 2009 and only
1.2% from 2009 to 2018 per 100,000 Medicare beneficiaries
Key words: Chronic spinal pain, low back pain, sacroiliac joint arthritis, interventional techniques,
sacroiliac joint injections
The Efficacy of Scrambler Therapy for the
Management of Head, Neck and Thoracic Cancer
Pain: A Randomized Controlled Trial
Authors: Bhatnagar Prof. Sushma
Published: February 2021

Background: Pain is still a common feature in all types of cancers including head and neck
and thoracic cancer. Neuromodulatory techniques have gained popularity over opioids in recent
times because of the risks associated with chronic opioid therapy. There are no clinical trials
evaluating the efficacy of scrambler therapy (ST) for the management of pain due to head and
neck and thoracic cancer.
Objective: This trial was undertaken to evaluate the efficacy of scrambler therapy (ST) for pain
relief and to assess the possible effect of ST on the dosage of opioids in patients suffering from
cancer pain.
Study design: A randomized control trial (RCT) was performed.
Setting: The trial was conducted at the Pain and Palliative Care Unit of the Dr. B.R. Ambedkar
Institute Rotary Cancer Hospital of All India Institute of Medical Sciences, New Delhi, India.
Method: Forty patients were included in each of the 2 arms, control and Intervention. In
both arms, patients were given pain management drugs. In the intervention group, patients
additionally received 10 consecutive sessions of ST with one follow-up after 7 days. A numeric
rating scale (NRS-11) was used to measure pain. Drug dosage was also recorded.
Results: Overall, pain decreased in both arms. However, pain decreased more in the intervention
arm as compared to the control arm. The total change in the mean score of the NRS-11 from
baseline to follow-up was 3.1 and 6.19 in the control and ST arms, respectively. Differences
between pain scores in both arms became significant from day 3 onwards. Mean morphine dose
was significantly lower in the intervention arm from day 7 onwards.
Limitations: The study followed the patients until one week after the last treatment session
and encouraged patients to return for treatment if their pain returned to previous levels within
10 days. Moreover, patients in the control arm received the standard of care in the form of
pharmacological treatment but did not receive either transcutaneous electrical nerve stimulation
(TENS) or a sham (placebo) procedure.
Conclusions: The trial showed that ST is an effective treatment for the management of pain
due to head and neck and thoracic cancer. On the basis of this study, the use of ST for the
management of refractory cancer pain in head and neck and thoracic cancer is recommended.
Key words: Calmare Therapy, cancer pain, noninvasive pain treatment, numerical rating scale,
opioids, RCT, scrambler therapy, TENS
Low Back Pain and Diagnostic Lumbar Facet Joint
Nerve Blocks: Assessment of Prevalence, FalsePositive Rates, and a Philosophical Paradigm
Shift from an Acute to a Chronic Pain Model
Authors: Manchikanti Laxmaiah
Published: February 2021

Background: Lumbar facet joints are a clinically important source of chronic low back pain. There
have been extensive diagnostic accuracy studies, along with studies of influence on the diagnostic
process, but most of them have utilized the acute pain model. One group of investigators have
emphasized the importance of the chronic pain model and longer lasting relief with diagnostic
blocks.
Objective: To assess the diagnostic accuracy of lumbar facet joint nerve blocks with controlled
comparative local anesthetic blocks and concordant pain relief with an updated assessment of the
prevalence, false-positive rates, and a description of a philosophical paradigm shift from an acute
to a chronic pain model.
Study Design: Retrospective study to determine diagnostic accuracy, prevalence and falsepositive rates.
Setting: A multidisciplinary, non-university based interventional pain management practice in the
United States.
Methods: Controlled comparative local anesthetic blocks were performed initially with 1%
lidocaine, followed by 0.25% bupivacaine if appropriate response was obtained, in an operating
room under fluoroscopic guidance utilizing 0.5 mL of lidocaine or bupivacaine at L3, L4 medial
branches and L5 dorsal ramus. All patients non-responsive to lidocaine blocks were considered
to be negative for facet joint pain. All patients were assessed after the diagnostic blocks were
performed with ≥ 80% pain relief for their ability to perform previously painful movements.
Results: The prevalence of lumbar facet joint pain in chronic low back pain was 34.1% (95%
CI, 28.8%, 39.8%), with a false-positive rate of 49.8% (95% CI, 42.7%, 56.8%). This study also
showed a single block prevalence rate of 67.9% (95% CI, 62.9%, 73.2%). Average duration
of pain relief ≥ 80% was 6 days with lidocaine block and total relief of ≥ 50% of 32 days. With
bupivacaine, the average duration of pain relief ≥ 80% was 13 days with total relief of ≥ 50%
lasting for 55 days.
Conclusion: This study demonstrated that the chronic pain model is more accurate and reliable
with concordant pain relief. This updated assessment also showed prevalence and false-positive
rates of 34.1% and 49.8%.
Key words: Chronic spinal pain, lumbar facet or zygapophysial joint pain, facet joint nerve
blocks, medial branch blocks, controlled comparative local anesthetic blocks, diagnostic accuracy,
prevalence, false-positive rate
Opioid Reduction and Long-Term Outcomes in
Abdominal Myofascial Pain Syndrome (AMPS):
A 6-Year Longitudinal Prospective Audit of 207
Patients
Authors: Niraj G
Published: February 2021

Background: Abdominal myofascial pain syndrome is an important cause of refractory chronic
abdominal pain. It causes severe functional impairment resulting in significant patient distress and
substantial health care costs, and it can be a challenge to treat. Opioid consumption is a recognized
challenge in this cohort.
Design: We conducted a prospective longitudinal audit over a 6-year period.
Setting: The study was conducted at a tertiary pain medicine clinic in a university teaching
hospital.
Methods: Over a 6-year period, 234 patients diagnosed with chronic abdominal pain secondary
to abdominal myofascial pain syndrome were included in a structured management pathway.
Long-term outcomes were prospectively audited at a tertiary-care university hospital. Patients
who completed a minimum of 12 months in the pathway were included. The main outcome
was reduction in opioid consumption. Treatment outcomes included treatment failure, number of
patients with clinically significant pain relief, durable pain relief, and long-term pain relief. Other
outcomes included patient satisfaction and success in maintaining gainful employment.
Results: Two hundred seven patients completed a minimum of 12 months of follow-up. Seventyeight percent (162 of 207) were on opioids at presentation. There was significant reduction in
opioid consumption at ≥ 12 months’ follow-up. Among patients who underwent interventional
management, clinically significant relief was reported in 31 patients (31 of 180, 17%), durable
relief in 71 patients (71 of 180, 40%) and long-term relief lasting 12 months in 23 patients (23 of
180, 13%). Twenty-six patients (26 of 180, 15%) reported cure from symptoms. The treatment
failure rate was 15%.
Limitations: This was an open-label study that took place at a single center.
Conclusion: The authors present the first prospective practice-based evidence report on the
long-term outcomes in patients diagnosed with abdominal myofascial pain syndrome. There was
significant reduction in opioid consumption at 12 months and over two-thirds of patients reported
significant durable relief on long-term follow-up. The authors present their recommendation for
managing this complex group of patients.
Keywords: Abdominal myofascial pain syndrome, abdominal plane blocks, chronic abdominal
wall pain, opioid reduction, quadratus lumborum block, TAP block, viscerosomatic convergence
Interventional Pain Management for Cancer
Pain: An Analysis of Outcomes and Predictors of
Clinical Response
Authors: Hochberg Uri
Published: February 2021

Background: Interventional procedures are offered routinely to patients seen in McGill University’s
interdisciplinary cancer pain management program. However, publications on these procedures are
scarce, making it difficult to predict which patients may benefit from them.
Objectives: We hypothesized that interventional pain procedures offered to cancer patients
could provide relief of pain as well as other symptoms. Furthermore, some variables may predict
the efficacy of such procedures.
Study Design: We conducted a retrospective chart review of interventional pain management
procedures.
Setting: The procedures reviewed were conducted at the Cancer Pain Program and performed at
the interventional suites of the McGill University Health Centre.
Methods: The retrospective chart review included interventional pain management procedures
performed between June 2015 and March 2017. Demographic data, details about the underlying
cancer and about the procedure and peripTrocedural patients’ reported outcomes were recorded
for analysis.
Results: Eighty-two of 126 procedures were included for analysis. Most patients presented with
metastatic disease (75%). Eighty percent of the patients reported pain relief, with the average pain
severity decreasing by more than 2 points on a 0-to-10 Numeric Rating Scale for pain (from 6.5 of
10 to 4.2 of 10). Forty-three percent of patients were considered responders (≥ 50% pain relief).
Responders also reported a significant decrease in fatigue, depression, anxiety, drowsiness, and
improved well-being. Among responders, average daily opioid use decreased significantly, by 60%
on average. None of the analyzed variables correlated with the response; however, psychosocial
variables like anxiety and depression showed a nonsignificant trend towards predicting procedure
failure.
Limitations: The core limitations of this study are its size and retrospective nature.
Conclusions: In this cohort of cancer pain patients, interventional cancer pain procedures
provided effective pain relief and other benefits, including pain relief, reduced burden of
symptoms, and reduction of opioid intake, while demonstrating a favorable safety profile. Patients
with poorer ratings of depression and fatigue derived less benefit from procedures, suggesting that
offering such procedures as part of patients’ treatment plan would be sensible, rather than leaving
interventions for later stages.
Key words: Cancer pain, pain management, pain intractable, treatment outcomes, palliative
care, advanced cancer, cancer, evidence-based madicine
Translaminar Osseous Channel–Assisted FullEndoscopic Flavectomy Decompression of
Thoracic Myelopathy Caused by Ossification of
the Ligamentum Flavum: Surgical Technique and
Results
Authors: Liao Wenbo
Published: February 2021

Background: Previous surgical procedures for the treatment of thoracic myelopathy (TM) due
to ossification of the ligamentum flavum (OLF) were accompanied by significant trauma and risk.
Objectives: Report a novel minimally invasive technique, translaminar osseous channel–assisted
posterior percutaneous full-endoscopic flavectomy (p-PEF), as an alternative surgical strategy for
the treatment of OLF-related TM.
Study Design: A retrospective cohort study.
Setting: A center for spine surgery and pain medicine.
Methods: Thirteen patients with TM caused by isolated OLF who underwent translaminar
osseous channel–assisted p-PEF were retrospectively analyzed. Preoperative and postoperative
radiographic findings and clinical results were compared to confirm the efficacy of the procedure
and perioperative complications were investigated to evaluate the technical safety.
Results: All 13 patients with 23 isolated ossified sites were successfully treated with the
translaminar osseous channel–assisted p-PEF technique and no additional internal fixation was
needed. With an average follow-up of 29.2 months (range, 24–36 months), no local instability
was detected. The preoperative and final follow-up cross-sectional area of the stenotic dural sac
was 47.87 ± 8.98 mm2
and 130.47± 19.07 mm2
, respectively (P < 0.0001). The mean modified
Japanese Orthopaedic Association score was significantly improved from 3.54 ± 1.26 points
preoperatively to 9.07 ± 1.48 points at final follow-up (P < 0.0001). The Visual Analog Scale scores
of thoracolumbar backaches were 5.3 ± 1.2 before surgery and 0.69 ± 0.75 at final follow-up (P =
0.001). No serious complications ensued.
Limitations: This was a retrospective study with several limitations, including the lack of a
control group, small number of included samples and unavoidable nature of the single-center
study design.
Conclusions: Translaminar osseous channel–assisted p-PEF technique, with less tissue trauma and
impact on the stability of the spine, can provide adequate decompression and satisfying outcomes
in the treatment of OLF-related TM and should be considered as an alternative procedure for
isolated OLF.
Key words: Translaminar osseous channel, percutaneous full-endoscopic flavectomy, thoracic
myelopathy, ossification of ligamentum flavum, minimally invasive spine surgery
Computed Tomography–Guided Percutaneous
Coblation of the Thoracic Nerve Root for
Treatment of Postherpetic Neuralgia
Authors: Ni Jia-Xiang
Published: February 2021

Background: Postherpetic neuralgia (PHN) is one of the most intractable pain disorders and often
does not respond to medication, physical, and interventional procedures. Coblation technology
has been demonstrated to have potential for neuralgia, but there are rare reports of the efficacy
and security of coblation for PHN. The thoracic segment is the most common predilection part of
PHN, so we conducted this long-term study to investigate the results of coblation for the treatment
of thoracic PHN.
Objectives: The aim of this study was to determine the efficacy and security of computed
tomography (CT)-guided coblation of the thoracic nerve root for treatment of PHN.
Study Design: Self before-after controlled clinical assessment.
Setting: Department of Pain Management, Xuanwu Hospital, Capital Medical University.
Methods: Seventy-seven patients with thoracic PHN sustained for at least 6 months and refractory
to conservative therapy were identified. Patients underwent CT-guided percutaneous coblation to
ablate the thoracic nerve root for thoracic PHN. The therapeutic effects were evaluated using a
Visual Analog Scale (VAS), medication doses, and pain-related quality of life (QoL) scale before
coblation, and at 1 week, and at 1, 3, and 6 months after the procedure. Patients who achieved
more than 50% pain relief were defined as responders. In addition, adverse effects were also
recorded to investigate the security of this procedure.
Results: The VAS score significantly decreased from 7.22 ± 1.15 before the coblation to 3.51 ±
1.12 (P = 0.01), 3.02 ± 1.21 (P = 0.006), 3.11 ± 2.15 (P = 0.014), and 2.98 ± 2.35 (P = 0.008) at 1
week, and at 1, 3, and 6 months after the procedure, respectively. The number of responders were
56 (77.78%), 54 (75%), 55 (76.39%), and 54 (75%) at 1 week, and at 1, 3, and 6 months after the
procedure, respectively. The doses of anticonvulsants and analgesics were decreased significantly
at all time points after the procedure compared with before treatment (P < 0.05). Patient responses
on the Brief Pain Inventory Short Form indicated mean scores that were significantly lower than
baseline across all domains of pain interference with QoL at all evaluations (P = 0.001). Most of the
patients had mild numbness and it did not affect the daily activities after the procedure. No other
severe adverse events occurred during or after the procedure.
Limitations: A single-center study, relatively small number of patients, short duration of review
of medical record, and the retrospective study.
Conclusions: CT-guided percutaneous thoracic nerve root coblation is an effective and safe
method for the treatment of thoracic PHN, and the procedure can also significantly improve the
QoL in patients with PHN.
Key words: Neuropathic pain, quality of life, radiofrequency ablation, plasma-mediated
technology, numbness
Two-Needle Technique for Lumbar Radiofrequency
Medial Branch Denervation: A Technical Note
Authors: Kenneth Chapman Kenneth Chapman
Published: February 2021

Background: Radiofrequency ablation (RFA) of the medial branches of the dorsal rami
has been reported to relieve facet joint–related back pain for 6 months to 1 year in 60% of
patients. Although providing benefit in a significant proportion of patients, there remains a
group of patients who do not experience any pain relief from RFA or experience only benefit
from the ablation for a short period. Failure of RFA has been attributed to technical failure
of coagulating the nerve or coagulation of a minimal section of the nerve, allowing for early
reinnervation. Increasing the success rate and duration of relief may require techniques that
increase the likelihood of successful nerve ablation over a relevant distance by maximizing
lesion size.
Objectives: The aim of this technical note is to detail a modification to the current
commonly used lumbar medial branch radiofrequency (RF) denervation approach to
increase lesion size.
Study Design: This is a technical report describing a novel two-needle approach to
lumbar RF medial branch denervation.
Setting: Large private interventional pain management institute.
Methods: A dual needle placement of two 10-mm active tip RF cannulas separated by
6 mm is used to optimally contact the superior articular process (SAP) from its ventral to
dorsal borders, which encompasses the anticipated course of the medial branch nerves.
Results: The described technique creates a lesion that we estimate to be 11.0-mm wide
and 11.6-mm long along the course of the medial branch adjacent to the SAP ensuring
adequate coverage and treatment.
Limitations: This report does not encompass a systematic evaluation of the clinical safety
and efficacy of the two-needle RFA approach. Future studies will have to assess the longterm efficacy and safety of the approach.
Conclusions: The detailed two-needle approach to lumbar RF medial branch denervation
appears to be promising in terms of projected treatment success by coagulating a large
volume of tissue, in a cost- and time-efficient manner.
Key words: Radiofrequency ablation, RFA, lumbar, medial branch, facet joint, pain,
rhizotomy
8% Capsaicin Patch in Treatment of Peripheral
Neuropathic Pain
Authors: Gonçalves Décia
Published: February 2021

Background: Neuropathic pain is a complex condition that is difficult to control and has a high
impact on quality of life. 8% Capsaicin patch can be a therapeutic strategy in the treatment of
peripheral neuropathic pain.
Objectives: This study aims to (1) evaluate clinical efficacy and (2) tolerability of 8% capsaicin
patch in a Pain Unit.
Study Design: Retrospective observational study
Setting: Portuguese Pain Unit
Methods: A sample of 120 patients diagnosed with peripheral neuropathic pain, underwent
treatment with the 8% capsaicin patch between February 2011 and February 2019 in a Portuguese
Pain Unit. Patients were included in one of the following groups according to the etiology of
pain: postherpetic neuralgia (PHN), chronic post-surgical pain (CPSP), post traumatic neuropathic
pain (PTNP), diabetic neuropathy (DN), regional pain syndrome. complex I and II (CRPS I / II), HIVassociated neuropathy (HIVN), lumbar neuropathic pain (LNP), trigeminal neuralgia (TN) and
other neuropathies (O). The evaluated parameters were: pain intensity according to unit protocol
(numerical rating scale), pain characteristics, location, size of the painful area. The evolution of
pain intensity after treatment (patients were considered as responders to therapy if the decrease in
NRS was equal to or greater than 30%; patients with a decrease in NRS of 50% or more were also
analyzed), the area of pain and the need for adjuvant analgesic therapy, as well as the tolerability
to treatment and the identification of eventual predictors of its efficacy were evaluated, at 15 days,
8 weeks and 12 weeks after 8% capsaicin patch.
Results: Of the 120 patients in the sample, 40.8% had a ≥ 30% decrease in basal pain intensity
15 days after treatment, 43.3% after 8 weeks and 45.0% after 12 weeks. 30.8% of patients had ≥
50% decreased basal pain intensity 15 days after treatment, 27.5% after 8 weeks and 30.0% after
12 weeks. Pain area decreased in 36.7% of patients and 18.3% reduced chronic analgesic therapy
within 12 weeks after 8% capsaicin patch application. There was only one case of intolerance to
the treatment.
Limitations: This study has the limitations inherent to a retrospective study. The study period was
only 12 weeks and some diagnostic groups included a small number of patients.
Conclusion: Treatment of peripheral neuropathic pain with 8% capsaicin patch seem to be
effective in the short and medium term, both in decreasing pain intensity and in reducing the
painful area. Its application is tolerated by most patients.
Key words: 8% capsaicin patch, peripheral neuropathic pain, pain intensity, painful area
A Multivariable Prediction Model for the
Chronification of Non-traumatic Shoulder Pain:
A Systematic Review
Authors: Struyf Filip
Published: February 2021

Background: Shoulder pain is the third most common musculoskeletal complaint and
many patients have an unfavorable outcome with long-term disability. Only 50% of all new
episodes of shoulder pain show complete recovery within 6 months. Little is known about
factors that contribute to chronicity of shoulder pain, although such information is needed for
the management of patients with acute and sub-acute shoulder pain.
Objective: To systematically review the literature for prognostic factors which are potential
predictors for either recovery or chronification in patients with acute and sub-acute nontraumatic shoulder pain.
Study Design: Systematic review.
Setting: This systematic review examined all studies involving the prognosis of shoulder pain
patients.
Methods: This systematic review was reported following the guidelines outlined in the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers
independently scored the methodological quality of the selected studies. Due to heterogeneity
of studies, a best-evidence synthesis of the available prognostic factors was provided.
Results: Nine studies met our inclusion criteria and were included in this systematic review.
There is strong evidence that high scores on the Shoulder Pain and Disability Index (SPADI),
high scores on shoulder pain severity, and a long duration of complaints are factors that
contribute to the chronification of shoulder pain. Moderate evidence was found supportive
for other prognostic factors that enhance chronification, like being male, being over 55 years
of age, having poor general health, having a gradual onset of complaints, a large amount of
sick leave, the perception of high job demand, the perception of low social support, and the
amount of visits to a health care professional. Also moderate evidence exists regarding factors
that contributed to a reduced possibility of chronification: an active treatment policy and not
taking medication on regular basis.
Limitations: The large variability in definitions of shoulder pain, and patient selection bias.
In addition, there is a paucity of strong longitudinal prospective studies.
Conclusion: This systematic review found evidence that high scores on the SPADI
questionnaire, more shoulder pain, and a longer duration of complaints are associated with
chronification of shoulder pain. In order to reduce chronification, clinicians can use the
International Classification of Functioning based model presented here that could aid their
decision-making.
Key words: Shoulder pain, prognostic factors, systematic review, prognosis, assessment