Objectives: Compare the effects of greater occipital nerve (GON) and sphenopalatine ganglion (SPG) blocks on headache intensity and duration, number of headache days, and disability in patients with episodic migraine. Methods: In this prospective single-blind randomized study, patients with episodic migraine were randomly divided into two groups: GON and SPG block groups. Patients received blocks once a week for 4 weeks, and once a month for 2 months. The number of headache days, the headache duration, numeric rating scale (NRS) scores, and number of acute medical treatments were assessed before the procedures and 1 month, 2 months, and 3 months after the procedures. Disability was evaluated using the migraine disability assessment (MIDAS) questionnaire at baseline and 3 months after treatment. This study protocol is registered at ClinicalTrials.gov (NCT06243874.). Results: 19 patients in the GON block group and 18 patients in the SPG block group were evaluated. Significant improvements in pain severity, headache duration, number of headache days, and the need for acute medical treatment were observed in the 1st, 2nd, and 3rd months compared to baseline in the two groups (p < 0.001). There were significant improvements in the MIDAS scores in the third month (p < 0.001). The GON block group showed a greater reduction in headache intensity, duration, number of headache days, and MIDAS scores compared to the SPG block group in the 3rd month (p < 0.001). Conclusions: GON block reduces headache duration, intensity, the number of headache days, and the need for acute medical treatment much more than SPG block in patients with episodic migraine.

Objective: To compare the efficiency of unilateral and bilateral transforaminal epidural steroid injections (TFESI) in patients with unilateral lumbar disc herniation (LDH). Methods: In this prospective randomized single-blinded study, patients with unilateral LDH were randomly divided into two groups: A unilateral TFESI group; and a bilateral TFESI group. The severity of pain and disability were assessed with the Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 1 week, 1 month, and 3 months after interventions. Treatment response was defined as ≥50% reduction in the NRS-11 at the 3-month follow-up. Changes in medication consumption at 3 months following the interventions were recorded. This study protocol is registered at ClinicalTrials.gov (NCT06240793). Results: A total of 104 patients were included in the study (n = 58 in the unilateral TFESI group and n = 46 in the bilateral TFESI group). The NRS-11, ODI scores and medical treatment consumption did not differ statistically between the groups at 3 months (p ˃ 0.05). At 3 months, the rates of patients with a > 50% decrease in NRS-11 scores were 13.8% and 32.6% in the unilateral TFESI group and bilateral TFESI group, respectively. Conclusions: Unilateral and bilateral TFESI both decrease pain severity and disability scores to a similar degree, although bilateral TFESI was more effective in reducing pain severity by over 50% in patients with single-level unilateral LDH.

Bevezetés A gyakran hangulatzavarokkal és funkcionális károsodással társuló krónikus migrén (CM) és a gyógyszertúlhasználat miatti fejfájás (MOH) jelentős terápiás kihívást jelent. Bár a profilaktikus gyógyszeres terápia továbbra is alapvető fontosságú, kiegészítő beavatkozások – mint a nervus occipitalis major (GON) és a supraorbitalis ideg (SON) blokádja – további előnyt kínálhatnak. A jelen vizsgálat célja annak felmérése volt, hogy e blokádok standard gyógyszeres profilaxis melletti alkalmazása javítja-e a hangulatot és a funkcionális állapotot CM-ben vagy MOHban szenvedő betegeknél. Módszerek Retrospektív elemzést végez- tünk 147 olyan beteg (131 nő, 16 férfi) adata alapján, akiket 2020. december és 2021. március között kezeltek. A betegeket három csoportba osztottuk: kizárólag profilaktikus gyógyszeres kezelésben részesültek; profilaktikus kezelés GON-blokáddal kiegészítve; valamint profilaktikus kezelés kombi- nált GON + SON blokáddal. A fájdalom- és funkcionális mutatókat a vizuális analóg skála (VAS), a Migraine Disability Assessment Scale (MIDAS) és a Beck Depresszió Kérdőív (BDI) segítségével értékeltük. A statisztikai elemzéshez a Statistical Package for the Social Sciences (SPSS) és az R szoftvert használtuk nem paraméteres longitudinális adatok feldolgozására. Eredmények A GON + SON blokád szigni- fikánsan csökkentette a VAS-értékeket már a 2. héttől kezdve (Mann–Whitney U-teszt p = 0,021), gyorsabb javulást mutatva a többi csoporthoz képest. A MIDAS-pontszámok minden csoportban szignifikánsan javultak, a csökkenés a kombinált GON + SON blokád esetében volt a legnagyobb (Wald- idő statisztika [WTS] = 1262,52; p < 0,01). A BDI-pontszámok szignifikánsan javultak az idő előrehaladtával (WTS = 997,89; p < 0,01), azonban kezelésspecifikus előny nem volt kimutatható. Csak minimális, jól kezelhető, enyhe szövődmények fordultak elő, ami megerősítette az eljárás biztonságosságát. Következtetés A GON- és SON-blokád hozzáadása a profilaktikus gyógyszeres kezeléshez fokozza a fájdalomcsökkenést és a funkcionális javulást CM- és MOH-betegekben. A kombinált blokád gyorsabb és szignifikáns előnnyel jár, a VAS-értékek már a második héttől javulnak. A BDI-pontszámok minden csoportban javultak, azonban a hangulatra gyakorolt pozitív hatás pontosabb megítéléséhez további vizsgálatok szükségesek. A jövőben multicentrikus, randomizált kontrollált vizsgálatok szükségesek.

Radiation Recall Myositis (RRM) is a rare phenomenon that occurs after radiotherapy and chemotherapy. Gemcitabine is the most commonly implicated agent in its development.

Background: Dorsal root ganglion (DRG) pulsed radiofrequency (PRF) is a minimally invasive neuromodulation technique used for the management of chronic radicular pain. While its analgesic effects are well-documented, its impact on sensorimotor integration at the cortical level remains unclear. This study aimed to investigate whether DRG PRF modulates sensorimotor integration via the cholinergic system using the short-latency afferent inhibition (SAI) paradigm. Methods: This prospective, 2-center study included 30 patients with chronic lumbosacral radicular pain who underwent DRG PRF at the L4-5 and L5-S1 levels. SAI was assessed using paired electrical stimulation of the tibial nerve and transcranial magnetic stimulation (TMS) of the motor cortex before and 2 weeks after DRG PRF. SAI measurements were conducted at 3 interstimulus intervals (ISIs: –2 ms, 0 ms, +2 ms of N20 latency). Data were analyzed using repeated measures ANOVA and paired t-tests. Results: The SAI paradigm confirmed significant sensorimotor inhibition at baseline in all 3 ISIs (P < .001). However, no statistically significant difference was found between pre- and post-DRG PRF SAI values at any ISI (P > .05). These results suggest that DRG PRF did not significantly modulate cholinergic-driven sensorimotor integration in lower limbs. Conclusion: DRG PRF effectively reduces pain in chronic radicular pain patients, but its effect on cortical cholinergic modulation, as measured by SAI, appears to be limited. This finding suggests that DRG PRF primarily exerts its effects through non-cholinergic mechanisms, such as GABAergic, glutamatergic, or noradrenergic pathways. Further studies are warranted to clarify the broader neurophysiological effects of DRG PRF.

Objectives: This study aims to compare the effects of dorsal root ganglion pulsed radiofrequency (DRG-PRF) and transforaminal epidural steroid injection (TFESI) on cutaneous silent period (CSP) parameters reflecting spinal inhibition in patients with lumbar radicular pain (LRP). Methods: In this prospective, single-blind, randomized controlled trial, 36 patients with unilateral LRP due to L4–L5 or L5–S1 disc herniation and chronic pain unresponsive to conservative therapy were randomized to receive DRG-PRF (n=18) or TFESI (n=18). Eighteen healthy volunteers were included as controls. CSP onset latency, offset latency, and duration were recorded at baseline, post-procedure Day 1, Week 1, and Month 1. Pain intensity was assessed using the Numerical Rating Scale (NRS-11), and disability was measured with the Oswestry Disability Index (ODI). Results: At baseline, CSP duration was significantly shorter in both patient groups compared with controls ( P =0.024 and P =0.022, respectively). Both DRG-PRF and TFESI significantly improved NRS-11 and ODI scores ( P <0.001), with no between-group difference. In the DRG-PRF group, CSP duration significantly increased on Day 1 and Week 1 ( P =0.001 and P =0.004, respectively), whereas no significant change occurred in the TFESI group. Discussion: These results suggest that shortened CSP duration reflects impaired spinal inhibition in LRP. While both DRG-PRF and TFESI were equally effective in reducing pain and disability, only DRG-PRF modified CSP parameters, indicating a potential central neuromodulatory effect. CSP evaluation may serve as an objective biomarker to clarify the mechanisms underlying interventional pain treatments.