Background: While long-term opioid therapy is a widely utilized strategy for managing chronic pain, many patients have understandable questions and concerns regarding its safety, efficacy, and potential for dependency and addiction. Providing clear, accurate, and reliable information is essential for fostering patient understanding and acceptance. Generative artificial intelligence (AI) applications offer interesting avenues for delivering patient education in healthcare. This study evaluates the reliability, accuracy, and comprehensibility of ChatGPT’s responses to common patient inquiries about opioid long-term therapy. Methods: An expert panel selected thirteen frequently asked questions regarding long-term opioid therapy based on the authors’ clinical experience in managing chronic pain patients and a targeted review of patient education materials. Questions were prioritized based on prevalence in patient consultations, relevance to treatment decision-making, and the complexity of information typically required to address them comprehensively. We assessed comprehensibility by implementing the multimodal generative AI Copilot (Microsoft 365 Copilot Chat). Spanning three domains—pre-therapy, during therapy, and post-therapy—each question was submitted to GPT-4.0 with the prompt “If you were a physician, how would you answer a patient asking…”. Ten pain physicians and two non-healthcare professionals independently assessed the responses using a Likert scale to rate reliability (1–6 points), accuracy (1–3 points), and comprehensibility (1–3 points). Results: Overall, ChatGPT’s responses demonstrated high reliability (5.2 ± 0.6) and good comprehensibility (2.8 ± 0.2), with most answers meeting or exceeding predefined thresholds. Accuracy was moderate (2.7 ± 0.3), with lower performance on more technical topics like opioid tolerance and dependency management. Conclusions: While AI applications exhibit significant potential as a supplementary tool for patient education on opioid long-term therapy, limitations in addressing highly technical or context-specific queries underscore the need for ongoing refinement and domain-specific training. Integrating AI systems into clinical practice should involve collaboration between healthcare professionals and AI developers to ensure safe, personalized, and up-to-date patient education in chronic pain management.

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.

Background/Objectives: Spinal cord stimulation (SCS) is an established therapy for chronic pain, but uncertainties remain regarding long-term real-world outcomes and the role of standardized selection pathways. This study aimed to evaluate real-world, longitudinal outcomes of SCS over 24 months within a structured clinical pathway, focusing on pain intensity, neuropathic symptoms, and health-related quality of life. Methods: A single-center, retrospective observational cohort study was conducted at the Fondazione Istituto G. Giglio (Cefalù, Italy). Data were drawn from the continuing, prospective institutional “SCS Pathway” and included consecutive patients implanted between May 2021 and September 2024. Eligible patients were ≥18 years of age with chronic pain refractory to conventional medical management. Outcomes included pain intensity (VAS, visual analog scale), neuropathic features (DN4, douleur neuropathique 4), and health-related quality of life (EQ-5D, EuroQol 5 Dimensions), assessed at baseline and 3, 6, 12, 18, and 24 months post-implantation. Multilevel models with full information maximum likelihood (FIML) were applied to repeated measures. Results: Seventy-six patients were included (mean age 67.3 ± 10.3 years; 39.5% female). The most frequent diagnoses were post-surgical pain syndrome (42.1%, 32/76) and chronic back and leg pain (40.8%, 31/76). 42.1% (32/76) had previous spine surgery, and 78.9% (60/76) reported neuropathic pain. Across 452 observations, mean VAS scores decreased from 7.9 ± 0.7 at baseline to 3.1 ± 1.1 at 3 months (61% reduction, p < 0.001), with sustained benefit at 24 months (4.5 ± 1.5; 43% reduction, p < 0.001). DN4 scores improved from 7.4 ± 0.8 to 3.2 ± 1.0 at 3 months (56% reduction, p < 0.001), with persistent decreases at 24 months (4.2 ± 1.2; 43% reduction, p < 0.001). EQ-5D improved from 22.8 ± 6.6 at baseline to 70.2 ± 10.6 at 3 months (increase of 208%, p < 0.001), with clinically meaningful gains sustained at 24 months (55.4 ± 13.7, increase of 143%, p < 0.001). Conclusions: In this real-world cohort, SCS therapy results in sustained, clinically significant improvements in pain, neuropathic symptoms, and quality of life. Findings highlight the value of structured selection and follow-up pathways. These data provide a benchmark for multicenter studies linking standardized referral frameworks to long-term, patient-centered outcomes.

Percutaneous epidural adhesiolysis and pulsed radiofrequency of the dorsal root ganglion (DRG-PRF) target two distinct components of chronic lumbosacral radicular pain: the restricted access of injected drugs to a nerve root shielded by epidural fibrosis, and the sensitization of the ganglion itself. A multifunctional steerable catheter carrying a bipolar electrode at its tip makes it technically feasible to perform both at the same anatomical target within a single procedure. This narrative review and illustrated technical report has three aims: to summarize the mechanistic rationale for each component (mechanical adhesiolysis, enzymatic lysis with recombinant human hyaluronidase, DRG-PRF, and the co-administered local anesthetic and corticosteroid); to describe the combined procedure step by step—landmarks, needle angles, radiofrequency parameters, injectate composition, safety checkpoints and the epidurographic endpoint—with original schematics; and to set out critically what the evidence does and does not establish. A structured but non-systematic search of MEDLINE and Embase identified a substantial, methodologically contested literature on adhesiolysis, a smaller one on hyaluronidase, and a single randomized trial of 41 patients directly comparing adhesiolysis with and without DRG-PRF. Mechanistic plausibility and technical feasibility are therefore well supported, whereas evidence of clinical benefit for the combined protocol is limited. The suggested place of the technique in the treatment pathway—as an interventional option in selected patients before surgical escalation, or when revision surgery is being considered—is a clinical proposal based on anatomical reasoning and single-center experience, not on comparative data. Comparative studies are needed to define its role.