Coccydynia is a chronic pain syndrome with a complex pathophysiology. While ganglion impar blockade (GIB) is an effective treatment, predictors of response are not well-established. This study aimed to evaluate whether hematologic inflammatory indices or coccygeal morphology could predict the clinical response to GIB in patients with chronic coccydynia. We retrospectively reviewed the records of 119 patients who underwent GIB. Demographics, pain characteristics, coccygeal morphology (Postacchini–Massobrio classification), and preprocedural indices were extracted from the medical records. The primary outcome at the 1-month follow-up was a response, defined as either a ≥50% reduction in the visual analog scale pain score or a global perceived effect (GPE) score ≥ 6. Hematologic indices and coccygeal morphology were analyzed to assess their ability to discriminate between responders and nonresponders at 1 month after GIB. The overall response rate was 62.2%, with a significantly higher rate observed in females compared to males ( P = .02). Responders had significantly higher baseline platelet-to-lymphocyte ratio (PLR; P = .006) and systemic immune-inflammation index (SII; P = .023), whereas other indices did not differ. Receiver operating characteristic analysis showed moderate discrimination for PLR (area under the curve = 0.650) and SII (area under the curve = 0.621). While overall coccygeal morphology was not associated with response ( P = .25), types III and V were significantly associated with a higher rate of nonresponse ( P = .048). GIB is an effective treatment for chronic coccydynia. Pre-procedural PLR and SII may serve as accessible biomarkers to identify patients more likely to benefit, while coccygeal types III and V may be associated with poorer outcomes.

Background and Objectives: Predicting treatment response following transforaminal epidural steroid injection (TFESI) in older adults with lumbar radicular pain (LRP) remains challenging. Hematological inflammatory indices have been proposed as accessible biomarkers; however, their clinical utility remains uncertain. This study aimed to evaluate the predictive value of preprocedural hematological inflammatory indices and determine whether clinical variables provide a more clinically relevant framework for predicting TFESI outcomes. Materials and Methods: This retrospective observational study included 190 patients aged ≥65 years who underwent TFESI for LRP. Pain intensity was assessed using the Numeric Rating Scale (NRS) at baseline and after 3 months. Treatment response was defined as a ≥50% reduction in the NRS (meaningful pain response, [MPR-50]). Pre-procedural hematological parameters and derived indices, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), were calculated. The pain phenotype was categorized as nociceptive, neuropathic, or mixed using the Douleur Neuropathique 4 (DN4) scale. Univariate and multivariable logistic regression analyses were performed, and receiver operating characteristic (ROC) analysis was used to assess the discriminative performance. Results: A meaningful pain response was achieved in 61.1% of the patients. Lymphocyte and monocyte counts were higher in responders; however, effect sizes were small. Importantly, patients with neuropathic pain exhibited significantly higher monocyte counts, SIRI, and AISI, indicating an association between pain phenotype and systemic inflammatory burden; however, these markers were not associated with treatment response. Furthermore, isolated inflammatory indices demonstrated limited standalone discriminative performance in the ROC analysis. In the adjusted hematological model, NLR demonstrated a modest statistical association with MPR-50; however, this association weakened in the final integrated model. Conclusion: Inflammatory indices and pain phenotypes may reflect biological and clinical heterogeneity in older adults with LRP; however, their standalone predictive value for TFESI outcomes appears limited. TFESI responsiveness is likely multifactorial and may be better evaluated using an integrated clinical framework.

Objective: The objective of this study was to evaluate the effect of different molecular weight (MW) hyaluronic acid (HA) application on pain and functional parameters in knee osteoarthritis (OA). Methods: This study was designed as retrospectively. Hospital records of the patients who received intraarticular HA injection therapy in our center were screened. The patients were divided into 3 categories according to the MW of the preparates as the follows; Group 1: 0,6-1,2 Milion Da of MW (N=26); Group 2: 1,1- 2,2 Million Da of MW (N=25); and Group 3: 1,7-2,1 Million Da of MW (N=25). All patients were assessed using Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) before the treatment and one month after the injection. Results: A total of 76 patients (61 females, 15 males) with a mean age of 62,1 years (minimum-maximum: 50-70 years) were included. VAS and WOMAC scores did improve significantly in all groups (all for p

Background/Objectives: The optimal duration of pulsed radiofrequency (PRF) applied to the dorsal root ganglion (DRG) remains unclear, particularly in patients with chronic lumbosacral radicular pain (LRP) who are unresponsive to conservative therapy. Although preclinical data suggest duration-dependent neuromodulatory effects, comparative clinical evidence for specific exposure times is limited. This study aimed to evaluate the outcomes of 4 min and 8 min DRG-targeted PRF applications performed in combination with transforaminal epidural steroid injection (TFESI) in patients with chronic LRP unresponsive to conservative treatment, to determine whether prolonged exposure provides superior analgesic and functional outcomes. Methods: In this prospective, single-center, observational comparative study, 72 patients with chronic lumbar radicular pain (LRP) refractory to conservative management received DRG-targeted PRF using standardized parameters (45 V, 20 ms, 2 Hz, ≤42 °C). Participants underwent either 4 min (n = 36) or 8 min (n = 36) PRF, assigned according to clinical discretion. All procedures were followed by transforaminal epidural injection of dexamethasone and bupivacaine. The primary endpoint was Numeric Rating Scale (NRS) pain intensity at 6 months. Secondary endpoints included Oswestry Disability Index (ODI), patient satisfaction, responder rates, and analgesic use across 1-, 3-, and 6-month follow-up. Results: Both groups achieved significant improvements from baseline at all time points. Linear mixed-effects analysis demonstrated a significant overall association favoring the 8 min protocol for pain (estimate: −0.81, 95% CI: −1.52 to −0.10, p = 0.025) and functional disability (estimate: −12.84, 95% CI: −19.36 to −6.32, p < 0.001). Functional benefits emerged by 3 months (p = 0.006), while pain reduction reached borderline statistical significance at 6 months (p = 0.048). The 8 min group showed numerically higher responder rates and patient satisfaction without increased adverse events. Conclusions: In this study evaluating a combined PRF and corticosteroid injection protocol, 8 min PRF exposure was associated with superior pain and functional outcomes compared to 4 min, without compromising safety. However, the observational design and concurrent medication administration limits causal inference. Randomized controlled trials are needed to confirm these findings and isolate the independent effect of PRF duration.

Background: This study aims to compare the clinical effectiveness and safety of intra-articular corticosteroid (IAC) injections versus radiofrequency ablation (RFA) of the femoral and obturator articular branches in patients with advanced hip osteoarthritis (OA). Patients and Methods: This single-center, retrospective cohort study included a total of 93 patients including 62 who received IAC and 31 who received RFA between January 2022 and May 2025. Pain severity (Numeric Rating Scale, NRS), clinical improvement (Global Perceived Effect, GPE), and analgesic use were evaluated at baseline, one month, and six months. Longitudinal changes were analyzed using the Generalized Estimating Equations (GEE) adjusted for age, sex, body mass index (BMI), and opioid use. Results: Of a total of 93 patients included in the study, 17 were male and 76 were female with a mean age of 66.8±12.3 (range, 27 to 89). Both groups exhibited significant reductions in NRS scores at one and six months compared to baseline ( p < 0.001). No significant inter-group differences were observed in absolute NRS scores or the proportion of patients achieving a good clinical response (GPE ≥ 6). At six months, the RFA group demonstrated numerically greater improvement; however, differences in absolute (median 2.0 vs. 0.0; p = 0.052) and percentage change (median 25.0% vs. 0.0%; p = 0.054) did not reach statistical significance. Longitudinal analyses using GEE confirmed a significant main effect of time, with no treatment group effect or group-by-time interaction after adjusting for age, sex, BMI, and baseline opioid use. Conclusion: Both IAC and RFA provide meaningful and comparable pain relief in patients with refractory hip OA. While the analgesic effect of IAC injections appears to diminish by the sixth month, RFA may offer a safe alternative with a potentially more sustained clinical trajectory.

Aims: To evaluate clinical outcomes, patient-reported global improvement, and documented adverse events associated with thoracic interlaminar epidural steroid injections in a real-world cohort with chronic thoracic pain, predominantly postherpetic neuralgia (PHN).Methods: This retrospective single-center study included consecutive adults who underwent thoracic interlaminar epidural steroid injection between January 2022 and December 2025. Pain intensity was assessed using the Numeric Rating Scale (NRS) at baseline and at 1 and 6 months. Global Perceived Effect (GPE), ≥30% and ≥50% NRS responder rates, repeat injections, and documented adverse events were evaluated. Limited missing follow-up information was completed by telephone in five patients under the ethics-approved protocol. Changes in NRS were analyzed using the Friedman test with Bonferroni-adjusted Wilcoxon signed-rank comparisons.Results: Forty-one patients were included; PHN was the predominant etiology (24/41, 58.5%). Median NRS decreased from 7.0 (IQR, 1.0; range, 6-9) at baseline to 3.0 (IQR, 4.0; range, 0-8) at 1 month and 1.0 (IQR, 3.5; range, 0-7) at 6 months (overall p