Background and Objectives: Knee osteoarthritis is a major cause of chronic pain and disability. Because the benefit of intra-articular corticosteroid injection is often limited, this study compared fluoroscopy-guided corticosteroid injection alone with corticosteroid injection combined with pulsed radiofrequency (PRF). Materials and Methods: This retrospective comparative study included 386 consecutive patients with symptomatic knee osteoarthritis treated with fluoroscopy-guided intra-articular corticosteroid injection alone (IAS, n = 190) or combined with PRF (IAS + PRF, n = 196). Pain and function were assessed using the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 1 week, 1, 3, and 6 months. The primary endpoint was the 6-month VAS score. Baseline-adjusted linear mixed-effects models were the primary analyses, with propensity score-matched analyses as sensitivity analyses. Results: Both groups showed significant improvements in pain over time. In the primary baseline-adjusted analyses, adding PRF was associated with greater early- and mid-term pain reduction, including significantly lower VAS scores at the 6-month primary endpoint and higher rates of clinically meaningful pain improvement (≥50% response). However, this adjusted difference was modest (below the minimal clinically important difference) and was no longer statistically significant after propensity score matching (6-month VAS median 5.0 in both groups; p = 0.763), indicating that baseline imbalance contributed to the apparent advantage. Conclusions: In baseline-adjusted analyses, adding PRF to intra-articular corticosteroid injection was associated with more favourable early- and mid-term pain outcomes than corticosteroid injection alone, although the difference was modest and was not confirmed after propensity score matching. Given the retrospective, non-randomized design and baseline imbalance, these findings should be considered hypothesis-generating. Prospective randomized, sham-controlled studies with longer follow-up are needed to clarify the role of PRF as an adjunctive treatment for knee osteoarthritis.

Background/aim: The objective of this study was to establish the oxidative stress determiners as a total oxidative state (TOS), total antioxidative state (TAS), paraoxonase (PON) activity, oxidative stress index (OSI), and thiol/disulfide levels before and after 6 months of immunomodulator therapy in patients who were diagnosed according to the revised McDonald Criteria. Materials and methods: Thirty-nine patients were included in our study who were diagnosed according to the revised McDonald Criteria, approved to participate in the study, and had been treated in the neurology inpatient clinic or presented in the neurology outpatient clinic of Ankara Yıldırım Beyazıt University Atatürk Training and Research Hospital. Blood samples were collected from patients before treatment and six months after treatment. The venous blood samples of the patients were evaluated for routine biochemical tests, TOS, TAS, PON activity, OSI, and thiol/disulfide levels. Results: The oxidative stress parameter levels of blood samples obtained before and after 6 months of the treatment were compared. The blood samples obtained after 6 months of therapy exhibited statistically significant results, including elevated levels of native thiol/total thiol (SH/SH+SS), PON, and TAS (p = 0.001). No significant relation was observed between the duration of disease, sex, used therapy agents, and oxidative stress parameters. Conclusion: In this study, we determined that TOS and OSI, which are indicators of oxidative stress, and TAS and PON, which exhibit antioxidative activity, can be employed to evaluate the therapy response. Additionally, we found that immunomodulator therapies canexhibit a protective effect, as evidenced by a reduction in oxidative stress indicators.

Background and Objectives: Chronic migraine (CM) remains a major cause of neurological disability, and a subset of patients remains highly treatment-resistant despite previous preventive and interventional treatments. Stellate ganglion block (SGB) has been proposed as a sympathetic neuromodulatory intervention, but evidence in this population remains limited. This study evaluated 6-month clinical outcomes and tolerability after a structured ultrasound-guided SGB protocol. Materials and Methods: This prospective, single-center, uncontrolled, single-group interventional study enrolled 42 adults with CM who had experienced insufficient benefit from prior preventive migraine treatment and previous interventional headache procedures. After an initial ultrasound-guided SGB to assess anatomical suitability and procedural tolerability, all participants proceeded to four additional weekly ultrasound-guided SGB sessions using 5 mL of 1% lidocaine, for five protocol-defined sessions in total. The primary outcome was the change in monthly headache days (MHD) from baseline to 6 months. Results: All 42 participants (mean age: 44.4 ± 7.4 years) completed the 6-month follow-up. Median MHD decreased from 29.0 days at baseline to 6.0 days at 6 months (Kendall’s W = 0.643, p < 0.001), corresponding to a median within-participant reduction of 17.0 days (BCa 95% CI: 13.0–19.0). A ≥50% reduction in MHD was achieved by 73.8% of participants (95% CI: 58.9–84.7) at 6 months, whereas 14.3% (95% CI: 6.7–27.8) achieved a ≥50% reduction in mean pain intensity. HIT-6 and MIDAS scores also improved significantly (p < 0.001). Six participants (14.3%) reported mild, self-limited adverse effects; no serious adverse events were documented. Conclusions: Ultrasound-guided SGB was associated with sustained reductions in headache frequency, analgesic use, and migraine-related disability over 6 months. Because this was an uncontrolled single-group study, the findings should be considered preliminary and hypothesis-generating. The frequency-dominant pattern of improvement and favorable tolerability support further controlled evaluation of SGB as a potential adjunctive neuromodulatory strategy in highly treatment-resistant CM.

Background and Objectives: Pulsed radiofrequency (PRF) of the cervical medial branches is a non-destructive neuromodulatory option for chronic cervical facet joint pain, yet evidence regarding the durability of clinical response and factors associated with sustained benefit remains limited. This study aimed to characterize the 6-month trajectory of pain and disability after fluoroscopy-guided cervical medial branch PRF and to explore baseline factors associated with meaningful pain relief (MPR). Materials and Methods: In this retrospective single-center cohort study, 75 patients with chronic cervical facet joint pain who achieved ≥50% temporary pain relief following a diagnostic medial branch block underwent fluoroscopy-guided cervical medial branch PRF, followed by injection of local anesthetic and corticosteroid at the treated levels. Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores were evaluated at baseline and at 1, 3, and 6 months. MPR was defined as ≥50% reduction in NRS from baseline. Global Perceived Effect (GPE) and changes in analgesic medication use were assessed as complementary clinical outcomes. An exploratory multivariable logistic regression analysis was performed to examine factors independently associated with MPR at 6 months. Results: Median NRS scores decreased from 7.0 at baseline to 4.0, 4.0, and 5.0 at 1, 3, and 6 months, respectively, while median NDI scores decreased from 30.0 to 14.0, 16.0, and 20.0 (both overall p < 0.001). Despite sustained improvement relative to baseline, MPR progressively declined from 57.3% at 1 month to 49.3% at 3 months and 36.0% at 6 months (overall p < 0.001). Favorable GPE and reduced analgesic medication use showed parallel declines, supporting attenuation of overall clinical benefit over time. In the exploratory multivariable model, fibromyalgia was independently associated with 75% lower odds of 6-month MPR (OR = 0.25, 95% CI: 0.088–0.709; p = 0.009). Age, sex, and baseline NRS were not significantly associated with 6-month MPR. No serious acute periprocedural adverse events were documented during the 2 h observation period. Conclusions: Fluoroscopy-guided cervical medial branch PRF, combined with post-procedural corticosteroid and local anesthetic administration, was associated with clinically meaningful improvements in both pain and neck-related disability, with the greatest benefit during the first 3 months and partial attenuation by 6 months. The progressive decline across pain response, patient-reported global improvement, and analgesic-use outcomes highlights the time-dependent nature of the benefit associated with the combined intervention. Fibromyalgia was independently associated with substantially lower odds of 6-month MPR in this exploratory analysis; this association should be interpreted cautiously and requires prospective validation before it can inform patient selection, although it may be relevant when counseling patients regarding the durability of response.