Purpose of Review: Lower back pain (LBP) has a lifetime prevalence of 80% in the United States population. Discogenic back pain (DBP), a subcategory of LBP, occurs as a result of the interverbal disc degeneration without disc herniation. Diagnosis relies on history, physical exam, and imaging such as MRI, provocative discography, or CT discography. Recent Findings: Treatment of DBP involves a multifaceted approach with an emphasis on conservative measures including behavioral modification, pharmacologic management, and other non-pharmacologic interventions with invasive therapy reserved for select patients. Due to the paucity of data on the treatment of DBP, treatment also relies on data derived from treatment of chronic LBP (CLBP). Summary: Despite the scarcity of data for the treatment of DBP, treatments do exist with varying efficacy for DBP. Novel techniques such as the use of biologics may provide another avenue for treatment though further studies are needed to better evaluate the most efficacious regimen for both novel and existing treatments.

Background: Although spinal cord stimulation (SCS) is an effective treatment for managing chronic pain, many patients have understandable questions and concerns regarding this therapy. Artificial intelligence (AI) has shown promise in delivering patient education in healthcare. This study evaluates the reliability, accuracy, and comprehensibility of ChatGPT’s responses to common patient inquiries about SCS. Methods: Thirteen commonly asked questions regarding SCS were selected based on the authors’ clinical experience managing chronic pain patients and a targeted review of patient education materials and relevant medical literature. The questions were prioritized based on their frequency in patient consultations, relevance to decision-making about SCS, and the complexity of the information typically required to comprehensively address the questions. These questions spanned three domains: pre-procedural, intra-procedural, and post-procedural concerns. Responses were generated using GPT-4.0 with the prompt “If you were a physician, how would you answer a patient asking…”. Responses were independently assessed by 10 pain physicians and two non-healthcare professionals using a Likert scale for reliability (1–6 points), accuracy (1–3 points), and comprehensibility (1–3 points). Results: ChatGPT’s responses demonstrated strong reliability (5.1 ± 0.7) and comprehensibility (2.8 ± 0.2), with 92% and 98% of responses, respectively, meeting or exceeding our predefined thresholds. Accuracy was 2.7 ± 0.3, with 95% of responses rated sufficiently accurate. General queries, such as “What is spinal cord stimulation?” and “What are the risks and benefits?”, received higher scores compared to technical questions like “What are the different types of waveforms used in SCS?”. Conclusions: ChatGPT can be implemented as a supplementary tool for patient education, particularly in addressing general and procedural queries about SCS. However, the AI’s performance was less robust in addressing highly technical or nuanced questions.

Purpose of Review: Insomnia is a complex sleeping disorder that affects the lives of many individuals worldwide. Insomnia often occurs in the presence of coexisting comorbidities making it a complex disorder that requires a multifactorial approach to therapy. First-line therapy is cognitive-behavioral therapy for insomnia (CBT-I). Pharmacotherapy for insomnia falls into four classes based on mechanism of action: benzodiazepine receptor agonists (BZRAs), histamine receptor antagonists, melatonin receptor agonists, and dual orexin receptor antagonists (DORAs). Recent Findings: Daridorexant is a dual orexin type 1 and types 2 (OX₁ and OX₂) receptor antagonist that was recently approved by the US FDA for the treatment of adults suffering from insomnia. It was shown to be effective in reducing insomnia symptoms, increasing daytime functioning, and improving the overall quality of sleep. Daridorexant offers patients relief from insomnia while avoiding the severe side effects and dependency issues of traditional treatments like benzodiazepines and sedatives. Summary: In this article, we review the most recent data on insomnia treatments and summarize the safety and efficacy of daridorexant in treating insomnia.

Purpose of Review: Notalgia paresthetica (NP) is a chronic cutaneous neuropathy primarily characterized by localized pruritus and associated dysesthesias, including sensations of pain, numbness, and tingling. The sensory neuropathy characteristic of NP is thought to result from spinal nerve entrapment caused by degenerative changes in the spine or musculoskeletal compression. This review summarizes the current medical literature with a focus on the past five years regarding NP, its pathophysiology, presentation, and current treatment options. Recent Findings: Though treatments exist with varying efficacy, to date, there exists no definitive treatment for NP. Treatment options for NP are varied and range from topical and oral agents to interventional procedures and physical therapy. Of the treatments evaluated, topical capsaicin remains the most efficacious treatment for NP. Conclusions: The lack of established treatment guidelines makes treating NP complicated as it dramatically affects patients’ quality of life. Further research with larger sample sizes is needed to evaluate better the most effective treatment and dosing regimen for patients afflicted with NP.