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: N-Methyl D-Aspartate (NMDA) receptor blockers have been shown to have protective effects against ischemia/reperfusion (I/R) injury in various tissues. The aim of this study was to investigate the effects of 90 ve 135 mg/kg doses of amantadine on lung in hepatic I/R injury. Method: The rats were randomly divided into six groups: Group Sham, Group I/R, Group Amantadine-90, Group Amantadine-135, Group I/R-90 and Group I/R-135. In I/R, an atraumatic vascular clamp was applied to the structures in the left portal triad for 45 minutes and reperfusion period was 2 hours after ischemia. Malondialdehyde (MDA), superoxide dismutase (SOD) and catalase (CAT) enzyme levels were performed the lung tissue and tissues were examined histopathologically. Result: A significant difference was found between the groups in terms of MDA, SOD, CAT levels (respectively; p < 0.001, p=0.008, p < 0.001). A significant difference was found between the groups in terms of lung tissue neutrophil/lymphocyte infiltration scores and alveolar wall thickening scores (respectively p=0.009, p=0.002). Conclusion: The biochemical and histopathological results of the present study suggested that amantadine, like other NMDA antagonist agents, may have a protective effect on lung tissues against the damage caused by hepatic I/R injury. Although we observed significant improvements after the administration of both doses studied, there was no significant difference between these two doses in terms of their success in protecting against distant organ lung injury. Amantadine appears promising as a therapeutic agent in treatment.

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/Objectives: Cancer-related pain remains difficult to control in a substantial proportion of patients despite contemporary pharmacological treatment, and interventional procedures may provide additional analgesic benefit. However, the relationship between the timing of these procedures and analgesic response remains insufficiently characterized. This study investigated whether the interval between cancer diagnosis and interventional pain treatment was associated with short-term analgesic response. Methods: We retrospectively analyzed 106 patients who underwent interventional procedures for cancer-related pain. Pain intensity was assessed using the Numeric Rating Scale (NRS), and opioid consumption was expressed as morphine equivalent daily dose (MEDD). Pain intensity was assessed at baseline, 1 week, and 1 month, whereas opioid consumption was assessed at baseline and 1 month. The primary outcome was a ≥50% reduction in NRS score at 1 month. Multivariable logistic regression was used to evaluate factors associated with response. Model assumptions, calibration, and internal validation were examined, and sensitivity analyses included generalized estimating equations, parsimonious and Firth-penalized models, and an analysis restricted to neurolytic procedures. Results: At 1 month, 52 patients (49.1%) achieved a ≥50% reduction in pain intensity. NRS scores decreased significantly over time (p < 0.001), while the reduction in MEDD at 1 month was statistically significant but modest (p = 0.005). Changes in NRS and MEDD were strongly correlated (ρ = 0.809, p < 0.001). A longer diagnosis-to-intervention interval was associated with lower odds of treatment response (OR = 0.913 per month; 95% CI, 0.853–0.977; p = 0.008). Metastatic disease was also associated with lower odds of response (OR = 0.067; 95% CI, 0.015–0.310; p < 0.001). These associations were directionally consistent across sensitivity analyses, and spline analysis showed no statistical evidence of a non-linear relationship between the diagnosis-to-intervention interval and response. Conclusions: A longer interval between cancer diagnosis and interventional pain treatment was associated with lower odds of short-term analgesic response. However, this interval does not represent pain duration or treatment delay and may reflect differences in disease burden and other unmeasured clinical factors. These findings should therefore be interpreted as associative rather than causal and warrant prospective investigation.

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.

Aim: To evaluate the short-term effectiveness and safety of ultrasound-guided proximal C2 greater occipital nerve block in patients with chronic migraine. Methods: This single-center, retrospective observational study included 41 consecutive adults with chronic migraine diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), who underwent ultrasound-guided greater occipital nerve block at the proximal C2 level in the Department of Pain Medicine. Pain intensity, monthly headache days, monthly number of days with headache severity > 5, attack duration, and patient-reported outcomes (HIT-6 and GPE) were assessed at baseline and at the 1st week, 1st month, and 3rd month follow-up visits. Changes over time were analyzed using appropriate non-parametric tests for repeated measures. Results: Monthly headache days, monthly number of days with headache severity >5, pain intensity, and attack duration were significantly lower at the 1st and 3rd months than at baseline (all p<0.001). GPE scores did not differ significantly during follow-up (p=0.059). HIT-6 scores were significantly lower at the 1st and 3rd months than at baseline (both p<0.001), with no significant difference between the 1st and 3rd months (p=1.000). When a Likert score of 2 was defined as treatment success, the success rate increased significantly across follow-up visits (Cochran’s Q test, p <0.001), from 7.3% at the 1st week to 36.6% at the 3rd month. No major procedure-related complications were observed. Conclusion: Ultrasound-guided greater occipital nerve block performed at the proximal C2 level appears to be a safe and clinically useful short-term treatment option in patients with chronic migraine. This approach was associated with reductions in headache burden, pain severity, and headache-related disability, with increasing patient-reported treatment success over the 3-month follow-up period.