Şebnem Rumeli

Background: Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly that often remain underrecognized in patients with low back pain (LBP), potentially leading to inappropriate management and disability. Objective: To determine the prevalence and distribution of LSTV subtypes in a large LBP cohort and to evaluate functional disability and healthcare utilization in patients with LSTV. Methods: In this single-center retrospective observational study, electronic records of 20,395 patients presenting with LBP between January 1, 2018 and January 1, 2024 were reviewed. Lumbar and lumbosacral imaging was evaluated and LSTV were classified according to the Castellvi system. Functional disability was assessed using the Oswestry Disability Index (ODI) in patients with LSTV. Associations between ODI scores, age, sex, Castellvi subtype and number of outpatient visits were analyzed. Results: LSTV were identified in 405 patients (prevalence 1.98%; mean age 52.9 ± 15.2 years; 63% female). Castellvi Type 2a was the most frequent subtype (25.7%). More than half of the patients reported pain duration of 1–5 years and 67.7% had multiple outpatient visits. Patients with multiple visits had significantly higher ODI scores than those with a single visit (42.65 ± 17.30 vs. 29.53 ± 18.05, p < 0.001) whereas ODI scores did not differ significantly across LSTV subtypes (p > 0.05). Conclusion: In patients with LBP, LSTV were present in approximately 2%. Patients with LSTV demonstrated substantial disability and frequent healthcare utilization. Prospective controlled studies are needed to determine whether these findings are specifically attributable to LSTV and to clarify potential causal relationships.

Mesut Bakır, Kaan Esen, Şebnem Rumeli, and İbrahim Yegül. Korean J Pain 2026;39:618-23. https://doi.org/10.3344/kjp.26193

Spontaneous cerebrospinal fluid (CSF) leaks are uncommon but significant causes of orthostatic headaches, often resulting from dural injuries. Although lumbar epidural blood patches (EBPs) are commonly used to treat such leaks, cervical EBPs are rarely performed due to the higher risk of complications, including spinal cord injury. This case series presents two patients with spontaneous cervical CSF leaks successfully treated with cervical EBPs under fluoroscopic guidance. The first case involved a 24-year-old female who presented with a two-month history of severe orthostatic headaches and tinnitus and a Visual Analog Scale (VAS) score of 8. After a cervical EBP with 3 mL of autologous blood, her symptoms resolved. The second case describes a 55-year-old male with a history of radiotherapy who presented with a VAS score of 10 and a four-month history of orthostatic headaches. A cervical EBP using a total of 6 mL of blood led to complete symptom resolution. Both cases highlight the efficacy and safety of cervical EBPs when performed with careful imaging guidance and minimal blood volumes. These findings suggest that this approach should be considered in cases of refractory cervical CSF leaks.

Epidural catheters and epidural port systems are widely used in interventional pain management; however, infectious complications remain an important safety concern, particularly during prolonged catheterization. This retrospective real-world cohort study evaluated the incidence, microbiological characteristics, and time-dependent risk factors of epidural catheter- and port-related infections in a tertiary pain clinic. A total of 352 patients were included after predefined exclusion criteria were applied. Infection was defined based on clinical findings and microbiological confirmation. The overall infection rate was 10.5% (37/352). Catheter duration was significantly longer in patients who developed infection and remained an independent predictor in multivariable logistic regression analysis (odds ratio per day: 1.12; 95% CI: 1.06–1.19; p = 0.002). Receiver operating characteristic analysis demonstrated moderate discriminatory ability of catheter duration for predicting infection (AUC = 0.68), with an optimal cut-off of 7 days. The most frequently isolated pathogens were methicillin-resistant coagulase-negative staphylococci. No cases of meningitis or sepsis occurred, and all infections were successfully managed with antibiotic therapy. These findings emphasize the importance of duration-based risk assessment and careful follow-up strategies in patients requiring prolonged epidural analgesia.

Ganglion impar block (GIB) is a commonly used interventional option for refractory chronic coccydynia. Caudal epidural steroid injection (CESI) targets the sacral and coccygeal roots and may theoretically augment the analgesic efficacy of GIB. Evidence comparing GIB alone with a combined GIB and CESI approach, however, remains limited. This study compared long‐term pain outcomes after GIB monotherapy versus GIB combined with CESI. In this retrospective single‐center study (Jan 2020–May 2025), we evaluated 56 adults with chronic coccydynia who underwent GIB alone (Group A) or in combination with CESI (Group B). Pain intensity was assessed using the 11‐point numeric rating scale (NRS‐11) at baseline and at 1 h, 1 month, and 6 months after the procedure. Multivariable logistic regression was used to explore predictors of 6‐month response, including early postprocedural pain change and sex. Significant improvements in pain intensity were observed in both groups and sustained over 6 months. Responder rates at 6 months were comparable between the GIB‐only (41.7%) and GIB with CESI (45.0%) groups (p > 0.05). Multivariable analysis revealed that greater early pain relief (baseline to 1 h) significantly predicted 6‐month favorable outcomes (OR: 2.08; 95% CI: 1.26–3.42; p = 0.004), whereas male sex was associated with significantly reduced odds of response (OR: 0.11; 95% CI: 0.02–0.72; p = 0.022). In this single‐center retrospective cohort, GIB was associated with sustained pain relief in a substantial proportion of patients with chronic coccydynia, while the addition of CESI did not confer a clear incremental benefit. Importantly, immediate postprocedural pain relief served as a robust predictor of long‐term success, whereas male sex was identified as a negative prognostic factor. Prospective, adequately powered randomized trials are needed to confirm these exploratory findings and to refine patient selection for GIB‐based interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT07200765

Catheter breakage is a rare complication of continuous peripheral nerve blocks. Retained fragments pose a significant technical challenge, particularly when they migrate from the insertion site. We report a 39‐year‐old woman with Fabry disease and chronic foot pain refractory to pharmacologic therapy who, after a successful diagnostic posterior tibial nerve block, received a continuous peripheral nerve catheter. She initially experienced excellent analgesia but, by Day 4, developed severe neuropathic symptoms; imaging showed proximal migration of a catheter fragment. Computed tomography and fluoroscopy guided surgical retrieval of the fragment was performed. This case highlights the need for early recognition of catheter‐related complications, precise localization with advanced imaging, and timely surgical intervention to reduce adverse outcomes from retained catheter fragments.

Background: Ganglion impar block (GIB) is a commonly used interventional option for refractory chronic coccydynia. Caudal epidural steroid injection (CESI) targets the sacral and coccygeal roots and may theoretically augment the analgesic efficacy of GIB. Evidence comparing GIB alone with a combined GIB and CESI approach, however, remains limited. This study compared long‐term pain outcomes after GIB monotherapy versus GIB combined with CESI. Methods: In this retrospective single‐center study (Jan 2020–May 2025), we evaluated 56 adults with chronic coccydynia who underwent GIB alone (Group A) or in combination with CESI (Group B). Pain intensity was assessed using the 11‐point numeric rating scale (NRS‐11) at baseline and at 1 h, 1 month, and 6 months after the procedure. Multivariable logistic regression was used to explore predictors of 6‐month response, including early postprocedural pain change and sex. Results: Significant improvements in pain intensity were observed in both groups and sustained over 6 months. Responder rates at 6 months were comparable between the GIB‐only (41.7%) and GIB with CESI (45.0%) groups ( p > 0.05). Multivariable analysis revealed that greater early pain relief (baseline to 1 h) significantly predicted 6‐month favorable outcomes (OR: 2.08; 95% CI: 1.26–3.42; p = 0.004), whereas male sex was associated with significantly reduced odds of response (OR: 0.11; 95% CI: 0.02–0.72; p = 0.022). Conclusions: In this single‐center retrospective cohort, GIB was associated with sustained pain relief in a substantial proportion of patients with chronic coccydynia, while the addition of CESI did not confer a clear incremental benefit. Importantly, immediate postprocedural pain relief served as a robust predictor of long‐term success, whereas male sex was identified as a negative prognostic factor. Prospective, adequately powered randomized trials are needed to confirm these exploratory findings and to refine patient selection for GIB‐based interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT07200765

Pain management, or algology, has developed significantly over the years, evolving from a basic understanding of pain to a specialized field of medicine. Historically, pain was attributed to supernatural causes, but advancements in anatomy, physiology, and neuroscience laid the groundwork for modern pain medicine. A pivotal moment came in the 1960s with the Gate Control Theory, which reshaped the understanding of pain perception. This period also saw the establishment of global organizations like the International Association for the Study of Pain (IASP) and the World Institute of Pain (WIP), promoting research, education, and certifications such as FIPP and EDPM. Globally, pain management became a recognized medical subspecialty in the late 20th century, with countries like the United States and Europe creating certification systems and multidisciplinary training programs. These efforts standardized pain care and emphasized a holistic approach, integrating pharmacological, psychological, and physical therapy interventions. In Türkiye, the term "algology" reflects its distinct recognition of pain as a specialized field. Algology was officially recognized as a medical subspecialty in 2011, with structured training programs established shortly after. Today, Turkey has over 400 certified algologists trained in centers equipped to provide both interventional and multidisciplinary care. The development of pain management worldwide and in Turkey underscores a shared commitment to improving patient care. With ongoing advancements, the field continues to evolve, aiming for broader accessibility and more innovative, patient-centered treatments.

Background/Objectives: Recurrent lumbar disc herniation (RLDH) refers to a lumbar disc herniation (LDH) that recurs at the same level, location, and side following surgical repair. This study aimed to evaluate the efficacy of transforaminal epidural steroid injection (TESI) and dorsal root ganglion pulsed radiofrequency (DRG PRF) therapy with and without caudal epidural steroid injection (CESI) for the treatment of lumbar radicular pain (LRP) associated with RLDH. Methods: This retrospective cohort study included 57 patients treated for RLDH in a hospital pain clinic between September 2022 and February 2024. A total of 27 patients received TESI and DRG PRF therapy (Group 1) and 30 patients received TESI, DRG PRF, and CESI therapy (Group 2). We evaluated patient age, sex, symptom duration, pain medication use, number of prior LDH operations, presence of stabilization on magnetic resonance imaging (MRI), intervention received, lumbar level and side of the intervention, and Numeric Rating Scale (NRS) pain scores before and at 1, 3, and 6 months post-procedure. Treatment success was defined as an NRS score at least 50% or 4 points lower than the pre-procedure score at post-procedure 6 months. Results: There was no significant difference in NRS scores between the groups during the 6-month follow-up period. Moreover, NRS scores did not differ based on the presence of stabilization on MRI or the use of pain medication (p > 0.05). Conclusions: TESI and DRG PRF therapy were effective in the treatment of LRP associated with RLDH over a 6-month follow-up period, and adding CESI did not increase treatment success.

Background. The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted the widespread use of corticosteroids as a treatment strategy, particularly in cases of severe pneumonia and cytokine storm. While this therapy has saved countless lives, its side effects have also been well-documented, including the development of avascular necrosis. Case presentation. This case report presents a rare instance of simultaneous bilateral avascular necrosis (AVN) affecting both the humeral and femoral heads in a 49-year-old male patient recovering from severe COVID-19. The patient was treated with high-dose corticosteroids, receiving 1250 mg of prednisolone over five days during hospitalization for COVID-19 pneumonia. Six months after discharge, he developed persistent hip pain, which was later diagnosed as AVN in both femoral heads. During hyperbaric oxygen therapy, the patient reported new shoulder pain, and MRI confirmed stage III AVN in both humeral heads. The patient’s pain was managed with bilateral suprascapular nerve radiofrequency ablation and bilateral Pericapsular Nerve Group (PENG) blocks, which provided significant relief. Conclusions. This case emphasizes the potential for corticosteroid-induced AVN, even months after treatment, and underscores the need for long-term monitoring of patients receiving corticosteroids for COVID-19. The involvement of four major joints highlights the severe musculoskeletal complications that can arise, supporting the importance of early diagnosis and timely intervention for pain relief.