Functional movement disorder (FMD) is a common cause of debilitating symptoms in neurology patients. Due to the stigma that is associated with FMD, it is possible that discrepancies between patient and physician judgements of severity and disability are more pronounced in FMD compared with non-FMD. A patient-physician discrepancy in judgement may be explained by associated comorbid non-motor symptoms. In the prospective TASMAN study, 171 FMD and 294 non-FMD patients were recruited from the Netherlands and Australia. Patient characteristics included non-motor symptoms: depression, anxiety, dissociation, pain and fatigue. Patient-reported and physician-reported severity and disability were collected using seven-point Likert scales. A quantitative measure of discrepancies was calculated by subtracting the physician's score from the patient's score. Associations between non-motor symptoms and disability were analysed using linear regression. Patients reported significantly higher severity and disability compared with physicians in both groups. Patient-physician discrepancies in both severity and disability outcomes were not statistically different between FMD and non-FMD. FMD patients scored significantly higher on all non-motor symptoms compared with non-FMD. Patient-reported, but not physician-reported, disability was associated with increased pain and fatigue in both the FMD and non-FMD groups. In FMD, dissociation was associated with disability in both patient-reported and physician-reported outcomes. In non-FMD, depression was associated with disability in both patient-reported and physician-reported outcomes. Our results do not support notions of ongoing FMD-specific stigmatisation in physicians. Similar patient-physician discrepancies regarding severity and disability exist in both FMD and non-FMD patients. Patient-physician discrepancies in disability in all movement disorder patients might be in part explained by different appreciation of the importance of non-motor symptoms.
Leading cause of global disability, lower back pain, affects 84% of adults and costs the U.S. $134 billion annually. Traditional care fails to improve outcomes despite rising spending. This study assessed the effectiveness of a digital musculoskeletal integrated practice unit (IPU) in reducing pain and function in adults with back pain. We conducted a retrospective cohort study of 784 adults (18-95 years) with low back pain enroled in our IPU between September 2023 and February 2025. Intervention included virtual physician/nurse practitioner and physical therapist assessments, coordinated care with health coaching and nutrition counselling, and digital physical therapy. Primary outcomes were improvement in pain (Numeric Pain Rating Scale) and function (Single Assessment Numeric Evaluation). Analyses used paired t-tests for within-subject changes, multivariable linear regression adjusting for baseline severity, follow-up duration, age, sex, and comorbidities, and engagement-stratified analyses to assess associations between visit frequency and outcomes. Among 784 patients (mean age 60.1 ± 17.0 years), mean pain scores decreased 4.94 ± 0.07 to 2.61 ± 0.08 (p < 0.001, Cohen's d = -1.02), with 61.9% achieving the MCID of ≥ 2-point pain reduction. Among patients with severe baseline pain (≥ 7), 78.1% achieved pain MCID. Among the 688 patients (87.8%) with paired functional data, SANE scores increased 51.18 ± 0.96 to 74.97 ± 0.83 (p < 0.001, Cohen's d = 0.94), with 58.0% achieving SANE MCID of ≥ 15 points. Digital musculoskeletal IPU care for low back pain may provide convenient access to care for patients while supporting clinical effectiveness.
Long-term alendronate use has been associated with tendinopathies and ligament disorders that may result in chronic pain and functional impairment. Platelet-rich plasma (PRP) therapy has emerged as a regenerative treatment option for chronic tendinopathies by promoting tissue healing and improving pain and function. A 61-year-old woman with an athletic lifestyle took alendronate for 14 years for osteopenia before she stopped taking it. Nine years later, she reported chronic right hamstring complex pain and loss of function after sustaining a lifting injury. She underwent conservative therapy, including stretching exercises and physical therapy and had an evaluation by an orthopedic surgeon. Her pain and function did not improve. She was referred to an interventional pain management physician who diagnosed her with chronic semimembranosus tendinopathy. She was initially treated with a 3-injection series of 12.5% dextrose prolotherapy which did not provide lasting pain relief nor lasting functional improvement. Her treatment was then changed to a holistic regimen of ultrasound-guided leukocyte-poor platelet-rich plasma injections, a post platelet-rich plasma physical therapy program, and acupuncture. This holistic treatment program enabled her to attain 90%-95% pain relief and a significantly improved functional status and quality of life. Platelet-rich plasma injection therapy is an evolving area in Medicine. It holds much promise for those in need of musculoskeletal repair, pain relief and improved function without the need for surgery or chronic use of medications. Much work remains to be done in developing more standardization of platelet-rich plasma therapy, but medical specialists are moving in the right direction as we become more sophisticated and attune in studying, understanding and implementing the potential that platelet-rich plasma injection therapy holds for healing. Incorporation of leukocyte-poor platelet-rich plasma using holistic treatment of chronic semimembranosus tendinopathy associated with chronic use of alendronate was much more effective for pain reduction and restoration of function as compared to only more conservative therapies of physical therapy, stretching exercises, acupuncture, and dextrose prolotherapy.
The transforaminal epidural steroid injection (TFESI) is a widely used interventional procedure for managing radicular pain. Although TFESI is well established as a safe and effective treatment, patients frequently seek detailed explanations regarding its procedural steps, expected outcomes, and potential risks. Artificial intelligence (AI)-based platforms, particularly large language models (LLMs) such as ChatGPT, have emerged as accessible sources of periprocedural medical information. However, the accuracy, readability, and empathy of AI-generated responses in the context of interventional pain management remain uncertain. To compare the accuracy and readability of responses generated by ChatGPT and fellowship-trained pain medicine physicians to common patient questions about TFESIs and to assess the potential utility of AI in patient education and periprocedural guidance. A cross-sectional comparative study. Twenty frequently asked patient questions about TFESIs were retrospectively identified from pain clinic consultations and submitted individually to ChatGPT-4o and to fellowship-level physicians. Two interventional pain specialists independently evaluated all responses for accuracy and empathy using a 5-point Likert scale; discrepancies were resolved by a third reviewer. Readability was analyzed using the Readable® tool kit across 7 indices: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGRL), Gunning Fog Index, SMOG Index, Coleman-Liau Index, average word and sentence length, and estimated overall reach. Both sources delivered highly accurate responses. However, ChatGPT's answers had significantly lower FRES scores, reflecting reduced reading ease, and higher scores across all other readability indices, indicating greater linguistic complexity and lower accessibility. These responses required a higher level of education to understand. Although empathy scores for ChatGPT were lower than the physicians', the difference was not statistically significant. This study assessed a single AI platform (ChatGPT-4o). Accuracy and empathy ratings were performed subjectively by 2 pain specialists, which might have limited generalizability. Additionally, AI-generated responses can vary with software updates, reducing reproducibility across time. ChatGPT provides accurate information regarding TFESIs but demonstrates lower readability and a less empathetic tone than answers given by fellowship-trained physicians. With targeted improvements in clarity and patient-centered communication, AI holds potential as a useful adjunct in patient education and clinical support.
Degenerative disc disease is a leading cause of low back pain. Conservative treatments like pain medication and exercise therapy have shown mixed results, while procedures like fusion surgery carry risks such as adjacent segment disorder and surgical morbidity. Therefore, there is a critical need for treatments that bridge the gap between conservative care and surgery. To assess the efficacy of intradiscal hydrogel implantation compared with sham treatment of intradiscal injection of saline in patients with chronic discogenic low back pain. Prospective, double-blind, randomized, controlled, multicenter trial. Two tertiary interventional pain care centers in Switzerland and in the Netherlands. Forty-nine patients with chronic discogenic low back pain unresponsive to conservative treatment were randomized to receive either intradiscal hydrogel implantation or a sham treatment. Control Group patients could cross over to hydrogel treatment after 6 months. The primary outcome was pain improvement at 6 months. Secondary outcomes included disability, quality of life, employment status, Patient Global Impression of Change score, analgesic use, disc space height, and disc degeneration. Adverse events were continually assessed. At 6 months postprocedure, the Hydrogel Group patients had improved pain scores compared to Control Group patients, though not statistically significant (P = 0.070). Six out of 24 patients in the Hydrogel Group reported much improvement on their Patient Global Impression of Change scores, compared to 0 out of 25 in the Control Group (P = 0.008). Within-group disability improvements were statistically significant in the Hydrogel Group but not in the Control Group. No significant differences were found between groups in disability, quality of life, or employment status. Only one serious adverse event was reported-a patient from the Hydrogel Group was hospitalized due to a possible exacerbation of low back pain 6 days postprocedure. This trial's limitations include strict eligibility criteria and questions about the validity of intradiscal saline as a placebo. This trial suggests that percutaneous intradiscal hydrogel implantation may reduce chronic discogenic pain and disability, with significant Patient Global Impression of Change improvements, though larger trials are needed to confirm efficacy.
Chronic axial spinal pain is a major cause of disability. The literature shows that expenditures related to low back and neck pain and other musculoskeletal disorders continue to rise, not only due to disability but also due to increasing healthcare costs, accounting for the highest expenditure among various disease categories. Based on current evidence utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been identified as potential sources of spinal pain. Therapeutic facet joint interventional modalities for axial spinal pain include radiofrequency ablation, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections. The objective of this systematic review and meta-analysis is to evaluate the effectiveness of radiofrequency ablation as a therapeutic modality in managing chronic axial spinal pain of facet joint origin. A systematic review and meta-analysis of randomized controlled trials (RCTs) utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The available literature on radiofrequency ablation in axial spinal pain was reviewed. The quality assessment criteria utilized included the Cochrane review criteria to assess risk of bias and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials. The evidence was graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The level of evidence was determined based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V.A comprehensive literature search of multiple databases from 1966 to June 2025, including manual searches of the bibliographies of relevant review articles, was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into both qualitative and quantitative analyses. The primary outcome measure was the proportion of patients achieving significant pain relief and functional improvement of greater than 50% for at least 6 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months). This assessment identified 17 RCTs, including 14 high-quality and 3 moderate-quality studies based on Cochrane criteria, and 11 high-quality and 6 moderate-quality studies based on IPM-QRB criteria. Based on the GRADE assessment, 8 trials demonstrated at least moderate levels of impact and certainty, whereas 7 trials showed low impact with low certainty, and 2 trials demonstrated very low impact and certainty. Despite the availability of multiple studies, the relative paucity of high-quality literature remains a major limitation. Based on this systematic review and meta-analysis of 17 RCTs, the evidence is Level II with moderate certainty and a moderate strength of recommendation for the use of radiofrequency ablation in managing chronic axial spinal pain of facet joint origin.
We identified significant gaps in perioperative pain management for sports medicine surgery at our hospital, including a high incidence of severe postoperative pain possibly due to a lack of preemptive analgesia. We aimed to improve pain management outcomes by optimizing multimodal analgesia, which was implemented by the "Pain-Free Hospital" project at Peking University Third Hospital. A single-center retrospective observational study. Peking University Third Hospital. A total of 6,610 sports medicine surgery patients seen from July 2022 through August 2023 were divided into baseline (the first 3 months) and intervention (the subsequent 11 months) phases. Data on postoperative Numeric Rating Scale (NRS-11) pain scores and analgesic utilization were extracted from the hospital information system. Analgesic consumption was measured by the Analgesic Use Rate (AUR) and Number of Defined Daily Doses (DDDs). The DDD value of each drug is provided by the World Health Organization (WHO). The proportion of Days with Severe Pain (DSP, NRS-11 ≥ 7) was assessed on the first postoperative day and over the first 3 days. We addressed the gap in preemptive analgesia, with its implementation rate increasing from 0% to 53.8%. Etoricoxib (not approved for use in the United States by the FDA) use increased significantly (AUR: 13.4% to 53.2%; DDDs: 116.0 to 433.1), while pethidine use decreased significantly (AUR: 48.5% to 19.6%; DDDs: 47.1 to 17.0). These changes were accompanied by significant reductions in severe postoperative pain: DSP declined from 21.3% to 8.8% on the first postoperative day and from 10.8% to 4.8% over the first 3 days. As a single-center retrospective study in a tertiary hospital in the People's Republic of China's capital, the regional patient pool may limit the generalizability of our findings. Additionally, the study did not account for the potential effect of COVID-19 on patient severity, surgical patterns, and analgesic prescription diversity during the pandemic. Our study demonstrates that implementing a structured perioperative protocol emphasizing preemptive analgesia and multimodal analgesia resulted in pain management effects, including decreased incidences of severe postoperative pain and reduced analgesic opioid consumption.
The transition toward value-based care in the United States has introduced episode-based payment models that increasingly tie physician reimbursement to longitudinal costs and standardized outcomes. The Centers for Medicare & Medicaid Services (CMS) Ambulatory Specialty Model (ASM), targeting chronic low back pain (cLBP), represents a pivotal extension of this framework into interventional pain management. While intended to reduce low-value utilization, such models risk redefining clinical success in ways that may not align with the heterogeneous and biopsychosocial nature of chronic pain. This perspective examines the potential for outcome-driven reimbursement to incentivize risk selection, marginalize clinically meaningful but non-durable functional gains, and exacerbate existing health disparities. Based on available literature, we propose a "Value Plus" framework incorporating enhanced risk adjustment and patient-centered composite outcomes to better align economic incentives with the realities of chronic pain care. In conclusion, in the field of interventional pain management, withdrawal of multiple conflicting models (ASM, WISER, etc.), and addition of a payment model including a value plus framework would better align incentives with the realities of delivering care to chronic pain patients.
The physician-patient relationship can be undermined by biased behaviours. There is a lack of epidemiological data in Europe and in the field of anaesthesia. BiPAC is a prospective and bicentric survey study, conducted in a public and a private hospital. We recruited both the patient and the physician during consultation. A biased behaviour is defined as any action or statement perceived as degrading. A total of 1980 patients were included, and physicians returned 258 questionnaires. Biased behaviour from the physician was experienced by 3.7% of the patients. The consequences were poor answers, disrespectful remarks, and denial of care. Patients encountering difficulties with the French language were more likely to be experiencing biased behaviour (OR = 6.90 [1.34-35.48]; p < 0.001), as were LGBTQ patients (OR=3.32 [1.38-7.97] ; p = 0.007). In contrast, being seen in a private centre was a protective factor (OR=0.52 [0.27-0.99]; p = 0.046). Biased behaviour from patients was experienced by 2.1% (n=63) of the physicians. Being a woman (p = 0.039) and European (p < 0.001) were risk factors. In multivariate analyses, being 60 years or older was a protective factor (OR=0.21 [0.09-0.54]; p = 0.001) while being a resident was a risk factor (OR=2.7 [1.38-5.68]; p = 0.004). Biased behaviours during pre-anaesthesia consultations, even when perceived as harmless, undermined patient trust, understanding, and perceptions of physician competence. Language barriers and identifying as LGBTQ were risk factors for patients, whereas belonging to an ethnic minority group was not. Among physicians, being a woman, a resident, or younger in age was associated with greater exposure.
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Pain Medicine fellowship programs have reported increasing numbers of unfilled positions in recent match cycles, accompanied by a growing perception that the applicant pipeline is shrinking. In response to concerns regarding application volume and applicant-program fit, the Electronic Residency Application Service® (ERAS) introduced program signaling for the Pain Medicine fellowship in the 2024-2025 application cycle. Of note, Pain Medicine was the first fellowship across all medical specialties to utilize signaling, with further plans by ERAS to expand access to signaling to other fellowships in the future. However, the effectiveness of this intervention in the context of fewer applications to the field remains unclear. To evaluate the association between ERAS program signaling and interview invitation rates in Pain Medicine fellowship applications, and to contextualize signaling outcomes alongside longitudinal National Resident Matching Program® (NRMP) match trends and unfilled positions. Our study integrated data from 3 sources: NRMP Specialties Matching Service reports (2019-2025), Association of American Medical Colleges ERAS signaling dashboards (2024-2025), and a post match survey distributed to all 442 applicants in the 2025 cycle. Primary outcomes included interview invitation rates by signal status and applicant type (MD, DO, international medical graduate [IMG]). Secondary outcomes included match rates at signaled vs nonsignaled programs and applicant perceptions of signaling. Cross-sectional. Sixty-five applicants responded (14.7% response rate), 86.1% matched. Applicants utilized a mean of 4.6 of the 5 available signals. Interview invitation rates were substantially higher for signaled applications than for nonsignaled applications across all applicant types. Among applicants who sent signals, interview rates were 70.3% for MDs, 58.3% for DOs, and 34.1% for IMGs, compared with 39.7%, 32.3%, and 18.0%, respectively, among nonsignaled applications. The signal-associated increase in interview rate was greatest for MD applicants (30.6 percentage points), followed by DOs (26.0 percentage points) and IMGs (16.1 percentage points). Of matched respondents, 70.7% matched at a program they had signaled. Applicant perceptions of signaling were mixed, with 64.1% reporting it as useful and 35.9% reporting it as useless. Program signaling is strongly associated with increased interview invitation rates in Pain Medicine fellowship applications and appears to improve applicant-program alignment, particularly for MD applicants. However, the differential benefits across applicant types raise equity concerns, and signaling cannot address the fundamental workforce changes driving a reduced applicant pool. Sustainable recruitment strategies must extend beyond match optimization to address the structural factors underlying declining interest in Pain Medicine fellowships.
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Decisions to limit life-sustaining treatment (LST) in intensive care frequently generate ethical tensions between physicians and patients' relatives. Although France and the United States both emphasize respect for patient autonomy, their decisional frameworks allocate different roles to physicians and surrogates, raising questions about how these models shape ethical practice. The aim of this study was to compare French and American approaches to LST decision-making to identify shared ethical difficulties in physician-relative interactions beyond framework differences. Qualitative comparative analysis combining a review of decisional frameworks with semi-structured interviews of intensivists and ethicists in France and the United States. Data were analyzed thematically. Three recurrent ethical issues emerged across both contexts. First, while patient autonomy remains a central normative reference, its implementation is limited by the scarcity, ambiguity, and contextual inadequacy of advance directives, as well as uncertainties in interpreting patients' wishes through relatives. Second, irrespective of formal decision-making authority, physicians report a strong sense of moral responsibility grounded in medical expertise and professional integrity, often associated with moral distress when asked to provide treatments perceived as non-beneficial. Third, conflicts with relatives commonly arise from value-based disagreements regarding proportionality of care and perceived medical futility. Despite contrasting legal models - physician-led decision-making in France and surrogate-led decision-making in the United States - ethical tensions surrounding LST decisions appear largely similar. These findings suggest that procedural frameworks alone are insufficient to address the moral complexity of end-of-life decision-making, underscoring the need to strengthen ethical deliberation, and recognition of shared moral responsibility between physicians and relatives.
The use of facet joint interventions for spinal pain management increased rapidly between 2000 and 2010, followed by slower growth from 2010 to 2019. Post-COVID analyses demonstrated a marked decline in facet joint interventions despite an increasing prevalence of chronic pain among traditional Medicare beneficiaries after 2019, together with multiple contributing factors over time, including enactment of the Affordable Care Act, COVID-19, the Inflation Reduction Act, and other influences. This study aims to update and analyze utilization patterns of facet joint interventions for chronic pain management in the U.S. traditional Medicare population across multiple periods from 2000 to 2024. A retrospective cohort study evaluating utilization trends and influencing factors for facet joint interventions in the fee-for-service (FFS) traditional Medicare population in the United States from 2000 to 2024. Data were derived from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary database (2000-2024). Utilization rates per 100,000 Medicare beneficiaries, percentage of change, and geometric average changes were calculated. Facet joint intervention utilization increased rapidly from 2000 to 2010 (15.5% annually), slowed from 2010 to 2019 (4.2% annually), and declined from 2019 to 2024 (-6.1% annually). Episodes followed similar patterns but declined less steeply than procedures (-6.7% vs. -27.1%). By 2024, service rates had returned to approximately 2012 levels (5,016 vs 5,046 per 100,000 beneficiaries). From 2000 to 2010, lumbar and cervical/thoracic facet joint blocks and radiofrequency ablation procedures increased substantially (13.5%-24.6% annually), followed by slower growth from 2010 to 2019 (2.8%-11.0%), a sharp pandemic-related decline from 2019 to 2020 (10.6%-17.4%), and partial recovery with modest growth or stabilization through 2024. Between 2019 and 2024, the episode ratio of facet joint nerve blocks to radiofrequency ablation declined from 1.9 to 1.7 for lumbar procedures and from 2.4 to 2.0 for cervical procedures, attributed to the mandatory radiofrequency policy. Interventional pain-related specialties accounted for the majority of facet joint procedures, increasing their share from 87.3% in 2010 to 95% by 2024, while surgical specialties declined from 4.8% to 2.0%. During the same period, the site of service shifted modestly from office settings (50.7% to 48.8%) and hospital outpatient departments (HOPD) (declining to 20.5%) toward ambulatory surgery centers (ASCs) (25.6% to 30.6%). These findings reflect increasing specialization, recent reductions in treatment intensity, and the influence of policy changes, Medicare Advantage shifts, and broader system pressures on pain management. The analysis was limited to the FFS traditional Medicare population and data availability through 2024, excluding utilization patterns for Medicare Advantage Plans, which covered 54% of Medicare enrollees in 2024. As with other retrospective claims-based studies, inherent limitations related to coding and administrative data apply. This retrospective analysis demonstrates a substantial decline in facet joint intervention episodes, with an overall reduction of 6.7% per 100,000 Medicare beneficiaries and an annual decline rate of 1.4% for episodes from 2019 to 2024. In contrast, services or procedures declined more markedly, with an overall reduction of 27.1% and an annual decline rate of 6.1% per 100,000 Medicare beneficiaries.
Understanding the concerns that motivate requests for assisted dying (euthanasia or assisted suicide) is essential for understanding these practices. Our objective was to determine whether there are significant trends in end-of-life concerns cited in requests for physician-assisted suicide (PAS) in Oregon and Washington. We estimated regressions using data on reported end-of-life concerns (autonomy, enjoyment, dignity, control, burden, pain, and finance) taken from annual state reports and which covered 6853 deaths. We pooled the data for our two states and estimated the trend for each end-of-life concern. We added controls for demographic variables, separated time trends for each state, and added other tests for robustness. Our estimates suggested no significant trend for autonomy or enjoyment. The common trend was negative and statistically significant for dignity and control, but control was not significant for Washington. Trends were significantly positive for burden, pain, and finance, but finance was not significant for Washington. There have been significant trends in reported end-of-life concerns that motivate requests for PAS in Oregon and Washington. The increase in perceived burdensomeness as a motivation for PAS adds weight to the argument that changing the law can have an adverse effect on the self-perception of those who receive care. Qualitative research has identified adverse impacts of assisted dying on pain management. Our findings suggest a significant increase in concerns about inadequate pain control since the legalization of PAS. We found no evidence that the Patient Protection and Affordable Care Act has reduced the proportion of people seeking death because of concerns about the cost of their care.
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Patients seeking information about Myofascial Pain Syndrome (MPS), which affects a large segment of the population, are increasingly turning to AI-based chatbots as an alternative to traditional methods. However, the medical accuracy of the content offered by these digital platforms, as well as its suitability to the "grade 6 reading level" standard, which determines its comprehensibility by patients, is a critical point of uncertainty. This study aims to fill this significant gap in the literature by systematically comparing MPS content generated by different AI models using readability indices, reliability, and quality metrics. The 18 most relevant keywords, derived from 25 keywords identified via Google Trends data, were queried using ChatGPT (GPT-5.2), Gemini 3 Flash, and Perplexity (Sonar-4 Large) models. The readability of the generated responses was analyzed using six different indices (FRES, FKGL, GFOG, CLI, ARI, SMOG), while content quality was assessed using GQS and EQIP scales, and reliability using DISCERN and JAMA scales by two independent observers. The responses generated by all AI models examined were found to be statistically significantly more complex than the suggested 6th-grade reading level (p < 0.001). In inter-model comparisons, ChatGPT exhibited the easiest readability [lowest linguistic difficulty] scores, while Perplexity scored significantly higher than both ChatGPT and Gemini in content quality and reliability metrics (JAMA, DISCERN, GQS, EQIP) (p < 0.05). Correlation analysis revealed a strong and positive relationship between quality and reliability parameters. Artificial intelligence platforms have been observed to exhibit high potential in the production of medical information. However, linguistic barriers exceeding sixth-grade reading comprehension, along with reliability limitations of current models, prevent them from replacing professional medical consultation. Perplexity has been found superior in terms of academic quality, while ChatGPT has been found superior in terms of readability. Nevertheless, positioning these systems as complementary "secondary consultation mechanisms" supporting physician oversight in clinical decision-making processes is critically important for patient safety.
A transversus abdominis plane block provides reliable abdominal wall analgesia, but which adjuvants best sustain its effect remains debated. By facilitating diffusion of local anesthetics, hyaluronidase may improve block quality. This study evaluated the safety and efficacy of 2 hyaluronidase doses added to bupivacaine for bilateral transversus abdominis plane blocks in patients having a cesarean delivery. A prospective, randomized, double-blind, controlled clinical trial. Benha University Hospital, Arab Republic of Egypt, from May 2023 through February 2024. A double-blind, controlled randomized trial was performed with 114 patients having elective cesarean delivery. The patients were allocated equally into 3 arms: Group I (bupivacaine alone), Group II (bupivacaine plus 750 IU hyaluronidase), and Group III (bupivacaine plus 1500 IU hyaluronidase). The time to first rescue analgesia served as the primary outcome. Secondary outcomes encompassed 24-hour morphine requirements, Visual Analog Scale pain score at rest and on coughing, patient satisfaction, hemodynamics, and adverse events. Analyses employed the appropriate statistical tests (parametric or nonparametric), with subsequent post hoc comparisons for significant findings. Both hyaluronidase groups had significant prolonged analgesia (median 8.1 hours and 9.6 hours) compared to the control group (5.8 hours) (P < 0.001). Morphine requirements over the first postprocedure 24 hours diminished significantly (P < 0.001); Groups II and III had lower pain scores at rest and on coughing between postprocedure hours 2 and 12 (all P < 0.05). Patient satisfaction increased with hyaluronidase (P = 0.0039). No group differences were observed for adverse events, including postoperative nausea and vomiting or local anesthetic toxicity. This single-center trial with 24-hour follow-up may restrict generalizability and long-term safety assessment; also only 2 hyaluronidase doses were examined. Adding hyaluronidase to bupivacaine for transversus abdominis plane block enhances analgesic duration and quality without compromising safety in patients having cesarean delivery. Both high and low doses appear equally effective, suggesting that even lower doses are sufficient for optimal effect.
ObjectivesLipedema is a chronic disorder characterized by pain and disproportionate fat distribution, and its diagnosis is frequently overlooked. The aim of this study was to evaluate and compare the responses generated by contemporary artificial intelligence models-ChatGPT-5o, Gemini-3, and Perplexity AI-to structured clinical questions developed in accordance with the 2024 S2k Lipedema Guideline. The models were analyzed in terms of clinical accuracy, readability, and reference reliability to assess their performance in delivering guideline-based medical information.MethodsThis cross-sectional and comparative study was conducted by submitting 30 structured clinical questions, prepared on the basis of the relevant guideline, to three large language models. Responses collected on 10 February 2026, were evaluated using a seven-point Likert scale (reliability) and a five-point scale (accuracy). Text readability was assessed using six established indices, including the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFOG). Reference reliability was examined by analyzing hallucination tendencies as defined in the literature.ResultsA statistically significant difference in reliability was observed among the models (p = .041); Perplexity (4.95 ± 1.20) achieved significantly higher scores than ChatGPT-5o (4.38 ± 1.05) (p = .038). In readability analyses, Perplexity (12.80 ± 2.10) required a significantly higher educational level according to FKGL scores compared to both ChatGPT-5o (p = .041) and Gemini-3 (p = .036). Regarding reference reliability, ChatGPT-5o outperformed Perplexity in source verifiability (p = .031), bibliographic precision (p = .044), and total RHS scores (p = .027), emerging as the most robust model in this domain. No statistically significant differences were found among the models in terms of clinical accuracy and usefulness (p > .05). Inter-rater agreement was excellent (Kappa: 0.92-0.97).ConclusionIn this study, ChatGPT-5o distinguished itself in reference quality, whereas Perplexity demonstrated superior reliability. However, the complex linguistic structures accompanying efforts to maintain high medical accuracy may constitute a significant barrier for individuals with limited e-health literacy. Although these systems show strong potential as medical information resources, they cannot yet replace expert physician oversight in terms of patient safety. A balanced approach between technical reliability and patient-centered simplification remains necessary.
Trigeminal neuralgia (TN) is a debilitating facial pain syndrome. Percutaneous balloon compression (PBC) and conventional radiofrequency thermocoagulation (CRF) are widely used for drug-refractory TN, but randomized evidence comparing their efficacy and safety remains limited. To compare the efficacy, safety, and mechanistic correlates of PBC vs CRF in patients with primary TN. Prospective, randomized, single-blind, controlled trial. The Pain Medicine Unit, Department of Anesthesiology, at a tertiary care medical institute in the Republic of India. Sixty adults with primary TN refractory to ≥ 2 medications were randomized 1:1 to PBC or CRF, stratified by age (< 60 or ≥ 60 years). PBC was performed via the Hartel approach with 0.8 mL contrast inflation and 90-second compression; CRF involved fluoroscopy-guided, electromyography-confirmed lesioning at 65°C and 70°C for 60 seconds. Independent blinded assessors recorded Numeric Rating Scale pain scores at baseline, and at postprocedure days 7, 30, 60, 90, and 180. Secondary outcomes included the Barrow Neurological Institute Pain Intensity Score, Brief Pain Inventory (BPI), Douleur Neuropathique 4 Questionnaire (DN4Q), the Pain Catastrophizing Scale (PCS), and safety measures. Correlations between balloon pressures at the beginning (P1) and end of compression (P2) or nerve division involvement and outcomes were analyzed. Baseline characteristics were comparable. Both the groups achieved significant pain relief at 6months, but PBC yielded superior outcomes in Numeric Rating Scale scores (mean ± SD) (1.4 ± 0.98 vs 2.35 ± 1.09; P = 0.002) and BNI (1.75 ± 0.91 vs 2.28 ± 0.76; P = 0.01). Improvement in BPI, DN4Q and PCS were similar. Safety was excellent; transient mild masseter weakness was more common with PBC at day 7 (30% vs 3.3%, P = 0.005) but resolved by day 30. Corneal sensation and other cranial nerve functions were preserved. Balloon pressures showed weak, nonsignificant correlations with 6-month outcomes; nerve division involvement had no correlation with the outcome. Single-center design and short 6-month follow-up. PBC provided superior 6-month pain and functional outcomes compared with CRF, with comparable long-term safety. These results support PBC as the preferred percutaneous intervention for appropriately selected patients with classic TN.