Reflections on Innovative Interventional Pain-Relieving Procedures: Lessons Learned from Previous Mistakes — Pain Medicine

Zhao Z, Larkin T, Cohen SP

The shoulder is one of the most complex joints in the body, with potential pain generators such as the glenohumeral and acromioclavicular joints, multiple bursae, and numerous soft tissue structures to include multiple tendons and muscles. The lifetime prevalence of shoulder pain is estimated at 7% to 67%, with the prevalence variation stemming from differences in study populations and diagnostic criteria. According to some sources, pain arising from subacromial impingement syndrome is the most common source of chronic shoulder pain, though many patients have pain from multiple pathologies and some have pain despite minimal or no radiologic pathology. In the United States, the estimated cost of chronic shoulder pain is largely unknown, though ∼$3 billion dollars are spent each year on the evaluation and management of rotator cuff tears alone. In Australia, the average annual cost per patient with chronic shoulder pain has been estimated at AU$22,378. Yet, despite the high prevalence and economic expenditures on shoulder pain, surgical and nonsurgical treatments are characterized by high failure rates. According to one systematic review, there is no difference in pain or functional outcomes between surgical and nonsurgical management for shoulder impingement syndrome. In this issue of Pain Medicine, Eckmann et al. report their results with radiofrequency (RF) ablation of the terminal sensory articular nerves of the shoulder joint for chronic, refractory shoulder pain.

Zhao, Z., Larkin, T., & Cohen, S. (2020). Reflections on Innovative Interventional Pain-Relieving Procedures: Lessons Learned from Previous Mistakes. Pain Medicine. https://doi.org/10.1093/pm/pnz380