Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996–2013. JAMA. 2016;316:2627–46. https://doi.org/10.1001/jama.2016.16885.

Article  PubMed  PubMed Central  Google Scholar 

Dieleman JL, Cao J, Chapin A, et al. US health care spending by payer and health condition, 1996–2016. JAMA. 2020;323:863–84. https://doi.org/10.1001/jama.2020.0734. This article is important as it identifies that U.S. health care spending rose from $1.4 trillion in 1996 to $3.1 trillion in 2016. Public insurance experienced the highest annual growth rate, and spending patterns varied by conditions, payers, and types of care.

Article  PubMed  PubMed Central  Google Scholar 

Manchikanti L, Pampati V, Vangala BP, et al. Spinal cord stimulation trends of utilization and expenditures in fee-for-service (FFS) Medicare population from 2009 to 2018. Pain Physician. 2021;24:293–308 PMID: 34323431.

PubMed  Google Scholar 

Manchikanti L, Pampati V, Sanapati MR et al. COVID-19 pandemic reduced utilization of interventional techniques 18.7% in managing chronic pain in the Medicare population in 2020: Analysis of utilization data from 2000 to 2020. Pain Physician. 2022; 25:223 – 38. PMID: 35652763. * This article is important as it identifies that utilization of interventional techniques for chronic pain management among the U.S. Medicare population declined by 18.7% from 2019 to 2020, partly due to the COVID-19 pandemic. Overall, from 2010 to 2020, there was a 22.0% decrease in utilization, despite annual population growth, indicating significant shifts in pain management practices.

Manchikanti L, Kaye AD, Latchaw RE, et al. Impact of COVID-19 pandemic on utilization patterns of facet joint interventions in managing spinal pain in Medicare population. Pain Ther. 2023;12:505–27. https://doi.org/10.1007/s40122-023-00476-3.

Article  PubMed  PubMed Central  Google Scholar 

Manchikanti L, Simopoulos TT, Pampati V et al. Impact of COVID-19 pandemic and updated utilization patterns of sacroiliac joint injections from 2000 to 2020 in the fee-for-service (FFS) Medicare population. Pain Physician. 2022; 25:239 – 50. PMID: 35652764. ** This article is important as it identifies that utilization patterns of sacroiliac joint interventions in the Medicare population saw significant changes due to the COVID-19 pandemic, including a 19.2% decline in intraarticular injections and varied trends in arthrodesis and fusion procedures. Overall, these trends reflect shifting patterns influenced by both the pandemic and evolving procedural codes.

Manchikanti L, Kosanovic R, Pampati V, Kaye AD. Declining utilization patterns of percutaneous adhesiolysis procedures in the fee-for-service (FFS) Medicare population. Pain Physician. 2021;24:17–29 PMID: 33400425.

PubMed  Google Scholar 

Manchikanti L, Pampati V, Knezevic NN, et al. The influence of COVID-19 on utilization of epidural procedures in managing chronic spinal pain in the Medicare population. Spine (Phila Pa 1976). 2023;48:950–61. https://doi.org/10.1097/BRS.0000000000004574.

Article  PubMed  Google Scholar 

Administrators CGS. LLC. Local Coverage determination (LCD). Epidural steroid injections for Pain Management (L39015). Original Effective Date: 12/05/2021.

Administrators CGS. LLC. Local Coverage determination (LCD). Facet Joint interventions for Pain Management (L38773). Revision Effective Date 03/17/2022.

Administrators CGS. LLC. Local Coverage Determination (LCD). Sacroiliac Joint Injections and Procedures (L39383). Effective Date 03/19/2023.

Manchikanti L, Knezevic NN, Navani A et al. Epidural interventions in the management of chronic spinal pain: American Society of Interventional Pain Physicians (ASIPP) comprehensive evidence-based guidelines. Pain Physician. 2021; 24:S27-208. PMID: 33492918. ** This article is important as it identifies that comprehensive guidelines were developed based on an extensive review of 47 systematic reviews and 43 RCTs, providing evidence-based recommendations for caudal, interlaminar, transforaminal, and percutaneous adhesiolysis procedures, with a focus on methodologic quality and evidence strength.

Manchikanti L, Kaye AD, Soin A et al. Comprehensive evidence-based guidelines for facet joint interventions in the management of chronic spinal pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2020; 23:S1-S127. PMID: 32503359.

Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4:CD013577. https://doi.org/10.1002/14651858.CD013577.

Article  PubMed  Google Scholar 

Manchikanti L, Knezevic E, Latchaw RE et al. Comparative systematic review and meta-analysis of Cochrane review of epidural injections for lumbar radiculopathy or sciatica. Pain Physician. 2022; 25:E889-916. PMID: 36288577. ** This article is important as it provides a systematic review which found that when properly categorized and evaluated, including only fluoroscopically guided studies, epidural injections showed strong evidence (Level I) for effectiveness at 1 and 3 months, and moderate evidence (Level II) at 6 and 12 months. This highlights the importance of accurate trial categorization and adherence to methodological standards in assessing treatment efficacy.

Manchikanti L, Knezevic NN, Knezevic E, et al. Efficacy of percutaneous adhesiolysis in managing low back and lower extremity pain: a systematic review and meta-analysis of randomized controlled trials. Pain Ther. 2023;12:903–37. https://doi.org/10.1007/s40122-023-00508-y.

Article  PubMed  PubMed Central  Google Scholar 

Zhitny VP, Do K, Kawana E et al. Radiation exposure in interventional pain management physicians: A systematic review of the current literature. Pain Physician. 2024; 27:E17-35. PMID: 38285025. ** This article is important as it demonstrates in a systematic review common body parts exposed to ionizing radiation during interventional pain procedures, such as the neck, chest, groin, hands, and eyes, and highlighted that wearing lead aprons and other protective equipment, along with maintaining a safe distance from the radiation source, can reduce radiation exposure by more than 90%.

Park S, Kim M, Kim JH. Radiation safety for pain physicians: principles and recommendations. Korean J Pain. 2022;35:129–39. https://doi.org/10.3344/kjp.2022.35.2.129. This article is important as it identifies that C-arm fluoroscopy is essential for interventional pain management, but its increasing use raises significant concerns about accumulated radiation exposure for pain physicians. To mitigate this risk, physicians should focus on reducing exposure time, increasing distance from the radiation source, and employing radiation shielding. Additionally, using techniques like collimation, minimal magnification, and selecting appropriate fluoroscopy modes (e.g., pulsed or low dose) can further reduce radiation exposure for both physicians and patients.

Article  PubMed  PubMed Central  Google Scholar 

Cohen SL, Schneider R, Carrino JA, Zeldin R, Pavlov H. Radiation dose practice audit of 6,234 fluoroscopically-guided spinal injections. Pain Physician. 2019; 22:E119-25. Erratum in: Pain Physician. 2019; 22:519. PMID: 30921989.

Braun E, Sack AM, Sayed D, et al. Reducing radiation exposure in lumbar transforaminal epidural steroid injections with pulsed fluoroscopy: a randomized, double-blind, controlled clinical trial. Pain Physician. 2018;21:53–60 PMID: 29357331.

Article  PubMed  PubMed Central  Google Scholar 

Yoo SH, Kim WJ, Jue MJ, Lee MJ. Comparison of radiation exposure to physicians between anteroposterior and lateral real-time fluoroscopy when performing lumbar transforaminal epidural steroid injections: a randomized controlled trial. Med (Baltim). 2022;101:e29684. https://doi.org/10.1097/MD.0000000000029684.

Article  Google Scholar 

Manchikanti L, Pasupuleti R, Pampati V, Sanapati MR, Hirsch JA. Assessment of radiation exposure with mandatory two fluoroscopic views for epidural procedures. Pain Physician. 2023; 23:557 – 67. PMID: 37976484. ** This article is important as it demonstrates the impact of a new Local Coverage Determination (LCD) on radiation exposure during epidural procedures, comparing metrics before and after the LCD implementation. It found significant increases in both radiation exposure time (21%) and dosage (133%) across various epidural procedures. The most notable increases were for lumbar interlaminar epidural injections in time (43%) and caudal epidural injections in dosage (191%). Cervical interlaminar epidural injections, using an oblique view, showed a smaller increase in dosage (94%) compared to other procedures. Overall, the study highlights substantial rises in radiation exposure and underscores the need for ongoing assessment and optimization of radiation safety practices.

Sacaklidir R, Ozturk EC, Sencan S, Gunduz OH. Radiation doses for different approaches of fluoroscopy-guided epidural injections: an observational clinical study. Pain Physician. 2022;25:E67–72 PMID: 35051153.

PubMed  Google Scholar 

McCormick ZL, Choxi SC, Lee DT, et al. The impact of body mass index on fluoroscopy time during lumbar epidural steroid injection; a multicenter cohort study. Pain Med. 2017;18:25–35. https://doi.org/10.1093/pm/pnw050.

Article  PubMed  Google Scholar 

Tiegs-Heiden CA, Murthy NS, Geske JR, et al. Fluoroscopically guided transforaminal epidural steroid injections at a quaternary-care teaching institution: effect of trainee involvement and patient body mass index on fluoroscopy time and patient dose. Clin Radiol. 2016;71:e16–20. https://doi.org/10.1016/j.crad.2015.10.003.

Article  CAS  PubMed  Google Scholar 

McCormick ZL, Mattie R, Ebrahimi A, et al. Is there a relationship between body mass index and fluoroscopy time during cervical interlaminar epidural steroid injections? Pain Med. 2017;18:1326–33.

Article  PubMed  Google Scholar 

Mattie R, McCormick ZL, Fogg B, Cushman DM. The effect of body mass index on fluoroscopy time and radiation dose in intra-articular glenohumeral joint injections. Clin Imaging. 2017;42:19–24. https://doi.org/10.1016/j.clinimag.2016.11.008.

Article  PubMed  Google Scholar 

Galbraith AS, Wallace E, Devitt A. Examining the association of body mass index and the depth of epidural space, radiation dose exposure and fluoroscopic screening time during transforaminal nerve block injection: a retrospective cohort study. Ir J Med Sci. 2019;188:295–302. https://doi.org/10.1007/s11845-018-1845-7.

Article  CAS  PubMed  Google Scholar 

Kendrick KN, Bode Padron KJ, Bomani NZ, et al. Equity in obesity review. Endocrinol Metab Clin North Am. 2023;52:617–27. https://doi.org/10.1016/j.ecl.2023.05.003.

Article  PubMed  Google Scholar 

Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022;133:155217. https://doi.org/10.1016/j.metabol.2022.155217.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Bluher M. Adipose tissue dysfunction contributes to obesity related metabolic diseases. Best Pract Res Clin Endocrinol Metab. 2013;27:163–77. https://doi.org/10.1016/j.beem.2013.02.005.

Article  CAS  PubMed  Google Scholar 

Taylor VH, Forhan M, Vigod SN, McIntyre RS, Morrison KM. The impact of obesity on quality of life. Best Pract Res Clin Endocrinol Metab. 2013;27:139–46. https://doi.org/10.1016/j.beem.2013.04.004.

Article  PubMed  Google Scholar 

Manchikanti L, Kaye AM, Knezevic NN et al. Comprehensive, evidence-based, consensus guidelines for prescription of opioids for chronic non-cancer pain from the American Society of Interventional Pain Physicians (ASIPP). Pain Physician. 2023; 26:S7-126. PMID: 38117465.

Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic pain among adults - United States, 2019–2021. MMWR Morb Mortal Wkly Rep. 2023;72:379–85. https://doi.org/10.15585/mmwr.mm7215a1.

Article  PubMed  PubMed Central  Google Scholar 

Vandenbroucke JP, von Elm E, Altman DG, STROBE Initiative, et al. Strengthening the reporting of Observational studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12:1500–24. https://doi.org/10.1016/j.ijsu.2014.07.014.

Article  PubMed  Google Scholar 

Manchikanti L, Atluri S, Boswell MV et al. Methodology for evidence synthesis and development of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Pain Physician. 2021; 24:S1-26. PMID: 33492917.

Manchikanti L, Kosanovic R, Pampati V, et al. Equivalent outcomes of lumbar therapeutic facet joint nerve blocks and radiofrequency neurotomy: comparative evaluation of clinical outcomes and cost utility. Pain Physician. 2022;25:179–92 PMID: 35322977.

PubMed  Google Scholar 

Manchikanti L, Kosanovic R, Pampati V, Sanapati MR, Hirsch JA. Outcomes of cervical therapeutic medial branch blocks and radiofrequency neurotomy: clinical outcomes and cost utility are equivalent. Pain Physician. 2022;25:35–47 PMID: 35051143.

PubMed  Google Scholar 

Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief. 2020;360:1–8 PMID: 32487284.

Google Scholar 

Anekwe CV, Jarrell AR, Townsend MJ, Gaudier GI, Hiserodt JM, Stanford FC. Socioeconomics of obesity. Curr Obes Rep. 2020;9:272–9. https://doi.org/10.1007/s13679-020-00398-7.

Article  PubMed  PubMed Central  Google Scholar 

Pearce C, Rychetnik L, Wutzke S, Wilson A. Obesity prevention and the role of hospital and community-based health services: a scoping review. BMC Health Serv Res. 2019;19:453. https://doi.org/10.1186/s12913-019-4262-3.