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Epidural fibrosis post laminectomy is the leading cause of failed back surgery syndrome. Little is known about the role and mechanisms of adipose tissues in epidural fibrosis. Here, we found that obese patients were more likely to develop epidural fibrosis after spine surgery. Similarly, obesity led to more progressive epidural fibrosis in a mouse model of laminectomy. Adipocyte–myofibroblast transition (AMT) occurs in epidural scarring. Mechanistically, large extracellular vesicles (EVs) from M2-type macrophages transfer mitochondria into adipocytes and promote AMT by activating the TGF-β and PAI-1 pathways. Blocking the PAI-1 pathway significantly attenuated the transition of adipocytes into myofibroblasts. We conclude that large EVs from macrophages transfer mitochondria to promote AMT in epidural fibrosis. [ABSTRACT FROM AUTHOR]

Background: Caudal epidural prolotherapy injection has emerged as a successful treatment for managing chronic pain. This study is a prospective randomized, double-blinded clinical trial. It assesses and compares the effectiveness of prolotherapy versus steroid injection for pain relief in cases of failed back surgery syndrome (FBSS). It involved randomly assigning 90 patients with FBSS to one of two equal groups: steroids or prolotherapy. The VAS was used to measure pain as the primary outcome, while disability was measured by the Oswestry disability index (ODI). McGill Pain Questionnaire (MPQ) and complications were recorded as secondary outcomes. Results: The VAS improved significantly from the baseline in both groups at all follow-up periods (p < 0.001). Nonetheless, after 2, 4, and 6 weeks post-injection, there was no statistically significant difference between the two groups, while at 8 weeks, 3, and 6 months, the VAS was statistically significantly lower in the steroids group than in the prolotherapy group (p < 0.001). The ODI and MPQ improved significantly from the baseline in both groups at all follow-up periods (p < 0.001). However, after 2 and 4 weeks post-injection, there was no statistically significant difference between the two groups; but, at 6 and 8 weeks, 3, and 6 months, the ODI and MPQ were statistically significantly lower in the steroid group compared to the prolotherapy group (p < 0.001). Only one patient in the steroid group suffered from pain and swelling at the injection site without a statistically significant difference between the two groups. Conclusion: Caudal epidural prolotherapy injection has good efficacy in managing pain that can be similar to steroid injection but shorter in duration in cases of FBSS with comparable safety profile. [ABSTRACT FROM AUTHOR]

Introduction: Chronic low back pain (CLBP) is the leading cause of disability in the United States and is associated with a steadily increasing burden of healthcare expenditures. Given this trend, it is essential to evaluate interventions aimed at reducing disability and optimizing healthcare utilization (HCU) in affected populations. This study investigates the impact of prior spinal surgery on functional outcomes and HCU patterns following high-frequency (10 kHz) spinal cord stimulation (SCS) therapy. Methods: This retrospective observational study included 160 subjects who underwent implantation of a 10 kHz SCS device. Participants were divided into surgical and non-surgical cohorts for comparative analysis. Pain relief was assessed using the Numeric Rating Scale (NRS), while disability levels were evaluated using the Oswestry Disability Index (ODI). HCU was examined through the frequency of emergency department (ED) visits, outpatient visits for interventional pain procedures, and opioid consumption measured in morphine milliequivalents (MME). Results: No statistically significant differences were observed between the surgical and non-surgical groups regarding pain relief and disability outcomes. Additionally, ED visits and outpatient visits for interventional pain procedures did not show significant differences between the two cohorts. Discussion: This study represents the first comparative analysis of pain, disability, and HCU trends between surgical and non-surgical populations following 10 kHz SCS therapy. The results suggest that prior spinal surgery may not substantially affect the efficacy of 10 kHz SCS therapy in terms of pain relief, disability reduction, or HCU patterns. [ABSTRACT FROM AUTHOR]

Background Caudal epidural prolotherapy injection has emerged as a successful treatment for managing chronic pain. This study is a prospective randomized, double-blinded clinical trial. It assesses and compares the effectiveness of prolotherapy versus steroid injection for pain relief in cases of failed back surgery syndrome (FBSS). It involved randomly assigning 90 patients with FBSS to one of two equal groups: steroids or prolotherapy. The VAS was used to measure pain as the primary outcome, while disability was measured by the Oswestry disability index (ODI). McGill Pain Questionnaire (MPQ) and complications were recorded as secondary outcomes.Results The VAS improved significantly from the baseline in both groups at all follow-up periods (p

Failed back surgery syndrome is a condition in which symptoms persist, recur, or develop after spinal surgery. Lumbar herniated intervertebral disc (HIVD) can cause low back pain along with pain and numbness in the lower extremities. However, these symptoms can be a result of referred pain in the soft tissue of the sacroiliac joint (SIJ). Therefore, careful evaluation of pain patterns and thorough physical examination are crucial for differential diagnosis. Acupotomy, utilizing specialized needles that combine the features of a scalpel and an acupuncture needle, is effective in dissecting soft tissue adhesions. This report presents the case of a 48-year-old male with an 8-year history of lumbago and left lower extremity pain and numbness, refractory to two surgical interventions. Careful physical examination, including specific tenderness patterns, led to a diagnosis of SIJ dysfunction rather than recurrent HIVD. His symptoms disappeared after 13 treatment sessions of acupotomy combined with Korean medicine.

Epidural fibrosis is a primary contributor to the failure of laminectomy surgeries, leading to the development of failed back surgery syndrome (FBSS). Post-laminectomy, neutrophils infiltrate the surgical site, generating neutrophil extracellular traps (NETs) that contribute to epidural fibrosis. Reactive oxygen species (ROS) play a pivotal role in mediating NETs formation. Molecular hydrogen, recognized for its selective antioxidant properties and biosafety, emerges as a potential therapeutic gas in suppressing epidural fibrosis. In this study, we developed an in-situ hydrogen release hydrogel that inhibits the formation of NETs and mitigates epidural scarring. Biodegradable magnesium (Mg) microspheres served as a hydrogen source, coated with PLGA to regulate hydrogen release. These microspheres (Mg@PLGA) were then incorporated into a PLGA-PEG-PLGA thermosensitive hydrogel (Mg@PLGA@Gel), providing a surgical implant for sustained, long-term hydrogen release. In vitro experiments confirmed the biocompatibility of the system, demonstrating that hydrogen produced by Mg@PLGA effectively neutralizes neutrophil intracellular ROS and inhibits NETs formation. Histological analyses, including H&E staining, MRI, Masson staining, and immunohistochemistry, collectively indicate that Mg@PLGA@Gel is biocompatible and effectively inhibits epidural fibrosis post-laminectomy. Furthermore, Mg@PLGA@Gel inhibits ROS accumulation and NETs formation at the surgical site. These findings suggest that Mg@PLGA@Gel ensures continuous, therapeutic hydrogen concentration, providing relief from epidural fibrosis in a laminectomy mouse model. • The hydrogen-releasing hydrogel combines the therapeutic effects of a physical barrier with immunomodulation. • In situ-generated molecular hydrogen scavenges ROS caused by surgical stress and suppresses NETs formation. • The hydrogen-releasing hydrogel is demonstrated to exhibit high biocompatibility and inhibit epidural scar formation in vivo. [Display omitted] [ABSTRACT FROM AUTHOR]

Failed back surgery syndrome is a postsurgical phenomenon that involves persistent low back pain following one or more spinal surgeries. The multidisciplinary approach to its management includes both conservative and surgical treatments. Anterior lumbar interbody fusion (ALIF) has stood out as a surgical option for refractory pain. We present five cases of patients with failed back surgery syndrome treated with ALIF. These patients demonstrated reduced pain scale scores and significant improvement in functional capacity after the application of the abovementioned technique, suggesting its effectiveness in this group of patients who are refractory to conservative treatments. It should be noted that previous studies supporting the usefulness of ALIF mention the importance of careful patient screening, considering both preoperative factors (pain pathophysiology and accurate assessment of the underlying cause) and postoperative factors (pain recurrence and biomechanical changes), to ensure the success of the technique. Therefore, while ALIF appears to be a promising surgical option for these patients--whose condition is challenging--the need for further studies with larger samples is highlighted to provide stronger scientific evidence supporting its efficacy for this condition. [ABSTRACT FROM AUTHOR]

Introduction: Failed Back Surgery Syndrome (FBSS) presents a formidable challenge, marked by the persistence of chronic lower back pain and leg pain despite undergoing surgical interventions. Multicolumn spinal cord stimulation (m-SCS) has recently emerged as a promising therapeutic strategy for addressing the pain associated with FBSS. This meta-analysis aims to study the efficacy of m-SCS in mitigating chronic back and leg pain among patients with FBSS. Methods: A comprehensive search of electronic databases (PubMed, Web of Science, Scopus, Cochrane Library) was conducted to identify relevant studies published up to October 25th, 2023. Inclusion criteria encompassed randomized controlled trials and cohort studies evaluating the outcomes of m-SCS in patients with FBSS. The primary outcome measured was the Visual Analog Scale (VAS) score for low back and leg pain at baseline, six months, and 12 months. Results: A total of eight studies, including 271 patients, were analyzed. At six months, there was a statistically significant reduction in the VAS scores for low back pain (MD, 4.76; 95% CI, 3.78 to 5.74) and leg pain (MD, 4.41; 95% CI, 2.93 to 5.90) compared to baseline. Similarly, at 12 months, there was a statistically significant reduction in the VAS scores for low back pain (MD, 4.77; 95% CI, 4.34 to 5.20) and leg pain (MD, 2.78; 95% CI, 0.72 to 4.85) compared to baseline. Conclusion: m-SCS effectively manages chronic back and leg pain in FBSS patients, providing sustained pain relief. Studies with more extended follow-up periods and qualitative analysis for the functional outcomes and overall improvement for the patients with FBSS are recommended. [ABSTRACT FROM AUTHOR]

Introduction: Persistent Spinal Pain Syndrome (PSPS) refers to chronic axial pain and/or extremity pain. Two subtypes have been defined: PSPS‐type 1 is chronic pain without previous spinal surgery and PSPS‐type 2 is chronic pain, persisting after spine surgery, and is formerly known as Failed Back Surgery Syndrome (FBSS) or post‐laminectomy syndrome. The etiology of PSPS‐type 2 can be gleaned using elements from the patient history, physical examination, and additional medical imaging. Origins of persistent pain following spinal surgery may be categorized into an inappropriate procedure (eg a lumbar fusion at an incorrect level or for sacroiliac joint [SIJ] pain); technical failure (eg operation at non‐affected levels, retained disk fragment, pseudoarthrosis), biomechanical sequelae of surgery (eg adjacent segment disease or SIJ pain after a fusion to the sacrum, muscle wasting, spinal instability); and complications (eg battered root syndrome, excessive epidural fibrosis, and arachnoiditis), or undetermined. Methods: The literature on the diagnosis and treatment of PSPS‐type 2 was retrieved and summarized. Results: There is low‐quality evidence for the efficacy of conservative treatments including exercise, rehabilitation, manipulation, and behavioral therapy, and very limited evidence for the pharmacological treatment of PSPS‐type 2. Interventional treatments such as pulsed radiofrequency (PRF) of the dorsal root ganglia, epidural adhesiolysis, and spinal endoscopy (epiduroscopy) might be beneficial in patients with PSPS‐type 2. Spinal cord stimulation (SCS) has been shown to be an effective treatment for chronic, intractable neuropathic limb pain, and possibly well‐selected candidates with axial pain. Conclusions: The diagnosis of PSPS‐type 2 is based on patient history, clinical examination, and medical imaging. Low‐quality evidence exists for conservative interventions. Pulsed radiofrequency, adhesiolysis and SCS have a higher level of evidence with a high safety margin and should be considered as interventional treatment options when conservative treatment fails. [ABSTRACT FROM AUTHOR]

Objectives: Lumbar spine surgery is a common procedure for treating disabling spine‐related pain. In recent decades, both the number and cost of spine surgeries have increased despite technological advances and modification in surgical technique. For those patients that have continued uncontrolled back and/or lower extremity pain following lumbar spine surgery, spinal cord stimulation (SCS) has emerged as a viable treatment option. However, the impact of lumbar spine surgical history remains largely unstudied. Specifically, the current study considers the impact of number of prior lumbar spine surgeries on pain relief outcomes following SCS implantation. Materials and Methods: We queried the electronic medical record of five separate pain practices for all patients who have undergone a SCS implant between January 1, 2017, and March 1, 2020. Inclusion criteria consisted of any patients with an SCS implant who underwent a prior lumbar spine surgery. The primary outcome was the mean calculated percentage pain relief in patients based on number of prior lumbar spine surgeries. Results: There was a total of 1974 total SCS implant cases identified across five separate pain clinics. There was no difference in mean calculated pain relief in patients with one prior spine surgery versus those with two or more prior spine surgeries (28.2% vs. 25.8%, adjusted β‐coefficient –3.1, 95% CI –8.9 to 2.7, p = 0.290). Similarly, when analyzing number of spine surgeries as a continuous variable, there was no association between number of spine surgeries and calculated pain relief (adjusted β‐coefficient –1.5, 95% CI –4.0 to 1.1, p = 0.257). Additionally, after patients were stratified based on waveform, there was no association between number of prior lumbar spine surgeries (analyzed both as a categorical and continuous variable) and calculated percentage pain relief. Conclusions: This multicentered retrospective study found that there was no significant difference in pain scores in individuals who received SCS following one or more lumbar spine surgeries. Additionally, the waveform of the SCS device had no statistically significant impact on post‐operative pain scores following one or more lumbar spine surgeries. [ABSTRACT FROM AUTHOR]

Laminectomy is a commonly performed surgical procedure by orthopedic and neurosurgeons, aimed at alleviating nerve compression and reducing pain. However, in some cases, excessive proliferation of fibrous scar tissue in the epidural space post-surgery can lead to persistent and intractable lower back pain, a condition known as Failed Back Surgery Syndrome (FBSS). The persistent fibrous tissue causes both physical and emotional distress for patients and also makes follow-up surgeries more challenging due to reduced visibility and greater technical difficulty. It has been established that the application of biomaterials to prevent epidural fibrosis post-lumbar surgery is more beneficial than revision surgeries to relieve dural fibrosis. Hydrogel-based biomaterials, with their excellent biocompatibility, degradability, and injectability and tunable mechanical properties, have been increasingly introduced by clinicians and researchers. This paper, building on the foundation of epidural fibrosis, primarily discusses the strategies for the preparation of natural and polymeric biomaterials to prevent epidural fibrosis, their physicochemical properties, and their ability to mitigate the excessive proliferation of fibroblasts. It also emphasizes the challenges that need to be addressed to translate laboratory research into clinical practice and the latest advancements in this field. [ABSTRACT FROM AUTHOR]

Objective: Patients with therapy-refractory chronic spinal pain after spinal surgery experience increased disability, resulting in substantial loss of employment and consequently lower quality of life. Despite findings that rehabilitation improves socio-economic outcomes in other chronic pain conditions, evidence for patients with chronic spinal pain after spinal surgery is limited. A systematic review was conducted to provide an overview of rehabilitation interventions and their effectiveness to improve work participation for patients with chronic spinal pain after spinal surgery. Methods: MEDLINE (via PubMed), Scopus, Embase, and Web of Science, were systematically searched. Risk of bias was assessed using the modified Downs and Black checklist and GRADE was used to assess certainty of evidence. The review protocol was prospectively registered on PROSPERO (CRD42022346091). Results: The search yielded 1,289 publications. Full-text screening of 48 articles resulted in the inclusion of 6 publications. The included interventions comprised multiple treatment components, consisting of back school, self-care, functional restoration, multidisciplinary rehabilitation, physiotherapy, and digital care programmes to improve work participation. Conclusion: Rehabilitation to improve return to work for patients with chronic spinal pain after spinal surgery was supported only by low-certainty evidence. Rehabilitation therapies that are personalized and that integrate the patient’s work seem most suitable.

IntroductionChronic low back pain (CLBP) is the leading cause of disability in the United States and is associated with a steadily increasing burden of healthcare expenditures. Given this trend, it is essential to evaluate interventions aimed at reducing disability and optimizing healthcare utilization (HCU) in affected populations. This study investigates the impact of prior spinal surgery on functional outcomes and HCU patterns following high-frequency (10 kHz) spinal cord stimulation (SCS) therapy.MethodsThis retrospective observational study included 160 subjects who underwent implantation of a 10 kHz SCS device. Participants were divided into surgical and non-surgical cohorts for comparative analysis. Pain relief was assessed using the Numeric Rating Scale (NRS), while disability levels were evaluated using the Oswestry Disability Index (ODI). HCU was examined through the frequency of emergency department (ED) visits, outpatient visits for interventional pain procedures, and opioid consumption measured in morphine milliequivalents (MME).ResultsNo statistically significant differences were observed between the surgical and non-surgical groups regarding pain relief and disability outcomes. Additionally, ED visits and outpatient visits for interventional pain procedures did not show significant differences between the two cohorts.DiscussionThis study represents the first comparative analysis of pain, disability, and HCU trends between surgical and non-surgical populations following 10 kHz SCS therapy. The results suggest that prior spinal surgery may not substantially affect the efficacy of 10 kHz SCS therapy in terms of pain relief, disability reduction, or HCU patterns.

Amid the worldwide increase in spinal surgery rates, a significant proportion of patients continue to experience refractory chronic pain, resulting in reduced quality of life and escalated healthcare demands. Failed back surgery syndrome (FBSS) is a clinical condition characterized by persistent or recurrent pain after one or more spinal surgeries. The diverse characteristics and stigmatizing descriptions of FBSS necessitate a reevaluation of its nomenclature to reflect its complexity more accurately. Accurate identification of the cause of FBSS is hampered by the complex nature of the syndrome and limitations of current diagnostic labels. Management requires a multidisciplinary approach that may include pharmacological treatment, physical therapy, psychological support, and interventional procedures, emphasizing realistic goal-setting and patient education. Further research is needed to increase our understanding, improve diagnostic accuracy, and develop more effective management strategies.

BACKGROUND: This review aimed to identify variables influencing clinicians application of spinal manipulative therapy (SMT) for persistent spine pain after lumbar surgery (PSPS-2). We hypothesized markers of reduced clinical/surgical complexity would be associated with greater odds of applying SMT to the lumbar region, use of manual-thrust lumbar SMT, and SMT within 1-year post-surgery as primary outcomes; and chiropractors would have increased odds of using lumbar manual-thrust-SMT compared to other practitioners. METHODS: Per our published protocol, observational studies describing adults receiving SMT for PSPS-2 were included. PubMed, Web of Science, Scopus, OVID, PEDro, and Index to Chiropractic Literature were searched from inception to January 6, 2022. Individual patient data (IPD) were requested from contact authors when needed for selection criteria. Data extraction and a customized risk-of-bias rubric were completed in duplicate. Odds ratios (ORs) for primary outcomes were calculated using binary logistic regressions, with covariates including age, sex, symptom distribution, provider, motion segments, spinal implant, and surgery-to-SMT interval. RESULTS: 71 articles were included describing 103 patients (mean age 52 ± 15, 55% male). The most common surgeries were laminectomy (40%), fusion (34%), and discectomy (29%). Lumbar SMT was used in 85% of patients; and of these patients was non-manual-thrust in 59%, manual-thrust in 33%, and unclear in 8%. Clinicians were most often chiropractors (68%). SMT was used > 1-year post-surgery in 66% of cases. While no primary outcomes reached significance, non-reduced motion segments approached significance for predicting use of lumbar-manual-thrust SMT (OR 9.07 [0.97-84.64], P = 0.053). Chiropractors were significantly more likely to use lumbar-manual-thrust SMT (OR 32.26 [3.17-327.98], P = 0.003). A sensitivity analysis omitting high risk-of-bias cases (missing ≥ 25% IPD) revealed similar results. CONCLUSIONS: Clinicians using SMT for PSPS-2 most often apply non-manual-thrust SMT to the lumbar spine, while chiropractors are more likely to use lumbar-manual-thrust SMT relative to other providers. As non-manual-thrust SMT may be gentler, the proclivity towards this technique suggests providers are cautious when applying SMT after lumbar surgery. Unmeasured variables such as patient or clinician preferences, or limited sample size may have influenced our findings. Large observational studies and/or international surveys are needed for an improved understanding of SMT use for PSPS-2. Systematic review registration PROSPERO (CRD42021250039).

About 16 million adults present with chronic back pain, the sixth most costly condition in the United States (US). Estimates suggest that about 60% of initial back surgeries have a successful outcome; however, many don't, leaving over 80,000 failed back surgeries per year. Failed Back Surgery Syndrome (FBSS) is defined by the International Association for the Study of Pain as back pain, with or without radiating pain, located in the lower limbs, of unknown origin, which persists or begins after surgical procedures are performed to treat lumbar disc herniations. Psychiatric comorbidities and psychosocial factors have been associated with patients presenting with this syndrome. A retrospective cross-sectional study was performed to identify the prevalence of FBSS in a population of patients during the period of January 2019-December 2020 across Hospital Corporation of America (HCA) Healthcare in the US. With a sample of 28,426 patients who underwent back surgery only 8% had FBSS. Those with FBSS (N = 2434) were mainly females (54.27%) with a mood disorder (61.18%), P -value <.0001. Among those with FBSS, there was a statistically significant relationship between mood disorder and smoking (57.37%) and obesity (54.61%) compared to non-smokers and non-obese. Lifestyle interventions may ameliorate disabling symptoms and improve the well-being of this population. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Spinal cord stimulation (SCS) has emerged as a prevalent therapy for chronic neuropathic pain and failed back surgery syndrome (FBSS) over the past three decades, offering various stimulation types differentiated primarily by frequency. CASE REPORT: A 51-year-old male patient in 2016 underwent lumbar discectomy – L4/L5 due to symptomatic discopathy, which resulted in pain relief; however, the symptoms returned. In 2021 a Stimwave high-frequency (HF) SCS was placed epidurally at Th8–Th10. The patient reported substantial improvement after stimulation, nevertheless, after two weeks there was sudden exacerbation of his symptoms, especially in the lumbar region. Despite multiple attempts at program change and confirmation of the electrode location, there was no improvement. The HF stimulator was not removed owing to the risk of complications and 20% relief of pain in the right lower limb. After two years he was qualified for the implantation of newer generation of stimulators – BurstDR™ stimulation. An epidural electrode was implanted at Th8–Th10, followed by the placement of a BurstDR™ pulse generator. Currently, the patient has two active electrodes, one with HF stimulation, the other with BurstDR™ stimulation. CONCLUSIONS: Our case report demonstrates that there is no need to abandon SCS after the first failed attempt and it is worth trying stimulation with a different modulation. Furthermore, according to our center’s experience, the therapeutic effects of HF stimulation are quickly depleted and only after using burst stimulation was the expected result achieved. The reasons for this phenomenon are unknown and should be further researched.

Background: Failed back surgery syndrome (FBSS) is a common and incapacitating condition affecting patients with previous spine surgery in whom treatment approach can be challenging. This study aimed to summarize existing secondary studies and up-to-date randomized clinical trials (RCTs) that assess the effectiveness of available treatment options for FBSS. Methods: Systematic searches were carried out in five databases (PubMed, Cochrane, Scielo, Epistemonikos, and Google scholar) for all systematic reviews on the effectiveness of treatment options for FBSS published after 2012. Outcomes of interest were pain levels measured through visual analog scale or numeric rating scale, Oswestry Disability Index, and quality of life. Methodological and risk of bias assessments were performed with the AMSTAR-2 tool for systematic reviews and the Joanna Briggs Institute checklist for RCT. Prospective PROSPERO registration: CRD42022307609. Results: Fifteen studies, seven systematic reviews, and eight RCTs met the inclusion criteria and fulfilled the methodological quality assessment. Of the 15 included studies, 8 were on neurostimulation, 4 on adhesiolysis, 4 on epidural or intrathecal injections, and 3 on other treatment modalities. The risk of bias was low in seven studies, moderate in five, and high in three. Conclusions: Based on this systematic overview and the considerable heterogeneity among studies, the FBSS therapeutic approach must be individualized. FBSS treatment should start with conservative management, considering the implementation of neurostimulation, a technique with the most robust evidence of effective results, in cases of refractory axial or neuropathic pain. As the last resource, in light of the evidence found, more invasive procedures or new surgical interventions are indicated.

Postoperative epidural fibrosis (EF) is still a major limitation to the success of spine surgery. Fibrotic adhesions in the epidural space, initiated via local trauma and inflammation, can induce difficult-to-treat pain and constitute the main cause of failed back surgery syndrome, which not uncommonly requires operative revision. Manifold agents and methods have been tested for EF relief in order to mitigate this longstanding health burden and its socioeconomic consequences. Although several promising strategies could be identified, few have thus far overcome the high translational hurdle, and there has been little change in standard clinical practice. Nonetheless, notable research progress in the field has put new exciting avenues on the horizon. In this review, we outline the etiology and pathogenesis of EF, portray its clinical and surgical presentation, and critically appraise current efforts and novel approaches toward enhanced prevention and treatment.

The article from the Korean Journal of Pain discusses the potential of using Methylcobalamin (MeCbl), an active form of vitamin B12, as a supplementary agent for treating chronic peripheral neuropathic pain. It highlights the role of vitamin B12 in nerve function and its potential benefits in managing neuropathic pain. Clinical trials suggest that MeCbl may be a beneficial option for some patients, especially those who experience intolerable side effects from conventional pharmacologic treatments. The article emphasizes the need for alternative and complementary approaches to effectively treat neuropathic pain, especially in light of the limitations of current pharmacological treatments. [Extracted from the article]