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2 Minute Medicine Rewind June 16, 2025
1. Reductions in pain catastrophizing are more closely associated with improvements in emotional functioning than with pain intensity
Evidence Rating Level: 2 (Good)
This prospective observational study investigated whether pain catastrophizing, a maladaptive cognitive-emotional response to pain, is a static trait or a dynamic state influenced by interventional treatment outcomes. Among 128 adults with chronic low back pain (cLBP) undergoing fluoroscopic-guided steroid-based injections, the authors assessed changes in Pain Catastrophizing Scale (PCS) and Brief Pain Inventory (BPI) scores at baseline and one month post-procedure. Despite moderate improvements in pain severity and interference (especially in the affective REM domain: relationships, enjoyment, mood), the reduction in PCS scores was not statistically significant (mean change: −2.41, p=0.12), and the study was underpowered for this outcome. Notably, regression analysis identified baseline PCS and changes in REM as the strongest predictors of follow-up PCS scores, while pain severity, activity-related pain (WAW domain), and demographic or clinical variables (e.g., opioid use, prior surgery) were not significant predictors. Correlation analysis revealed that improvement in emotional-affective domains of functioning, rather than pain intensity alone, was more closely tied to reductions in catastrophizing. These findings suggest that emotional recovery may be a more relevant therapeutic target than sensory pain relief alone when aiming to reduce maladaptive pain coping mechanisms. The study also supports conceptualizing catastrophizing as a modifiable psychological state rather than a fixed trait.
1. For patients with facet-mediated spine pain that achieve ≥80% pain relief after a medial branch block, a second diagnostic block does not improve post-radiofrequency ablation pain outcomes but may delay definitive treatment.
Evidence Rating Level: 2 (Good)
This retrospective study examined whether receiving one versus two medial branch blocks (MBBs) prior to thermal radiofrequency ablation (tRFA) influenced pain outcomes in patients with facet-mediated spine pain. Existing guidelines often recommend dual MBBs before tRFA, though their necessity remains controversial. At a single academic center, 645 tRFA procedures performed between 2017 and 2021 were screened, yielding 312 cases with adequate follow-up data: 161 underwent one MBB and 151 received two. All patients had ≥80% pain relief after MBB, the center’s threshold for a positive diagnostic block. Pain outcomes at 3 months post-tRFA were assessed and compared using t-tests and χ² analyses. The average reported pain relief was 69.5%, with 85.3% of patients reporting ≥50% relief and 58.3% reporting ≥80% relief—no significant differences emerged between the one- and two-block groups. However, the time from the first MBB to tRFA was significantly longer in the two-block group (95.3 vs. 44.2 days, p<0.001). These findings align with prior research suggesting minimal added value of a second diagnostic block in predicting tRFA success and support recent guideline revisions discouraging routine use of dual MBBs. Limitations include the retrospective design, exclusion of many cases due to incomplete data, and reliance on self-reported pain outcomes.
1. Routine single-session screening for emotional and cognitive issues post-stroke does not improve long-term societal participation but may offer modest early benefits in anxiety and quality of life
Evidence Rating Level: 1 (Excellent)
The ECO-stroke trial, a multicenter, cluster-randomized controlled study, evaluated whether structured screening and care for emotional and cognitive problems at 6 weeks post-ischemic stroke improves societal participation at one year. Conducted across 12 Dutch hospitals, 531 patients discharged home without inpatient rehabilitation were enrolled. Intervention patients received a 1-hour nurse-led consultation including standardized screening tools (CLCE-24, MoCA, HADS), self-management support, and referrals as needed. The primary outcome—societal participation at one year measured via USER-P-R—did not significantly differ between intervention and usual care groups (mean difference [MD] 0.77; 95% CI −2.47 to 4.06; p=0.652). However, secondary outcomes at 3 months showed modest improvements favoring the intervention group: reduced anxiety symptoms (HADS-A MD −0.86), improved quality of life (EQ-5D-5L MD 0.044; EQ-VAS MD 2.9), and greater self-efficacy (GSES MD 0.97). These effects persisted to a lesser extent at 1 year. No significant differences were observed in cognitive or depressive symptoms, disability (mRS), or societal participation at either follow-up point. The study suggests that a single screening session may be insufficient to meaningfully impact complex outcomes like participation. Strengths include the large sample and pragmatic design; limitations include low referral rates and potential underpowering for secondary endpoints. Future analysis will assess cost-effectiveness.
1. AI-assisted electrocardiogram (ECG) improves early detection of low ejection fraction in hospitalized patients by enhancing diagnostic precision without increasing echocardiogram use
Evidence Rating Level: 1 (Excellent)
This pragmatic randomized controlled trial evaluated the impact of an AI-enabled ECG algorithm on the early diagnosis of low ejection fraction (EF ≤50%) in hospitalized patients under non-cardiologist care. Conducted at a single academic medical center in Taiwan, the study randomized 13,631 inpatients to either an intervention group (n = 6,840) receiving AI-assisted ECG interpretations or a control group (n = 6,791) receiving standard care. The AI model flagged patients as high or low risk based on ECG-derived probabilities for low EF. The primary outcome was the 30-day incidence of newly diagnosed low EF. The intervention significantly increased diagnosis rates (1.5% vs. 1.1%, HR 1.50, 95% CI: 1.11–2.03; p = 0.023), particularly among AI-identified high-risk patients (13.0% vs. 8.9%, HR 1.55, 95% CI: 1.08–2.21). Notably, overall echocardiogram utilization did not increase (17.1% vs. 17.3%, HR 1.00), but the diagnostic yield improved: 34.2% of high-risk intervention patients undergoing echocardiography were diagnosed with low EF, compared to 20.2% in controls (p < 0.001). Post-hoc analysis revealed increased cardiology consultation among high-risk intervention patients (29.3% vs. 23.5%; p = 0.027), suggesting AI alerts prompted more targeted diagnostic actions. The intervention improved diagnostic efficiency without escalating imaging burden or mortality. The algorithm’s real-time integration into clinical workflows enabled more accurate risk stratification and selective use of downstream resources.
1. Frailty scores alone (mFI-5, CCI) are poor predictors of intensive care unit (ICU) admission or prolonged hospital stay in elderly patients undergoing diverse elective surgeries
Evidence Rating Level: 3 (Average)
This single-center retrospective study evaluated the predictive value of the Modified Frailty Index (mFI-5) and Charlson Comorbidity Index (CCI) for critical care admission and hospital length of stay (LoS) in elderly patients undergoing non-cardiac surgery. Conducted at the Mater Misericordiae University Hospital in Dublin, the study included 100 patients aged >65 who attended the preoperative clinic between November and December 2023. The mFI-5 and CCI scores were calculated for each patient, and their ability to predict critical care needs and extended LoS (>5 days) was assessed using AUROC analysis. The results showed that neither score effectively predicted critical care admission (AUROC: mFI-5 = 0.52, CCI = 0.53) or extended hospital stay (AUROC: mFI-5 = 0.62, CCI = 0.59). Despite frailty being a known risk factor for adverse postoperative outcomes, these indices alone failed to provide sufficient predictive power in a diverse surgical population. The authors suggest this may be due to the heterogeneity of procedures and the elective nature of the surgeries, where preoperative clinician judgment and conservative management may confound objective risk models. The study concludes that mFI-5 and CCI, while useful in specific surgical contexts, are insufficient as standalone tools for predicting postoperative resource needs in general elderly surgical populations. Future risk stratification models should integrate frailty scores with surgery- and anesthesia-specific variables to enhance perioperative planning and optimize resource allocation.
Image: PD
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