{"doi":"10.1093/pm/pnaf108","title":"Reply to Wang et al.'s Reply to “Notable concerns in methodology and conclusions of the Wang et al. Meta-analysis in BMJ by the American Academy of Pain Medicine” by Schuster et al.","abstract":"We thank Wang et al. for their response. Interventional pain procedures are best analyzed through the lens of current best practices. In their response, Wang et al. present a new subgroup analysis entirely consisting of radiofrequency randomized controlled trials (RCTs) using patient selection and procedural techniques not reflective of current best practices. Review of eFig 2 together with Supplementary Tables 7 and 24 enables readers to identify the included and excluded RCTs. Wang et al. excluded from this subgroup analysis positive, double-blind RCTs conducted according to current best practices. While they state this subgroup analysis was based on blinding, the notable difference between the included and excluded papers was not in blinding quality but rather in outcomes. Meanwhile, all the included RCTs have flawed patient selection and/or procedural techniques.1 These flaws include (1) 2 studies using lumbar radiofrequency ablation (RFA) using the Shealy technique, where electrodes are placed lateral and caudal to the superior articular process, thus missing the medial branches; (2) three studies of lumbar RFA using perpendicular electrode placement, which has a substantially lower likelihood of successfully ablating target nerves; (3) a sacroiliac RFA study using a strip electrode, a failed technique that is no longer routinely used; (4) studies using small 22-gauge electrodes rather than larger electrodes that create adequately sized lesions to reliably ablate target nerves, (4) studies with inadequate selection tests and criteria for RFA such as intra-articular blocks or use of an inadequate (2/10) pain reduction threshold in numeric pain score with diagnostic blocks to proceed to RFA; (5) studies using single diagnostic blocks, which continue to be subject to debate; and (6) in one study, pooling results from the traditional RFA and non-ablative pulsed radiofrequency (PRF) treatment arms into a single treatment arm as if the same intervention. The inadequacy of these selection and treatment standards has been well established for several years.2","journal":"Pain Medicine","year":2025,"id":573139,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9542,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1139954,"name":"Mustafa Broachwala","orcid":"0009-0005-6700-5767","position":1,"is_corresponding":false},{"id":1428771,"name":"Farshad Ahadian","orcid":"0000-0003-3451-0992","position":2,"is_corresponding":false},{"id":390775,"name":"Charles E. Argoff","orcid":"0000-0002-4961-8069","position":3,"is_corresponding":false},{"id":242821,"name":"Steven P. Cohen","orcid":"0000-0001-5928-2127","position":4,"is_corresponding":false},{"id":1139950,"name":"Shravani Durbhakula","orcid":"0000-0002-5335-8298","position":5,"is_corresponding":false},{"id":258131,"name":"Amitabh Gulati","orcid":"0000-0003-1654-8639","position":6,"is_corresponding":false},{"id":402034,"name":"Robert W. Hurley","orcid":"0000-0001-6591-9390","position":7,"is_corresponding":false},{"id":18737,"name":"Lynn Kohan","orcid":"0000-0003-0407-806X","position":8,"is_corresponding":false},{"id":827893,"name":"Zachary L. McCormick","orcid":"0000-0002-2483-1090","position":9,"is_corresponding":false},{"id":18743,"name":"Sayed Wahezi","orcid":"0000-0003-3720-6443","position":10,"is_corresponding":false},{"id":1358523,"name":"Antje M. Barreveld","orcid":"0000-0003-1126-2797","position":11,"is_corresponding":false},{"id":618379,"name":"Nathaniel M. Schuster","orcid":"0000-0002-4970-6296","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:57:32.445190Z","pmid":"40833010","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}