Ultrasound-guided minimally invasive interventions for refractory musculoskeletal pain: a real-world study from an interventional rheumatology unit.

BACKGROUND: Chronic musculoskeletal pain represents a global health challenge, with a substantial proportion of patients failing to achieve adequate symptom control despite conventional treatment. Interventional rheumatology units (IRUs) incorporating ultrasound-guided minimally invasive procedures have emerged as a promising strategy for the management of refractory musculoskeletal pain. However, real-world evidence regarding the performance of these units in routine clinical practice remains limited. This study evaluated the effectiveness and safety of an IRU in routine clinical practice. METHODS: This retrospective, observational, single-center study included consecutive patients with chronic musculoskeletal pain refractory to conventional treatment, who underwent ultrasound-guided interventions at an IRU between April 2023 and February 2026. Procedures were categorized as myofascial infiltrations, shoulder procedures, erector spinae plane block, and a miscellaneous group of other procedures. The primary outcome was a clinically meaningful pain reduction, defined as a reduction of at least 2 points on the Numerical Rating Scale (NRS) at the first post-procedure follow-up visit. RESULTS: A total of 170 patients (77.6% women; median age 61 years) were included. Overall, 125 of 170 patients (73.5%) achieved the primary endpoint, with no significant differences across procedural groups. Median NRS decreased from 7.0 [IQR, 7.0-8.0] to 3.0 [IQR, 2.0-6.0] at follow-up, corresponding to a median reduction of 4.0 points (IQR, 1.0-6.0; p < 0.001). Two minor adverse events (1.2%) were recorded, and 30 patients (17.6%) required repeat procedures. In multivariable logistic regression analysis, a higher baseline NRS score was the only independent predictor of a clinically meaningful response (OR 1.74, 95% CI, 1.30-2.34; p < 0.001). Overall, 50 patients (29.4%) required referral to another specialty, although no baseline clinical variable independently predicted this outcome. Overall, 50 patients (29.4%) required referral to another specialty, although no baseline clinical variable independently predicted this outcome; the remaining 70.6% were managed or discharged by the IRU. CONCLUSION: Ultrasound-guided minimally invasive procedures performed within an IRU were associated with high rates of clinically meaningful pain reduction, and a favorable safety profile in patients with chronic musculoskeletal pain. These findings suggest that IRUs may have a role within multidisciplinary pain management pathways, although prospective controlled studies are needed to confirm these results.