Journal of Pain Research最新文献

Objective: Acupotomy in the treatment of cervical spondylosis (CS) is effective and widely used in clinic, but the mechanism is still unclear. In this study, we started from treating CS with acupotomy "regulating muscles to treat bone disorders" and cervical myocyte apoptosis, the mechanism of acupotomy activates PI3K/Akt signaling pathway mediated by FGF7,10/KDR signaling axis to regulate apoptosis was explored, providing theoretical basis for clarifying the target and molecular mechanism of acupotomy for CS.

Methods: Seventy-four SPF SD rats were divided into 9 groups, including acupotomy group, sham operation group, model group, normal group, control AAV group, control AAV+model group, AAV+model group, and AAV+model+acupotomy group. The CS model was verified by cervical spine X-ray and transmission electron microscopy. Multiple immunofluorescence and COIP techniques were used to verify the interaction between FGF7, FGF10 and KDR proteins in splenius capitis. The tension and pain threshold of rats were measured to evaluate motor and sensory disorders. HE staining was used to observe the pathological changes of splenius capitis. Finally, the expressions of FGF7, FGF10, KDR, PI3K, Akt, bcl2 and Caspase9 were detected by qPCR and Western blot.

Results: X-ray and transmission electron microscopy showed that the CS model was successfully constructed. Multiple immunofluorescence and COIP techniques identified the interaction between FGF7, FGF10 and KDR proteins. Acupotomy can effectively improve the tension and pain threshold of CS rats and also improve cervical vertebrae degeneration. After modeling, the expressions of FGF7, FGF10, KDR and Caspase9 were increased, while the expressions of PI3K, Akt and bcl2 were decreased, which could be reversed by acupotomy. The effect is alleviated after knockdown of KDR, and the downstream signal transmission is blocked.

Conclusion: Acupotomy activates PI3K/Akt signaling pathway mediated by FGF7,10/KDR signaling axis, regulates cervical myocyte apoptosis, and repairs strained muscles, which may be the key molecular mechanism of treating CS with acupotomy "regulating muscles to treat bone disorders".

Purpose: This study aimed to investigate the functional and structural characteristics of the pelvic floor in CP/CPPS patients using surface electromyography (sEMG), pelvic floor ultrasound, and the Psychosomatic Symptom Scale (PSSS).

Methods: Thirty CP/CPPS patients and thirty age-matched healthy males were assessed using the Glazer sEMG protocol and pelvic floor ultrasound to evaluate muscle activity, thickness, and elasticity. PSSS was used to evaluate psychological health. Independent samples t-tests were used for group comparisons.

Results: CP/CPPS patients exhibited significantly higher average EMG values during pre- and post-rest phases, prolonged relaxation time after rapid contractions, and greater variability during endurance contractions (p < 0.05). No significant differences were observed in ultrasound measurements (p > 0.05). PSSS scores were significantly higher in the CP/CPPS group across all subscales (p < 0.05).

Conclusion: CP/CPPS is characterized by increased pelvic floor muscle excitability, reduced coordination, and pronounced somatic and psychological symptom burden, without significant global structural abnormalities. The Glazer sEMG protocol may help identify characteristic pelvic floor abnormalities, while the PSSS offers valuable insights into psychological symptomatology.

Background: Spinal cord stimulation (SCS) can successfully treat neuropathic pain when conventional medication fails. Current evaluation methods, however, are primarily subjective. This study explored the use of infrared thermography as an objective method to detect physiological effects of SCS.

Methods: This prospective observational study included 25 patients treated with SCS for neuropathic pain. Skin temperature was measured using infrared thermography before and during the first 60 minutes of stimulation. Pain intensity was assessed using an 11-point Numerical Rating Scale (NRS). The primary hypothesis was that SCS would lead to a significant skin temperature increase of at least 1°C.

Results: Mean skin temperature in the affected area increased significantly from 29.1 ± 2.3°C to 30.8 ± 1.8°C (p = 0.0002). On the contralateral side, it increased from 29.3 ± 2.2°C to 30.0 ± 1.8°C (p = 0.0037). Temperature responses varied among individuals. A post hoc analysis showed that patients with a temperature increase of ≥1°C (responders) demonstrated significantly greater long-term improvement in pain chronification scores compared to non-responders (p = 0.002).

Conclusion: SCS produces measurable increases in skin temperature in patients with neuropathic pain. A ≥1°C temperature increase may indicate favorable long-term response. Infrared thermography may serve as a valuable objective measure for evaluating SCS efficacy.

Objective: To evaluate the long-term outcomes and prognostic factors of surgical versus non-surgical treatment for lumbar spinal stenosis (LSS).

Methods: This retrospective cohort study included 210 patients with LSS (122 surgical, 88 non-surgical) from three tertiary spine centers, with a minimum five-year follow-up. Primary outcomes included Oswestry Disability Index (ODI), pain scores, and maintaining minimal clinically important difference (MCID). Secondary outcomes encompassed quality of life measures, walking capacity, and patient satisfaction. Prognostic factors were analyzed using Cox proportional hazards models.

Results: At baseline, the surgical group exhibited more severe symptoms (ODI: 47.5±12.9 vs 41.3±14.7, P<0.001) and higher prevalence of multi-level stenosis (63.1% vs 49.2%, P=0.007). At six months, surgical patients demonstrated greater improvement in ODI (23.5 vs 11.8 points, P<0.001) and leg pain (VAS reduction: 4.6 vs 2.0, P<0.001). This advantage persisted at one year, with 74.6% of surgical patients achieving MCID compared to 42.2% in the non-surgical group. Long-term follow-up (mean 7.1±1.7 years) revealed sustained but attenuated treatment effects, with higher rates of maintaining MCID in the surgical group (63.2% vs 46.4%, P=0.004). Younger age, predominant leg pain, shorter symptom duration, and absence of depression predicted favorable surgical outcomes, while spondylolisthesis negatively impacted non-surgical outcomes.

Conclusion: Surgical decompression provides superior early improvement in functional status and pain compared to non-surgical management, with benefits partially maintained beyond five years. However, outcome convergence over time suggests that both approaches can be effective for appropriately selected patients. Prognostic factors identified in this study may guide personalized treatment decisions for patients with LSS. This study suggests an association between surgical decompression and superior initial improvement. However, due to the non-randomized design, these findings must be interpreted with caution.

One-size-fits-all opioid treatment for chronic pain may undermine treatment effectiveness and cause adverse effects. We explore personalized nonpharmacological and noninvasive chronic pain treatment as a promising approach to minimize these risks and optimize outcomes for each patient. Our paper introduces the definition of personalized treatment, emphasizes the significance of intervention personalization, and outlines strategies for inter- and intra-patient personalization in chronic pain management. We also discuss empirical studies on personalized chronic pain treatment. Research has shown a variety of strategies for personalizing nonpharmacological and noninvasive chronic pain treatment. These strategies have demonstrated the potential to improve effectiveness. However, many critical scientific questions remain unanswered. To fully harness the potential of personalized nonpharmacological and noninvasive chronic pain treatment, future research should conduct robust clinical trials and meta-analyses comparing personalized and non-personalized chronic pain interventions, examine diverse personalization approaches, incorporate ecological momentary assessment into outcomes assessment, leverage digital technologies, engage patients in treatment design, and assess factors influencing the implementation of personalized chronic pain treatment.

Objective: To construct a contemporaneous symptom co-occurrence network of patients with lumbar disc herniation (LDH) to extract symptom clusters and identify core and bridge symptoms using network analysis.

Methods: A questionnaire was administered to 312 LDH patients hospitalized in a tertiary-level hospital in Hubei Province from September 21, 2024, to March 31, 2025, using convenience sampling. Instruments included a general information questionnaire, the Japanese Orthopaedic Association's Low Back Pain Assessment Scale (JOA), the Visual Analogue Scale (VAS), and the Self-Rating Anxiety Scale (SAS). Symptomatic data were collected and downscaled using exploratory factor analysis to reduce dimensionality and extract symptom clusters with intrinsic associations. The symptom network was constructed using R, relationships between symptoms were analyzed, and centrality indices were calculated to identify key symptom nodes.

Results: Exploratory factor analysis extracted four symptom clusters. They were the symptom cluster of limited lumbar mobility function, the symptom cluster of limited lower extremity mobility function, the symptom cluster of abnormal distal limb sensation, and the symptom cluster of lower extremity motor coordination disorder. The top three symptoms for node strength were Difficulty standing (rs = 5.72), Difficulty walking (rs = 5.43), and Difficulty turning over (rs = 5.35); the top three for bridge strength were Difficulty standing (rs = 4.58), walking ability (rs = 4.49), and Difficulty walking (rs = 4.37).

Conclusion: Difficulty standing, Difficulty walking, and Difficulty turning are the most central symptoms in LDH patients, while Difficulty standing, walking ability, and Difficulty walking are bridge symptoms.

Background: Non-cardiac chest pain (NCCP) is a prevalent clinical symptom frequently associated with psychosocial factors. This study aimed to investigate the relationship between anxiety, depression, fatigue, and NCCP, with a particular focus on how these psychosocial factors influence the risk of NCCP occurrence.

Methods: Based on data from the NHANES database, we analyzed the clinical characteristics, psychosocial status, and the occurrence of non-cardiogenic chest pain in 4557 participants. After weighting, the sample size was 64,650,723.91. Spearman correlation analysis and weighted multivariable logistic regression models were used to explore the associations between anxiety, depression, fatigue, and non-cardiogenic chest pain and to assess the independent impact of these factors on the risk of non-cardiogenic chest pain.

Results: The results of the weighted logistic regression indicate that anxiety and depression are significantly associated with non-cardiac chest pain, and the severity of anxiety is positively correlated with the risk of non-cardiac chest pain (OR = 2.778, 95% CI = [2.772, 2.784]). Furthermore, compared with participants who reported "no fatigue at all", those who reported feeling fatigued "almost every day" had a 1.927-fold higher risk of non-cardiac chest pain. Multivariate regression analysis identified depressive and anxious symptoms as important predictors of non-cardiac chest pain.

Conclusion: This study highlights the important role of psychosocial factors in the occurrence of Non-cardiac chest Pain, particularly the significant influence of anxiety, depression, and fatigue on Non-cardiac chest Pain risk. The findings underscore the need to incorporate psychosocial assessments into the clinical diagnosis and management of Non-cardiac chest Pain, offering new perspectives and strategies for pain management.

Background: Chronic neck pain (CNP) and chronic respiratory diseases (CRD) have been shown to be associated, though such findings remain inconclusive.

Objective: This study aims to investigate the association between CNP and CRD in middle-aged and elderly Chinese populations using nationally representative longitudinal data.

Methods: This study utilized 7-year longitudinal data (2011-2018) from the China Health and Retirement Longitudinal Study (CHARLS). The study population comprised respondents who reported chronic neck pain (CNP) without comorbid chronic respiratory diseases (CRDs) in the 2011 survey. Pain sites were assessed via self-reported questionnaires, and CRDs were confirmed based on self-reported prior diagnoses. Logistic regression was employed to analyze the association between CNP and CRDs.

Results: A total of 6864 participants were included, with 650 developing CRD during the follow-up. After adjusting for confounding factors such as gender, age, and other chronic diseases, CNP was significantly associated with incident CRD (OR = 2.25, 95% CI: 1.77-2.86, P < 0.0001). Gender-stratified analyses revealed that the positive association between CNP and CRD risk remained significant in both males (OR = 3.08, 95% CI: 2.11-4.48, P < 0.0001) and females (OR = 1.87, 95% CI: 1.37-2.57, P < 0.0001), with a stronger magnitude observed in males.

Conclusion: Among Chinese CNP patients aged ≥45 years, the risk of developing CRD is increased by 2.25-fold, with evident gender differences. In clinical and community practice, conducting respiratory health assessment and screening for middle-aged and elderly patients with CNP (chronic neck pain), and initiating rehabilitation training as early as possible, is of vital importance for reducing their risk of developing chronic respiratory diseases.

Background: Herpes zoster-associated neuralgia (HZN) is a disease caused by the reactivation of the varicella-zoster virus (VZV) that is latent within the spinal nerves, with a major impact on patients' quality of life. The objective of this study is to evaluate the efficacy and safety of Pulsed Radiofrequency (PRF) combined with Platelet-Rich Plasma (PRP) in the treatment of HZN, comparing it with PRF alone.

Methods: A thorough search was conducted on multiple databases. Several clinical studies from the inception of each database up to December 2024 were included in the study. The primary clinical outcome was the postoperative pain intensity score. Secondary clinical outcomes encompassed sleep quality, the utilization of rescue analgesics postoperatively, and the incidence of adverse events.

Results: The final analysis incorporated a total of seven studies, encompassing 568 subjects. With regard to the alleviation of pain, PRF combined with PRP therapy has shown more significant pain relief for HZN when compared with conventional PRF therapy. The combination of PRF and PRP therapy has been demonstrated to be more efficacious in enhancing patients' sleep quality. With regard to the administration of postoperative rescue analgesics, the dosage of such medication was found to be lower in cases where PRF was combined with PRP therapy. The incidence of adverse events was consistent across both groups.

Conclusion: The PRF - PRP is more effective than the traditional radiofrequency pulse therapy in treating HZN. This combination has been demonstrated to enhance sleep quality and reduce the necessity for postoperative rescue analgesics. The potential for this approach extends to its utilization as a novel therapeutic modality for HZN.