Journal of Pain Research最新文献

Background: Chronic knee pain from osteoarthritis (OA) affects a significant proportion of adults over 40. Total knee arthroplasty (TKA) remains the standard for advanced OA, yet up to 20% of patients experience chronic postsurgical pain (CPSP). Genicular nerve radiofrequency ablation (GNRFA) can alleviate pain in those unresponsive to conservative treatments or TKA. However, anatomical variability of the genicular nerves may limit treatment durability. This retrospective, single-center observational study investigated whether using a novel V-shaped active tip needle-which creates larger lesions-could improve outcomes.

Methods: Fifty patients with symptomatic knee OA or CPSP, who had a ≥50% reduction in pain after diagnostic genicular nerve blocks, underwent GNRFA with a V-shaped active tip needle between September 2020 and January 2022. Pain and function were assessed using the visual analogue scale (VAS) at rest and during movement, Western Ontario and McMaster Universities Arthritis Index (WOMAC), Douleur Neuropathique en 4 Questions (DN4), and EuroQol-5 Dimensions (EQ-5D) at baseline and 1, 3, 6, and 9 months post-procedure.

Results: By 6 months, 64% of patients showed ≥50% reduction in VAS pain scores, sustained at 9 months (p<0.0001). Median WOMAC scores improved from 62.0 at baseline to 40.0 at 6 months (p<0.0001). DN4 scores declined from a median of 4.0 at baseline to 2.0 at 6 months and 1.0 at 9 months (p<0.001). EQ-5D scores demonstrated significant enhancement in quality of life (p<0.01). Pain intensity differences at rest and during movement remained substantially improved at 9 months (p<0.0001).

Conclusion: GNRFA using a V-shaped active tip needle is a promising intervention for chronic knee pain, offering significant and sustained pain relief and functional improvement. Larger lesions created by the novel needle may overcome anatomical challenges, though further randomized studies are warranted to validate efficacy and safety.

Artificial Intelligence (AI) has the potential to optimize personalized treatment tools and enhance clinical decision-making. However, biases in AI, arising from sex, race, socioeconomic status (SES), and statistical methods, can exacerbate disparities in pain management. This narrative review examines these biases and proposes strategies to mitigate them. A comprehensive literature search across databases such as PubMed, Google Scholar, and PsycINFO focused on AI applications in pain management and sources of biases. Sex and racial biases often stem from societal stereotypes, underrepresentation of females, overrepresentation of European ancestry patients in clinical trials, and unequal access to treatment caused by systemic racism, leading to inaccurate pain assessments and misrepresentation in clinical data. SES biases reflect differential access to healthcare resources and incomplete data for lower SES individuals, resulting in larger prediction errors. Statistical biases, including sampling and measurement biases, further affect the reliability of AI algorithms. To ensure equitable healthcare delivery, this review recommends employing specific fairness-aware techniques such as reweighting algorithms, adversarial debiasing, and other methods that adjust training data to minimize bias. Additionally, leveraging diverse perspectives-including insights from patients, clinicians, policymakers, and interdisciplinary collaborators-can enhance the development of fair and interpretable AI systems. Continuous monitoring and inclusive collaboration are essential for addressing biases and harnessing AI's potential to improve pain management outcomes across diverse populations.

Background: Lumbar disc herniation (LDH) is a common cause of low back pain and radiculopathy. Selective Nerve Root Block (SNRB) has been widely used as a treatment for LDH; however, its efficacy across different types of LDH remains unclear. This study aims to evaluate the clinical efficacy of SNRB in treating various LDH subtypes, classified according to the Michigan State University (MSU) classification system, and to explore its potential as a safe and minimally invasive percutaneous treatment option.

Methods: This is a single-blind, Prospective Cohort Study. A total of 200 patients diagnosed with LDH will be recruited and allocated into 10 groups (20 patients per group) based on their MSU classification (1-A, 1-B, 1-C, 2-AB, 2-A, 2-B, 2-C, 3-AB, 3-A, and 3-B). All patients will receive SNRB treatment under fluoroscopic guidance. Primary outcomes will include the Visual Analogue Scale (VAS) for pain intensity. Secondary outcomes will include the Oswestry Disability Index (ODI), health-related quality of life (Short Form-36, SF-36) and average weekly analgesic consumption. Assessments will be conducted at baseline, 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year post-treatment.

Discussion: This study will provide high-quality evidence on the efficacy of SNRB in different LDH subtypes, classified according to the MSU system. The findings will guide clinical decision-making and promote the adoption of SNRB as a minimally invasive, safe, and effective treatment option for LDH.

Trial registration: This clinical trial is registered on the Chinese Clinical Trial Registry platform (ChiCTR) at https://www.chictr.org.cn/index.html, identifier: ChiCTR2200067212.

Purpose: This study aimed to investigate the feasibility of interlaminar endoscopic surgery for the treatment of adjacent segment disease (ASD) after posterior instrumented lumbar fusion.

Materials and methods: Between January 2019 and March 2023, the data of 22 patients with ASD who underwent revision interlaminar technique (R-ILT) endoscopic surgery after posterior instrumented lumbar fusion were retrospectively analyzed. For comparison, the data of 30 patients with single segment lumbar spinal stenosis who underwent primary interlaminar technique (P-ILT) endoscopic surgery were collected. The patient demographics and perioperative indicators were recorded and the clinical outcomes were analyzed with relevant evaluation scales. The surgical satisfaction was assessed using the modified MacNab criteria, lumbar stability was evaluated using the change in dynamic position radiographs of the spine at the final follow-up.

Results: There were no statistical differences in patient demographics. The operation time, blood loss, fluoroscopy time, and the incidence of dural sac tears were higher in R-ILT group (p < 0.05). Both groups had significant relief in their lower back and leg pain symptoms, but the relief of the low back pain in R-ILT group was not as good as that in P-ILT group. Regarding recovery of lower limb function, the results of both groups were similar, according to the modified MacNab criteria, the good-to-excellent rate was 81.82% in R-ILT group and 86.66% in P-ILT group. The change in dynamic position X-ray of the spine proved that ILT would not destroy the stability of the spine.

Conclusion: Interlaminar endoscopic surgery is a feasible option for treating ASD. However, due to the impact of the initial operation, the difficulty and risk of reoperation have increased; therefore, surgical indications must be strictly controlled, and superb surgical skills are required.

Background: This network meta-analysis (NMA) aimed to explore the impact of Non-pharmacological therapies (NPT) on alleviating primary dysmenorrhea (PD) symptoms and assess the effectiveness differences among various NPT.

Methods: We searched seven databases and summarized clinical trials of PD treated with NPT from inception to September 6, 2023. Randomized controlled clinical trials (RCTs) of PD treated with NPT. The outcomes were the Visual Analog Scale (VAS), the Cox menstrual symptom scale (CMSS), and response rate. Quality was assessed using the Cochrane risk of bias assessment tool. Pairwise meta-analysis and network meta-analysis (NMA) was performed by RevMan (5.4), Stata (15.0), and WinBUGS (1.4.3). The ranking probabilities for all treatment interventions were performed using the Surface Under the Cumulative Ranking curve (SUCRA).

Results: A total of 16 RCTs were finally included, involving 8 kinds of NPT. Results of pairwise meta-analyses: For the VAS score results, moxibustion (SMD: -0.591,95% CI: -0.916, -0.266) was more effective than acupuncture, acupuncture (SMD: -0.948,95% CI: -1.853, -0.044) was more effective than placebo, and yoga (SMD: 2.634,95% CI: -4.28, -0.988) was more effective than the blank control. NMA results: Compared to the blank control, acupuncture (SMD: -4.81; 95% CI: -6.63, -3.00), auricular point therapy (SMD: -4.36; 95% CI: -7.18, -1.60), yoga (SMD: -2.12; 95% CI: -3.13, -1.09), moxibustion (SMD:5.54; 95% CI: 3.33, 7.68), and placebo (SMD: 3.10; 95% CI: 1.03, 5.27) proved to be a superior reduction in VAS. The use of acupressure (SMD: 2.49; 95% CI: 0.03, 5.03), moxibustion (SMD: -2.45; 95% CI: -4.06, -0.71), and acupuncture (SMD: -1.72; 95% CI: -2.75, -0.56) demonstrated a greater decrease in VAS efficacy than placebo. The consolidated ranking outcomes indicate that moxibustion, acupuncture, and auricular acupoint therapy occupy high SUCRA positions across various outcome metrics.

Conclusion: Acupuncture, moxibustion and auricular point may be the best treatment for PD. In the future, more trials are needed to obtain higher-quality evidence and the best protocols.

Persistent pain is a common complaint among civilians and military personnel after a lateral ankle sprain (LAS). Most individuals who experience pain after an LAS self-report a moderate pain intensity level that interferes with activity. This pain experience is mostly described through study designs and outcomes that limit the understanding of the acute to chronic pain transition after an LAS. The purpose of this prospective study is to quantify the prevalence rate of chronic ankle pain at 6-months post-injury and identify susceptibility and resiliency factors that contribute to pain chronification after an LAS. The objective of this study will be accomplished through a two-site prospective cohort study design with data collected at four timepoints (<7 days post-LAS, 3-, 6-, and 12-months post-LAS). A target sample size of 200 men or women (100 per site) between 18 and 45 years of age who sustain an acute LAS within the previous 7-days will be enrolled. Participants will complete a series of standardized electronic surveys at each timepoint to self-report the presence of chronic ankle pain, healthcare utilization patterns, subsequent musculoskeletal injury, and new co-morbid conditions. Additionally, participants will complete validated patient-reported outcomes (PROs) electronically to characterize the pain burden and undergo quantitative sensory testing to assess mechanical pain sensitivity via pressure pain thresholds, pain facilitation via temporal summation, and pain inhibition via a conditioned pain modulation response at all timepoints. Lastly, clinician-based outcomes will be completed at 3-, 6-, and 12-months post-LAS to examine dynamic postural control, functional performance, and walking mechanics. We hypothesize that 30% of participants will self-report chronic ankle pain at 6-months post-injury. In addition, chronic pain at 6-months will be predicted by a combination of healthcare utilization patterns, prolonged levels of peripheral sensitization and pain facilitation, and worse functional performance and PROs.

Background: Post-dural puncture headache (PDPH) is the most common and troublesome complication following iatrogenic puncture of the dura. This study aims to evaluate the efficacy and safety of intrathecal or epidural saline injection to prevent PDPH.

Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, supplemented by a manual search of reference lists of related articles. Studies were eligible if they compared intrathecal or epidural injection or continuous saline infusion with no intervention in patients with accidental or intentional dural puncture. Trials reporting PDPH outcomes were considered eligible. The type of surgeries and patient populations were not restricted. Risk ratios (RRs) with 95% confidence intervals (CI) were calculated for the risk estimate of dichotomous outcomes. The funnel plot, Egger, and Begg tests were performed to assess the publication bias.

Results: We identified 13 studies involving 1589 patients, revealing a high publication bias. Normal saline injection reduced the incidence of PDPH (RR=0.57, 95% CI: 0.43 to 0.74, P<0.0001, I²=66%, P-heterogeneity=0.0004) and the requirement for an epidural blood patch (RR=0.37, 95% CI: 0.25 to 0.54, P<0.00001, I²=29%, P-heterogeneity=0.23).

Conclusion: Saline administration after dural puncture appears to be a promising option for preventing PDPH. However, heterogeneity among the studies and publication bias with positive results limits the available evidence. Therefore, further large-scale randomized controlled trials are needed to confirm our findings.

Register: CRD42022342509.