Journal of Pain Research最新文献

This narrative review synthesizes preclinical evidence from 54 studies to outline the distinct, stage-dependent mechanisms of manual acupuncture (MA) and electroacupuncture (EA) in inflammatory pain. Following a systematic search, we conducted a detailed thematic analysis of studies using CFA-induced rodent models and organized the findings into three pathological phases: acute (1-3 days), subacute (4-14 days), and chronic (>14 days). The results demonstrate a temporal evolution of therapeutic mechanisms that underscores the necessity of stage-specific intervention strategies for optimizing clinical outcomes. In the acute phase, interventions primarily produce rapid analgesia by engaging immediate descending inhibitory pathways and modulating peripheral ion channels. During the subacute phase, treatments work to counteract central sensitization through immune microenvironment reprogramming and the regulation of synaptic plasticity. For the chronic phase, strategies expand beyond pain relief to alleviate neuropsychiatric comorbidities and promote systemic tissue repair via limbic circuit remodeling. By integrating these findings, this work proposes a time-sensitive mechanistic framework. It underscores the principle of "time-window" optimization for precision acupuncture intervention in inflammatory pain, while also pointing to the critical need for future clinical translation and validation.

Objective: Degenerative lumbar spondylolisthesis (DLS) is a common degenerative disease that causes low back pain and lower extremity pain. Transforaminal Lumbar Interbody Fusion (TLIF) is an effective surgical method for treating this condition. However, postoperative complications exist, such as cage subsidence, whose causes are complex. This study investigated the characteristics and risk factors of cage subsidence after TLIF in DLS patients.

Methods: A total of 131 TLIF patients were divided into the subsidence group (subsidence group, n=39) and the non-subsidence group (non-subsidence group, n=92). General patient data were collected, including sex, age, body mass index (BMI), surgical time, intraoperative blood loss, hypertension and diabetes. The imaging data collected included the degree of multifidus muscle atrophy (MMA) at the surgical segment preoperatively; the lumbar lordosis angle, segmental lordosis angle, and intervertebral height before surgery, immediately after surgery, and 12 months postoperatively. Univariable analysis and multivariable logistic regression analysis were used to identify independent risk factors for subsidence after TLIF in patients with DLS.

Results: The degree of MMA before surgery in the subsidence group was significantly greater than that in the non-subsidence group (p< 0.001). There were statistically significant differences in the final follow-up Visual Analogue Scale (VAS) scores for lower back pain and postoperative Oswestry Disability Index (ODI) scores between the two groups. Intervertebral height correction (OR=11.19, p=0.0001), segmental lordosis angle correction (OR=3.43, p=0.0001), and MMA (OR=0.73, p=0.003) were all independent risk factors for cage subsidence.

Conclusion: Intervertebral height correction, segmental lordosis angle correction and MMA were identified as independent risk factors for cage subsidence after TLIF in patients with DLS. In clinical practice, preoperative physiotherapy and core muscle strengthening training aimed at improving the quality of the multifidus muscle can reduce MMA. Meanwhile, selecting an appropriate height for the interbody fusion cage and avoiding excessive correction of the lordotic angle can be used to reduce the incidence of interbody fusion cage subsidence after TLIF and improve patients' clinical outcomes.

Background: Approximately 60-80% of patients with advanced liver cancer experience pain, significantly impairing quality of life. While the three-step analgesic regimen has limitations, acupuncture has gained attention for cancer pain management, though evidence for its combined use remains inconsistent. This Bayesian network meta-analysis evaluated the clinical value of acupuncture combined with the three-step regimen.

Methods: Randomized controlled trials on acupuncture combined with three-step analgesia for liver cancer pain were searched in Chinese and English databases up to August 2025. Bayesian network meta-analysis was performed using R software.

Results: Twenty-seven studies involving 2220 patients were included, covering six acupuncture modalities: Chinese herbal acupoint application, acupoint injection, acupuncture and moxibustion, acupuncture alone, heat-sensitive moxibustion, and floating acupuncture. For pain relief efficacy, SUCRA rankings were: acupuncture plus moxibustion combined with three-step therapy (0.96) > acupuncture plus herbal application combined with three-step therapy (0.65) > floating acupuncture plus herbal application combined with three-step therapy (0.64). For pain intensity (NRS), rankings were: herbal acupoint application combined with three-step therapy (0.72) > floating acupuncture plus herbal application combined with three-step therapy (0.70) > acupuncture combined with three-step therapy (0.63). For adverse events, rankings were: herbal acupoint application combined with three-step therapy (0.80) > acupuncture combined with three-step therapy (0.74) > heat-sensitive moxibustion combined with three-step therapy (0.72). CINeMA assessment indicated generally low evidence quality.

Conclusion: Current evidence suggests that herbal acupoint application and acupuncture combined with moxibustion may enhance the three-step analgesic regimen for liver cancer pain, but conclusions are limited by low evidence quality and require further high-quality trials for validation.

Background: With the continued advancement of artificial intelligence (AI), large language models (LLMs) such as GPT-4 may assist clinicians in evaluating patient candidacy for spinal cord stimulation (SCS). We compared a general-purpose, non-fine-tuned LLM (GPT-4), an expert multidisciplinary team (MDT), and a clinician-input, rule-based e-Health decision-support tool. The study focused exclusively on decision agreement and did not assess clinical outcomes (eg, pain relief or device retention).

Methods: This single-center, retrospective cohort was conducted at Fondazione Istituto G. Giglio (Cefalù, Italy) and included 93 consecutive adults referred to the MDT for SCS evaluation between January 2022 and March 2024. The MDT issued binary recommendations ("proceed" vs "do not proceed") as the reference standard. The e-Health tool generated "yes", "maybe", or "no" outputs from structured clinician-entered data. GPT-4 was applied zero-shot, using a single standardized prompt on anonymized vignettes within an offline environment. The primary endpoint was agreement (weighted κ) among MDT, e-Health, and GPT-4; sensitivity/specificity analyses explored three interpretations of "maybe".

Results: The MDT recommended SCS for 91.4% of patients, compared with 54.8% for the e-Health tool and 46.2% for GPT-4. Agreement was moderate for MDT vs e-Health (κ = 0.51) and e-Health vs GPT-4 (κ = 0.46), and fair for MDT vs GPT-4 (κ = 0.29). GPT-4 demonstrated a more conservative profile, favoring specificity over sensitivity.

Conclusion: A non-fine-tuned GPT-4 approximated but did not replicate MDT decision-making, functioning as a high-specificity, low-sensitivity filter. A layered workflow combining rule-based tools with expert oversight and targeted LLM adaptation may best optimize SCS candidate selection.

Background: Metabolic syndrome (MetS) and low back pain (LBP) are major health concerns, but their relationship remains unclear. Components of MetS, such as abdominal obesity and hypertension, may contribute to musculoskeletal degeneration. This study investigated the association and causality between MetS and LBP.

Methods: We analyzed 5,523 adults (≥20 years) from NHANES 1999-2004 with complete MetS and LBP data. MetS was defined using National Cholesterol Education Program's Adult Treatment Panel III (ATPIII), International Diabetes Federation (IDF), and "modified World Health Organization (mWHO) criteria". Weighted logistic regression and stratified analyses assessed associations. Mediation analysis examined the role of C-reactive protein (CRP), and Mendelian randomization (MR) using GWAS summary statistics tested causal effects of MetS components on LBP.

Results: MetS prevalence was higher in participants with LBP (IDF: 41.0% vs 34.4%; ATPIII: 31.6% vs 25.8%; mWHO: 25.6% vs 21.2%). Fully adjusted models confirmed significant associations: IDF (OR = 1.27; 95% CI: 1.06-1.53), ATPIII (OR = 1.26; 95% CI: 1.05-1.50), mWHO (OR = 1.21; 95% CI: 1.03-1.42). CRP did not mediate these associations. MR analysis supported causal effects of hypertension (OR = 2.34; 95% CI: 1.38-3.97; FDR p = 0.002) and waist circumference (OR = 1.45; 95% CI: 1.34-1.57; FDR p < 0.001) on LBP, while other MetS components showed no causal links.

Conclusion: MetS is associated with LBP across multiple definitions, with genetic evidence implicating abdominal obesity and hypertension. Improving metabolic health may be a promising strategy to reduce LBP burden.

Objective: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) presents with persistent pelvic pain, urinary symptoms, and psychological burden, severely affecting patients' quality of life. While antibiotics and α-blockers are commonly prescribed, their long-term efficacy is limited and adverse reactions are frequent. Chinese patent medicines (CPMs) have emerged as promising alternatives, yet the lack of head-to-head evidence among formulations hinders evidence-based clinical recommendations.

Methods: Eight databases-CNKI, WanFang, VIP, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library-were searched from inception to November 1, 2025. Randomized controlled trials enrolling adults with CP/CPPS treated with CPMs versus standard therapy (ST) were included. Bias was assessed with ROB 2, and evidence certainty with CINeMA. A Bayesian network meta-analysis was performed, and outcomes were summarized using forest plots, league tables, and SUCRA curves in RStudio.

Results: Seventy-six trials (n=8431) involving 12 CPMs were analyzed. All studies were conducted in China, and all CPMs outperformed ST in enhancing the total effective rate and reducing NIH-CPSI scores. Shuangshi Tonglin Capsules (SSTL) ranked highest for both overall efficacy (OR = 5.6; 95% CI [2.0, 17]; SUCRA 73.8%) and NIH-CPSI reduction (MD = -8.0; 95% CI [-11, -4.8]; SUCRA 93.3%). SSTL also provided the largest improvements in pain (MD = -5.4; 95% CI [-8.0, -2.8]) and quality of life (MD = -4.3; 95% CI [-5.7, -2.9]).

Conclusion: Compared with ST, CPMs significantly improved CP/CPPS symptoms, with SSTL showing the greatest overall benefit. However, since all included studies originated from China, the generalizability of these findings to other populations may be limited.

Objective: Despite its global adoption and translation, studies reporting age-stratified Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I and II findings remain scarce. This study aimed to 1) compare TMD diagnostic categories, psychosocial/behavioral profiles, and Oral Health-related Quality of Life (OHRQoL) across age groups, 2) explore correlations between psychosocial/behavioral variables and OHRQoL, and 3) identify factors associated with low OHRQoL among Chinese adult TMD patients.

Methods: A total of 798 participants were recruited from a dental hospital and categorized into: young (YA: 18-44), mature patients (MA: 45-64), and old patients (OA: ≥65 years). They were assessed using DC/TMD Axis I procedures and Axis II measures for depression, anxiety, oral behaviors, and jaw function. OHRQoL was evaluated with the Oral Health Impact Profile for TMDs. Statistical analyses were performed using Chi-square/non-parametric tests and logistic regression (α = 0.05).

Results: The final sample included 798 participants (79.6% women), of whom 88.0%, 11.0%, and 1.0% were YA, MA, and OA, respectively. Significant differences in education level (YA > MA/OA), intra-articular TMDs (YA > MA), jaw overuse behaviors (YA > MA/OA), jaw functional limitation (MA > YA), and OHRQoL (MA > YA) were observed. Moderate correlations were noted between OHRQoL and depression, anxiety, and jaw functional limitation (r_s = 0.50-0.61) across all groups, as well as between jaw overuse behavior and both depression and anxiety (r_s = 0.43-0.45) for the MA group.

Conclusion: Mature (MA/OA) TMD patients exhibited reduced oral behaviors but experienced greater jaw function and OHRQoL impairments. TMD pain doubled the likelihood of low OHRQoL.

Clinical relevance: Age-related differences in physical diagnosis, oral behaviors, jaw function, and OHRQoL are evident among TMD patients. Older individuals exhibit fewer oral behaviors but face greater jaw limitations and poorer OHRQoL, highlighting the importance of tailored management across age group.

Purpose: Ultrasound-guided quadratus lumborum plus modified erector spinae plane (QLESP) block and pericapsular nerve group (PENG) plus lateral femoral cutaneous nerve (LFC) block are novel regional analgesia techniques for total hip arthroplasty (THA). This retrospective study aimed to compare the analgesic efficacy and opioid-related outcomes of the QLESP block and the PENG + LFC block following THA.

Methods: This retrospective study included 2180 patients who underwent THA between January 2022 and December 2024. In this study, 272 patients received the QLESP block (QLESP group) and 420 patients accepted the PENG + LFC block (PELF group). Propensity score matching (PSM) was performed to match patients in a 1:1 ratio.

Results: Of 2180 patients identified, 256 pairs between QLESP group and PELF group were successfully matched. In the match cohort, the QLESP group demonstrated significantly lower cumulative sufentanil consumption (QLESP: 13.0 ± 1.3 μg; PELF: 14.6 ± 3.3 μg; p < 0.001) and patient-controlled intravenous analgesia (PCIA) frequency (QLESP: 1 (0-3); PELF: 2 (0-4); P < 0.001) at 6 hours postoperatively compared to the PELF group. Additionally, the QLESP group was associated with a lower incidence of rescue analgesia (QLESP: 9.0%; PELF: 15.2%; P = 0.030) and a shorter postoperative length of stay (QLESP: 10.6 ± 6.0 days; PELF: 11.7 ± 6.2 days; P = 0.038). No significant differences were found in visual analogue scale (VAS) or time to first walk.

Conclusion: This observational study suggested that the QLESP block was associated with a modest reduction in early postoperative sufentanil consumption, PCIA frequency at 6 hours, and postoperative length of stay for total hip arthroplasty, compared to PENG + LFC block. Given the inherent limitations of the retrospective PSM design, the routine incorporation of these blocks into enhanced recovery pathways for total hip arthroplasty in clinical practice warrants further large randomized controlled trials.

Purpose: To explore and compare the clinical efficacy and radiological changes of oblique lateral interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) in patients with severe lumbar spinal stenosis (LSS).

Patients and methods: We retrospectively collected data from 34 patients with severe LSS (Schizas grade C or D) who underwent either OLIF or PLIF at our institution between June 2014 and June 2020. Imaging evaluation included the cross-sectional area (CSA) of the spinal canal and ligamentum flavum on MRI. Clinical evaluation included Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI). Statistical analysis was performed using independent sample t-tests and analysis of variance for repeated measures.

Results: The cross-sectional area of the spinal canal in the OLIF group was gradually expanded from 47.6 ± 16.5 mm² preoperatively to 67.0 ± 17.8 mm² at 3 weeks and further to 97.5 ± 22.3 mm² at 1 year (P < 0.05), while the area of ligamentum flavum was decreased from 119.9 ± 49.7 mm² to 107.0 ± 38.9 mm² and to 87.8 ± 25.3 mm², respectively (P < 0.05). At 3 weeks after the operation, the improvement of VAS score (Low back: 1.3 vs 3.8; Leg: 1.6 vs 3.6) and ODI (12.24 vs 35.21) of low back and leg pain in the PLIF group was better than that in the OLIF group (P < 0.05). There was no significant difference in VAS score and ODI between the two groups 1 year after operation (P > 0.05).

Conclusion: OLIF technology provides significant mid-term (1-year) spinal canal dilatation and clinical improvement in severe LSS, achieving outcomes comparable to PLIF. Therefore, OLIF can be considered a viable and effective surgical option for severe LSS.