Journal of Pain Research最新文献

Objective: To compare the efficacy and safety of ultrasound-guided transverse abdominis plane block (TAPB) with ropivacaine combined with hydromorphone versus ropivacaine alone for postoperative analgesia in parturients undergoing cesarean section.

Methods: A randomized controlled trial was conducted with 90 eligible parturients scheduled for elective cesarean section. They were randomly assigned to the experimental group (Group R+H, n=45) receiving TAPB with 0.25% ropivacaine plus 0.2 mg hydromorphone (20 mL per side), and the control group (Group R, n=45) receiving TAPB with 0.25% ropivacaine. The primary outcome was the time to first rescue analgesia. Secondary outcomes included serum prolactin (PRL) levels, pain intensity, patient-controlled analgesia (PCA) usage, postoperative recovery indicators, adverse reactions, and patient satisfaction.

Results: The time to first PCA use was significantly longer in Group R+H than in Group R (7.32±4.80 h vs. 3.49±1.74 h, p<0.001). Group R+H showed lower PCA consumption at 4, 12, 24, and 48 hours post-TAPB (all p<0.05). Numerical rating scale (NRS) scores at rest and during movement were significantly lower in Group R+H at 4 and 12 hours post-TAPB (all p<0.05), but no significant differences were observed at 24 and 48 hours. There were no significant differences in serum PRL levels, postoperative recovery indicators (time to first ambulation, flatus, and spontaneous urination), or the incidence of adverse reactions between the two groups (all p>0.05). Patient satisfaction with analgesia was significantly higher in Group R+H (9 (9, 10) vs. 8 (8, 9), p=0.004).

Conclusion: Ultrasound-guided TAPB with ropivacaine combined with hydromorphone provides superior early postoperative analgesia, reduces rescue analgesic requirements, and improves patient satisfaction in parturients undergoing cesarean section. It does not affect perioperative PRL levels or postoperative recovery, nor does it increase adverse events, making it a safe and effective analgesic strategy.

Purpose: This study conducted a randomized controlled trial by analyzing resting-state functional magnetic resonance imaging (rs-fMRI) data to determine the mechanisms by which Tuina alleviates pain and modulates multiple brain networks in lumbar disc herniation (LDH) patients.

Patients and methods: This study included 38 healthy subjects and 76 LDH patients. LDH patients were randomly assigned into the test group (TG; n = 38) and control group (CG; n = 38). TG patients received 14 days of Tuina therapy, whereas CG patients received a combination of transcutaneous electrical nerve stimulation (TENS) and lumbar traction therapy. The primary outcome measure, simplified McGill Pain Questionnaire (SF-MPQ), was used to assess pain. Pain pressure threshold (PPT), Oswestry Disability Index (ODI), Beck Depression Inventory II (BDI-II), and Beck Anxiety Inventory (BAI) were evaluated as secondary outcomes. Fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) values were evaluated from the rs-fMRI data before and after treatment.

Results: The SF-MPQ score significantly decreased in both TG subjects [-13.00 (-19.00, -9.00); P <0.001] and CG subjects [-11.00 (-14.00, -7.00); P <0.001]. SF-MPQ scores were significantly different between the two groups (P <0.05). In TG subjects, Tuina inhibited spontaneous neural activity in the bilateral inferior frontal gyrus triangular part (IFGtri) and suppressed the interaction between IFGtri and other brain regions. Changes in FC between IFGtri.R and STG.pole.R positively correlated with improvements in SF-MPQ scores (r = 0.511, P = 0.005). Changes in FC between IFGtri.L and IFGtri.R negatively correlated with reduced PPT of the bilateral gluteus maximus (r = -0.518, P = 0.004).

Conclusion: Tuina effectively alleviates pain, lumbar dysfunction, and negative emotions in LDH patients by regulating the interactions between multiple neural networks in the brain, especially through the inferior frontal gyrus triangle area.

Introduction: Interlaminar epidural steroid injections (ESIs) are widely used for chronic spinal pain caused by disc herniation and degenerative stenosis. The interlaminar approach allows for broad medication distribution across multiple nerve roots. However, technical variations, including loss-of-resistance (LOR) technique and injection site selection, may influence efficacy and complication rates. This study examines practice patterns among interventional pain physicians, assessing technique variations and their clinical impact while exploring opportunities for standardization.

Methods: A questionnaire was distributed to interventional pain physicians from a range of specialties and practice settings who perform ESIs. Practice parameters of lumbar ESIs were surveyed including loss-of-resistance (LOR) technique, methods of accessing the epidural space via the interlaminar approach, and contrast spread patterns when using the midline approach.

Results: Among 92 respondents, 53.3% use LOR to saline, while 42.4% use LOR to air. When accessing the epidural space, 80.4% prefer an ipsilateral approach to the side of pain or pathology. Use of a paramedian approach showed wide variation, with 24.2% reporting "always", 33.0% "most of the time", 30.8% "sometimes", and 12.1% "rarely". For midline approaches, only 4.4% of physicians reported always achieving bilateral contrast spread. The majority noted achieving it "most of the time" (54.4%) or "sometimes" (36.7%). A minority indicated they rarely (2.2%) or never (2.2%) achieve bilateral spread when performing midline ILESIs.

Conclusion: Despite widespread use, significant variability exists in ESI technique. While consensus guidelines offer safety recommendations, standardization remains limited. Identifying common practices can help refine techniques and improve patient outcomes.

Painful trigeminal neuropathy (PTN) is a very disabling but often unrecognized facial pain from various etiologies. Patients with PTN suffer from persistent, intense facial pain with significantly impaired sensory function in the trigeminal territories. This article reviews the anatomy and pathophysiology of PTN, as well as its clinical presentation and management. The peripheral inflammatory cascades, including immune cell activation, inflammatory mediator-induced nociceptor activation, and sensory hyperexcitability in the trigeminal nerve, are discussed, as are the central sensitization processes, including postsynaptic NMDA receptor activation, glial cell-mediated inflammation, and reduced inhibitory pathways in the central nervous system. A comprehensive literature review that covers multiple specialties and discusses various treatment options based on the available evidence is presented. Collectively, a practical algorithm is proposed to improve current PTN management. It provides novel guidance for managing PTN in an evidence-based, integrative, and mechanism-specific approach. In conclusion, a multidisciplinary team approach targeting both peripheral and central sensitization would be an ideal strategy for delivering optimal, mechanism-specific management in painful trigeminal neuropathy.

Background and objective: Population aging is a major driver of the ergonomic low back pain(LBP) burden, but its impact may vary across regions with different development levels. This study aimed to quantify and compare these differences.

Methods: Using data from the Global Burden of Disease Study 2021 (GBD 2021), we conducted a decomposition analysis to assess the independent contributions and attributable fractions of population aging and epidemiological rate changes to the disability-adjusted life years(DALYs) of ergonomic LBP from 1990 to 2021. Differences were compared across Socio-demographic Index(SDI) regions and by sex.

Results: From 1990 to 2021, population aging contributed to an increase of 958,564.25 DALYs globally (attributable fraction: 24.74%). The highest attributable fraction was observed in high-middle SDI regions (127.9%). Globally, reductions in DALY rates fully offset the effects of aging (R < -1), with the largest relative impact seen in low-SDI regions (R = 14.64). The contribution of aging was higher in men (29.36%) than in women (21.70%) across all regions.

Conclusion: The impact of aging on the burden of ergonomic LBP is not uniform and follows a non-linear pattern across SDI levels. Public health efforts can mitigate this burden. Targeted strategies focusing on high-middle SDI regions and male workers are needed to support healthy aging and reduce disparities in global occupational health protection.

Background: Suprascapular nerve entrapment is a medical condition characterized by clinical symptoms such as neck and shoulder pain, discomfort, upper limb weakness, and heaviness. These symptoms are caused by the compression of the suprascapular nerve at the suprascapular notch. The treatment of this nerve entrapment has been a long-standing challenge. Intelligent-assisted radiofrequency neurolysis is a novel and promising non-pharmacological treatment. Herein, we presented the therapeutic efficacy of this technique in 40 patients.

Objective: This study was designed to evaluate the feasibility of three-dimensional (3D) CT imaging integrated with intraoperative intelligence-assisted calibration for radiofrequency ablation of the suprascapular nerve.

Methods: A total of 40 patients were enrolled. The control group received the conventional surgery, while the treatment group was given 3D CT imaging plus the intraoperative intelligence-assisted calibration. Intelligence-assisted refers to the use of a smartphone app based on gravity calibration to realize the precise measurement and correction of the puncture needle angle during the operation, combined with 3D CT imaging to achieve the accurate positioning of the suprascapular nerve entrapment site. Data was analyzed on the two groups, including the time taken from starting positioning to successful puncture, Visual Analogue Scale (VAS) scores and ROWE scores before and after treatment, the therapeutic effect, complications, and number of cases with abnormal electromyography (EMG) items before and after treatment.

Results: Time of puncture completion in the treatment group was significantly shorter than that in the control group (8.06 vs 15.98 min, p < 0.05). Postoperative therapeutic effect in the treatment group was also superior to that in the control group. The treatment group had significant differences between pre- and post-treatment VAS scores and had superior ROWE scores compared to the control group.

Conclusion: The application of 3D CT imaging combined with intraoperative intelligence-assisted calibration for suprascapular nerve radiofrequency ablation can effectively shorten the operation time, improve the procedural efficiency and therapeutic effect and significantly reduce patients' clinical symptoms.

Acupoint sensitization is a key manifestation of disease response and plays a critical role in determining the effectiveness of acupuncture treatment. Chronic atrophic gastritis, characterized by persistent and pronounced acupoint sensitization, serves as an ideal model for studying this phenomenon. We aim to link local molecular alterations at sensitized acupoints with the pain-sensitization phenotype, thereby elucidating the comprehensive molecular mechanisms underlying acupoint sensitization and ultimately providing mechanistic guidance for how acupuncture exerts therapeutic effects in the clinical treatment of CAG. This study will recruit and sampling 30 patients with chronic atrophic gastritis who are aged between 40 and 65 years and whose CV12 and non-acupoint pain threshold are greater than 10N, aiming to explore the local metabolomics and proteomics changes in the acupoint in these patients. The non-acupoint located in the lateral abdomen, corresponding to the same spinal segment as the CV12 acupoint, will serve as the control group. We expect to find that, compared with the non-acupoint group, the content of pain-related metabolites and proteins in the tissue fluid of the CV12 acupoint will increase. These changes are anticipated to be correlated with the pain sensitization phenotype. The study will comply with the Declaration of Helsinki and has been approved by the Ethics Committee of Beijing University of Chinese Medicine (No. 2024BZYLL1006). All participants will undergo standardized training on the study protocol, and informed consent will be obtained from all patients.Trial registration: ITMCTR2025000156; International Traditional Medicine Clinical Trial Registry (https://itmctr.ccebtcm.org.cn/mgt/project/user/user-project-view/C96AC314-9A6A-44A4-ABD1-B602A84F5792).

Purpose: Lumbar fusion surgery is commonly associated with severe postoperative pain and high opioid requirements. The erector spinae plane block (ESPB) has demonstrated promising analgesic effects in spine procedures; however, its efficacy specifically in lumbar fusion surgery remains uncertain, given the heterogeneity of the existing evidence. This systematic review and meta-analysis aimed to evaluate the impact of ESPB on perioperative opioid consumption, postoperative pain, and related outcomes in patients undergoing lumbar fusion surgery.

Patients and methods: Following the PRISMA 2020 statement, PubMed, Embase, and the Cochrane Library were searched from inception to August 2025 for randomized controlled trials (RCTs) comparing ESPB with placebo, sham, or no-block controls in adult patients undergoing lumbar fusion. The primary outcomes were intraoperative and 24-hour postoperative opioid consumption, expressed as intravenous morphine milligram equivalents (MME). Secondary outcomes included postoperative pain scores and the incidence of postoperative nausea and vomiting (PONV). Study quality was assessed using the Cochrane Risk of Bias 2.0 tool, and certainty of evidence was graded using GRADE criteria.

Results: Fifteen RCTs involving 1035 patients were included. ESPB significantly reduced intraoperative opioid use (MD -31.70 mg; 95% CI -41.69 to -21.71) and 24-hour postoperative opioid consumption (MD -11.02 mg; 95% CI -14.42 to -7.63), as well as resting pain scores (MD -0.49; 95% CI -0.77 to -0.22). ESPB was also associated with a lower risk of PONV (RR 0.71; 95% CI 0.53-0.94). Considerable heterogeneity (I² >80%) was observed, largely attributable to variations in study design, comparator rigor, and blinding quality.

Conclusion: Low- to moderate-certainty evidence suggests that ESPB probably reduces perioperative opioid consumption, early postoperative pain, and opioid-related adverse events such as PONV following lumbar fusion surgery. Although substantial heterogeneity and variability in methodological quality warrant cautious interpretation, the consistent direction and clinical relevance of observed effects support ESPB as a promising adjunct within multimodal analgesia pathways. Further well-designed, blinded RCTs with standardized protocols and extended follow-up are needed to confirm long-term effectiveness and refine clinical implementation.