Journal of Pain Research最新文献

Chronic nonspecific low back pain (CNSLBP), a debilitating condition associated with abnormal anterior cingulate cortex (ACC) activity and central sensitization, may be addressed through intermittent theta-burst stimulation (iTBS), a non-invasive neuromodulation technique. iTBS is designed to restore the ACC's excitatory/inhibitory balance by suppressing abnormal gamma oscillations and enhancing synaptic plasticity. Clinical evidence shows that iTBS can reduce ACC gamma power, strengthen corticostriatal circuit connectivity, and provide short-term pain relief, although efficacy varies with protocol, pain subtype, and individual differences. In conclusion, iTBS represents a promising approach for managing CNSLBP by modulating neuroplasticity. Future efforts should focus on optimizing stimulation parameters, integrating multimodal data for personalized treatment, and validating long-term benefits through large-scale trials to shift the therapeutic paradigm towards remodeling maladaptive neural pathways.

Objective: Postherpetic neuralgia (PHN) is considered as the most common complication of herpes zoster, and its incidence is increasing. The aim of this study was to explore the risk factors of postherpetic neuralgia (PHN) (ICD-10: B02.29) and to construct a predictive line graph model for early identification and prevention of PHN.

Methods: In this study, we focused on a cohort of 650 patients who had been diagnosed with herpes zoster (HZ)(ICD-10: B02) and subsequently admitted to Wuhan Fourth Hospital over a span of seven years, specifically from January 2018 to June 2025. The study cohort was randomly divided into a training set (n=458) and a validation set (n=192), with an average age of 57.31±12.64 years in both groups. The Nomogram model, designed to predict the elevated risk of PHN in individuals with HZ was constructed through the R4.2.1 software "rms" package. The nomogram model's predictive performance was evaluated using the decision curve, while the calibration curve was utilized for internal validation. The model was also externally validated using a validation set of data.

Results: The logistic regression analysis revealed that independent risk factors for PHN included age, the course of HZ, herpes in specific areas, VAS score, severity of skin damage, and temperature rising >1°C. The proposed Nomogram model, developed with the previously mentioned indicators, exhibits ROC curve area values of 0.943 for the training set and 0.900 for the validation set. The correction curve suggests that the model maintains high accuracy. Furthermore, the DCA outcomes reveal that the model possesses enhanced clinical utility at risk thresholds ranging from 0 to 0.99 for the training data and from 0.04 to 0.89 for the validation data.

Conclusion: Our study confirms that age, the course of herpes zoster, herpes in special sites, VAS score, the severity of skin lesions, and a temperature increase of >1°C are independent risk factors for the occurrence of Postherpetic neuralgia (PHN). The nomogram model established based on these six indicators demonstrates good developmental potential and exhibits high discriminative predictive performance for Postherpetic neuralgia (PHN)in patients with herpes zoster.

Background: Acupuncture has pain-relief effects, but no data are available on transcutaneous electrical acupoint stimulation (TEAS) for pain relief during transurethral removal of ureteral stents. This study aimed to evaluate the efficacy of TEAS in reducing pain during cystoscopic ureteral stent extraction.

Methods: This prospective, double-blinded, randomized controlled trial enrolled 122 patients scheduled for cystoscopic ureteral stent removal between June 2023 and March 2024. Participants were randomized into three groups: TEAS at Hegu (LI4) and Neiguan (PC6) (Group A, n=37), TEAS at Sanyinjiao (SP6) and Zusanli (ST36) (Group B, n=38), and sham TEAS (Group C, n=47). TEAS or sham TEAS were administered 30 minutes before the procedure. The primary endpoint was pain measured by visual analog scale (VAS) at stent removal (T2). Secondary endpoints included VAS at cystoscope insertion (T1) and 10 minutes post-procedure (T3), along with hemodynamic parameters.

Results: Baseline characteristics were comparable (p > 0.05). Both TEAS groups showed significantly lower VAS scores during stent removal (T2: median 0.00 [IQR: 0.00-2.50] for Group A and median 0.00 [IQR0.00-2.50] for group B vs 0.00 [IQR: 2.00-5.00] for Group C; p = 0.027) and at 10 minutes post-procedure (T3: median 0.00 [IQR: 0.00-0.00] for Group A and median 0.00 [IQR0.00-1.00] for group B vs 0.00 [IQR: 0.00-2.00] for Group C; p = 0.012). Repeated measures ANOVA with gender and age group as covariates revealed a significant Time × Gender interaction (F = 7.044, p = 0.006), indicating different temporal patterns of pain reduction between males and females. However, no significant interaction was found involving the Age Group factor or the three-way interaction with the treatment groups. No significant hemodynamic differences were observed. One patient in Group C withdrew due to severe pain.

Conclusion: TEAS effectively reduces procedural and post-procedural pain during cystoscopic ureteral stent extraction without affecting hemodynamic stability. Notably, the analgesic effect of TEAS demonstrated gender-specific temporal patterns (Time × Gender interaction, p = 0.006), being more pronounced in female patients, while remaining consistently effective across all age groups. These findings support TEAS as a valuable non-pharmacological analgesic adjunct in outpatient urological procedures, though further multicenter and heterogeneous population studies are warranted to validate its generalizability.

Background: Pain in Parkinson's disease (PD) is common and arises from both central and peripheral mechanisms, manifesting as distinct subtypes. While physical exercise is considered one of the nonpharmacological treatments for managing pain in PD, it remains unknown how the effects of exercise differ depending on the type of pain.

Objective: To explore the differential effects of cycling exercise on various pain subtypes in patients with early PD.

Methods: In the randomized controlled pilot trial, 22 participants with early PD were initially assigned to the cycling exercise group and 11 to the control group. This exploratory subgroup analysis included 25 patients after applying the inclusion/exclusion criteria, comprising 16 cycling exercise participants and 9 controls. The exercise intervention consisted of 40-60 minutes of cycling, three sessions weekly, for 24 weeks. Pain subtypes were assessed using the King's PD Pain Scale. Changes in pain severity and newly developed pain were analyzed descriptively.

Results: After 24 weeks, a greater proportion of participants in the cycling group showed improvement in fluctuation-related, nocturnal, and orofacial pain compared with controls. However, musculoskeletal pain newly developed in 40% of cycling participants, compared to 20% in the control group. For other pain subtypes, both groups showed similar patterns in pain severity changes and newly developed pain.

Conclusion: Cycling exercise may alleviate fluctuation-related, nocturnal, and orofacial pain in PD but may also increase the risk of musculoskeletal pain in some cases. These observations warrant further large-scale investigations.

Purpose: This study systematically evaluated the effects of isokinetic muscle strength training (IMST) on pain, function, and muscle performance in patients with knee osteoarthritis (KOA).

Patients and methods: Randomized controlled trials comparing IMST with other interventions for KOA were searched across multiple international and Chinese databases up to January 2025. Two investigators independently screened literature, extracted data, and assessed risk of bias according to the Cochrane Handbook Version 6.1.0. The RevMan 5.4 software was used to perform the meta-analysis. Overall quality of evidence was rated using GRADE approach.

Results: Nineteen RCTs involving 1386 patients were finally included. Three of which had high risk bias. Compared with other treatments, IMST showed a borderline improvement in Lysholm score (MD = 1.21, 95% CI: [-0.62, 3.04], I ²= 95%, very low certainty), and tended to enhance extensor peak torque (MD = 4.12, 95% CI: [-0.17, 8.41], I ²= 74%, very low certainty) while significantly increasing flexor peak torque (MD = 7.94, 95% CI: [4.23, 11.66], I ²= 71%, low certainty). Besides, IMST also significantly reduced VAS scores (MD = -0.64, 95% CI: [-1.19, -0.10], I ²= 95%, Moderate certainty) and showed a trend toward lower (MD = -6.96, 95% CI: [-15.85, 1.92], I ²= 98%, Moderate certainty), indicating overall improvements in knee function, pain, and stiffness.

Conclusion: IMST appears to improve pain and function in patients with KOA, but the overall certainty of evidence is limited. Further high-quality RCTs are needed to confirm these benefits and guide clinical practice.

Objective: This study compared unilateral percutaneous curved kyphoplasty (PCK) and bilateral percutaneous kyphoplasty (PKP) for treating single-level osteoporotic vertebral compression fractures (OVCFs).

Methods: A retrospective analysis was conducted on patients with single-level OVCF treated with either unilateral PCK or bilateral PKP between September 2023 and December 2024. Clinical and radiographic evaluations were performed preoperatively and postoperatively at 1 day, 1, 3, 6 months, and at the latest available follow-up. The final data analysis was conducted in July 2025. Given the study period, the latest follow-up time varied among patients, ranging from 6 to 12 months. The median follow-up time for the entire cohort was 12 months. Parameters assessed included operative time, blood loss, fluoroscopy frequency, cement volume, cement leakage, visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), vertebral height restoration, Cobb angle correction, and complication rates.

Results: The PCK group showed superior intraoperative outcomes, including shorter operative time (37.44 ± 6.52 min vs 44.56 ± 7.74 min), reduced blood loss (8.78 ± 2.91 mL vs 12.81 ± 2.51 mL), fewer fluoroscopic exposures (15.37 ± 2.09 vs 21.79 ± 2.46), and lower cement volume (4.62 ± 0.60 mL vs 5.14 ± 0.69 mL). Cement leakage was significantly less frequent with PCK (4.9% vs 18.8%). Both techniques achieved equivalent long-term clinical results, with no significant differences in VAS scores, ODI scores, vertebral height maintenance, Cobb angle correction, or refracture rates at final follow-up. No major complications occurred in either group.

Conclusion: In this retrospective cohort, with a median follow-up of 12 months, unilateral PCK achieved clinical outcomes comparable to those of bilateral PKP. Furthermore, PCK was associated with superior intraoperative efficiency and reduced radiation exposure. These results suggest that PCK may be a viable and advantageous surgical alternative; however, these findings warrant validation in future randomised controlled trials.

Objective: To compare the effectiveness of ultrasound (US) guidance alone versus combined nerve stimulation (NS) and US in subcostal quadratus lumborum block (SQLB) for patients undergoing laparoscopic nephrectomy.

Methods: Eighty-four patients scheduled for laparoscopic nephrectomy were randomized to receive a SQLB with either US alone (US group) or combined US and NS guidance (US-NS group). Each patient received 25 mL of 0.5% ropivacaine for the block. The primary endpoint was the block success rate within 5 minutes after block. Secondary endpoints included the extent of sensory block, intravenous morphine equivalent consumption, NRS scores, frequency of rescue analgesia administration, puncture time, number of needle insertion attempts, ultrasonic images quality, and incidence of adverse reactions and complications.

Results: The US-NS group demonstrated significantly higher block success rate compared to the US group (92.5% vs 62.5%, P < 0.05). Additionally, the US-NS group exhibited lower opioid requirements and fewer rescue analgesia interventions within the initial 24-hour postoperative period, broader sensory block coverage at 5, 10, and 15 minutes following injection, and lower NRS scores both at rest and during coughing at 6, 12, 24, and 48 hours post-surgery. However, the US-NS group required a longer puncture duration and more attempts to complete the SQLB. No significant differences were found between the two groups regarding the quality of ultrasound images and the incidence of adverse effects.

Conclusion: Dual guidance with NS and US was superior to US alone for performing SQLB, resulting in higher block success rates and improved analgesic efficacy for laparoscopic nephrectomy.

Erector Spinae Plane Block (ESPB) is a fascial plane-based regional analgesia technique that involves injecting local anesthetics between the deep aspect of the erector spinae muscle and the transverse processes of the vertebrae. This blocks the dorsal rami of spinal nerves, thereby achieving multi-segmental analgesia. With the widespread adoption of ultrasound guidance, ESPB has gained extensive application in acute and chronic pain management due to its relative simplicity and high safety profile. However, its systematic evaluation and value positioning in chronic pain management remain to be clarified. This article aims to provide a comprehensive overview of ESPB, spanning from its anatomical basis to clinical innovations. It focuses on reviewing its mechanisms of action, clinical efficacy, technical advantages, and limitations in managing chronic pain (including cancer-related pain and neuropathic pain). Future research directions are also discussed to inform clinical practice and related studies.

Purpose: Sacroiliac joint (SIJ) pain is a widely recognized source of chronic low back pain. The safety and effectiveness of SIJ fusion is supported by multiple systematic reviews. Most evidence involves lateral transiliac placement of metallic implants. We report two-year outcomes from lateral SIJ fusion using a 3D-printed porous threaded fusion implant (PTI, iFuse TORQ, SI-BONE).

Patients and methods: A retrospective chart review was undertaken at two centers. Medical records of patients who underwent lateral SIJ fusion between January 2022 and May 2023 with at least two years of follow up were reviewed. Data collection included demographics, complications, and postoperative outcomes. The study protocol was reviewed by WCG IRB and was granted exemption authorization.

Results: 49 patients underwent surgery and had two-year outcomes. Mean age was 63.8 and 71% were women. There were no device- or procedure-related adverse events. Pain scores averaged 8.7 at baseline and 2.8 at follow-up (change of 5.8 points, p<0.0001). Pain score improvements were similar across surgeons and were independent of a history of prior lumbar fusion.

Conclusion: In our case series, lateral SIJ fusion with a titanium 3D printed threaded implant was safe and effective at 2 years of follow-up. No implant breakage or migration was observed. Outcomes were consistent with existing studies.

Purpose: Lower back and radiating leg pain are common worldwide. Most cases are treated with invasive treatments, including injection therapy and nerve blocks; however, their efficacy remains unclear. In the present study, we describe a study protocol for comparing the effectiveness, cost-effectiveness, and safety of non-pharmacological treatment strategies with those of active pharmacological treatment strategies for non-acute lumbar disc herniation (LDH).

Patients and methods: The primary outcomes of this study are the Oswestry Disability Index and Numerical Rating Scale scores at 13 weeks from baseline. This two-arm, parallel, multicenter, pragmatic, randomized trial will be conducted in four hospitals in South Korea. Two hundred patients with LDH symptoms confirmed via magnetic resonance imaging will be randomly assigned to either a non-pharmacological or pharmacological treatment group. The non-pharmacological group will receive acupuncture and spinal manipulation therapy, whereas the pharmacological group will receive active pharmacological interventions for 8 weeks with a follow-up period of 3 years. Secondary outcomes include the European Quality of Life 5 Dimensions 5 Level Version, Short Form-12 Health Survey Version 2, and Patient Global Impression of Change. A cost survey will be conducted for economic evaluation. The primary analysis will involve the intention-to-treat approach, and differences between the two groups will be analyzed using a linear mixed model. This is the first well-designed, large-scale clinical trial comparing non-pharmacological and pharmacological strategies in patients with non-acute LDH. The findings of this study may provide high-quality evidence on the effectiveness, cost-effectiveness, and safety of non-pharmacological strategies centered on manual therapy.

Ethics and dissemination: All participants will provide written informed consent. The study protocol, case report form, informed consent form, and all other study-related documents are approved by the IRB of Jaseng Hospital of Korean Medicine. Approval numbers: JASENG 2023-05-001 (Jaseng hospital of Korean Medicine), 2023-05-002 (Daejeon Jaseng hospital of Korean Medicine), 2023-05-003 (Haeundae Jaseng Hospital of Korean Medicine), 2023-05-004 (Bucheon Jaseng hospital of Korean Medicine).

Registration details: The protocol has been registered on ClinicalTrials.gov (number: NCT06024460; July 20, 2023).