Journal of Pain Research最新文献

Background: Flotation-Restricted Environmental Stimulation Therapy (flotation-REST) is a novel nonpharmacologic intervention for chronic pain. Previous reviews have examined the effects of flotation-REST on other outcomes, but a comprehensive review centered on chronic pain has not been conducted.

Objective: To describe the extent, range, and nature of research evaluating flotation-REST for chronic pain and associated comorbidities, including psychological, physiological, and biomarker outcomes.

Eligibility criteria: No restrictions were placed on study design or setting. Studies conducted in animals, not published in English, or assessing outcomes outside the scope of the review were excluded.

Sources of evidence: Ovid MEDLINE, the Cochrane Library, Embase, and PsycINFO were searched from inception to January 2025. Reference lists of relevant studies and reviews were screened.

Charting methods: Two reviewers independently screened titles, abstracts, and full texts. One reviewer extracted data. Variables included study design, population, controls, outcomes, and intervention parameters. Risk of bias for randomized trials was assessed using the Cochrane RoB 2 tool.

Results: Eight studies (6 randomized controlled trials, and 2 single-arm pre/post) comprising 401 participants met inclusion criteria. Studies consistently reported improvements in pain intensity and frequency, fewer pain locations, and greater pain tolerance and detection. Anxiety and depression were substantially reduced in most studies. Sleep quality and latency improved in some studies, though others reported no benefit. Stress consistently declined, and optimism increased. Physiological outcomes were variable. Biomarker analysis demonstrated a post-treatment reduction in 3 methoxy-4-hydroxyphenylethyleneglycol (MHPG), a norepinephrine metabolite, and increased prolactin. Considerable heterogeneity in study designs, intervention protocols, outcome measures, and follow-up duration precluded meta-analysis.

Conclusion: Flotation-REST appears promising for reducing chronic pain and enhancing psychological well-being. Physiological and biomarker effects remain unclear. High-quality randomized trials with standardized interventions and longitudinal follow-up are needed to confirm efficacy, sustainability, and clinical applicability.

Background: Effective management of procedure-related pain, such as venipuncture, is a critical clinical need. The Eutectic Mixture of Local Anesthetics (EMLA) cream is a standard topical analgesic but has limitations including contraindications and potential adverse effects. The Cortex Erythrinae formula recorded in the Golden Mirror of Medicine is traditionally used to dispel wind-dampness, unblock collaterals, and relieve arthralgia.

Objective: This study aimed to develop a novel Traditional Chinese Medicine (TCM) ointment based on classical prescriptions and to evaluate its efficacy against mechanical allodynia, using EMLA cream as a positive control.

Methods: Fifty male Sprague-Dawley rats were randomly allocated to five groups (n=10). Mechanical allodynia was induced; the mechanical withdrawal threshold (MWT), pain-related behaviors, skin irritation, and systemic toxicity were assessed following topical application of low-, medium-, or high-concentration TCM ointment, EMLA cream, or blank vehicle.

Results: High-concentration TCM ointment significantly elevated MWT (P < 0.001 vs EMLA) and reduced paw-licking and writhing responses, without inducing skin irritation or systemic toxicity.

Conclusion: The high-concentration TCM ointment provided rapid (within 20 min), superior, and cost-effective analgesia with an excellent safety profile, suggesting its promise as an alternative to EMLA for managing mechanical allodynia.

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.