Journal of Pain Research最新文献

Background: Pharmacological treatment of chronic pain in older adults presents a therapeutic challenge. The severity of symptoms contrasts with the risk-benefit ratio of available drugs, especially in the presence of comorbidities and polypharmacy. This underlines the need to evaluate alternative therapies such as cannabis-based medicines (CBM).

Objective: To assess the safety, tolerability and effectiveness of cannabidiol (CBD)-dominant full-spectrum extracts (CBD > tetrahydrocannabinol [THC]) versus pure THC/dronabinol (THC/DRO) in patients aged ≥65 years with chronic or refractory pain.

Methods: Retrospective, longitudinal, exploratory analysis of anonymized data from the German Pain e-Registry. Two propensity-score-matched cohorts of 484 patients each were evaluated over ≥24 weeks. The primary composite endpoint required no discontinuation due to an adverse drug reaction (ADR) AND a clinically relevant improvement (≥20 mm VAS or ≥50% from baseline) in average 24-h pain intensity (PIX), pain-related disability (mPDI), or nighttime sleep (mPDI subitem #6). Secondary analyses covered pain intensities, daily-life functioning, quality of life, well-being and affective distress. Safety analyses included ADR frequency, spectrum, and concomitant analgesic use.

Results: Both treatments were associated with symptom relief. Greater improvements were observed with CBD > THC across all domains (all p < 0.001). ADRs were less frequent with CBD > THC (104 vs 342 events), with fewer patients affected (15.5% vs 35.7%) and lower discontinuation rates (5.6% vs 19.2%; all p < 0.001). The composite endpoint was achieved by 85.7% (CBD > THC) vs 21.9% (THC/DRO; p < 0.001; OR 21.5; RR 3.9; effect size 0.640; NNT 2).

Conclusion: In this real-world cohort of older adults with chronic pain, CBD-dominant extracts were associated with more favorable multidimensional outcomes and better tolerability than THC/DRO. Findings are exploratory and warrant confirmation in randomized controlled trials.

Trial registration: HMA-EMA Catalogues of Real-World Data Sources and Studies. http://www. https://encepp.europa.eu/index_en, EU PAS number EUPAS1000000490.

Purpose: The transversus abdominis plane (TAP) block provides analgesia for laparoscopic colorectal cancer surgery. To extend block duration and provide adequate analgesia, adjuvants such as dexamethasone and hydromorphone have been used. This study hypothesized that hydromorphone is an effective adjuvant for local anesthetics, and it is noninferior to dexamethasone for the TAP block duration.

Patients and methods: Eighty-one subjects undergoing laparoscopic colorectal cancer surgery were randomized to Group C (given TAP- block with 40 mL of 0.25% ropivacaine and saline), Group H (given TAP- block with 40 mL of 0.25% ropivacaine, 0.05mg/mL hydromorphone and saline), or Group D (given TAP- block with 40 mL of 0.25% ropivacaine, 0.25mg/mL dexamethasone and saline). The primary outcome was the first request time for patient-controlled intravenous analgesia (PCIA). Additional outcomes included visual analog scale (VAS) scores, total opioid use, side effects including nausea, vomiting, pruritus, and respiratory depression.

Results: Eighty subjects completed the study. Compared with Group C (428.6 ± 175.3 min), both Group D (546.1 ± 190.5 min; P = 0.032) and Group H (620.2 ± 185.3 min; P = 0.001) showed significantly prolonged first request time for PCIA. Moreover, the difference between the mean first request time for PCIA in Group H and Group D was 74.0 (95% confidence interval [CI], -37.7 to 185.7, P = 0.020 for noninferiority). The VAS score on coughing in Group D showed a significant decrease compared with Group C at 12 h post-operatively (P = 0.006). No significant differences were observed in other outcomes.

Conclusion: The addition of hydromorphone to ropivacaine in TAP block provided noninferior analgesia duration compared to dexamethasone for laparoscopic colorectal cancer surgery.

Purpose: This meta-analysis systematically compares the clinical efficacy and safety of ultrasound-guided versus non-ultrasound-guided (ie, x-ray fluoroscopy, CT imaging, or anatomical landmark-guided) nerve blocks for cervical spondylotic radiculopathy (CSR).

Patients and methods: Randomized controlled trials (RCTs) comparing ultrasound-guided with conventionally guided nerve blocks for CSR were searched in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and Wanfang databases from inception to July 1, 2025. Literature screening, data extraction, and risk of bias assessment were performed independently by two reviewers using the Cochrane tool. Meta-analysis was conducted with RevMan 5.4 and Stata 19.0. Primary outcomes included overall response rate and Visual Analog Scale (VAS) scores; secondary outcomes comprised first-attempt success rate, Neck Disability Index (NDI), 36-Item Short Form Health Survey (SF-36), and complication incidence.

Results: Thirteen RCTs involving 1072 patients were included. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) evidence quality was moderate for overall response rate and low for other outcomes. Compared with conventional guidance, ultrasound-guided nerve blocks resulted in a significantly higher overall response rate (risk ratio (RR) = 1.10, 95% confidence interval (CI): 1.01-1.20, p = 0.030), greater reduction in VAS (MD = -0.72, 95% CI: -1.15 to -0.29, p < 0.001), improved NDI (mean difference (MD) = -1.03, 95% CI: -1.95 to -0.11, p = 0.030), and higher first-attempt success rate (RR = 1.25, 95% CI: 1.12-1.39, p < 0.001). Complication rates were lower but not statistically significant (RR = 0.53, 95% CI: 0.19-1.47, p = 0.230).

Conclusion: This meta-analysis demonstrates that ultrasound-guided nerve blockade is an efficacious and safe intervention for cervical spondylotic radiculopathy, offering advantages over conventional techniques. However, the current evidence is limited by the number and methodological quality of included studies. Future high-quality trials should adopt a multimodal assessment strategy, integrating objective physiological measures with patient-reported outcomes, to strengthen the evidence base and guide personalized management.

Background: Lumbar disc herniation (LDH) poses a significant global health burden, with lifetime prevalence rates reaching 40%. While acupuncture is widely used for LDH, the heterogeneity in acupoint selection hinders the standardization of treatment protocols. This study aimed to systematically screen clinical literature and utilize data mining techniques to identify core acupoint combinations and therapeutic strategies for LDH.

Methods: A comprehensive systematic search was conducted across seven electronic databases (PubMed, The Cochrane Library, Web of Science, SinoMed, CNKI, Wanfang, and VIP) from inception to January 2025. Descriptive statistics were analyzed using Microsoft Excel 2023. Association rule mining was performed via R Studio (v4.3.0, arules package) using the Apriori algorithm (support ≥ 0.07, confidence ≥ 0.6). Hierarchical cluster analysis was conducted in SPSS Statistics (v26.0) employing Ward's linkage method with squared Euclidean distance to group high-frequency acupoints. Additionally, neural distribution analysis was performed to map acupoint-nerve relationships.

Results: A total of 537 studies were included, comprising 766 distinct acupuncture prescriptions and 149 unique acupoints. Frequency analysis showed that 13 core acupoints accounted for 74.65% of total usage, with Weizhong (BL40, 9.68%), Huantiao (GB30, 8.47%), and Dachangshu (BL25, 8.30%) being most frequently utilized. The Bladder meridian was the most frequently used channel (57.68%). Association rule analysis yielded 449 core rules, identifying the Weizhong (BL40)-Dachangshu (BL25) pair as the strongest combination (support: 42.43%). Cluster analysis delineated six distinct therapeutic strategies, with the core Bladder meridian cluster demonstrating the highest clinical significance. Neural distribution analysis indicated predominant involvement of lumbar nerves (25.72%) and the sciatic nerve complex (22.55%).

Conclusion: This study presents a comprehensive data mining analysis of acupuncture for LDH. Although constrained by the heterogeneity of included studies and data limitations, the revealed core combinations provide valid quantitative evidence to support the standardization of treatment protocols and inform clinical decision-making.

Background: Low back pain (LBP) is a leading cause of disability worldwide. Although body mass index (BMI) is a well-established risk factor for LBP, a substantial proportion of patients with LBP do not present with abnormal BMI, suggesting the involvement of BMI-independent mechanisms. However, the genetic architecture underlying BMI-independent LBP remains poorly understood. This study aimed to identify and characterize genetic variants associated with LBP that are independent of BMI.

Methods: This study was a secondary analysis of publicly available genome-wide association study (GWAS) summary statistics. Genetic associations were analyzed using a Genomic Structural Equation Modeling (Genomic SEM) framework. BMI summary statistics were obtained from the Genetic Investigation of ANthropometric Traits (GIANT) consortium (~700,000 individuals of European ancestry), and LBP data were derived from the FinnGen cohort, including 60,099 cases and 440,249 controls of European ancestry, with LBP defined by the International Classification of Diseases, 10th Revision (ICD-10) code M54. Genome-wide association study by subtraction (GWAS-by-subtraction) was applied to identify BMI-independent LBP associations. Statistical fine-mapping, transcriptome-wide association studies (TWAS), proteome-wide association studies (PWAS), and colocalization analyses were subsequently performed to prioritize putative causal genes.

Results: Three independent genome-wide significant loci associated with BMI-independent LBP were identified: rs6916321 at B7NZA1 (P = 2.41 × 10^-10), rs2596501 near HLA-B (P = 6.56 × 10⁻⁹), and a novel locus rs4148946 at SEC24C (P = 1.74 × 10⁻⁸). Fine-mapping highlighted rs2596501 as a likely causal variant with a posterior inclusion probability of 0.9999. Multi-omic integration consistently prioritized CHST3 as a candidate gene (P = 4.49 × 10⁻⁵ in PWAS). Pathway enrichment analyses implicated neuronal signaling and immune-related pathways, with cell-type enrichment observed in differentiated neurons (P = 0.0063). These findings were derived from large population-based cohorts of European ancestry.

Conclusion: This study refines the genetic architecture of BMI-independent LBP and identifies novel loci with convergent multi-omic evidence implicating CHST3 in disease susceptibility. The results highlight biological mechanisms beyond adiposity that may contribute to LBP risk and provide a foundation for future functional and translational research.

Objective: Remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) are growing digital health applications. The use of RPM, focusing on objective physiologic data, has been supported by evidence for managing chronic conditions. RTM, which collects subjective patient-reported data, is newer, but offers great potential in musculoskeletal (MSK) rehabilitation and chronic pain management that has already been recognized clinically and by reimbursement frameworks. However, in comparison with RPM, there is limited evidence directly assessing whether RTM contributes to improved clinical outcomes. This review compares the quality of current evidence for improved clinical outcomes from RTM in MSK and pain-related conditions with RPM in chronic disease management.

Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted through March 2025 using keywords related to remote monitoring, digital health, and MSK conditions. Only reviews and meta-analyses were included for RPM, while both primary and review studies were considered for RTM, restricted to MSK or pain-related outcomes. Three reviewers independently screened and read all articles to reduce risk of bias.

Results: 22 studies met inclusion criteria (9 RPM, 13 RTM). RPM reviews consistently demonstrated clinical benefits, including reduced blood pressure, HbA1c, and hospitalizations. Across RTM studies, feasibility, patient satisfaction, and engagement were consistently high, although studies were heterogeneous, with some yielding improved pain and activity levels, while others found no difference relative to usual care.

Conclusion: RTM consistently demonstrates strong feasibility and patient engagement in MSK rehabilitation and chronic pain management, though evidence for clinical superiority compared to standard care remains limited. Future studies should emphasize larger randomized trials with standardized functional outcomes, therapy adherence, and integration into rehabilitation and pain management workflows.

Background: Fibromyalgia (FM) is a chronic condition, imposing a substantial burden on patients. Pregabalin, a first-line treatment, offers incomplete efficacy for many and is associated with dose-limiting central nervous system adverse effects. Crisugabalin is a novel α2δ ligand with 23-fold higher binding affinity than pregabalin and has shown potentially fewer central nervous system adverse effects in animal models. While crisugabalin has shown efficacy in other neuropathic pain conditions, its efficacy in FM, particularly in a direct comparison with pregabalin, remains unclear.

Methods and analysis: This multicenter, prospective, randomized, pregabalin-controlled, open-label, blinded-endpoint study will be conducted at 10 hospitals in China. A total of 1116 adult patients with FM and a baseline average daily pain intensity of ≥4 on an 11-point numerical rating scale will be enrolled. Participants will be randomly assigned (1:1) to receive either crisugabalin or pregabalin for 12 weeks using a standardized, flexible-titration protocol. While participants and treating physicians will be aware of the treatment allocation, outcome assessors and data analysts will remain blinded. The primary outcome is the proportion of patients achieving at least a 50% reduction in average pain intensity from baseline at week 12. Secondary outcomes include pain intensity measures, study drug dosing and rescue analgesic utilization, Revised FM Impact Questionnaire, Brief Pain Inventory severity and interfere subscales, short-form 36 Health Survey, Patient Global Impression of Change Scale, Medical Outcomes Study Sleep Scale, Beck Depression Inventory-II, and incidence of adverse events. Analyses will be performed on the modified intention-to-treat and per-protocol populations.

Ethics and dissemination: This study, approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University (KY2025-217-03), will be conducted in accordance with the Declaration of Helsinki. Written informed consent will be obtained from all participants, and findings will be disseminated through peer-reviewed publications and scientific conferences.

Trial registration: Clinical Trials.gov identifier: NCT07196657. Registered on September 29, 2025 (https://www.clinicaltrials.gov/search?term=NCT07196657).

Background: Surgical treatment of combat injuries often requires continuous analgesia for many weeks, which can be achieved with continuous peripheral nerve blocks. Existing data on the safety and efficacy of sciatic nerve catheterization in civilian and military populations are difficult to extrapolate to the population of combat-injured patients in Ukraine.

Purpose: To add to the body of evidence on the safety and efficacy of tunneled sciatic nerve catheters for pain control in combat-injured patients treated at Role 3 facilities.

Patients and methods: This retrospective study included patients with poorly controlled acute pain due to combat-related lower limb injuries. Sciatic nerve catheters were inserted for pain management. All catheters were tunneled intradermally. Analgesic efficacy was assessed by numeric rating scale of pain intensity, opioid requirement, and pain-related sleep disturbance. Infectious and neurological complications were recorded. Kaplan-Meier analysis was used to estimate the risk of catheter-associated infection over time.

Results: The final study population included 185 cases. The median dwell time of sciatic nerve catheter was 11 days (range from 1 to 57). In 59 cases (31.9%), the catheters remained in situ for more than 14 days. Continuous sciatic nerve block was ineffective in 15.7% cases. The rates of infectious complications, neurological complications and local anesthetic systemic toxicity were 9.2%, 2.2% and 1.1% respectively. One case of neuropathic pain and one case of catheter-associated infection were lost to follow-up. All other complications required no treatment and resolved after removal of catheters. Risk of catheter-associated infection did not increase progressively with increasing catheter dwell time.

Conclusion: In a large-scale war environment, tunneled sciatic nerve catheters provided effective analgesia for painful combat injuries throughout the prolonged wound closure process at the Role 3 level. Tunneled sciatic nerve catheters were associated with a relatively high rate of infections and non-infectious complications, but most complications required no treatment and resolved upon catheter removal. Routine removal of uninfected tunneled sciatic nerve catheters based solely on catheter dwell time is not justified, as the risk of infections does not appear to increase progressively with catheter dwell time.

Purpose: Phantom limb pain (PLP) is a common condition after limb amputation which is notoriously difficult to treat. The Russian full-scale invasion of Ukraine has resulted in over 100,000 people with amputated limbs and persistent PLP. This study reports on the feasibility of implementing two novel treatment approaches, Phantom Motor Execution (PME) and Progressive Motor Training (PMT), during the Russian war on Ukraine.

Methods: PME and PMT follow the principle of facilitating motor training of the phantom limb and are grounded on the Stochastic Entanglement hypothesis for the pathogenesis of PLP. PME employs myoelectric pattern recognition on residual limb muscles to control virtual and augmented reality environments (mixed reality). PMT uses mixed reality to guide patients to imagine or execute predefined movements according to their evolving motor skills, and it is suitable for patients where myoelectric signals are not viable. Nineteen participants with major limb amputation were treated with PME (N=8) and PMT (N=11).

Results: Participants who completed 9 sessions reported a reduction of PLP greater than 50%. Participants received half of the training time per session and less sessions than reported in previous studies, yet clinically meaningful pain reductions were observed.

Conclusion: This study demonstrates the feasibility of implementing PME and PMI for the treatment of PLP during war time and constraint resources. Ukrainian clinicians found the technologies and treatment approaches efficient and effective at reducing PLP and have introduced them as part of their clinical practice.

Background: Knee osteoarthritis (OA), a common degenerative joint disease. Anteromedial osteoarthritis (AMOA) specifically targets the knee's medial compartment. We compared total knee arthroplasty (TKA) and mobile-bearing unicompartmental knee arthroplasty (MB-UKA) regarding postoperative functional mobility and quality of life in patients with AMOA.

Methods: A retrospective comparative analysis was conducted on 193 AMOA patients who received TKA (n=101) or MB-UKA (n=92) treatment between January 2020 and December 2024. Patient outcomes were evaluated two years postoperatively using range of motion (ROM), visual analog scale (VAS) for pain, the simplified Chinese version of the Forgotten Joint Score (SC-FJS), Hospital for Special Surgery (HSS) Knee Score, Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and SF-36 quality of life questionnaire.

Results: MB-UKA demonstrated superior functional outcomes. MB-UKA showed significantly greater improvement in ROM (124.44° vs 121.94°, P<0.001) and SC-FJS scores (90.52 vs 89.25, P=0.002) at two years. Mechanical axis alignment was also significantly better in the MB-UKA group (178.65° ± 0.35° vs 178.53° ± 0.41°, P=0.025). Functional mobility was enhanced with MB-UKA, as indicated by higher HSS (P=0.003), OKS (P=0.002), and KOOS (P=0.002) scores. MB-UKA patients reported better physical functioning (PF score: 68.98 vs 66.52, P=0.008) and vitality (VT score: 81.14 vs 78.96, P=0.009) on the SF-36.

Conclusion: MB-UKA offers enhanced functional mobility and quality of life compared to TKA for patients with AMOA, while maintaining a comparable safety profile. MB-UKA should be considered a favorable surgical option for appropriately selected patients seeking optimized functional recovery.