Journal of Pain Research最新文献

Background: Chronic non-specific low back pain (CNSLBP) is a disabling condition worldwide, with exercise therapy as its first-line intervention. Traditional Chinese exercises (eg, Tai Ji, Baduanjin, Wuqinxi) have gained attention, but their comparative efficacy remains unclear.

Objective: To compare the efficacy of six traditional Chinese exercises-Tai Ji, Yijinjing, Wuqinxi, Baduanjin, Chan-Chuang Qigong, and Liuzijue-in patients with CNSLBP via Bayesian network meta-analysis.

Methods: We searched Chinese (CNKI, Wanfang, VIP, SionMed) and English (PubMed, Web of Science, Cochrane Library, Embase) databases up to December 3, 2025. A total of 24 randomized controlled trials (RCTs) with 2,067 participants were included. The overall methodological quality was moderate, with common limitations in blinding and allocation concealment. A Bayesian random-effects model was used to compare interventions based on visual analogue scale (VAS) and Oswestry disability index (ODI) scores, with ranking performed via the surface under the cumulative ranking curve (SUCRA). Conventional therapy (CT) was defined as rehabilitation training (eg, core muscle strengthening, suspension training, rehabilitation gymnastics), Western medicine, manipulation, or acupuncture.

Results: For pain reduction (VAS), Wuqinxi combined with CT (SUCRA=0.80), Chan-Chuang Qigong combined with CT (0.77), and Yijinjing alone (0.69) ranked highest. In pairwise comparisons, these interventions showed statistically significant improvements over conventional therapy alone (P < 0.05). For functional improvement (ODI), Liuzijue combined with CT (0.99), Baduanjin combined with CT (0.76), and Tai Ji combined with CT (0.72) performed best, with significant differences versus CT (P < 0.05). Notably, combined therapies generally outperformed single-modality exercises. Meta-regression suggested that longer intervention durations enhanced the effects of Baduanjin and Wuqinxi.

Conclusion: Traditional Chinese exercises, particularly Wuqinxi and Liuzijue when combined with conventional therapy, show promising effects for pain relief and functional improvement in CNSLBP. However, the evidence quality is moderate to low, limited by heterogeneity and methodological constraints. Future studies should prioritize higher-quality designs, longer follow-up, and standardized intervention protocols.

Background: Metabolic factors play a critical role in the onset of lower limb joint pain, especially in middle-aged and older individuals. TyG and its derivatives, have emerged as promising indicators of insulin resistance, and are linked with several metabolic diseases, yet their relationships with lower limb joint pain remains insufficiently studied.

Methods: This study utilized 9-year longitudinal data (2011-2020) from the China Health and Retirement Longitudinal Study (CHARLS). TyG and its derivatives were collected at baseline (2011). Incident lower limb joint pain was recorded during follow-up. The associations were evaluated using Multivariable Cox proportional hazards models, Restricted Cubic Spline (RCS), and Kaplan-Meier curves. The robustness of the findings was assessed by Fine-Gray competing risk model and subgroup analyses.

Results: Among 6817 participants, 2909 (42.67%) developed lower limb joint pain. The highest incidence occurred in the fourth quartile of TyG-BMI, TyG-WHtR and TyG-WC, but not TyG alone. There existed significant positive associations of TyG-BMI (p for trend: 0.015) and TyG-WHtR (p for trend: 0.004) with lower limb joint pain risk, especially the fourth quartiles of TyG-BMI (HR: 1.15; 95% CI: 1.02-1.30), TyG-WHtR (1.18 [1.05-1.32]) and TyG-WC (1.14 [1.01-1.27]). The Fine-Gray competing risk model confirmed this robust association, and RCS indicated significant positive linear relationships of TyG-BMI and TyG-WHtR with new-onset lower limb joint pain. Subgroup analysis identified gender as a significant interactive factor for TyG-BMI, with a notable association in females. These results suggested that TyG derivatives, specifically adiposity-integrated indices, were associated with an increased risk of new-onset lower limb joint pain in middle-aged and older individuals, rather than TyG alone.

Conclusion: These results highlight the importance of monitoring TyG derivatives, specifically adiposity-integrated indices (TyG-BMI and TyG-WHtR) for early clinical detection and intervention in high-risk individuals, and offer novel perspectives for the assessment and treatment of lower limb joint pain.

Objective: To identify and summarize the best available evidence for postoperative pain management in adult intensive care unit (ICU) patients to inform clinical practice.

Methods: Using evidence-based nursing methodology, an evidence-based question on postoperative pain management in adult ICUs was formulated. A systematic literature search was conducted. The quality of included literature was appraised, and evidence was graded and extracted according to the Joanna Briggs Institute (JBI) evidence-based healthcare center's literature quality appraisal criteria and evidence grading system.

Results: Eighteen publications were included, comprising 2 clinical decision tools, 4 guidelines, 5 evidence summaries, 4 systematic reviews, and 3 expert consensus documents. Through professional judgment, 35 best evidence recommendations were ultimately synthesized, covering six aspects: pain assessment tools, non-pharmacological pain management measures, pharmacological interventions, dynamic assessment, and quality improvement measures for pain management.

Conclusion: This study summarizes the current best evidence for postoperative pain management in adult ICU patients. It can serve as an evidence-based reference for standardizing pain management practices among ICU healthcare professionals, helping to reduce the incidence of patient pain and related complications, improve patient outcomes, and enhance the quality of nursing care.

Objective: The aim of this meta-analysis was to evaluate the effect of perineural (PN) dexamethasone on the duration of analgesia in paravertebral block (PVB).

Methods: We systematically searched PubMed, Embase, Web of Science, The Cochrane Library, and CNKI up to October 2025 for relevant randomized controlled trials (RCTs) comparing PN dexamethasone to a placebo in PVB. The primary outcome was the duration of analgesia. The mean difference (MD) and the risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. Trial sequential analysis (TSA) was also carried out to calculate the required information size (RIS).

Results: Ten trials with 731 participants were included. PN dexamethasone prolonged the duration of analgesia by approximately 350 minutes compared with placebo. In the trial sequential analysis, the cumulative Z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit, and reached RIS. In addition, PN dexamethasone decreased Visual analogue scale (VAS) scores at 2 hours, 6 hours, 12 hours and 24 hours after surgery with lower incidence of postoperative nausea and vomiting (PONV, risk ratio [RR] 0.41; 95% CI 0.25 to 0.69) and less cumulative opioid consumption (MD = -8.85; 95% CI: -13.39 to -4.32).

Conclusion: This study suggested PN dexamethasone effectively prolongs the duration of analgesia in PVB and reduces the cumulative opioid consumption. TSA suggested that no more trials are required to confirm that PN dexamethasone effectively prolongs the duration of analgesia in PVB.

Background: Dorsal scapular nerve (DSN) entrapment is a common cause of chronic interscapular pain. Ultrasound-guided corticosteroid hydrodissection is an effective intervention, but no randomized controlled trial has directly compared the efficacy of the proximal (scalene) and distal (scapular) injection approaches.

Methods: In this multicentre, prospective, randomized controlled study conducted across seven centers in Egypt, patients and outcome assessors were blinded; proceduralists could not be blinded due to inherent technical differences. Sixty patients with electrodiagnostically-confirmed DSN entrapment were randomly assigned to receive a single ultrasound-guided hydrodissection injection of triamcinolone acetonide (40 mg) and lidocaine in 10 mL saline. Group I (n=30) received the injection at the DSN within the middle scalene muscle, while Group II (n=30) received it below the levator scapulae muscle. The primary outcome was the Visual Analog Scale (VAS) for pain at rest. Secondary outcomes included VAS during movement, Fatigue Assessment Scale (FAS), patient satisfaction, and motor distal latency, assessed at baseline, 1, and 3 months.

Results: The groups were well-matched at baseline. The scalene group demonstrated a significantly greater reduction in pain at rest at both 1 month (Z = 6.68, p < 0.001) and 3 months (Z = 6.68, p < 0.001). Similar significant differences favoring the scalene group were observed for pain during movement and fatigue scores at all follow-ups (p < 0.001). Patient satisfaction was significantly higher in the scalene group at all follow-ups (p < 0.001). No significant between-group difference was found in motor distal latency, and no major complications occurred.

Conclusion: Ultrasound-guided corticosteroid hydrodissection administered at the middle scalene muscle resulted in significantly greater short-term improvement in pain, fatigue, and patient satisfaction over three months compared to the distal scapular approach. The scalene approach may be considered more effective for short-term management, though longer-term studies are needed to confirm durability.

Pain is a prevalent clinical complaint that often defies explanation within conventional biomedical frameworks, particularly in chronic and idiopathic conditions, frequently leading to patient invalidation and inadequate care. We evaluate the potential of philosophy to expand the understanding of pain beyond biological reductionism by conceptualizing pain as a lived experience. This narrative review aims to integrate key philosophical perspectives with contemporary pain medicine and to examine their relevance for clinical practice. A narrative review of philosophical and medical literature was conducted, focusing on phenomenology, existential philosophy, philosophy of language, biopolitics, and neurophilosophy. These frameworks conceptualize pain as a disruption of embodied existence, a challenge to identity and autonomy, a phenomenon that resists full linguistic expression, a condition shaped by institutional and sociopolitical structures, and an inferential process influenced by prior experience and context. Together, these perspectives suggest that effective pain management requires more than symptom reduction and objective measurement. Attending to patients' lived experiences may strengthen therapeutic alliances, enhance clinical communication, and support more ethical, person-centered, and clinically meaningful approaches to pain care.

Background: Intrathecal anesthesia is commonly used for analgesia in anorectal surgery, often supplemented with low-dose opioids such as morphine or fentanyl to prolong the duration of analgesia. However, the utility of these opioids is constrained by their adverse effects or inadequate analgesia. Hydromorphone, an opioid with pharmacodynamic properties intermediate between those of morphine and fentanyl, theoretically offers a favourable balance of prolonged analgesia and reduced side effects. Nevertheless, evidence regarding the efficacy and safety of intrathecal hydromorphone for postoperative analgesia in anorectal surgery remains scarce.

Purpose: To determine whether the addition of hydromorphone can effectively prolong the duration of analgesia provided by single-agent intrathecal ropivacaine, reduce the requirement for rescue analgesics, and avoid a significant increase in adverse effects.

Patients and methods: A total of 76 patients scheduled for elective benign anorectal surgery will be enrolled and randomly allocated in a 1:1 ratio to either the intervention group (Group H: intrathecal ropivacaine 10 mg + hydromorphone 75 μg) or the control group (Group C: intrathecal ropivacaine 10 mg). The primary outcome will be the duration of postoperative analgesia, defined as the time to first request for rescue analgesia. Secondary outcomes will include Numerical Rating Scale (NRS) pain scores at various postoperative time points (4, 6, 8, 10, 12, and 24 hours), total 24-hour rescue analgesic consumption, the incidence of adverse effects, and patient satisfaction.

Conclusion: To our knowledge, this is one of the first randomized controlled trials to evaluate the analgesic value of intrathecal hydromorphone in patients undergoing anorectal surgery. If the outcomes are positive, this approach may offer a superior multimodal analgesic option for anorectal procedures, support the implementation of Enhanced Recovery After Surgery (ERAS) protocols, and provide high-quality evidence to inform clinical decision-making in this field.

Trial registration: The study was registered with the Chinese Clinical Trial Registry (Registration No.: ChiCTR2500100994).

This study systematically evaluated the efficacy of Governor Vessel-based acupuncture for lumbar disc herniation (LDH) and examined whether different acupuncture paradigms or combined interventions offered additional benefits. A comprehensive search of nine major databases identified 689 records, and 15 randomized controlled trials involving 670 patients met the inclusion criteria. Meta-analysis demonstrated that Governor Vessel-based acupuncture significantly improved overall clinical effectiveness compared with control treatments (RR = 1.21, 95% CI: 1.15-1.27), with a stable predictive interval. Pain intensity was also markedly reduced, as evidenced by a substantial decrease in visual analogue scale scores (SMD = -1.77, 95% CI: -2.18 to -1.36). Subgroup analyses revealed no meaningful differences among Wenyang Tongdu, spine-regulating Governor Vessel, and Bushen-Huoxue techniques, nor between acupuncture alone and combined modalities. These findings indicate that Governor Vessel-based acupuncture provides consistent and clinically relevant benefits for patients with LDH. However, methodological heterogeneity and the limited number of single-modality Governor Vessel trials should be considered when interpreting these findings. Nevertheless, higher-quality multicenter randomized trials are needed to validate long-term outcomes and clarify mechanistic pathways.

Introduction: Pancreatic Quantitative Sensory Testing (P-QST) is a neurosensory evaluation used to characterize pancreatic pain. Given racial differences in experimental pain sensitivity, it is crucial to investigate this phenomenon before widespread P-QST adoption. We aimed to study experimental pain sensitivity in African American (AA) vs non-AA individuals with no abdominal pain or known pancreatic disease (controls), and AA controls vs AA participants with chronic pancreatitis (CP).

Methods: In this cross-sectional, multi-center study, race was dichotomized (AA and non-AA) and was self-reported. Participants underwent P-QST testing assessing pressure pain detection threshold (pPDT), pressure tolerance threshold (pPTT), cold pressor endurance (CPE), conditioned pain modulation (CPM), temporal summation (TS), and the Hospital Anxiety and Depression Scale (HADS).

Results: A total of 157 AA and 110 non-AA control participants were tested, as well as 35 AA participants with CP. No differences in P-QST testing were seen between racial groups in control participants. Compared to AA controls, AA participants with CP showed signs of impaired CPM, significantly lower pPTTs and suggestion of lower pPDTs, as well as increased TS scores of the upper abdomen. The lower pPDTs and pPTTs and decreased CPM in AA CP participants compared to AA controls are consistent with findings in other racial groups.

Conclusion: No significant differences in experimental pain results were found between AA and non-AA controls. Alterations in experimental pain sensitivity appear to mainly accompany the CP disease state in the group of AA participants studied.