Journal of Pain Research最新文献

[This corrects the article DOI: 10.2147/JPR.S507695.].

Objective: To compare the effects of transversalis fascia plane (TFP) block versus intravenous lidocaine infusion on early recovery after gynecologic laparoscopic surgery.

Methods: In this randomized trial, 59 patients were assigned to: Group L (n = 30): Intravenous lidocaine (bolus 1.5 mg/kg followed by 25 μg/kg/min infusion); Group T (n = 29): Bilateral ultrasound-guided TFP block with 40 mL of 0.33% ropivacaine. Both groups underwent standardized general anesthesia and patient-controlled intravenous analgesia (PCIA). The primary outcome was quality of recovery-15 (QoR-15) scores on postoperative day 1 (POD1). Secondary outcomes included numerical rating scale (NRS), PCIA demand, inflammatory markers (IL-6, TNF-α), time to first flatus, and adverse events.

Results: No significant differences were observed in QoR-15 scores, intraoperative drug consumption, pain scores, PCIA demand, inflammatory markers, or adverse events (P > 0.05). However, Group L exhibited a shorter time to first flatus (P < 0.05).

Conclusion: TFP block and lidocaine infusion provided comparable recovery quality, though lidocaine may accelerate gastrointestinal recovery.

Objective: To investigate the association of auricular plaster therapy (AP) with preoperative anxiety in patients undergoing total knee arthroplasty (TKA) and pancreaticoduodenectomy (Whipple).

Methods: A prospective matched-cohort observational study was conducted at Peking Union Medical College Hospital from March 2024 to May 2025. The primary outcome was Perioperative Anxiety Scale-7 (PAS-7) scores at different preoperative timepoints. Secondary outcomes included modified Pittsburgh Sleep Quality Index (M-PSQI), satisfaction visual analog scale (VAS-satisfaction), intraoperative blood loss, postoperative VAS-pain scores, Self-Rating Anxiety Scale (SAS) scores, and incidence of delirium.

Results: A total of 168 patients completed the study, and 98 patients (49 matched pairs) were included in the final analysis. The results revealed that auricular plaster (AP) therapy was significantly associated with reduced preoperative anxiety scores. Specifically, the AP exposed group demonstrated substantially lower median PAS-7 scores at both 12±2 hours before surgery (T2) and 2 hours before surgery (T3), with median differences of -4.00 points and -5.00 points, respectively (both p < 0.001). Generalized Estimating Equations further confirmed a significant group × time interaction effect (Wald χ² = 44.73, p < 0.001), indicating a favorable association between AP therapy and attenuated anxiety progression. Similarly, AP therapy was significantly associated with improved perioperative sleep quality. The AP exposed group showed superior M-PSQI scores at T2 and at 72±2 hours postoperatively (T4), with a median difference of -4.00 points at T2 and a mean difference of -3.27 points at T4 (both p < 0.001). This was supported by a significant cumulative trend (Wald χ² = 30.44, p < 0.001). Furthermore, the AP exposed group was associated with more favorable postoperative outcomes, including significantly lower VAS pain scores (mean difference: -1.00, p < 0.001) and SAS scores (mean difference: -4.02, p = 0.012). Multivariable regression identified treatment allocation as a key predictor of PAS-7 scores, with the model demonstrating moderate goodness-of-fit (adjusted R² = 0.50). No significant associations were observed between AP therapy and intraoperative blood loss, postoperative length of stay, or incidence of delirium. The AP exposed group exhibited a lower incidence of adverse events (10.2% vs 16.4%), with only three cases of mild local reactions reported, suggesting an acceptable safety profile.

Conclusion: In this observational study, AP was associated with reduced preoperative anxiety and improved sleep quality and may contribute to optimized postoperative recovery through its cumulative effects. Larger randomized controlled trials are needed to establish causality.

Introduction: Postoperative nausea and vomiting (PONV) remains a prevalent complication following laparoscopic cholecystectomy, often linked to perioperative opioid use. This randomized controlled trial aims to evaluate the efficacy of opioid-free anesthesia (OFA) in reducing PONV incidence and improving postoperative recovery quality compared to conventional opioid-based anesthesia (OBA).

Methods/analysis: This study is a prospective randomized, controlled clinical trial with a concealed allocation of patients scheduled to undergo elective laparoscopic cholecystectomy 1:1 to receive either a standard anesthesia protocol or an OFA. A total of 96 patients were recruited in the study. Primary outcomes include the Rhodes Index of Nausea and Vomiting and the incidence of nausea and vomiting at 6 and 24 hours postoperatively.

Ethics and dissemination: This trial has been approved by the Institutional Review Board of Beijing Friendship Hospital of China Capital University. The trial study protocol was approved on April 16, 2025, with an anticipated patient recruitment period of 12 months. The ethical approval number was BFHHZS20250091. The trial started recruiting patients after registered on the Chinese Clinical Trial Registry.

Trial registration number: CTR2500102278; Pre-results.

Introduction: Insomnia is one of the most common complications in cancer patients, and Cognitive Behavioral Therapy for Insomnia (CBT-I) is the first-line treatment for insomnia in the general population and patients with a cancer diagnosis. Traditional CBT-I is susceptible to limitations such as geography, physical condition, and cost of access to healthcare, hindering its widespread adoption. With the application and development of digitalization and artificial intelligence providing opportunities for the administration and promotion of Digital Cognitive Behavioral Therapy for Insomnia (DCBT-I) to provide a better sleep treatment option for cancer pain patients, this study aims to evaluate its efficacy.

Methods: This single-center trial will randomize 158 cancer pain patients with insomnia to DCBT-I or sleep hygiene education (1:1) to test if DCBT-I is superior for improving sleep quality. Assessments will also cover pain intensity, mental health, and quality of life.

Discussion: This study will provide valuable clinical evidence that DCBT-I helps to improve sleep quality, pain intensity, mental health, and quality of life in cancer pain patients suffering from insomnia and contributes to the dissemination of this non-pharmacological alternative treatment option.

Conclusion: This study protocol outlines a rigorous randomized controlled trial to evaluate the efficacy of Digital Cognitive Behavioral Therapy for Insomnia (DCBT-I) compared to Sleep Hygiene Education (SHE) in cancer pain patients with comorbid insomnia. The Resleep smartphone-based intervention integrates evidence-based CBT-I components (sleep restriction, stimulus control, cognitive restructuring, and relaxation training) to address the limitations of traditional therapy, such as accessibility and cost.

Clinical trial registration: This study is a registered clinical trial.

Registry: Chinese Clinical Trial Registry (ChiCTR), listed in the WHO International Clinical Trials Registry Platform (WHO ICTRP).

Trial registration number: ChiCTR2500096855.

Date of registration: 07 February 2025.

Registration url: https://www.chictr.org.cn/index.html.

Background: The selection of root canal obturation material is critical for the successful management of acute irreversible pulpitis. Vitapex, an iodoform-calcium hydroxide-based paste, possesses recognized antimicrobial and biocompatible properties. However, comprehensive evidence comparing its efficacy in single-visit root canal treatment against the conventional gutta-percha/zinc oxide-eugenol (ZOE) sealer combination remains relatively limited.

Objective: To compare the clinical efficacy of Vitapex paste versus gutta-percha/ZOE sealer in single-visit root canal treatment for acute irreversible pulpitis.

Methods: In this single-center retrospective cohort study, clinical data from 112 patients with acute irreversible pulpitis who underwent single-visit root canal therapy between April 2022 and August 2024 were analyzed. Patients were allocated into two groups based on the obturation material: the Vitapex group (n=56), obturated with Vitapex paste, and the gutta-percha/ZOE group (n=56), obturated using the cold lateral compaction technique with gutta-percha points and ZOE sealer. Key outcome measures included time to pain relief, time to swelling resolution, time to return to normal masticatory function, Visual Analogue Scale (VAS) scores, bite force, chewing efficiency, levels of inflammatory factors (hs-CRP, IL-6, TNF-α), periodontal health indices (Bleeding Index-BI, Plaque Index-PLI, Probing Depth-PD), and the incidence of adverse reactions.

Results: The Vitapex group showed significantly shorter recovery times for pain relief, swelling resolution, and return to normal function (all P<0.001), significantly lower VAS scores at 1 and 4 weeks (P<0.05), and greater improvements in masticatory function at 4 weeks (P<0.05). Inflammatory markers and periodontal health indices improved more significantly with Vitapex (all P<0.001). The adverse reaction rate was lower with Vitapex (5.4% vs 12.5%), though not statistically significant (P=0.325).

Conclusion: Vitapex demonstrates superior outcomes in single-visit treatment for irreversible pulpitis, offering faster recovery, better pain control, improved function, and reduced inflammation compared to gutta-percha/ZOE, making it a valuable clinical alternative.

Objective: This study aimed to describe the need for multidisciplinary management in a pediatric chronic pain service, characteristics of pediatric patients, types of pain management, and outcomes in a tertiary care university hospital in Thailand.

Methods: This retrospective study included pediatric patients aged between 0 and 17 years old receiving chronic pain services, both inpatient and outpatient, between August 2021 and December 2023. Demographic data, primary medical diagnosis, pain diagnosis, pain characteristics, psychological diagnosis, multidisciplinary management, and patient outcomes were collected. Pain-related diagnoses were then coded into the 11^th revision of the International Classification of Diseases (ICD-11) of the World Health Organization.

Results: There were 99 patients included in the study. Mean (SD) age of the patients was 11.5 (4.8) years old. Most patients were male sex (60.6%). The most common pain diagnoses were chronic cancer-related pain (43.4%) and chronic neuropathic pain (21.2%). For multidisciplinary management, 46 (46.5%) patients were sent for psychiatric consultation (95% CI 37.0-56.2), which turned out to be 36 (36.4%) patients who had mental health disorders (95% CI 27.6-46.2). Fifty-six (56.6%) patients had rehabilitation (95% CI 46.7-65.9). Twenty (20.2%) patients required both psychiatric and rehabilitation treatments. Gabapentinoids were used in 68 (68.7%) patients. Strong opioids via oral route were reported in 59 (59.6%) patients. Overall, 54 (54.5%) patients were able to be discharged from the service, while 27 (27.3%) patients died.

Conclusion: A significant proportion of children with chronic pain required psychiatric and rehabilitation management.

Background: This exploratory study investigated the neurobiological mechanisms of cancer pain by examining functional brain alterations using resting-state functional magnetic resonance imaging (fMRI), aiming to characterize neural network changes and identify potential neuroimaging biomarkers.

Methods: A cross-sectional study was conducted from October 2021 to October 2022, involving 20 cancer pain patients and 20 age-, sex-, and education-matched healthy controls. Participants underwent comprehensive clinical assessments and 3.0T resting-state fMRI scanning. Inclusion criteria were patients aged ≥18 years with pathologically confirmed malignant neoplasms experiencing moderate to severe pain (NRS ≥ 4). Functional connectivity and low-frequency amplitude analyses were performed using the right nucleus accumbens as a seed region.

Results: Significant neuroplastic changes were observed in cancer pain patients, primarily in the right hemisphere. Low-frequency amplitude analysis revealed reduced spontaneous neural activity in critical brain regions, including the right medial prefrontal cortex (T = -4.36), right superior/middle frontal gyrus (T = -5.21), and right precuneus (T = -4.15). Functional connectivity analysis showed substantially decreased connectivity between the right nucleus accumbens and bilateral medial prefrontal cortex (T = -4.86), left temporal pole (T = -5.62), and right superior temporal gyrus (T = -5.05).

Conclusion: The study provides preliminary evidence of right hemispheric neuronal dysfunction in cancer pain, highlighting altered functional connectivity in emotion regulation and pain processing neural circuits. These findings offer insights into the neurobiological mechanisms of cancer pain and potential objective assessment approaches.

[This corrects the article DOI: 10.2147/JPR.S578652.].

Purpose: Fibromyalgia has predominantly been classified as a condition of amplified pain processing associated with greater sensitivity to pain. Beyond disturbed pain processing, emerging evidence suggests that people with fibromyalgia experience intolerances (increased unpleasantness) across sensory modalities. Limited research, however, has investigated how discrimination and detection in different senses are affected in this group. Understanding how basic perception is affected in fibromyalgia has important implications for treatment and could lead to the development of new perceptual training interventions. This study used self-report methods to investigate how different aspects of sensory processing in fibromyalgia, including detection/discrimination and intolerance, are affected across modalities.

Patients and methods: One hundred and eighty-eight people with fibromyalgia and 121 controls completed the Sensory Hypersensitivity Scale (intolerance) and the Sensory Perception Quotient (discrimination/detection) online.

Results: Pre-registered group comparisons revealed that the fibromyalgia group reported increased intolerance across all measured sensory modalities and an increased subjective perceptual ability (discrimination/detection) across all modalities except smell and taste. Exploratory cluster analysis identified three fibromyalgia subgroups. While one group reported low intolerance that was comparable to healthy controls, the remaining two groups primarily differed in their subjective perceptual ability with one group enhanced and the other reduced.

Conclusion: These findings suggest that there are heterogenous sensory features in fibromyalgia that point to the potential value of treatments focusing on non-pain perceptual processing for some people. Future research should investigate whether the higher subjective perceptual abilities reported by people with fibromyalgia are matched by superior objective perceptual ability.