Journal of Pain Research最新文献

Introduction: Around 25% of children and adolescents report chronic pain, which is often associated with a range of negative consequences. Targeted dissemination of research findings is crucial to inform patients, families, and healthcare professionals about chronic pain and its treatment. To do so, a key step is to identify the knowledge needs of the targeted audience, and to determine how to best reach them.

Objective: We investigated satisfaction with current knowledge transfer concerning pediatric chronic pain and its treatment amongst adolescents with chronic pain, their parents, and healthcare professionals.

Methods: Focus groups and semi-structured interviews with adolescents with chronic pain, parents of children with chronic pain, and healthcare professionals were carried out. The discussions and interviews were analyzed applying structural content analysis.

Results: Three adolescents with chronic pain, four caregivers and twelve healthcare professionals from Switzerland participated in the study. Patients and caregivers highlighted barriers related to social, medical, organizational, and information-specific areas, and expressed a strong desire for more tailored and accessible support. Participants emphasized the importance of recipient-specific dissemination strategies that address both informational preferences and contextual realities. Healthcare professionals, while well-networked within Switzerland, emphasized the importance of access to pediatric research data, specifically from Swiss populations.

Conclusion: Dissemination of scientific results on pediatric chronic pain to those who need it remains inadequate. The findings highlight the urgent need for pain education resources targeted to the different audiences, ensuring that affected families and healthcare providers are equipped with the information they need.

Purpose: This randomized controlled trial aimed to evaluate the efficacy of preoperative ultrasound-guided left stellate ganglion block (SGB) on postoperative pain and opioid consumption in patients undergoing uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea-hypopnea syndrome (OSAHS).

Patients and methods: Sixty patients scheduled for UPPP were randomly assigned to receive either preoperative ultrasound-guided left SGB with 6 mL of 1% lidocaine (SGB group, n=30) or no block (Control group, n=30). The primary outcome was postoperative pain intensity measured by the visual analog scale (VAS) at extubation, 6 h, 24 h, and 48 h after surgery. Secondary outcomes included intraoperative sufentanil consumption, number of patient-controlled analgesia (PCA) attempts, hemodynamic parameters, and incidence of postoperative complications.

Results: There was no significant difference in VAS scores and postoperative complications between the two groups at each time point after surgery, but compared with the control group, the intraoperative sufentanil dosage, postoperative PCA compression times in SGB group were significantly reduced (all p<0.05).

Conclusion: Preoperative ultrasound-guided left SGB did not significantly reduce postoperative VAS scores in OSAHS patients undergoing UPPP, but it effectively decreased intraoperative opioid use, postoperative analgesic demand. SGB may serve as a valuable adjunct in multimodal analgesia to improve perioperative outcomes in this patient population.

Background: Low back pain (LBP) is a major global health concern with genetic and central nervous system factors. Recent studies have indicated associations between brain morphometry and LBP, but the causal relationships remain unclear.

Methods: We conducted a two-sample Mendelian randomization (MR) analysis to investigate the causal effects of brain morphometric features on LBP, leveraging genome-wide association study (GWAS) summary statistics. Genetic instruments for cortical structure were obtained from the ENIGMA consortium, while instruments for regional brain volumes were derived from UK Biobank imaging data; sulcal morphology traits were obtained from a large neuroimaging GWAS. LBP summary statistics were sourced from the FinnGen consortium. The inverse variance weighted (IVW) method was used as the primary analysis, complemented by multiple sensitivity analyses, including MR-Egger regression, weighted median estimation, and MR-PRESSO, to evaluate the core MR assumptions and assess robustness.

Results: After false discovery rate correction, ten brain morphometric traits were identified as being causally associated with LBP. These associations primarily involved greater global cortical surface area and larger volumes in frontal and temporal regions, the cingulate cortex, and the thalamus, indicating consistent protective effects. In contrast, no causal associations were observed for sulcal morphology traits.

Conclusion: Genetically reduced global cortical surface area and frontal-thalamic brain volumes were causally associated with an increased risk of LBP, providing novel evidence for a central neuroanatomical contribution to pain vulnerability.

Background: Effective postoperative pain management is vital for the recovery, mobility, and quality of life of patients undergoing anterior cruciate ligament reconstruction (ACLR) surgery. Our retrospective analysis aims to identify factors affecting postoperative breakthrough pain after ACLR, with a focus on analgesic modalities.

Methods: This retrospective study included 848 patients who underwent ACLR surgery at Peking University Third Hospital from January 1, 2019, to September 30, 2022. After applying exclusion criteria, patients were categorized into four groups: general anesthesia with femoral nerve block (Group G + F, n = 156), general anesthesia alone (Group G, n = 129), spinal anesthesia with femoral nerve block (Group S + F, n = 314), and spinal anesthesia alone (Group S, n = 249). The collected data included demographic details, analgesic methods, and the timing of the first pain relief request. Statistical analysis was performed using the chi-square test and multivariable logistic regression to evaluate intergroup differences and the effect of covariates.

Results: A significant difference was found in the timing of the first analgesic request among the groups (p < 0.001). Group G and Group S requested their initial postoperative analgesics sooner than Groups G + F and S + F, respectively (p < 0.001). Multivariable analysis showed that gender was associated with postoperative breakthrough pain (odds ratio [OR] 0.502; 95% confidence interval [CI] 0.307 to 0.821). Postoperative routine use of non-steroidal anti-inflammatory drugs (NSAIDs) also reduced breakthrough pain incidence (OR 0.286; 95% CI 0.182 to 0.451). Breakthrough pain at 12 and 24 hours post-surgery was associated with prolonged hospital stays (p = 0.001 and 0.006, respectively).

Conclusion: The administration of a single-shot femoral nerve block (FNB) significantly delayed the first request for analgesia after ACLR, without leading to prolonged hospitalization. Factors associated with postoperative breakthrough pain during hospitalization included gender, regular NSAID use, and analgesic modality selection.

Background: Pharmacological self-management of osteoarthritis (OA) with over the counter (OTC) drugs remains challenging.

Aim: To compare the safety, tolerability, and efficacy of a finished phytotherapeutic product (FPP; 2-propanolic dry extract from stinging nettle leaves, Hox alpha [HOXA]) with conventional non-steroidal anti-inflammatory drugs (NSAIDs) used as OTC self-medication in OA.

Methods: Retrospective, longitudinal exploratory analysis of depersonalized data from the German Pain e-Registry. Two propensity score-matched cohorts of 1073 OA patients each, reporting at least 3 months of continuous OTC treatment with HOXA or NSAIDs, were evaluated. The composite primary endpoint was the proportion of patients who did not discontinue due to an adverse drug reaction (ADR) AND achieved a clinically relevant reduction in average 24‑h pain intensity at the end of the evaluation period. Secondary endpoints included improvements in pain intensities, pain‑related disability, and physical/mental quality of life; safety analyses assessed ADR frequency, number of affected patients, and ADR‑related discontinuations.

Results: Both treatments were associated with significant relief of OA-related symptoms compared to baseline, with greater improvements observed for HOXA across all evaluated domains (all p < 0.001). The frequency of ADRs (789 vs 152), the proportion of patients with ADRs (46.8 vs 13.1%) and ADR-related discontinuations (25.2 vs 2.1) were all significantly higher with NSAIDs compared to HOXA (all p < 0.001). The composite primary endpoint was achieved by 96.2% (HOXA) vs 73.2% (NSAIDs; p < 0.001; OR 9.23; RR 7.02; effect size 0.319).

Conclusion: In this real‑world OTC setting, HOXA use was associated with fewer ADRs and more favorable multidimensional outcomes compared with NSAID. Given the retrospective design, these findings should be interpreted as exploratory and hypothesis‑generating and confirmed in randomized controlled trials.

Trial registration: HMA‑EMA Catalogues of real‑world data sources and studies; EU PAS number 1000000564 (encepp.europa.eu).

Purpose: To evaluate the short-term efficacy and safety of ultrasound-guided hydrodissection alone versus hydrodissection combined with acupotomy release for deep gluteal syndrome (DGS).

Methods: This retrospective study included 82 patients with DGS, divided into a hydrodissection group (n = 41) and a combined hydrodissection with acupotomy group (n = 41). Both groups underwent ultrasound-guided sciatic nerve hydrodissection; the combined group additionally received acupotomy to incise surrounding fascia. Primary outcomes were changes in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores at two weeks post-treatment.

Results: No complications (eg, bleeding, nerve injury) occurred in either group from immediately post-treatment to two weeks. At two weeks, both groups showed significant improvements in VAS and ODI scores compared to baseline (P<0.001)). The combined group had greater VAS improvement [median (IQR): 4.00 (4.00, 5.00)] than the hydrodissection group [3.00 (2.00, 4.00); P < 0.001] and greater ODI improvement [40 (20, 60) vs 20 (20, 30); P = 0.004].

Conclusion: Ultrasound-guided hydrodissection combined with acupotomy release was associated with greater short-term pain relief (VAS) and functional improvement (ODI) in patients with DGS compared with hydrodissection alone.

Purpose: Pamidronate is a nitrogen-containing bisphosphonate with immunomodulatory and anti-osteoclastic properties that has shown benefit in early-onset complex regional pain syndrome (CRPS), yet evidence in persistent CRPS remains limited. Given that chronicity may attenuate therapeutic response, this study evaluates the effectiveness and tolerability of intravenous pamidronate in CRPS patients managed in routine clinical practice.

Patients and methods: We conducted a single-center retrospective observational study, including all adult CRPS patients treated with pamidronate between 2014 and 2024 at our tertiary referral center. Data were collected from medical records at baseline, during treatment and at routine follow-up at approximately 1-, 3-, 6-, and 12-months post-treatment. The primary outcome was the pain trajectory, analyzed using a linear mixed-effects model. Responders were defined by a ≥2-point NRS reduction or subjective benefit when NRS data were unavailable.

Results: Of 110 eligible patients, 97 were included with a median age of 45 (IQR 32-54), and a median disease duration of 31 months (IQR 9-97). Baseline mean NRS was 7.95 (95% CI: 7.66 to 8.25), declining by 1.10 points (95% CI: -1.49 to -0.70; p<0.001) at 1 month and by 0.66 points (95% CI: -1.13 to -0.20; p<0.01) at 3 months. Responder rates were 34% and 22%, respectively. Treatment-related adverse events occurred in 91% of patients but led to discontinuation in only 6%.

Conclusion: In patients with predominantly persistent CRPS, intravenous pamidronate was well tolerated and associated with a modest, short-term pain relief up to 3 months. No sustained analgesic benefit was evident at later timepoints.

Purpose: Chronic neck pain (CNP), defined as pain localized to the cervical spine region persisting for more than three months, represents a major global health problem with a steadily increasing prevalence worldwide. This randomized controlled trial aimed to investigate the effectiveness of adding jaw exercises to cervical stabilization exercises on pain, sensorimotor function, and functional outcomes in individuals with CNP.

Patients and methods: A total of 62 individuals aged 18-65 years with cervical spine pain lasting longer than three months and a pain intensity of ≥3 cm on the Visual Analogue Scale (VAS) were included. Participants were randomly allocated to the Rocabado group (RG, n=31) or the control group (CG, n=31). The CG performed cervical stabilization exercises (CSE), while the RG performed Rocabado exercises in addition to CSE for 6 weeks. Pain intensity (VAS), pressure pain threshold and tolerance, balance, cervical range of motion, muscle endurance, Neck Disability Index (NDI), and cervical proprioception were assessed at baseline and post-treatment. Sample size was calculated based on the NDI as the primary outcome.

Results: Both groups demonstrated significant improvements in pain intensity, cervical range of motion, muscle endurance, disability, balance, and proprioception after 6 weeks (p<0.05). Compared with the control group, the Rocabado group showed significantly greater improvements in pressure pain threshold and tolerance (η² = 0.29-0.41), cervical propriosepsiyon (η² = 0.14-0.19), and static and dynamic balance parameters (η² = 0.27-0.46), indicating moderate to large group-by-time effects (p<0.05).

Conclusion: Adding Rocabado exercises to cervical stabilization exercises provides superior improvements in sensorimotor function and pain-related outcomes in individuals with chronic neck pain. These findings suggest that integrating jaw-focused exercises into cervical rehabilitation programs may offer clinically meaningful benefits.

Trial registration: This clinical trial was registered at http://clinicaltrials.gov (Number: NCT05887349, registration date: 05/23/2023).

Background: With the global population ageing rapidly, the combined health burden of chronic pain and chronic diseases is increasingly evident. Despite this, significant gaps remain in understanding the interrelationship between these factors.

Objective: This study aimed to examine the associations between chronic pain and a range of chronic diseases in a nationally representative sample of US adults.

Study design: A cross-sectional analysis was performed using data from the National Health and Nutrition Examination Survey (NHANES).

Methods: Data from four NHANES cycles (1999-2004, 2009-2010) were analyzed, including 7,135 adults aged 20 years and older. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between chronic pain and each chronic disease, adjusting for sociodemographic, lifestyle, medication use, and anthropometric factors.

Results: A significant comorbidity risk was identified between chronic pain and multiple chronic diseases, with the strongest associations observed for arthritis (OR = 3.07, 95% CI: 2.71-3.48), renal failure (OR = 1.85, 95% CI: 1.36-2.51), liver disease (OR = 1.77, 95% CI: 1.37-2.29), and congestive heart failure (OR = 1.72, 95% CI: 1.24-2.40). Additionally, smoking (OR = 1.83, 95% CI: 1.66-2.02), prescription medication use (OR = 2.33, 95% CI: 2.10-2.58), and widowhood (OR = 2.13, 95% CI: 1.72-2.65) were also significant risk factors for chronic pain. Subgroup analyses of chronic conditions comorbid with chronic pain further explored the influence of specific factors.

Conclusion: Chronic pain, as a comorbid factor, should be integrated into the management of chronic diseases. Clinical practice should prioritize synergistic prevention strategies, such as smoking cessation interventions, to reduce both pain and comorbidity risks. To better understand the causal relationships between chronic pain and chronic diseases, future studies should focus on longitudinal designs and include objective pain measures, such as biomarkers.