Pain Medicine最新文献

Background and purpose: Intra-articular injection of the lateral atlantoaxial joint is used for occipital pain; however, limited literature exists on technique demonstration, adverse event reporting, and real-world clinical outcomes. This study was designed to characterize procedural technique, describe clinical outcomes, and report subsequent cervical fusion rates following lateral atlantoaxial joint injections.

Materials and methods: A retrospective cohort analysis was conducted on all lateral atlantoaxial joint injections performed at our institution from January 1, 2002, through August 1, 2024. Descriptive statistics characterized the cohort, procedural features, pain score changes, and cervical fusion rates during follow-up.

Results: 140 lateral atlantoaxial joint injections were performed on 104 patients (mean age 72.6 ± 12.4 years, 68.3% female), primarily by fluoroscopy (77.1%). Mean pre-injection pain was 5.99 ± 1.96, with immediate post-injection pain at 1.84 ± 2.33 and 1-month clinic visit pain at 4.28 ± 2.68. Significant reductions in pain from pre-injection were observed immediately post-injection (p < 0.0001) and at 1-month (p < 0.0001). Most injections were successful on first attempt (97.1%), with no serious adverse events identified throughout follow-up documentation. Overall, 26.9% of patients underwent cervical fusion involving the C1-C2 level during available follow-up.

Conclusion: This study comprises the largest cohort of patients with image-guided lateral atlantoaxial joint injections and provides descriptive data on technique, clinical outcomes, adverse events, and observed subsequent cervical fusion rates. Short-term reductions in pain were common 1-month from injections with no serious adverse events identified throughout follow-up and only one-quarter of patients undergoing eventual cervical fusion. This study adds valuable data to an uncommonly performed procedure.

Objective: Lumbar epidural steroid injections (ESIs) are widely used to treat chronic low back pain. We conducted a systematic review and narrative synthesis to evaluate the effectiveness and safety of varying lumbar ESI corticosteroid doses.

Methods: We searched PubMed, Embase, and Web of Science for English-language studies in humans comparing corticosteroid doses for lumbar ESI, published through 12 August 2025. Of 1,553 records, 14 studies were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomized controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions tool for non-randomized studies.

Results: Methylprednisolone was most frequently used (7 of 14 studies), followed by dexamethasone and triamcinolone (3 studies each), and betamethasone (1 study). Across studies, higher corticosteroid doses did not yield significantly greater improvements in pain relief or function than lower doses but were linked to greater risks of adverse effects, particularly endocrine complications such as hyperglycemia and hypothalamic-pituitary-adrenal axis suppression.

Conclusions: Pain relief and functional outcomes after lumbar ESI do not improve linearly with corticosteroid dose, whereas adverse effects tend to increase with higher doses. These findings support using the lowest effective corticosteroid dose. The lowest reported doses with efficacy not statistically different from higher doses in lumbar ESI include dexamethasone 4 mg, methylprednisolone 20 mg, triamcinolone 10 mg, and betamethasone 3 mg. Our review is expected to help develop standardized protocols for comparing corticosteroid doses in lumbar ESIs and to identify the lowest effective dose.

Background: Neuromodulation via transcutaneous electrical stimulation shows promise in fibromyalgia, but conventional devices have limited coverage. The EXOPULSE Mollii Suit is a full-body garment with 58 electrodes, potentially addressing widespread pain. This study evaluated repeated Mollii Suit sessions on disease impact, pain, and fibromyalgia-related symptoms.

Methods: In this double-blind, randomized, sham-controlled crossover trial (phase 1), adults with fibromyalgia received two weeks of daily active or sham stimulation (1 hour/day), followed by a ≥ 2-week washout and crossover. Participants were offered a four-week open-label extension (phase 2). The primary outcome was the Fibromyalgia Impact Questionnaire (FIQtotal). Secondary outcomes included pain, anxiety, depression, and quality of life.

Results: Twenty-two patients completed phase 1 and 20 completed phase 2. In phase 1, FIQtotal scores significantly decreased following the active intervention (66.06 ± 13.46 to 50.81 ± 23.22, Friedman's p < 0.01, Bonferroni-adjusted Dunn's p < 0.05), whereas no significant effects were observed following the sham intervention. Improvements were also observed in several secondary measures (pain catastrophizing and some quality of life domains). Phase 2 also revealed significant benefits in FIQtotal as well as several secondary outcomes. No severe adverse events occurred at any time.

Conclusions: EXOPULSE Mollii Suit led to clinically meaningful improvements in fibromyalgia impact and related outcomes. The results of this work are in line with those of previous trials and support its potential as a home-based neuromodulation therapy for fibromyalgia. Future large-scale studies would help further understand the effects of this medical device.

Objective: To investigate the influence of anxiety/depression, sleep quality and pain catastrophizing in conditioned pain modulation (CPM) in women with episodic/chronic migraine and pain-free women.

Design: A cross-sectional case-control study.

Setting: Laboratory experimental study.

Subjects: Seventy women with chronic migraine, 70 women with episodic migraine and 70 pain-free women.

Methods: Migraine features and psychological/emotional (e.g., anxiety, depression, sleep, pain catastrophizing) aspects were evaluated. Pressure pain thresholds (PPT) were assessed at the temporalis, lateral epicondyle, and tibialis anterior muscle. Heat (HPT) and cold (CPT) pain thresholds were assessed at the frontalis muscle. Thus, CPM was evaluated immediately after one minute cold-pressor test paradigm on changes in mechanical/thermal stimuli after the conditioned stimulus.

Result: Significant group*time interactions without significant effect of anxiety/depressive levels, sleep quality, or pain catastrophizing for PPTs at the temporalis muscle (Wilk's λ = 0.646, F[2,201]=55.108, p < 0.001, n2p = 0.354, 1-β=0.999), epicondyle (Wilk's λ = 0.736, F[2,201]=36.024, p < 0.001, n2p = 0.264, 1-β=0.999), and tibialis anterior (Wilk's λ = 0.798, F[2,201]=25.148, p < 0.001, n2p = 0.202, 1-β=0.999) were found: PPTs were higher in all points after the conditioned stimulus in pain-free women (increases from 10.7-16.2%) whereas PPTs in all points were lower after conditioned stimulus in women with migraine (decrease from -7.6% to -0.3%) as compared to PPT at baseline. Changes in HPT and CPT were small (<1%).

Conclusion: Women with migraine showed CPM deficits against mechanical, not thermal, stimuli compared to women without migraine. Deficits in CPM were similar between women with episodic/chronic migraine. Anxiety/depressive levels, sleep quality and pain catastrophizing did not influence CPM in women with migraine.