Pain physician最新文献_第4页

In Response to Comments on "Could the Hanging Drop Technique be an Alternative Technique to Loss of Resistance in Cervical Epidural Injections?" 对“吊滴技术能否成为宫颈硬膜外注射阻力丧失的一种替代技术？”

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Shahin Azizov

引用次数: 0

Comment on "Safety and Efficacy of Platelet-Rich Plasma versus Genicular Nerve Radiofrequency Ablation in Knee Osteoarthritis". 关于“富血小板血浆与膝神经射频消融术治疗膝骨关节炎的安全性和有效性”的评论。

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Rekib Sacaklidir

引用次数: 0

Development of a Model for Predicting the Effectiveness of Low-Temperature Plasma on Zoster-Associated Pain. 低温等离子体治疗带状疱疹相关疼痛疗效预测模型的建立。

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Zhao Gao, Chengxi Xi, Hao Zhou, Jinxia Yin, Youwei Li, Yanjun Sun

Background: Zoster-associated pain (ZAP) is a condition characterized by severe, persistent pain caused by herpes zoster (HZ), which impacts the patient's daily activities, mental health, and quality of life significantly. Low-temperature plasma (LTP) technology, as an emerging therapeutic approach, has been applied widely in various biomedical fields. At our center, this technology has been utilized for the treatment of postherpetic neuralgia. Preliminary studies have demonstrated that LTP can effectively alleviate pain symptoms in patients with ZAP. However, a small subset of patients experiences suboptimal outcomes, with limited pain relief following LTP treatment.Objectives: This study was conducted to investigate the efficacy of LTP for treating ZAP, analyze the risk factors for poor therapeutic response, and establish a predictive model to provide clinical decision-making support.Study design: A single-center prospective cohort study was conducted to analyze outcomes of using LTP to treat ZAP.Setting: Patients treated at the Pain Department of Zhongda Hospital, Southeast University, between January 2018 and December 2023, were included.Methods: Patients who received LTP treatment underwent a 6-month follow-up, during which their Visual Analog Scale (VAS) scores were recorded. A post-treatment VAS score ≥ 4 was defined as a poor therapeutic response. Risk factor analysis was performed on patients with poor therapeutic response, and a predictive model was developed. The model was evaluated using threefold cross-validation, with its performance assessed by the area under the receiver operating characteristic (ROC) curve (AUC). Calibration curves and decision curve analysis were used to assess the model's calibration and clinical applicability.Results: A total of 120 patients who underwent LTP treatment were included in the study, with an overall response rate of 67.5%. Analysis of 43 variables revealed that age, coronary heart disease (CHD), disease duration, albumin-to-globulin ratio (AGR), white blood cell (WBC) count, neutrophil count, and scores on the VAS, Dermatology Life Quality Index (DLQI), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA1), HAMA2, and Barthel Index were significantly different between the groups (P < 0.05). Stepwise bidirectional regression identified 4 independent factors significantly associated with outcomes: CHD, AGR, PSQI, and HAMA1. Using logistic regression, a predictive model was constructed and validated through 3 cross-validation methods. The mean AUC for the training set was 0.768 (95% CI: 0.690-0.942), with a sensitivity of 68.7% and a specificity of 83.7%. The mean AUC for the validation set was 0.762 (95% CI: 0.589-0.935), with a sensitivity of 58.5% and a specificity of 76.4%.Limitations: The study was conducted at

背景：带状疱疹相关性疼痛（ZAP）是一种以带状疱疹（HZ）引起的严重、持续疼痛为特征的疾病，它显著影响患者的日常活动、心理健康和生活质量。低温等离子体（LTP）技术作为一种新兴的治疗手段，已广泛应用于生物医学的各个领域。在我们中心，这项技术已被用于治疗带状疱疹后神经痛。初步研究表明，LTP可有效缓解ZAP患者的疼痛症状。然而，一小部分患者经历了次优结果，LTP治疗后疼痛缓解有限。目的：探讨LTP治疗ZAP的疗效，分析治疗效果不佳的危险因素，建立预测模型，为临床决策提供支持。研究设计：采用单中心前瞻性队列研究，分析LTP治疗ZAP的疗效。研究对象为2018年1月至2023年12月在东南大学中大医院疼痛科就诊的患者。方法：对接受LTP治疗的患者进行为期6个月的随访，记录其视觉模拟评分（VAS）。治疗后VAS评分≥4被定义为治疗反应差。对治疗反应差的患者进行危险因素分析，并建立预测模型。采用三次交叉验证对模型进行评价，并以受试者工作特征曲线下面积（AUC）评价模型的性能。采用校正曲线和决策曲线分析评价模型的校正性和临床适用性。结果：共纳入120例LTP治疗患者，总有效率为67.5%。43个变量的分析显示，年龄、冠心病、病程、白蛋白/球蛋白比（AGR）、白细胞（WBC）计数、中性粒细胞计数、VAS评分、皮肤病生活质量指数（DLQI）、匹兹堡睡眠质量指数（PSQI）、汉密尔顿焦虑量表（HAMA1）、HAMA2、Barthel指数在两组间差异均有统计学意义（P < 0.05）。逐步双向回归确定了4个与结果显著相关的独立因素：CHD、AGR、PSQI和HAMA1。采用logistic回归构建预测模型，并通过3种交叉验证方法进行验证。训练集的平均AUC为0.768 (95% CI: 0.690-0.942)，敏感性为68.7%，特异性为83.7%。验证集的平均AUC为0.762 (95% CI: 0.589-0.935)，敏感性为58.5%，特异性为76.4%。局限性：该研究在单个中心进行，病例数量较少，可能具有有限的通用性。需要更大的、多中心的前瞻性研究来验证这些发现。结论：对于ZAP患者，CHD、AGR、PSQI和HAMA1评分是LTP治疗后慢性疼痛持续的高危因素。该预测模型具有较高的敏感性和特异性。这一发现表明，结合这些指标可以在一定程度上预测患者对LTP的治疗反应。

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引用次数: 0

Is Fibromyalgia a Nociplastic or a Mixed-pain Condition? International, Multidisciplinary Recommendations for Pain Phenotyping in Fibromyalgia Syndrome. 纤维肌痛是致伤性疼痛还是混合性疼痛？纤维肌痛综合征疼痛表型的国际多学科推荐。

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Ismail Saracoglu, Randy Neblett, Esra Akin, Bilge Basakci Calik, C Paul van Wilgen, Marc Schiltz, Josue Fernandez Carnero, Bart Morlion, Pawel Zalewski, Slawomir Kujawski, Aleksandra Modlinska, Rainer Freynhagen, Robert Gerwin, Mariana Arias Avila, Paula Rezende Camargo, Jo Nijs

Background: Fibromyalgia syndrome (FMS) is a complex condition characterized by numerous symptoms, especially long-lasting widespread pain. Available evidence suggests that the main causes of FMS are nociplastic pain mechanisms, but nociceptive and neuropathic pain components can also be involved, which would in these cases characterize FMS as a mixed-pain condition. In 2021, a comprehensive set of clinical criteria and grading systems was developed in accordance with the International Association for the Study of Pain. The establishment of these criteria is an important step toward precision pain medicine, with great potential for the assessment and treatment of FMS.

Objectives: The aim of this study was to develop clinical recommendations for pain phenotyping, including the phenotyping of mixed pain, in patients with FMS.

Study design: Narrative review.

Methods: Within this framework, an international and multidisciplinary group of pain specialists have developed clinical recommendations for integrating a mixed pain phenotype into the current framework of phenotyping FMS. A modified nominal group technique was used to develop the consensus recommendations. A manual is provided to allow clinicians to differentiate between predominant nociplastic pain and mixed pain when phenotyping FMS patients.

Results: A 7-step diagnostic approach, performed in 2 parts, is presented and illustrated using 3 case examples to enhance understanding and encourage effective implementation of this approach in research settings and clinical practice.

Limitations: Studies examining the clinometric properties of these recommendations and this grading system for mixed pain in FMS are warranted.

Conclusion: The current recommendations systematically summarize the methods that allow individuals with FMS to be classified into nociplastic or mixed pain phenotypes, based on potential nociceptive and neuropathic pain components.

背景：纤维肌痛综合征（FMS）是一种以多种症状为特征的复杂疾病，尤其是持久的广泛性疼痛。现有证据表明，FMS的主要原因是伤害性疼痛机制，但伤害性和神经性疼痛成分也可能参与其中，这将在这些病例中表征FMS是一种混合性疼痛状况。2021年，根据国际疼痛研究协会制定了一套全面的临床标准和分级系统。这些标准的建立是迈向精准疼痛医学的重要一步，对FMS的评估和治疗具有很大的潜力。目的：本研究的目的是制定疼痛表型的临床建议，包括FMS患者的混合性疼痛表型。研究设计：叙述性回顾。方法：在这个框架内，一个国际和多学科的疼痛专家小组已经制定了将混合疼痛表型整合到当前表型FMS框架的临床建议。一种改良的名义群体技术被用来发展共识建议。手册提供，让临床医生区分主要的伤害性疼痛和混合性疼痛时，表型FMS患者。结果：7步诊断方法，分两部分执行，并通过3个案例说明，以加强理解和鼓励有效实施该方法在研究环境和临床实践。局限性：研究这些建议的斜视特性和FMS混合性疼痛分级系统是有必要的。结论：目前的建议系统地总结了基于潜在的伤害性和神经性疼痛成分，将FMS患者分为伤害性或混合性疼痛表型的方法。

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引用次数: 0

Intravenous Lidocaine Decreases Pain Scores 24 Hours Post Cardiac Surgery: Substudy of a Randomized Controlled Trial. 静脉注射利多卡因降低心脏手术后24小时疼痛评分：一项随机对照试验的亚研究。

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Rebecca Klinger, Amanda Strickland, Mary Wright, Joseph P Mathew, Padma Gulur

Background: Post cardiac surgery pain remains a problem for a significant number of patients. While opioids have long been used for cardiac surgery pain control and hemodynamic stability, methods to improve pain control while also reducing reliance on opioids are desired. Intravenous lidocaine has shown promise for pain and opioid reduction in multiple operative settings, yet its role in cardiac surgery lacks conclusive data.Objective: To determine the effect of intravenous lidocaine on pain scores and opioid consumption in the first 48 hours post cardiac surgery.Study design: Preplanned substudy of a single-center, double-blind, placebo-controlled, randomized controlled trial.Setting: This study was conducted in a tertiary/quaternary care academic hospital in the United States.Methods: Following institutional review board approval and informed consent, a total of 449 patients who met the inclusion criteria were enrolled and randomized to receive either a bolus of one mg/kg of lidocaine administered after anesthesia induction followed immediately by a continuous infusion at 48 mu-g/kg/min for the first hour, 24 mu-g/kg/min for the second hour, and 10 mu-g/kg/min for the next 46 hours (lidocaine group) or normal saline (placebo group). Primary outcomes were Visual Analog Scale (VAS) scores and opioid consumption in of morphine milligram equivalents at 24 and 48 hours post surgery. Secondary endpoints included the administration of other nonopiod analgesic medications, postoperative antiemetic medication use, intensive care unit length of stay, hospital length of stay, and time to return of bowel function. Univariable and multivariable regression analyses were performed.Results: A total of 215 patients who received a placebo and 218 patients who received lidocaine were evaluated. We observed a statistically significant difference in VAS pain score at postoperative 24 hours (adjusted mean difference -0.68; 95%CI, -1.23 to 0.13; P = 0.016) between patients treated with lidocaine vs placebo; however, no difference was observed at postoperative 48 hours. The cumulative opioid use in morphine milligram equivalents was not significant, both in univariable and multivariable analysis, at all timepoints between patients receiving lidocaine vs placebo. Among secondary outcomes, the only significant effect was a decrease in odds of acetaminophen use in the first postoperative 48 hours (adj. odds ratio 0.54; 95% CI 0.32 to 0.90, P = 0.018).Limitations: Although pain scores were a preplanned outcome of the parent study, opioid consumption was not. Furthermore, postoperative pain management was not specifically standardized for this study.Conclusions: We found that intravenous lidocaine resulted in a statistically significant decrease in VAS pain scores at 24 hours post cardiac

背景：心脏手术后疼痛仍然是一个相当数量的患者的问题。虽然阿片类药物长期用于心脏手术疼痛控制和血流动力学稳定性，但需要改善疼痛控制同时减少对阿片类药物的依赖的方法。静脉注射利多卡因在多种手术环境中显示出减轻疼痛和阿片类药物的希望，但其在心脏手术中的作用缺乏确凿的数据。目的：探讨静脉注射利多卡因对心脏手术后48小时疼痛评分和阿片类药物消耗的影响。研究设计：单中心、双盲、安慰剂对照、随机对照试验的预先计划亚研究。环境：本研究在美国的一家三级/四级护理学术医院进行。方法：经机构审查委员会批准和知情同意，共有449例符合纳入标准的患者入组并随机分组，在麻醉诱导后给予1 mg/kg的利多卡因，随后立即以48 μ g/kg/min的速度连续输注第1小时，第2小时24 μ g/kg/min，接下来的46小时10 μ g/kg/min（利多卡因组）或生理盐水（安慰剂组）。主要结局是术后24和48小时的视觉模拟量表（VAS）评分和吗啡毫克当量的阿片类药物消耗。次要终点包括其他非阿片类镇痛药物的使用、术后止吐药物的使用、重症监护病房的住院时间、住院时间和肠功能恢复时间。进行单变量和多变量回归分析。结果：共评估了215名接受安慰剂治疗的患者和218名接受利多卡因治疗的患者。我们观察到，利多卡因组与安慰剂组患者术后24小时VAS疼痛评分差异有统计学意义（校正平均差-0.68;95%CI, -1.23 ~ 0.13; P = 0.016）；然而，在术后48小时内没有观察到差异。在单变量和多变量分析中，在接受利多卡因和安慰剂的患者之间的所有时间点，吗啡毫克当量中阿片类药物的累积使用均不显著。在次要结局中，唯一显著的影响是术后48小时内使用对乙酰氨基酚的几率降低（比值比0.54;95% CI 0.32 ~ 0.90, P = 0.018）。局限性：虽然疼痛评分是父母研究的一个预先计划的结果，阿片类药物的消耗不是。此外，在本研究中，术后疼痛管理并没有特别标准化。结论：我们发现静脉注射利多卡因导致心脏手术后24小时VAS疼痛评分有统计学意义的降低，阿片类药物的消耗没有差异。虽然在其他手术患者群体中已经注意到这种疼痛益处，但我们的发现很重要，因为接受心脏手术的患者是独特的，因为与体外循环移植相关的生理变化。

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引用次数: 0

Comment on "Effectiveness of Peripheral Nerve Stimulation in Managing Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials". 外周神经刺激治疗慢性疼痛的有效性：随机对照试验的系统回顾和荟萃分析

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Hoa Ngan Doan, Min Cheol Chang

引用次数: 0

In Response to Comment on"The Efficacy and Safety of Applying the Combination of Pulsed Radiofrequency and Platelet-Rich Plasma to the Gasserian Ganglion for the Treatment of Idiopathic Trigeminal Neuralgia: A Protocol for A Multi-Center, Prospective, Open-Label, Propensity Score Match Cohort Study". 针对“脉冲射频和富血小板血浆联合应用于Gasserian神经节治疗特发性三叉神经痛的有效性和安全性：一项多中心、前瞻性、开放标签、倾向评分匹配队列研究方案”的评论。

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Yixuan Yang, Fang Luo

引用次数: 0

The Assessment of Neuropathic Pain in Patients with Lymphedema Secondary to Breast Cancer. 乳腺癌继发淋巴水肿患者神经性疼痛的评价。

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Mert Sancar, Ekim Can Ozturk

Background: Lymphedema is a chronic, progressive condition characterized by excessive fluid retention due to impaired lymphatic drainage. While neuropathic pain is known to affect a significant proportion of chronic pain sufferers, the frequency of neuropathic pain in patients with breast cancer-associated secondary lymphedema remains unclear. This study investigates the prevalence and characteristics of neuropathic pain in women with secondary lymphedema caused by breast cancer treatments.

Objective: To determine the prevalence of neuropathic pain in female patients diagnosed with breast cancer-associated secondary lymphedema and to explore that pain's association with lymphedema severity.

Study design: A cross-sectional study.

Setting: A tertiary hospital physical medicine and rehabilitation center.

Methods: This cross-sectional study included 100 women aged 18 to 65 diagnosed with secondary lymphedema related to breast cancer. Neuropathic pain was assessed using the Self-reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and Douleur Neuropathique 4 (DN-4) questionnaires. Lymphedema was staged according to the International Society of Lymphology classification. Data on pain levels and quality of life were collected using the Numeric Rating Scale (NRS-11) and the Lymphedema Life Impact Scale (LLIS).

Results: Neuropathic pain was identified in 14% of patients through the DN-4 and 17% through the S-LANSS. A significant correlation was found between higher lymphedema grades and increased neuropathic pain scores (P < 0.001). Patients with Grade 3 lymphedema reported significantly higher pain levels than did those with lower grades.

Limitations: Cross-sectional nature of the study and the single-center design.

Conclusion: Neuropathic pain is prevalent in patients with breast cancer-associated secondary lymphedema, especially in more advanced cases of cancer. Early identification and targeted pain management strategies are crucial to improving the quality of life for these patients.

背景：淋巴水肿是一种慢性进行性疾病，其特征是淋巴排水受损导致液体潴留过多。虽然神经性疼痛已知影响相当大比例的慢性疼痛患者，但乳腺癌相关继发性淋巴水肿患者神经性疼痛的频率尚不清楚。本研究探讨乳腺癌治疗引起的继发性淋巴水肿女性神经性疼痛的患病率和特点。目的：了解诊断为乳腺癌相关继发性淋巴水肿的女性患者神经性疼痛的患病率，并探讨疼痛与淋巴水肿严重程度的关系。研究设计：横断面研究。单位：三级医院物理医学康复中心。方法：这项横断面研究包括100名年龄在18至65岁之间诊断为乳腺癌相关继发性淋巴水肿的妇女。神经性疼痛采用利兹神经症状和体征自我报告评估（S-LANSS）和Douleur神经病变4 （DN-4）问卷进行评估。淋巴水肿的分期是根据国际淋巴学会的分类。使用数字评定量表（NRS-11）和淋巴水肿生活影响量表（LLIS）收集疼痛水平和生活质量的数据。结果：14%的患者通过DN-4和17%的患者通过S-LANSS诊断为神经性疼痛。淋巴水肿等级升高与神经性疼痛评分升高之间存在显著相关性（P < 0.001）。3级淋巴水肿患者报告的疼痛程度明显高于低级别患者。局限性：研究的横断面性质和单中心设计。结论：神经性疼痛在乳腺癌相关继发性淋巴水肿患者中普遍存在，尤其是在晚期癌症患者中。早期识别和有针对性的疼痛管理策略对改善这些患者的生活质量至关重要。

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引用次数: 0

Lifestyle Habits as Potential Predictors of Impaired Blood Glucose Regulation in Patients with Chronic Low Back Pain vs. Healthy Controls: A Secondary Analysis of a Randomized Crossover Trial. 生活习惯作为慢性腰痛患者与健康对照者血糖调节受损的潜在预测因素：一项随机交叉试验的二次分析

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

M Elena Gonzalez-Alvarez, Ömer Elma, Perseverence Savieri, Sevilay Tumkaya Yilmaz, Peter Clarys, Tom Deliens, Jorge Hugo Villafane, Jo Nijs, Josue Fernandez Carnero, Anneleen Malfliet

Background: Chronic low back pain (CLBP) affects over 20% of adults worldwide. Despite the socioeconomic burden caused by this condition, there is no gold standard treatment for CLBP, and its etiology remains nonspecific in 85% of cases. Available evidence indicates that CLBP patients have higher postprandial glycemic responses to beverages that rank high on the glycemic index and that this finding correlates with pain severity. Therefore, understanding modifiable factors that predict blood glucose regulation in CLBP patients could reveal important information for the management of the condition.

Objectives: This study aimed to (1) examine the relationship between predictor variables and the overall glycemic response, measured by the incremental area under the curve (IAUC), and (2) assess the temporal changes in patients' blood glucose levels immediately after sucrose intake. This dual approach enables a nuanced understanding of both the cumulative and immediate impacts of sucrose intake on glycemic control, facilitating insights into personalized management strategies for mitigating glycemic variability.

Study design: A secondary analysis of a case-control randomized controlled crossover trial to identify predictive factors for impaired blood glucose regulation.

Setting: Vrije Universiteit Brussel, Belgium.

Methods: Individuals with chronic low back pain (CLBP) were randomized to consume either a sucrose or isomaltulose beverage. Body composition, dietary intake, physical activity levels, psychological factors, and blood glucose levels were measured. Multiple linear regression was used to examine the relationship between baseline variables and postprandial glucose response following intake of the high-glycemic index beverages, and a linear mixed model (LMM) was applied to assess the relationship between sucrose intake and identified potential predictors.

Results: Our findings revealed that higher weight (P < 0.001; t = -4.06), higher age (P = 0.003; t = 3.06), higher inflammatory dietary properties (P = 0.025; t = 2.28), worse mental health (P = 0.021; t = 2.34), and lower diet quality (P = 0.002; t = 3.22) were associated with a significant predictive value for altered postprandial sucrose responses.

Limitations: This study is a secondary analysis of a crossover case-control trial, so causal interpretations should be made cautiously. Additionally, postprandial glucose was measured using a self-monitoring finger-prick device, which lacked real-time data, and the findings were specific to women and may not apply to men.

Conclusion: These results confirm the potential relevance of targeting lifestyle factors in people with CLBP.

背景：慢性腰痛（CLBP）影响全球超过20%的成年人。尽管这种情况造成了社会经济负担，但CLBP没有金标准治疗方法，其病因在85%的病例中仍然是非特异性的。现有证据表明，CLBP患者对血糖指数高的饮料有更高的餐后血糖反应，这一发现与疼痛严重程度有关。因此，了解预测CLBP患者血糖调节的可变因素可以为该疾病的治疗提供重要信息。目的：本研究旨在(1)检验预测变量与总体血糖反应之间的关系，通过增量曲线下面积（IAUC）来测量，(2)评估患者摄入蔗糖后血糖水平的时间变化。这种双重方法可以细致入微地了解蔗糖摄入对血糖控制的累积影响和直接影响，促进对减轻血糖变异性的个性化管理策略的见解。研究设计：对一项病例对照随机对照交叉试验进行二次分析，以确定血糖调节受损的预测因素。地点：比利时布鲁塞尔自由大学。方法：患有慢性腰痛（CLBP）的个体被随机分配饮用蔗糖或异麦芽糖饮料。测量了身体组成、饮食摄入、身体活动水平、心理因素和血糖水平。使用多元线性回归来检验摄入高血糖指数饮料后基线变量与餐后血糖反应之间的关系，并使用线性混合模型（LMM）来评估蔗糖摄入量与确定的潜在预测因子之间的关系。结果：我们的研究结果显示，较高的体重（P < 0.001; t = -4.06）、较高的年龄（P = 0.003; t = 3.06）、较高的炎症性饮食特性（P = 0.025; t = 2.28）、较差的心理健康（P = 0.021; t = 2.34）和较低的饮食质量（P = 0.002; t = 3.22）与餐后糖反应改变的显著预测值相关。局限性：本研究为交叉病例-对照试验的二次分析，故因果解释应谨慎。此外，餐后血糖是用一种自我监测的手指刺破装置测量的，这种装置缺乏实时数据，而且研究结果只针对女性，可能不适用于男性。结论：这些结果证实了靶向生活方式因素与CLBP患者的潜在相关性。

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引用次数: 0

Efficacy of Ultrasound-Guided Pulsed Radiofrequency in the Management of Pain Caused by Knee Osteoarthritis: A Systematic Review and Meta-Analysis. 超声引导脉冲射频治疗膝关节骨关节炎疼痛的疗效：系统回顾和荟萃分析。

IF 2.5 2区医学 Q2 ANESTHESIOLOGY

Pain physician

Pub Date : 2025-11-01

Shifeng Lai, Huimin Li, Jinlian Li, Yu Ma, Na Luo, Min Xu, Ping Liu, Hongping Zhang, Qinglan He

Background: Knee osteoarthritis (KOA) is a prevalent degenerative disease that leads to significant disability among elderly individuals. Ultrasound-guided pulsed radiofrequency (UG-PRF) has been shown to be a nonpharmacological, less invasive alternative to other treatment methods for reducing severe chronic joint pain.Objective: To establish whether using UG-PRF to manage KOA pain improves short-term and long-term clinical outcomes for patients with that condition.Study design: A systematic review and meta-analysis.Methods: Within PubMed, MEDLINE, Embase, and the Cochrane Library, a comprehensive search of relevant studies published from those databases' inception through July 11, 2024, was conducted. Studies assessing the effectiveness of UG-PRF in KOA patients were selected based on predefined inclusion criteria that required the exclusive use of UG for PRF delivery. Data extraction and synthesis utilized a random-effects model to analyze outcomes related to pain reduction and physical function improvement. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to appraise the robustness of the evidence.Results: A total of 658 records were identified, with 8 studies involving 688 patients included in the meta-analysis. UG-PRF was associated with significant reductions in visual analog scale (VAS) scores at one month (MD = -14.40; 95% CI [-19.61, -9.19]; P < 0.01; GRADE: high), 3 months (MD = -7.83; 95% CI [-10.38, -5.27]; P < 0.01; GRADE: high), 6 months (MD = -5.64; 95% CI [-7.62, -3.66]; P < 0.01; GRADE: high), and 12 months after treatment (MD = -1.08; 95% CI [-1.94, -0.23]; P < 0.01; GRADE: moderate), and those results all exhibited substantial heterogeneity (I² > 90%; P < 0.01). Similarly, secondary outcomes were associated with significant improvements in WOMAC scores at one month (MD = -20.71; 95% CI [-27.43, -13.99]; P < 0.01; GRADE: high) and 3 months after treatment (MD = -22.09; 95% CI [-31.33, -12.84]; P < 0.01; GRADE: high), with high heterogeneity (I² = 77% at one month, 89% at 3 months; P < 0.01). Sensitivity analysis confirmed the robustness of results, except for the VAS at 12 months. Subgroup analysis indicated no significant differences across treatment targets (P > 0.05). Publication bias was suggested for VAS outcomes at one and 6 months, yet fail-safe analysis (N = 86 required to nullify the 12-month effect) and trim-and-fill methods maintained the significance of the findings.Limitations: Incomplete reporting of WOMAC scores constrain the robustness of the study's conclusions, particularly as far long-term efficacy as is concerned. Additionally, the current study's limited data on nerve regeneration mechanisms after pulsed radiofrequency ablation (RFA) restricts a comprehensive understanding of the factors that contribute to pain recurrence

背景：膝骨关节炎（KOA）是一种常见的退行性疾病，在老年人中导致严重的残疾。超声引导脉冲射频（UG-PRF）已被证明是一种非药物的、侵入性较小的治疗方法，可用于减轻严重的慢性关节疼痛。目的：探讨UG-PRF治疗KOA疼痛是否能改善KOA疼痛患者的短期和长期临床预后。研究设计：系统回顾和荟萃分析。方法：在PubMed、MEDLINE、Embase和Cochrane图书馆中，对从这些数据库建立到2024年7月11日发表的相关研究进行全面检索。评估UG-PRF在KOA患者中的有效性的研究是根据预先确定的纳入标准进行选择的，这些标准要求只使用UG进行PRF的递送。数据提取和综合利用随机效应模型来分析与疼痛减轻和身体功能改善相关的结果。我们使用分级建议评估、发展和评价（GRADE）框架来评估证据的稳健性。结果：meta分析共纳入658条记录，其中8项研究涉及688例患者。UG-PRF与视觉模拟量表(血管)得分显著减少在一个月(MD = -14.40; 95%可信区间[-19.61,-9.19],P < 0.01;等级:高),3个月(MD = -7.83; 95%可信区间[-10.38,-5.27],P < 0.01;等级:高),6个月(MD = -5.64; 95%可信区间[-7.62,-3.66],P < 0.01;等级:高),治疗后12个月(MD = -1.08; 95%可信区间[-1.94,-0.23],P < 0.01;等级:温和),这些结果都表现出异质性(我²> 90%;P < 0.01)。同样，次要结局与治疗后1个月（MD = -20.71; 95% CI [-27.43, -13.99]; P < 0.01； GRADE：高）和3个月（MD = -22.09; 95% CI [-31.33, -12.84]; P < 0.01； GRADE：高）WOMAC评分的显著改善相关，异质性较高（1个月时I²= 77%，3个月时I²= 89%;P < 0.01）。敏感性分析证实了结果的稳健性，除了12个月时的VAS。亚组分析显示各治疗目标间差异无统计学意义（P < 0.05）。1个月和6个月的VAS结果存在发表偏倚，但失效安全分析（N = 86才能消除12个月的影响）和修整填充方法维持了研究结果的意义。局限性：WOMAC评分报告的不完整限制了研究结论的稳健性，特别是就长期疗效而言。此外，目前关于脉冲射频消融（RFA）后神经再生机制的研究数据有限，限制了对12个月后疼痛复发因素的全面了解。结论：UG-PRF在短期内可有效减轻KOA疼痛，改善功能，治疗后6个月仍有显著疗效。然而，镇痛效果在12个月后会减弱，这表明需要进一步研究该技术的长期疗效和潜在机制。该meta分析支持UG-PRF作为治疗40岁（平均62.1±9.4岁）成人KOA疼痛的安全、微创选择的临床应用，尽管持续的疼痛缓解可能需要额外的干预措施。

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引用次数: 0