Pain and Therapy最新文献

Introduction: The primary analysis of the MiroTAS study in patients with lumbar spinal stenosis (LSS) taking non-steroidal anti-inflammatory drugs showed that mirogabalin add-on therapy further improved pain and quality of life (QOL) without new safety concerns.

Methods: This post hoc analysis of the MiroTAS study examined the timing of onset of mirogabalin-related adverse drug reactions (mrADRs) (composite of somnolence, dizziness, edema, and peripheral edema), factors affecting safety and efficacy, and the relationships between baseline numbness severity (by spine painDETECT questionnaire [SPDQ] score), EQ-5D-5L scores, leg pain improvement (by visual analogue scale [VAS]), and patient satisfaction (by Patient Global Impression of Change [PGIC] scores).

Results: Among 110 patients, there were no significant differences in the incidence rates of mrADRs by patient characteristics. The mrADRs occurred mainly after the first administration and uptitration period of mirogabalin. EQ-5D-5L scores significantly improved from baseline to week 12 in patients with mrADRs vs those without (difference 0.0767; p = 0.0304 by t test). The proportion of patients with PGIC scores ≤ 3 at week 12 was numerically higher in patients with mrADRs vs those without. There were no differences in the percentage of patients with reduced leg pain by VAS score (improvement ≥ 20 mm) at week 12 by patient characteristics except for spondylolysis/spondylolisthesis as a complication. Baseline SPDQ numbness scores were positively correlated with improvement in EQ-5D-5L at week 12 (Spearman's rank correlation coefficient 0.2811, p = 0.0092).

Conclusions: Mirogabalin was not related to specific patient characteristics regarding the onset of mrADRs and was effective for LSS regardless of patient characteristics. Caution is needed regarding the onset of mrADRs after first administration and uptitration of mirogabalin, but these may not reduce QOL or patient satisfaction. Patients with high numbness scores may be more likely to benefit from treatment with mirogabalin in terms of QOL.

Trial registration: Japan Registry of Clinical Trials (jRCTs021200007).

Introduction: Transcutaneous electrical nerve stimulation (TENS) is a widely used physical therapy for knee osteoarthritis (OA) pain management. However, the optimal electrode placement for TENS in knee OA remains unclear. Given that TENS delivers stimulation via electrodes to cutaneous nerves, placing electrodes in areas with high nerve density should be the precondition to exert its therapeutic effects. However, high-density nerve areas around the knee and corresponding electrode placement strategies have yet to be investigated.

Methods: An anatomic study was conducted on 20 adult formalin-fixed cadavers to identify the high-density nerve areas around the knee. Then, to standardize electrode placement, the patellar width was used as a reference to determine distances from the patellar borders. Subsequently, 80 patients with Kellgren-Lawrence grade 2 or 3 knee OA were enrolled in a randomized, double-blinded trial. Participants received TENS therapy with electrodes placed either on the identified high-density nerve areas (study cohort, n = 40) or on traditional pain areas (control cohort, n = 40).

Results: Four high-density nerve areas were identified: the quadriceps tendon, patellar ligament, medial joint line area, and superior medial area of the knee. Over the follow-up period, patients in the study cohort showed significantly greater improvements in VAS score and WOMAC index total score, as well as in pain, stiffness, and function subscales compared with those in the control cohort (all P < 0.05).

Conclusions: These findings suggest that positioning electrodes over high-density nerve areas allows TENS more effectively activate sensory afferents, thereby enhancing pain relief.

Trial registration: Chinese Clinical Trial Registry identifier, ChiCTR2500098200, 4 March 2025, retrospectively registered.

The posterior cervical area exhibits a complex anatomy comprising fascia, nerves, and muscles. With the widespread adoption of ultrasound in regional anesthesia, numerous posterior cervical interfascial plane block techniques have been developed in recent years. The injectate spreads along the fascial plane, blocking nerves that traverse the interfascial space after being injected into the target plane. The posterior cervical interfascial blocks have been manifesting the great potential for perioperative analgesia and chronic pain management in the head, neck, and shoulder regions. However, a comprehensive review of these methods as well as their indications, contraindications, and complications remain lacking. This article summarizes the anatomy of the posterior cervical musculofascial layers, highlighting the characteristics of interfascial plane block techniques and their potential limitations. By using the fascial anatomy as an entry point for studying interfascial plane blocks, it enhances our understanding of the mechanisms underlying the efficacy and complications of these block techniques. It not only reviews well-studied blocks such as trapezius plane (TP), multifidus cervicis plane (MCP), inter-semispinal plane (ISP), and erector spinae plane (ESP) block but also includes recently developed techniques from the past 5 years, such as the retrolaminar cervical block, serratus posterior superior intercostal plane (SPSIP) block, and C2 dorsal root ganglion (DRG) "three-in-one" block. The available evidence suggests that while posterior cervical interfascial plane blocks effectively target the dorsal rami of cervical nerves, non-posterior cervical block techniques also exhibit analgesic potential for the posterior cervical region. This review aims to provide insights for further exploration of novel approaches in this emerging field. In conclusion, posterior cervical interfascial plane blocks demonstrate significant clinical value and warrant further development and optimization.

Introduction: Differences in in-hospital pain and consumption of opioids after primary total hip arthroplasty (THA) and knee arthroplasty (TKA) have been rarely studied in a setting where the patient course is otherwise similar. The aim of this study was to compare early pain intensity and opioid usage between patients who have undergone THA and TKA to identify potential implications for outpatient surgery.

Methods: This institutional register study included 4655 patients receiving THA and 2675 patients receiving TKA. Pain at rest and during mobilization were collected once preoperatively, and postoperatively at five time-points, twice on the Day of surgery, once each on day 1 and day 2 after surgery, and at discharge, on a numeric rating scale (NRS) 0-10. Rescue opioids in oral morphine-equivalent doses (MME) were consecutively registered. Postoperative mobilization was registered twice daily.

Results: Overall mean pain were 2.0 (Cl 2.0-2.0) after THA and 2.3 (Cl 2.3-2.4) after TKA at rest, and 3.3 (Cl 3.3-3.3) and 3.7 (Cl 3.7-3.8) during mobilization, respectively. Patients undergoing TKA had a transient increase in pain intensity the day after surgery, whereas patients undergoing THA had improved pain levels. Outpatient criteria for pain (NRS < 5 during mobilization) were feasible for 37% of THA and 35% of TKA. Total median MME was 30.0 (0-573) after THA and 52.5 (0-390) after TKA. Patients undergoing TKA were less mobilized during hospitalization.

Conclusion: A comparable number of THA and TKA cases were eligible for same-day discharge based on outpatient discharge criteria for pain. Patients receiving TKA can expect an increase in pain intensity and opioid needs on the day after surgery.

Introduction: Image-guided spinal injections are commonly performed by pain physicians and supported by literature. A recent survey showed that half of the Canadian providers still perform landmark-guided injections. This comprehensive review aims to describe the evidence supporting imaging modalities (fluoroscopy, computed tomography (CT) and ultrasound) in improving the accuracy and safety in several commonly performed spine injections. Relevant anatomy and pitfalls of landmark-guided injections are also discussed.

Methods: An extensive literature search was conducted in PubMed, Medline and Embase databases, complemented by a manual search. Search terms included all spine interventions and imaging modalities.

Results: Literature shows that incorrect needle placement without imaging guidance can reach 50% in caudal, 30.4% in lumbar interlaminar and 53% in cervical interlaminar epidural steroid injections. Lumbar and cervical transforaminal steroid injections require imaging to identify intravascular or intradiscal needle placement; misplacement rates can be as high as 20% at cervical, 8% at thoracic, 6-15% at lumbar and 16.5-21% at sacral levels. Imaging techniques for sacroiliac joint steroid injections are superior to non-imaging techniques, while medial branch blocks and facet joint injections require image guidance.

Conclusion: Image guidance is a mandatory requirement when performing spinal procedures for pain management. Fluoroscopy enhances the safety and accuracy of spinal injections, with stored images benefiting patient records. Ultrasound also has an increasingly important role either alone or with fluoroscopy. CT is also effective but with limited accessibility.

Introduction: Patients at risk of developing chronic pain are often significantly impaired in their daily, social and work activities. An early interdisciplinary multimodal assessment (IMA) includes a systematically integrated view of medical, psychosocial and functional factors to direct patients to need-based treatment services. This multicentre, randomised, controlled trial examined the effects of an IMA on preventing chronic pain and improving care for adult patients.

Methods: The intervention group (IG) received an IMA in accordance with standardised guidelines. The control group (CG) was offered a unimodal medical pain assessment (MPA). Data from the Characteristic Pain Intensity (PI) and Disability Score (DS), as primary outcomes, were collected at assessment and 3 and 6 months later together with secondary outcomes (e.g. depression, anxiety, stress, catastrophizing, health-related quality of life).

Results: A total of 620 (68.4%) valid questionnaires were available at the 6-month follow-up. The mean reduction (numerical rating scale, 0-10) in terms of improvement within both groups (IG/CG) was 1.6/1.7 points for PI and 1.9/1.8 points for DS. Most secondary outcomes improved as well. However, the differences between the two groups did not reach statistical significance, although there was a tendency for the IG to have a greater effect on some psychological outcomes. Regarding the recommended treatment approaches, the focus in the IG was more on physical activity and psychological and psychosomatic interventions, whereas in the CG there was also a preference for adjusting the medication.

Conclusions: Both early MPA and IMA seem to have a positive effect on outcomes such as pain intensity, functional limitations and psychological factors for patients at risk of developing chronic pain. We critically reflect on the results of the primary research question by discussing the limitations in detail and conclude that further research should ensure that the control conditions reflect standard care and that the follow-up period is long enough.

Trial registration: German Clinical Trials Register (DRKS-ID: DRKS00015443).

Acute pain, a critical aspect of patient care, presents a challenge due to its subjective nature and complex biological underpinnings. Biomarkers for acute pain promise a paradigm shift in how pain is perceived, diagnosed, and managed. The study of genetic, inflammatory, and neurotransmission markers associated with pain experience may hold the key for the development of personalized and effective pain management strategies. This narrative review explores the neurobiological pathways of acute pain, encompassing inflammatory responses and neurotransmission mechanisms. It synthesizes current research on the identification and clinical application of biomarkers, emphasizing their potential to enhance diagnostic precision, treatment effectiveness, and risk prediction. We underscore the promising role of acute pain biomarkers in identifying patients at risk for developing acute and potentially chronic pain, predicting patients' response to pharmacological interventions, and aiding in the development of novel therapeutic and pain preventive strategies. The evolving landscape of biomarker research not only deepens our understanding of pain mechanisms but also lays the foundation for more tailored and patient-specific healthcare interventions.

Introduction: Patient satisfaction is important in pain management. Satisfaction with prescribed pain relievers and continued use of these drugs may be affected by a patient's understanding of their efficacy and safety. We investigated the association between patients' satisfaction and understanding of their prescribed medication for three oral pain relievers (lasmiditan, mirogabalin, and tramadol) that recently became available in Japan.

Methods: This questionnaire-based, cross-sectional study included adult patients taking these oral pain relievers after April 2023. The primary endpoint was overall satisfaction (five-point rating) and the secondary endpoint was overall understanding (five-point rating) of the oral pain relievers.

Results: In total, 328 patients (lasmiditan, 36.9%; mirogabalin, 55.5%, tramadol, 8.8%; four patients had been prescribed more than one medication) were included, and 71.6% of patients reported high satisfaction (score 4, 5) with their oral pain relievers (lasmiditan, 62.0%; mirogabalin, 76.1%; tramadol, 85.2%). The proportion of patients in the total population who reported a high understanding (score 4, 5) of their oral pain relievers was 68.0% (lasmiditan, 77.7%; mirogabalin, 63.3%; tramadol, 55.6%). In the total population and the lasmiditan and mirogabalin subgroups, the patient satisfaction level was significantly associated with scores on medication understanding (Cochran-Armitage test, p < 0.0001 for all). Discontinuation rates were higher in patients who were unsatisfied with their treatment than those who were satisfied (38.7% and 9.8%, respectively).

Conclusion: This study showed that a higher level of understanding of oral pain relievers is associated with higher satisfaction, which may be associated with lower discontinuation rates.

Clinical trial registration: UMIN000052629.

Introduction: Chronic knee pain caused by osteoarthritis (OA) is a prevalent source of disability in the adult population. Total knee arthroplasty (TKA) is an effective surgical treatment for advanced disease, but many patients continue to suffer from chronic post-surgical pain (CPSP). In recent years, minimally invasive techniques targeting peripheral nerves have been explored. Cryoanalgesia of the genicular nerves (GNCryo) is one such intervention that disrupts sensory input by applying extremely low temperatures to the target nerves, potentially leading to sustained pain relief without the need for neurodestructive heat lesions. This study aims to evaluate the effectiveness of ultrasound-guided GNCryo in patients with chronic knee pain due to primary OA or CPSP after TKA.

Methods: This retrospective, single-center study included 90 patients who underwent GNCryo between September 2021 and February 2023. Inclusion criteria were patients over 18 years of age, symptomatic knee OA or CPSP after TKA, and a positive response (≥ 50% pain relief) to diagnostic genicular nerve blocks. Ultrasound guidance was used to optimize needle placement and reduce complications. Clinical outcomes were assessed at baseline and at 1, 3, 6, and 9 months post-procedure. Outcome measures included the Visual Analog Scale (VAS, 0-10) for pain intensity, the Western Ontario and McMaster Universities Arthritis Index (WOMAC, 0-100) for assessing pain, stiffness, and physical function related to OA, the Douleur Neuropathique en 4 Questions (DN4, 0-10) for neuropathic pain, and the EuroQol 5-Dimension (EQ-5D, 0-100) for quality of life.

Results: Ninety patients completed the 9 months follow-up. The median VAS score decreased from 7.0 (6.0, 8.0) at baseline to 4.0 (3.0, 5.0) at 1 month, remained at 4.0 (3.0, 5.0) at 3 months, and increased slightly to 5.0 (4.0, 5.0) at 6 months and 5.0 (4.0, 6.0) at 9 months, yet pain relief remained lower than baseline. WOMAC scores decreased from 65 (55, 71) at baseline to 35 (30, 40) at 1 month and 35 (30, 40) at 3 months, increased to 40 (35, 50) at 6 months and 55 (45, 65) at 9 months. DN4 scores decreased from 7 (5, 8) at baseline to 4 (3, 4) at 1 month and 3 (2, 4) at 3 months, increased to 3.5 (3, 5) at 6 months and 5 (4, 6) at 9 months, yet remained lower than baseline. EQ-5D scores increased from 64.5 (47, 84) at baseline to 42 (32, 58) at 1 month, 43.5 (31, 59) at 3 months, 45.5 (35, 60) at 6 months, and 52 (41, 72) at 9 months.

Conclusions: Ultrasound-guided GNCryo is a promising minimally invasive treatment for chronic knee pain, providing pain relief and improved quality of life for up to 9 months. Although some outcomes showed a trend toward baseline over time, pain relief remained lower than baseline, consistent with potential nerve regeneration or recovery. Larger prospective, controlled trials are necessary to confirm these findings and to

Introduction: Lumbar prolapsed disc (LPD) is a leading cause of low back pain, contributing significantly to global disability and healthcare burden. This study aimed to develop machine learning models to predict the risk of LPD by analysing gene expression profiles for early detection.

Methods: Transcriptomic data from peripheral blood samples were obtained from the Gene Expression Omnibus (GEO) database, with dataset GSE150408 used for training and GSE124272 for testing. The training dataset included 17 patients with sciatica resulting from LPD, all of whom had magnetic resonance imaging confirmation of single-level LPD at either the L4/5 or L5/S1 levels. Data from 17 healthy volunteers were used as controls. Recursive feature elimination (RFE) was employed to identify the most relevant gene signatures among 23 pain-related genes. Machine learning models, including support vector machine (SVM), random forest, k-nearest neighbours (KNN), logistic regression, and Extreme Gradient Boosting (XGBoost), were trained and evaluated. Model performance was assessed using accuracy, area under the curve (AUC), F1 score, and Matthews correlation coefficient (MCC).

Results: Eight key gene signatures were identified as significant predictors of LPD, with MMP9 exhibiting the highest importance score. Most of these genes were differentially expressed between patients with LPD and healthy controls (p < 0.05). Among the models, random forest demonstrated the highest accuracy (0.80, 95% CI 0.73-0.85) and MCC (0.64, 95% CI 0.53-0.76), followed by KNN, XGBoost, and SVM. Overall, the random forest model exhibited the most robust performance in predicting the risk of LPD.

Conclusion: The results of our study suggest that machine learning models based on pain-related gene signatures may identify patients at high risk of developing LPD with reasonably high accuracy. These prediction models could perhaps be integrated into clinical diagnostic tools to enhance early diagnosis and prevention.