Pain Research & Management最新文献

Background: Pain control remains a cornerstone in endodontic practice, particularly in cases of symptomatic irreversible pulpitis where achieving profound anaesthesia is often challenging. As the inferior alveolar nerve block (IANB) frequently fails to provide profound pulpal anaesthesia, optimizing pain control in such cases requires evidence-based modifications to anaesthetic techniques and the use of supplemental approaches.

Aim: This narrative review aims to synthesize current evidence on clinical strategies for improving pain management in mandibular molars with symptomatic irreversible pulpitis, with particular emphasis on enhancing the efficacy of IANB and supplemental injection techniques.

Methods: A narrative review methodology was employed to synthesize clinical trials and systematic reviews published between 1975 and 2025.

Results: Evidence indicates that increasing the anaesthetic volume and applying supplemental techniques, including intraligamentary, intraosseous and intrapulpal injections, significantly enhances anaesthesia success. Adjunctive measures such as cryotherapy and temperature modification of anaesthetic solutions further improve pain control. The integration of these methods provides a predictable and multimodal approach to managing endodontic pain in challenging clinical scenarios.

Conclusion: Effective pain management in mandibular molars with symptomatic irreversible pulpitis relies on a comprehensive strategy that combines optimized anaesthetic volume and supplemental techniques. Intrapulpal anaesthesia remains essential for achieving pulpal anaesthesia when all other techniques fail. Continued clinical research is essential to refine these approaches and establish standardized protocols for achieving reliable anaesthesia in endodontic practice.

Background: Although pain management plays an important role in the treatment of acute pancreatitis (AP), current guidelines lack clear and consistent recommendations for the management of abdominal pain. The aim of this study was to investigate factors associated with analgesic use in Chinese hospitalized patients with AP.

Methods: This was a single-center retrospective study. Patients discharged with a diagnosis of AP were consecutively included. Patients were divided into the analgesic group and the nonanalgesic group based on whether they received analgesic therapy. Clinical parameters, including baseline pain scores and serum lipase level, were compared using univariate analysis and multivariate logistic regression.

Results: A total of 151 patients were included, with 69 (45.7%) receiving analgesic treatment and 82 (54.3%) receiving no analgesics. Patients with moderate-to-severe pain (score 4-7) at admission were 6.86 times more likely to receive analgesics than pain-free patients (95% confidence interval [CI]:1.12-41.99, p = 0.037). Moderately severe and severe AP (vs. mild) were associated with 2.94-fold (odds ratio [OR] = 3.94, 95% CI: 1.19-12.98, p = 0.024) and 4.05-fold (OR = 5.05, 95% CI: 1.22-20.8, p = 0.025) increased risk of analgesic use, respectively. Although 108.1 U/L ≤ lipase level < 293.4 U/L and 293.4 U/L ≤ lipase level < 809.6 U/L (vs.< 108.1 U/L) did not significantly increase analgesic use risk, patients with lipase level ≥ 809.6 U/L had a 2.8-fold increased risk (OR = 3.8, 95% CI: 1.27-11.37, p = 0.017).

Conclusions: Elevated serum lipase (≥ 809.6 U/L), higher baseline pain scores, and AP severity are key factors associated with analgesic use in Chinese AP patients. These findings highlight serum lipase as a potential biomarker for individualized pain management strategies in AP.

Background: Research highlights the potential role of physical activity (PA) in preventing chronic pain and reducing both acute and persistent pain symptoms. While increasing PA is an evidence-based intervention for chronic pain, the relationship between pain processing and PA remains unclear. This study aimed to investigate associations of both PA and fitness assessments with multiple measures of pain sensitivity, hypothesizing links with both static and dynamic pain sensitivity metrics.

Methods: Sixty-four healthy adults (30 female) representing both high and low activity levels completed a series of pressure-based quantitative sensory tests (QST), including static measures (pressure pain thresholds [PPTs]) and dynamic measures (temporal summation [TS] and conditioned pain modulation [CPM]). PA was evaluated using the International Physical Activity Questionnaire (IPAQ, self-report) and accelerometry (objective). Cardiorespiratory fitness (CRF) was assessed using the YMCA step test. Correlation and regression analyses were used to evaluate these relationships.

Results: Higher PPTs were related to more self-reported moderate-to-vigorous PA, vigorous PA, and total PA; accelerometry vigorous PA; and high CRF (p ≤ 0.01). Self-reported vigorous PA was inversely correlated with TS (p = 0.01), while the other PA or CRF metrics were not significantly associated with either TS or CPM (p ≥ 0.04).

Conclusion: CRF or vigorous PA metrics were more consistently related to static pressure QST (PPT) than to dynamic QST (TS and CPM). Our findings in a single cohort mirror the inconsistencies noted across cohorts in the literature, suggesting that PA and CRF exhibit distinct relationships with various QST measures.

Background: Prior research has demonstrated the clinical efficacy of two specialized Tuina techniques, namely, high-speed oblique Tuina (HSOT) and low-speed oblique Tuina (LSOT), in the treatment of lumbar disc herniation (LDH). These techniques integrate principles of traditional Chinese medicine with modern manual therapy. Despite their proven therapeutic benefits, the biomechanical effects of HSOT and LSOT on spinal structures remain poorly understood.

Aim: Finite element analysis (FEA) was utilized to investigate the biomechanical effects of HSOT and LSOT on a patient with LDH, aiming to elucidate their underlying treatment mechanisms.

Methods: The mechanical parameters of HSOT and LSOT applied to a participant with left L4/5 LDH were meticulously measured using a state-of-the-art Multipoint Thin Film Pressure Testing System. These comprehensive data, along with the corresponding high-resolution computerized tomography (CT) scan data, were subsequently input into four advanced finite element analysis (FEA) software programs. These programs were employed to conduct a detailed analysis of the stress-strain characteristics of both HSOT and LSOT on the spinal structures, enabling a thorough comparison of their biomechanical effects and potential therapeutic outcomes.

Results: The maximum stress and average displacement of vertebral and ligamentous structures during HSOT in the lumbar vertebrae-pelvis model doubled those of LSOT. HSOT caused the maximum average displacement of the L4/5 right intertransverse ligament, whereas LSOT induced the maximal mean displacement of the L4/5 left intertransverse ligament. Additionally, HSOT caused the maximum average displacement of the right iliolumbar ligament, but the maximum mean displacement was observed in the left iliolumbar ligament during LSOT.

Conclusion: Both HSOT and LSOT produced small displacements of the lumbar and pelvic structures, but HSOT elicited significantly greater displacement and stress on various spinal tissues than LSOT. These mechanical responses may be the biomechanical effects of HSOT and LSOT in people with LDH. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2200065450.

Background: Ganglion impar block (GIB) is a commonly used interventional option for refractory chronic coccydynia. Caudal epidural steroid injection (CESI) targets the sacral and coccygeal roots and may theoretically augment the analgesic efficacy of GIB. Evidence comparing GIB alone with a combined GIB and CESI approach, however, remains limited. This study compared long-term pain outcomes after GIB monotherapy versus GIB combined with CESI.

Methods: In this retrospective single-center study (Jan 2020-May 2025), we evaluated 56 adults with chronic coccydynia who underwent GIB alone (Group A) or in combination with CESI (Group B). Pain intensity was assessed using the 11-point numeric rating scale (NRS-11) at baseline and at 1 h, 1 month, and 6 months after the procedure. Multivariable logistic regression was used to explore predictors of 6-month response, including early postprocedural pain change and sex.

Results: Significant improvements in pain intensity were observed in both groups and sustained over 6 months. Responder rates at 6 months were comparable between the GIB-only (41.7%) and GIB with CESI (45.0%) groups (p > 0.05). Multivariable analysis revealed that greater early pain relief (baseline to 1 h) significantly predicted 6-month favorable outcomes (OR: 2.08; 95% CI: 1.26-3.42; p = 0.004), whereas male sex was associated with significantly reduced odds of response (OR: 0.11; 95% CI: 0.02-0.72; p = 0.022).

Conclusions: In this single-center retrospective cohort, GIB was associated with sustained pain relief in a substantial proportion of patients with chronic coccydynia, while the addition of CESI did not confer a clear incremental benefit. Importantly, immediate postprocedural pain relief served as a robust predictor of long-term success, whereas male sex was identified as a negative prognostic factor. Prospective, adequately powered randomized trials are needed to confirm these exploratory findings and to refine patient selection for GIB-based interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT07200765.

Objectives: We aimed to investigate changes in pain perception, acute exercise-induced hypoalgesia (EIH), and endogenous pain modulation responses following 4-week treadmill running exercises of different intensities in healthy individuals.

Methods: Fifty-six healthy individuals were included in this study. All participants were randomly assigned to a control group and three experimental groups (treadmill running at high intensity [TRH], treadmill running at moderate intensity [TRM], and treadmill running at low intensity [TRL]). All participants performed 12 treadmill running sessions within 4 weeks at different intensities based on their target heart rate (THR). A running assessment was administered 1 week before running sessions. The magnitudes of EIH, conditioned pain modulation (CPM), and temporal summation (TS) responses following regular treadmill running were assessed. Pressure pain thresholds (PPTs) or mechanical pain thresholds (MPTs) were also determined following regular treadmill running.

Results: All groups exhibited an EIH effect (p < 0.001, F = 9.424) with an increase in PPT and MPT during the running sessions (p = 0.004 and F = 2.084), and the TRM and TRL groups were significantly higher than the TRH group (p < 0.001). The CPM of the TRM and TRL groups significantly increased (p < 0.001), and the TS of the TRM significantly decreased (p < 0.001). Correlation analysis showed that the acute EIH-A (r = 0.724, p < 0.001), EIH-L (r = 0.726, p < 0.001), and EIH-M (r = 0.347, p = 0.009) were positively correlated with the CPM, while EIH-A (r = -0.529, p < 0.001) and EIH-L (r = -0.544, p < 0.001) were negatively correlated with the TS.

Conclusion: A 4-week low-to-moderate intensity treadmill running improved acute EIH response by enhancing endogenous pain modulation in healthy individuals. Future studies should consider sex, behavior, and physiological factors to provide a comprehensive understanding of the changes in EIH following regular exercises.

Trial registration: ClinicalTrials.gov identifier: ChiCTR2300074367.

Objectives: To explore existing evidence and identify whether dry needling (DN) intervention has effects on sleep disturbance in patients with musculoskeletal pain.

Methods: The Arksey and O'Malley framework guided the scoping review methodology. Seven databases were searched for clinical trials investigating DN in musculoskeletal pain disorders. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Data extraction included study year, location, study design, musculoskeletal pain disorder, needling intervention type, and sleep outcome measure utilized.

Results: After duplicates were removed, 2292 articles were identified, and 33 studies were included in the review after independent screening. Two supplemental searches (May 2023 and January 2024) in addition to a hand search yielded an additional 146 articles. A total of 21 of those studies were also included, increasing the total to 54 studies. A total of 46 (84%) articles were RCTs and 8 (16%) were single-group, pretest-posttest clinical trials. A total of 9 studies were of optimal quality (PEDro score ≥ 8), and 11 were of moderate-to-high quality (PEDro score = 7).

Discussion: Due to significant variability in intervention, sleep outcome measurement, patient population, and study methodology quality, the evidence is mixed and inconclusive to support or refute the effects of DN on sleep deficits in individuals with musculoskeletal pain. However, future studies investigating the effects of needling interventions on musculoskeletal pain conditions should include valid sleep outcome measurements if considered.

Background: Studies revealed that contact-heat stimulations mediate pain perception due to temporal summation of second pain (TSSP). How heat intensity affects the reliability of the pain rating of individuals with different heat tolerance is not well examined. This study investigated (1) the influence of the preceding contact-heat stimuli with different levels of intensity on the reliability of subjective pain rating and (2) the differences in reliability of subjective pain rating of participants with high and low sensory sensitivity or heat tolerance.

Method: Participants with intact sensory function were divided into (1) high (n = 17) and low (n = 13) sensitivity groups based on the cutoff temperature of 42°C or (2) high (n = 18) and low (n = 12) pain-tolerance groups based on the cutoff temperature of 47°C equivalent to numerical rating scale (NRS) of 7. In each trial, participants were given a pair of 2-s contact-heat stimuli (an interstimulus interval of 2.5 s) at the left thenar eminence and were asked to report an NRS rating. Four blocks of intensity combinations were given: Low-Low, High-High, Low-High, and High-Low conditions, with 72 trials in each block.

Results: Findings revealed that high heat-tolerance group results had lower intraclass correlation coefficients (ICCs) when contact-heat stimuli were preceded by another with higher intensity (ICC = 0.551-0.747) compared to those preceded by lower intensity (ICC = 0.724-0.818). In contrast, the ICCs of the low heat-tolerance group were found to be relatively higher regardless of heat intensity (ICC = 0.595-0.806).

Conclusions: The TSSP effect reflected by lower pain rating reliability appears to be induced in the high heat-tolerance group when a contact-heat stimulation is preceded by another stimulation with higher intensity but with the same duration. This is possibly due to the longer offset time of contact-heat stimulations with higher intensity, and also the top-down modulatory effects in this high heat-tolerance group. Further electrophysiological studies would be needed to investigate the underlying neural processes of TSSP in individuals with different heat tolerance.

Background: Joint pain is a major cause of chronic disability worldwide, with complex mechanisms and limited treatment options. Inflammatory cytokines have been implicated in the pathogenesis of joint pain; however, their causal roles remain unclear. This study employed Mendelian randomization (MR) to explore the causal relationships between 41 inflammatory cytokines and the risk of joint pain.

Methods: We integrated genome-wide association study (GWAS) summary statistics from European-ancestry populations, including data on joint pain (1451 cases and 461,559 controls) and inflammatory cytokine levels (8293 Finnish participants). Genetic variants meeting instrumental variable assumptions (p < 1 × 10^-5) were selected. Causal estimates were derived using inverse-variance weighted (IVW), weighted median, and MR-Egger regression. Sensitivity analyses incorporated Cochran's Q test, MR-Egger intercept analysis, and leave-one-out validation to evaluate heterogeneity and potential pleiotropy.

Results: Cutaneous T-cell attracting chemokine (CTACK)/CCL27 (OR: 0.998 and 95% CI: 0.996-0.999) and interleukin-2 receptor α subunit (IL-2RA) (OR: 0.997 and 95% CI: 0.995-0.999) were inversely associated with the risk of joint pain, while interleukin-18 (IL-18) (OR: 1.0007 and 95% CI: 1.0001-1.0012) demonstrated a positive causal relationship. Sensitivity analyses supported the robustness of the main findings (Cochran's Q p = 0.413), though evidence of horizontal pleiotropy was detected (MR-Egger intercept p < 0.05).

Conclusion: This study identifies IL-18, CTACK, and IL-2RA as potential causal mediators of joint pain, providing genetic evidence that informs future precision approaches to analgesia. Future research should validate these findings across diverse populations and elucidate the molecular mechanisms underlying them to advance targeted therapies.