Pain management最新文献

Acute pain is a prevalent clinical concern that impacts millions worldwide and often initiates opioid use. Despite advances in multimodal analgesia, challenges such as opioid dependency, under-treatment, and patient heterogeneity persist. This narrative review aims to present recent evidence on emerging technologies in acute pain management, covering innovations in diagnostics, therapeutics, and drug delivery systems. We searched PubMed and Embase databases and included studies from 2015 to 2025 that presented positive evidence of the investigation of these technologies. The review identifies a wide range of emerging tools and interventions, including digital pain assessment scales, wearable biosensors, virtual reality, hypnosis, music therapy, and multimodal distraction. Pharmacological innovations such as sublingual sufentanil, liposomal bupivacaine, Nav 1.8 inhibitors, cebranopadol, and co-crystals of tramadol-celecoxib also show promise. Novel delivery systems - oral patient-controlled analgesics devices, transdermal iontophoretic fentanyl, and bioresorbable nerve stimulators - further enhance individualized pain control. Technological advancements are expanding the toolkit for acute pain management, offering non-opioid, patient-centered, and precision-based alternatives. However, further large-scale and longitudinal studies are required to validate their efficacy, safety, and cost-effectiveness across diverse patient populations and clinical settings.

Introduction: Chronic pain exerts an enormous personal and economic burden, affecting around 30% of people worldwide yet both patients and providers report low satisfaction with chronic pain care. One of the potential causes stems from insufficient decision-making autonomy in chronic pain patients that hampers their ability to properly get involved in their treatment regimen. Improving said autonomy should thus allow better management in the clinical setting.

Methods: Via a conceptual and philosophical exploration informed by targeted literature, this Perspective examines the role of decision‑making autonomy in the care of patients living with chronic pain, a specific subject that is scarcely addressed in the literature.

Results: In chronic pain, patient autonomy is not only an ethical principle to be respected, but also a competence to foster. Promoting decision-making autonomy can improve pain management by fostering necessary patient empowerment and better involvement in one's treatment regimen.

Discussion: Concepts and specific tools exist that can help clinicians better evaluate and promote patient decision-making autonomy in their pain practice. Future avenues for research are suggested to help ensure that autonomy is better assessed in the clinical setting.

Aims: Persistent neck pain is a leading cause of years lived with disability. The aim of the current study is to describe and evaluate cognitive functional therapy for patients with persistent neck pain.

Methods: We recruited 74 patients (73% women) aged 22-76 years, with persistent neck pain. The outcomes were neck pain at activity and rest measured by 11-point numeric rating scales (NRS), disability by Neck Disability Index (NDI) (0-100), Fear Avoidance Beliefs Questionnaire (FABQ), Hopkin Symptom Check List (HSCL-10) at baseline and post-treatment. The treatment program included 5 sessions and focused on cognitive strategies and exposure to physical activities.

Results: Sixty (81%) patients had follow-ups. Neck pain during activity was reduced by a mean of 3.3 (95% Confidence interval (CI) 2.6 to 3.2) and 2.5 (95% CI 1.9 to 3.1) at rest. NDI was reduced by 16.3 (95% CI 12.0-20.5). Similar large improvements were observed for FABQ and HSCL-10. Ninety-eight percent of the participants reported that they would recommend the program to other patients.

Conclusions: Clinically relevant improvements were observed in pain, disability, fear-avoidance beliefs, and emotional distress following CFT in patients with persistent neck pain.

Objective: The primary objective is to characterize patients presenting to a multidisciplinary spine center to understand sociodemographic features, pain characteristics, and functional status across diagnoses. The secondary objective is to identify factors associated with worse outcomes in radiculopathy patients.

Methods: In this retrospective, registry-based cohort study, we extracted questionnaire and EHR data for 10,069 patients. Baseline sociodemographic, clinical, and pain-related were examined across the top 10 diagnostic categories. Thereafter, we performed an analysis of radiculopathy patients (n = 653) using GLMM with random intercepts to identify baseline factors associated with changes in NRS and PROMIS-PI.

Results: At presentation, patients had moderate pain intensity (mean NRS:5.1, SD:2.1), significant impairment in PROMIS-PI (mean:64.6, SD:7.9), and PROMIS-PF (mean:37.7, SD:8.9), regardless of the diagnosis. Longitudinal analysis of radiculopathy patients identified multiple statistically significant factors (p < 0.05) associated with worse outcomes, including sleep interference, depression/anxiety, smoking, BMI, and being female, Black/African American, or Asian race.

Conclusions: This study explores predictors of poor outcomes that may identify opportunities for interventions targeting modifiable risk factors and highlights the need for further research into how health disparities influence treatment outcomes. Identifying non-responders could improve selecting effective treatments through precision care, ultimately reducing costs and disability associated with chronic pain.

Ketamine's clinical role has expanded beyond anesthesia into a mechanism-based, non-opioid analgesic used across acute, perioperative, and chronic pain settings. As a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine attenuates central sensitization, modulates opioid tolerance, and enhances descending inhibitory control. At subanaesthetic doses (0.1-0.5 mg/kg), it consistently reduces pain scores and postoperative opioid consumption while maintaining hemodynamic and respiratory stability. In acute and perioperative care, analgesic efficacy is comparable to opioids, though clear superiority has not been demonstrated. In chronic pain, particularly complex regional pain syndrome (CRPS), multi-day infusions provide temporary relief, but durability remains limited. In cancer-related pain, ketamine offers adjuvant benefits for opioid-refractory syndromes with variable outcomes. Short-term adverse effects such as dizziness and mild dysphoria are common, whereas psychomimetic symptoms, hepatobiliary injury, and cystitis restrict prolonged use. Overall, ketamine provides context-dependent, opioid-sparing analgesia with defined but specific clinical utility. Its evolving role in pain management will likely remain targeted, emphasizing patient selection, standardized dosing, and realistic expectations for benefit.

Background: This study evaluated the feasibility of two minimally equipped, blended supervised and tele-supported exercise programs, a moderate intensity training (MIT) and high intensity training (HIT) program, in healthy sedentary adults, and explored signals of efficacy on central pain processing.

Methods: Participants were randomized to a 10-week MIT or HIT program, each comprising one supervised group session and two tele-supported home-based sessions per week. MIT involved a Start-to-Run protocol at 60-70% of heart rate reserve, while HIT involved strength exercises at > 80% of predicted maximum heart rate. Feasibility outcomes included recruitment, retention, adherence, and acceptability. Quantitative sensory testing (QST) assessed central pain processing pre- and post-intervention.

Results: Eighteen participants were enrolled (8 MIT, 10 HIT). Retention was lower in the MIT group (5 completed) than the HIT group (11 completed), with high adherence in both. Participants appreciated the blended format but noted challenges with digital tools, and suggested refinements. No significant differences in QST outcomes were observed, likely due to small sample size and inter-individual variability. Individual responses suggested reduced pain inhibition following MIT and enhanced inhibition after HIT.

Conclusions: Both programs were feasible, supporting a larger-scale study to optimize implementation and confirm effects.

Clinical trial registration: ClinicalTrails.gov (ID: NCT06207422).

Aim: To evaluate patients' pain perception and satisfaction, with ethyl chloride spray compared to placebo during intravenous cannulation.

Methods: A randomized, double-blinded, placebo-controlled trial in emergency-observation ward of a tertiary-care-hospital was conducted from February 2023 to January 2024. A total of 417 patients were randomly assigned to experimental (n = 209) or control group (n = 208). Patients underwent intravenous cannulation in antecubital fossa (left/right). Pain perception and patient satisfaction following the use of ethyl-chloride-spray (ECS) compared to placebo, assessed using a 0-10 Verbal-Numeric-Rating-Scale and satisfaction questionnaire. Nurses' satisfaction with ECS and placebo, evaluated by Likert-scale, along with the observation of adverse effects. Final data analyzed using STATA, included 404 participants (202 in each group).

Results: Demographic, clinical profile, and baseline pain perception scores between groups did not show any significant differences. Experimental group reported significantly less pain than control (p < 0.001). Nurses found cannulation easier in 43% of experimental cases versus 33% in controls (p < 0.001). In experimental group, 81% of patients were satisfied and recommended ECS for future use. In both groups, no adverse effects were reported.

Conclusion: Ethyl chloride spray significantly reduced pain perception during intravenous cannulation. High levels of patient satisfaction and nurse endorsement for pain management during IV cannulation.

Clinical trial registration: https://ctri.nic.in/Clinicaltrials/login.php, identifier is CTRI/2019/09/021285.

Aim: This study aimed to evaluate the effectiveness of an inpatient multidisciplinary program for patients diagnosed with Functional Neurological Disorder (FND) presenting with chronic pain.

Methods: Data was obtained from 100 patients with FND who completed a four-week inpatient multidisciplinary team (MDT) program between 2021 and 2023. Clinical outcomes were compared between patients presenting with chronic pain as their main symptom and those without predominant pain. The results were also compared to data collected nine years earlier.

Results: FND patients with predominant chronic pain showed significant improvements in ratings on depression and anxiety symptoms, occupational and health status, including pain. Patients without predominant pain also significantly improved in their outcome measures. The extent of overall improvement did not differ significantly between the groups. Compared to earlier data, there was a shift from opiates to increased prescribing of neuropathic pain agents. A significant increase in referrals of FND patients with chronic pain was also observed over time.

Conclusions: Our findings suggest that FND patients presenting predominantly with chronic pain can benefit from inpatient multidisciplinary rehabilitation. Further research is needed to confirm these findings. Integrating a pain management team, particularly to address opiate medication use, would promote a more cohesive approach to treatment.

Greater trochanteric pain syndrome (GTPS), a common cause of hip pain, is typically managed with conservative treatments such as physical therapy and corticosteroid injections. However, some cases do not respond to these conservative treatments, so alternative therapeutic options become necessary. Peripheral nerve stimulation (PNS) is a promising modality for chronic pain management and may be effective for GTPS. A 71-year-old female with a BMI of 30 kg/m² and chronic left hip pain for over a year, unresponsive to conservative treatments, underwent temporary PNS lead placement targeting the trochanteric branch of the femoral nerve. Within one week, she reported a 90% reduction in pain, improving to 95% at two months. She regained independent mobility and improved quality of life. Leads were removed at two months, with benefits sustained at 24 months. This is the first reported case of successful PNS (SPRINT PNS System, SPR Therapeutics, Cleveland, Ohio, US) targeting the trochanteric branch of the femoral nerve for treating GTPS.

Neuropathic pain is a common but often under-recognized and undertreated complication of Guillain-Barré syndrome (GBS), with the potential to significantly hinder rehabilitation. We describe the case of a young man with GBS who developed severe upper limb pain, allodynia, and hyperalgesia that were refractory to intravenous immunoglobulin and pharmacologic treatment. The pain caused significant distress and limited therapy participation. A structured trial of transcutaneous electrical nerve stimulation (TENS) was introduced as part of a multimodal rehabilitation program, alongside pharmacological analgesia and routine physical therapy - initially administered during a six-week inpatient stay, then independently at home for another six weeks. High-frequency TENS was applied over the contralateral left paraspinal region at C6-T1, targeting the right upper limb. By weeks two and six, the patient demonstrated clinically meaningful pain relief (revised Short-form McGill Pain Questionnaire), decreased reliance on analgesics, and improved functional independence (motor Functional Independence Measure). Further gains were observed at 12-week follow-up. TENS was well tolerated with no reported adverse effects. This case highlights the potential role of TENS as a safe, noninvasive adjunct for managing GBS-related neuropathic pain and supporting functional recovery. It may also promote long-term self-management beyond the inpatient setting.