Pain management最新文献

Aims: In low back pain (LBP) research, recovery is commonly used as an outcome measure. However, there is no method used to measure recovery or acceptable definition for recovery. This research aims to investigate patients' perceptions of recovery from LBP.

Materials & methods: A cross-sectional survey was conducted in which 350 patients with chronic LBP participated. Demographic and clinical information was collected by a comprehensive and inclusive questionnaire. A checklist of improvement indicators was given to the patients and completed by them. It was aimed to identify the most important criteria for recovery in patients with chronic LBP.

Results: The results showed that pain reduction alone is not a reliable indicator of recovery. The patients' view about the recovery from chronic LBP includes a wide range of factors in different areas of symptomatic improvement, fear of recurrence injury, functional disability, fatigue and reduced energy level. Also, a significant correlation was observed between recovery indicators and pain duration, body mass index, and pain intensity in patients with chronic LBP.

Conclusions: The framework of recovery for patients with chronic LBP is complicated and is a highly individual structure. It is determined by the impact of symptoms on activities of daily living factors.

Background: Gynecologic enhanced recovery after surgery (ERAS) pathways have been developed to reduce postoperative narcotic use through multimodal pain management. While incisional injection of local anesthetic is standard practice, regional nerve blockades using liposomal agents are emerging as a promising adjunct technique for post-laparoscopy pain. Current data are conflicting regarding the benefits of regional nerve blocks on postoperative pain after laparoscopic hysterectomy.

Objectives: To determine the impact of preoperative quadratus lumborum (QL) block on postoperative pain following laparoscopic hysterectomy. Our primary outcomes will be intraoperative and immediate postoperative opioid use (within 24 hours). Secondary outcomes will include pain scores, functional impact of pain, and postoperative complications.

Study design: This is a prospective, double-blind, randomized-controlled trial comparing opioid use in women undergoing laparoscopic hysterectomy who receive a preoperative QL block to local injection. Seventy-six patients undergoing laparoscopic or robotic hysterectomy will be randomized to the study arm, preoperative QL block with liposomal bupivacaine and intraoperative placebo incisional injection of 0.9% saline, or the control arm, preoperative sham QL block with 0.9% saline and intraoperative incisional injection of 0.25% bupivacaine. Outcomes will be measured at several timepoints: intraoperative, postoperative prior to discharge, and 1, 3, 5, 14 days, and 4-6 weeks postoperatively.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT06709716.

Pudendal neuropathy is a cause of pelvic pain, specifically pudendal neuralgia. The pudendal nerve is related to sensory, motor, and autonomic functions. We present the case of a 41-year-old man who suffered from chronic pelvic pain. In detail, the patient described stinging burning pain in the glans penis, proctalgia, lower urinary tract symptoms, sensation of "muscle tension" and squeezing pain. He was diagnosed with prostatitis and, following, pudendal neuralgia. Our patient was treated with antibiotics and analgesics, without improvement of symptoms. He was then submitted to decompression surgery of the pudendal nerve, with partial improvement. The patient started a rehabilitation program and was treated with OnabotulinumtoxinA (BoNT-A) injections into the piriformis muscle with benefit. BoNT-A positive effects on pain relief may corroborate piriformis muscle compression of the pudendal nerve. BoNT-A may also reduce the release of neurotransmitters from the pain pathways. Early identification of pudendal neuralgia could have prevented the progression to chronic pain. There is still not an established role for BoNT-A in post-operative pudendal nerve decompression patients. Our case corroborates that more studies should be performed to explore BoNT-A administration in these patients.

Fremanezumab is a monoclonal antibody inhibiting the CGRP signaling leading to migraine prophylaxis. Its efficacy and potential safety concerns are updated here. All available data on fremanezumab were searched in PubMed with emphasis on the mechanisms of action, efficacy, tolerability, and safety. There is class I evidence for the efficacy of fremanezumab in the prophylaxis of both EM and CM, by reducing 1 to 2 monthly migraine days over placebo, but in real-world studies the magnitude of efficacy was greater. Though the size of efficacy looks like that of some repurposed anti-migraine treatments, its excellent tolerably highly improves the likelihood to help versus harm outcome over all traditional medications. Fremanezumab works in people with migraine and medication overuse, in people with previous treatment failures, as well as in people with concomitant depression, improving both migraine and depression measures. The latest data, along with the recent approval for use in children and adolescents, are unique among all migraine treatments. Alone or in combination with botulinumtoxin A may improve resistance to migraine. Mild reactions at the injection site are the most common side effects. Thus, fremanezumab represents an optimal treatment for people with migraine and should be considered as first-line choice.

Aim: We developed a simple dynamic orthosis for lateral epicondylitis (DOLE) assisting wrist extensors. This study aimed to compare the pain-relieving effects of DOLE and the counterforce brace in patients with lateral epicondylitis during pickup motion.

Patients & methods: Eighteen patients with lateral epicondylitis performed a pickup test using a 1 kg sandbag under three conditions: without a brace, with a counterforce brace, and with DOLE. Pain during the task was assessed using a visual analogue scale (VAS). The pain-relieving effect was calculated as the percentage reduction in VAS compared to baseline (without an orthosis).

Results: The VAS in the pickup test was 63.2±18.8 mm without orthosis, 53.9±21.0 mm with the counterforce brace, and 38.9±17.0 mm with DOLE. The pain-relieving effect was 0.11 (0-0.20) for the counterforce brace and 0.38 (0.24-0.52) for DOLE, which was greater in DOLE than in the counterforce brace (p = 0.001).

Conclusion: DOLE significantly reduced lateral elbow pain during pickup motion, outperforming the counterforce brace; however, given the relatively small sample size, these findings should be interpreted as preliminary evidence requiring confirmation in larger longitudinal studies. Its simple, worker-friendly design and strong pain-relief effect suggest its potential utility in treating lateral epicondylitis.

Background: Aim of the present study was to investigate the postoperative pain outcome following the implementation of a superficial parasternal intercostal plane (SPIP) block in children undergoing cardiac surgery with a sternotomy.

Methods: We conducted a retrospective cohort study in children undergoing extracardiac Fontan operation or a secundum atrial septal defect closure receiving a SPIP in addition to standard pain treatment versus standard pain treatment only. The primary outcome was the worst pain intensity within 24 hours (median (interquartile range)).

Results: Mean age of the study groups (54 patients each) was 3.22 years (±0.95), respectively 4.26 years (±2.76) in the control group. There was no statistically significant reduction in worst pain intensity 24 hours after surgery in children treated with a SPIP block (3(1-5)) compared to control group (4(2-5)) (p1-tailed = 0.16, d = 0.19). However, 4 and 12 hours after surgery there were significant improvements in median pain intensity in children treated with a SPIP block (p1-tailed = 0.04).

Conclusions: This study showed that implementation of a SPIP block might further improve postoperative pain management following cardiac surgery in children. However, due to lower baseline pain intensity in the control group primary outcome failed significantly. Therefore, further trials are urgently requested.

Introduction: Ketorolac, a non-steroidal anti-inflammatory drug, is proposed to have a ceiling effect. We studied if ketorolac at lower doses was as effective and safe as the standard doses.

Area covered: Randomized trials on different doses of ketorolac were searched in MEDLINE, Embase, Scopus, and Web of Science from the inception date to 12 December 2024. The extent of change in pain, pain relief, need for rescue analgesia, reduction in patient opioid consumption, and adverse event rates were outcomes of interest. The risk of bias was assessed using the Cochrane Risk of Bias tool version 2.

Expert opinion/commentary: In acute, postoperative, and cancer pain, there was no difference in the analgesic effect of lower doses of ketorolac in comparison to routine doses. In addition, the results did not show higher adverse effects.

Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42023480153.

Chronic pain imposes a significant healthcare burden, with treatments often limited by side effects, opioid dependency, and preventable surgeries. Emerging evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1RAs), developed for diabetes and obesity, may offer novel analgesia and treat drug-seeking behavior. This review examines the role of GLP-1RAs in pain management, focusing on inflammation, macrophage repolarization, oxidative stress, and dopaminergic pathways in substance use disorders. We conducted a literature search in PubMed and Embase (Ovid) from January 2000 to February 2025, identifying studies on GLP-1RA and pain in headaches, osteoarthritis, diabetic neuropathy, and substance use disorders. GLP-1RAs offer a promising shift in pain management, potentially reducing opioid dependence, preventing surgical interventions, and lowering healthcare costs. While early evidence suggests analgesic and disease-modifying effects beyond weight loss, significant knowledge gaps remain. In osteoarthritis, they appear to reduce inflammation and cartilage degradation, but trials in non-obese, non-comorbid patients are needed. In diabetic neuropathy, GLP-1RAs show potential for nerve repair, but optimal dosing and long-term efficacy need clarification. Preclinical data support GLP-1RAs signaling in migraines, but human studies are lacking. Trials in alcohol addiction show promise, though evidence for other substances remains inconclusive. Larger-scale trials are needed to confirm these findings.