Pain management最新文献

Wheelchair basketball (WB) has evolved from a recreational activity to an internationally recognized sport. It is useful in enhancing psychophysical well-being in athletes with disabilities. However, WB professional players' medical management, especially regarding musculoskeletal pain (MSP), poses unique challenges and the related scientific literature still seems fragmentary. An extensive review of the PubMed, Cochrane, and Embase databases was performed to identify the available evidence regarding the medical management of WB players MSP. It emerges that WB players often face musculoskeletal injuries due to repetitive movements and game-specific actions. The management of these injuries requires a multidisciplinary approach. Firstly, the use of pharmacological treatments like Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) is common, though care must be taken to comply with World Anti-Doping Agency (WADA) regulations. Then, preventive strategies, including tailored rehabilitation and strength conditioning, are essential. Moreover, the use of dietary supplements, while popular for enhancing recovery and performance, carries risks, particularly contamination with prohibited substances. Therefore, medical staff must exercise caution when recommending supplements. Finally, this review highlights that WB players' MSP management requires balancing effective treatment with adherence to anti-doping rules, limiting the use of traditional drugs where possible and improving the clinical application of non-pharmacological treatments, such as physical and rehabilitation medicine approaches.

Background: Effective postoperative pain management remains a critical challenge, particularly in lower abdominal surgeries where multimodal approaches are underexplored. This study aimed to evaluating the efficacy of this combination in reducing pain and analgesic requirements.

Methods: In this double-blind, randomized controlled trial, 59 patients undergoing elective lower abdominal surgery were randomly assigned to receive either subcutaneous metoclopramide plus lidocaine or lidocaine alone after surgery. Postoperative pain scores were assessed at 1, 6, 12, and 24 hours using the Visual Analog Scale (VAS), and analgesic consumption was recorded over the first 24 hours.

Results: 59 patients (mean age: 41.8 ± 11.8 years; 43.1% male, 56.9% female) receiving the metoclopramide-lidocaine combination demonstrated significantly lower pain scores at all assessed time points compared to lidocaine alone, with values of 5.2 ± 1.1 versus 7.7 ± 0.8 at 1 hour, 3.8 ± 0.9 versus 6.2 ± 0.9 at 6 hours (p = 0.004), 2.9 ± 1.0 versus 5.4 ± 1.4 at 12 hours, and 2.1 ± 0.7 versus 4.4 ± 1.1 at 24 hours postoperatively (p < 0.001). Furthermore, the combination group showed a 28.6% reduction in analgesic requirements during the first 24 hours (47.4 ± 18.1 mg vs 66.3 ± 25.2 mg, p = 0.002), highlighting the opioid-sparing effect of this approach.

Conclusion: The addition of metoclopramide to subcutaneous lidocaine resulted in improved postoperative pain control and reduced analgesic requirements following lower abdominal surgeries under general anesthesia.

Clinical trial registration: Iranian Registry of Clinical Trials identifier is IRCT20231228060548N1.

Background: The primary objective of this randomized, double-blind, parallel-group trial is to evaluate the efficacy and safety of intrathecal hyperbaric bupivacaine in conjunction with either fentanyl or dexmedetomidine in mitigating visceral pain during cesarean delivery.

Method: One hundred and sixteen parturients, classified as ASA II-III and scheduled for elective cesarean section, will be randomized 1:1 into two groups: Group BF will receive 10 mg hyperbaric bupivacaine in combination with 10 µg fentanyl. In contrast, Group BD will receive 10 mg hyperbaric bupivacaine in combination with 5 µg dexmedetomidine. The primary outcome is the frequency and intensity of visceral pain, assessed using an 11-point numerical rating scale at pivotal intraoperative stages. Secondary outcomes include hemodynamic stability, neonatal Apgar scores, shivering frequency, and the incidence of adverse effects.

Conclusion: The primary hypothesis of this study is that dexmedetomidine may offer superior visceral pain control with a reduced incidence of adverse effects.

Making cesarean births more comfortable: Comparing Two Pain Relief Medicines Used in A cesarean birth (C-section) is often done under spinal anesthesia, which numbs the lower body, while the mother stays awake. While this works well for most women, some still feel uncomfortable or experience painful sensations in their belly during surgery, especially when the uterus is touched or moved. This kind of deep belly pain is called visceral pain.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT06367660; Nepal Health Research Council (NHRC) Protocol ID: 98-2024.

Chronic pelvic pain is a severe condition affecting patients with endometriosis. Treatment options range from physical therapy, medical management, to surgical resection. However, some patients continue to have severe pain after maximal management. We review current treatment options for endometriosis and discuss regional anesthesia techniques currently used for acute pain that may be used for chronic pelvic pain patients. A comprehensive literature search was conducted using PubMed, Cochrane Library, and Google Scholar databases through 2025. An algorithm on which procedure to choose was also created to guide treatment in hopes to bridge the gap for patients who are recalcitrant to current available therapies.

Introduction: Opioid sparing by co-prescription of cannabinoids may enable patients to reduce their opioid consumption prescribed for chronic benign pain.

Methods: One cohort attending a small private pain clinic (N = 102), already taking opioids, was co-prescribed cannabinoids and another cohort (N = 53) attending a separate pain clinic nearby received only opioids. The two groups were studied prospectively for a year before their drug consumption was assessed.

Results: At baseline, median opioid consumption was 40 mg/day in both cohorts. Medicinal cannabis was administered daily in an oil formulation usually starting at 2.5 mg/day and was titrated to maximize benefits. At 12 months, the median dose contained 15 mg delta-9-tetrahydrocannabinol and 15 mg cannabidiol. At one-year follow-up, 46 of 102 cases had dropped out compared with only one of 53 controls. Opioid consumption had decreased significantly at one-year follow-up, the final median dose being lower in cases (2.7 mg/day) than controls (42.3 mg/day) (p < 0.05 in an intention-to-treat analysis). Disability and insomnia had also decreased in cases.

Conclusion: The introduction of cannabinoids can produce useful reductions in opioid consumption in real-world settings, with additional benefits for disability and insomnia. However, this treatment is tolerated by only a subgroup of patients.

Clinical audit registration: https://www.anzctr.org.au/ identifier is ACTRN12621000875808.

Clinical investigations of resiniferatoxin (RTX) analgesia are currently ongoing for several human pain indications. RTX is an agonist of the TRPV1 receptor cation ion channel which is activated by capsaicin, heat, and inflammatory conditions. RTX injection at peripheral sites of pain generation will produce a chemo-inactivation of local nerve terminals and axons and block the transmission of nociceptive signals to spinal cord. Clinical human studies with RTX to treat osteoarthritis (OA) pain were preceded by extensive animal and cell system testing which revealed mechanisms of action, range of potentially treatable pain problems, and the safety and efficacy of this interventional analgesic agent. The present review concentrates on RTX, but also examines intraarticular (IA) capsaicin, a lower potency TRPV1 agonist, for the same indication. We review studies of RTX in human patients and canine veterinary subjects with OA pain. To date, results of several phase I clinical trials have only been reported in abstract form and these studies, despite their preliminary nature, will be examined herein. The present assessments indicate that RTX has strong therapeutic promise to be an innovative approach to medical management of pain relief in osteoarthritis and may be permissive to beneficial tissue remodeling.

Migraine is a debilitating neurological disorder affecting 1 billion people worldwide. Traditional preventive drugs showed low efficacy and poor tolerability. Monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptors offer a new efficacious and safe therapeutic option for migraine patients. According to randomized controlled trials, these disease-specific drugs reduce migraine frequency by ≥ 50% within 3 months. However, real-world studies show that some patients require a longer treatment duration (6 or 12 months). This narrative review aimed to investigate the occurrence of late and ultra-late responses to anti-CGRP therapy, exploring their potential mechanisms and clinical significance. A literature search was performed [PubMed, Web of Science and Google Scholar; publications up to July 2025] to identify relevant studies for this narrative review. Across 10 real-world studies, a proportion of patients who did not respond at 3 months achieved a meaningful clinical response at later time points: some between 3 and 6 months ("late responders") and others between 6 and 12 months ("ultra-late responders"). Around one-third of initial non-responders improved by 6 months, and among those who remained non-responsive at that point, a further proportion benefited by 12 months. The pathophysiological mechanism behind late response is a field of investigation, and the interaction of anti-CGRPs on the process of central desensitization seems to be crucial. Our review underscores the need to extend treatment beyond the typical 3-month period to attain meaningful benefits from anti-CGRP therapies.

Background: Cancer-related pain affects quality of life despite advancements in management. Bibliometric and altmetric analyses provide insights into the academic and societal impact of research.

Objective: This study analyzed the top 100 most-cited articles on cancer-related pain using bibliometric and altmetric indicators, exploring correlations between altmetric scores, citations per year, and total citations.

Methods: A search of the Web of Science Core Collection database was conducted on 2 November 2024, to identify articles related to cancer pain published between 1975 and 2024. The top 100 most-cited articles were selected based on total citation counts. Only English-language articles with full-text access were included. Bibliometric data were collected. Altmetric scores were retrieved using the Altmetric Explorer platform, and correlations were assessed using Spearman's test.

Results: The 100 most-cited articles appeared in 35 journals, with PAIN contributing the most (n = 19). Total citations and citations per year showed a strong correlation (r = 0.64), but the correlation between altmetric scores and total citations was weak (r = 0.18).

Conclusion: This study highlights the academic and societal impact of cancer pain research. The weak correlation between citations and altmetric scores suggests a need for better dissemination strategies to enhance public engagement.

Trial registration: RBR-3pxmycv. This study protocol was registered in ensaiosclinicos.gov.br (Brazilian Registry of Clinical Trials), published on 19 December 2023, https://ensaiosclinicos.gov.br/rg/RBR-3pxmycv.