Pain management最新文献

Introduction: Effects of Spinal Cord Stimulation (SCS) on physical activity and self-efficacy remain unexplored.

Purpose: To evaluate effects of SCS on pain intensity, physical activity, health-related quality of life (HRQL), and self-efficacy among chronic neuropathic pain patients.

Methods: Randomized controlled trial, the first phase of a 3-part intervention study. Patients >18 years of age underwent SCS implantation after a test trial and were randomized 1:1 to active SCS or conventional medical management (CMM) with the SCS switched off. Data were collected at baseline and 3 months after implantation regarding pain (Numeric Rating Scale; NRS), physical activity (accelerometer), HRQL, and self-efficacy.

Results: Participants implanted with SCS (n=42) were randomized to active SCS (n=21) or CMM (n=21). Nineteen participants crossed over from CMM to active SCS due to lack of pain relief. Neuropathic pain intensity decreased significantly from baseline to 3 months (NRS 6.7 to 4.5; p <0.001) in patients with active SCS. Moderate-to-vigorous physical activity increased by 26 minutes/week (87%), although not statistically significant. Patients reported significant improvements in HRQL and self-efficacy.

Conclusion: SCS seems to reduce neuropathic pain intensity which might contribute to improvements in HRQL and self-efficacy. Low physical activity levels in this population should prompt targeted rehabilitation interventions.

Clinical trial registration: The https://clinicaltrials.gov/ identifier is NCT03740763 and the Västra Götaland Region (VGR) registry (https://www.researchweb.org/is/vgr/) identifier is 216271.

Lumbar disc herniation is a common cause of low back pain leading to significant functional impairment. High-intensity, low-frequency pulsed electromagnetic field (Diamagnetic therapy) gained attention to treating several diseases. We report a 47-year-old man with severe post-traumatic low back pain radiating bilaterally to the lower limbs (VAS: 8; Douleur-Neuropathique-4: 5/10). MRI showed an annulus fibrosus fissure and a partially extruded left paramedian L4-L5 disc herniation compressing the dural sac. Pharmacological treatments (NSAIDs, corticosteroids, opioids, muscle relaxants) and physical therapy (Capacitive and resistive electric transfer therapy) provided no benefit. At presentation to our Pain Room, clinical findings included positive Lasegue at 30°, bilateral Valleix signs, paraspinal tenderness, and significant quality-of-life impairment (SF-36). The patient underwent a full course of diamagnetic therapy after providing written informed consent and following ethics committee approval. After 16 sessions (twice weekly, 20 minutes each; high-intensity fluids off/biostimulation), the VAS score decreased to 0/10 and the Douleur-Neuropathique-4 to 0/10, with MRI evidence of herniation resorption. This case illustrates that diamagnetic therapy improved the patient's clinical condition in refractory post-traumatic low disc herniation, supporting its potential as a promising noninvasive option for selected patients, although further controlled studies are required to confirm its efficacy.

Uncontrolled cancer pain remains one of the most common reasons for unscheduled medical care in the UK, yet primary and community care services often lack standardized approaches to management. This scoping review explored existing evidence on cancer pain management within primary and community care settings, focusing on integration strategies, barriers to access, and facilitators of equitable pain management, particularly in underserved populations. Six electronic databases were searched for studies published between 2000 and 2025. Thirty-two articles were included, encompassing systematic reviews, qualitative and quantitative studies, randomized controlled trials, and mixed-methods research. Findings were synthesized narratively under broad thematic headings. Considerable variability in pain management practices, limited GP training, workforce constraints, and fragmented communication between generalist and specialist services were identified. Digital technologies and patient education promoted better access, empowerment, and self-management, although adoption remained inconsistent. Socioeconomic inequities and digital exclusion continue to impede equitable pain control. Cancer pain management in primary care is hindered by systemic, educational, and structural barriers. Integration of pain and palliative care services, standardized assessment protocols, and targeted digital and educational interventions could enhance equity and effectiveness. Future research should evaluate integrated care models and the role of digital health in supporting community-based pain management.

Recent evidence shows that pro-inflammatory diets-high in saturated fats, added sugars, and ultra processed foods-have been linked to elevated levels of cytokines like interleukin-6 (IL-6) and tumor necrosis factor (TNF), showing a marked increase in systemic inflammation, disrupted immune function and altered anesthetic drug metabolism. These effects have been linked to prolonged recovery, impaired wound healing, and increased complication rates. Additionally, a pro-inflammatory diet changes the gut microbiome, impacting pain perception, opioid sensitivity and stress response by the gut-brain axis. On the contrary, an anti-inflammatory diet reduces inflammatory markers and is associated with a shorter hospital stay. This review synthesizes data from randomized controlled trials (RCT), meta-analyses, and mechanistic studies from 2000-2025, emphasizing literature on omega-3 fatty acids, specialized pro-resolving mediators (SPMs), and short-chain fatty acids (SCFAs). Targeted interventions such as education on nutrition and dietary assessment risk could enhance surgical recovery. Perioperative interventions discussed include pre/probiotic supplementation, omega-3 fatty acid administration, and also dietary counseling as part of Enhanced Recovery After Surgery (ERAS) pathways.

Chronic perineal pain is a common complication among patients with cancer. Due to the complex innervation of this anatomical region, pain management is often challenging and significantly impacts patients' quality of life. We present the case of an elderly patient with advanced-stage rectosigmoid junction adenocarcinoma who experienced severe coccygeal-perineal oncologic pain. Despite a multimodal analgesic treatment approach, the patient exhibited refractoriness to conventional pain management. Consequently, an interventional analgesic approach was implemented using an impar ganglion block with botulinum toxin type A (BoNT-A). Following the intervention, a significant reduction in pain intensity and opioid consumption was observed. This case highlights the therapeutic potential of the impar ganglion block with BoNT-A as an effective option for the management of refractory pelvic-perineal oncologic pain.

Introduction: Vinorelbine (VNR) frequently causes vasculitis and vascular pain during administration, potentially compromising treatment adherence and patient quality of life. This study aimed to identify risk factors and temporal distribution patterns for VNR associated with vasculitis and vascular pain, and to evaluate the prophylactic efficacy of NSAIDs and non-NSAID analgesics in patients receiving postoperative adjuvant chemotherapy.

Methods: We conducted a retrospective analysis of 49 non-small cell lung cancer patients who received cisplatin (CDDP) and VNR combination therapy. The treatment cycle was stratified into two temporal phases: "before day 8" (period between CDDP and VNR administration on day 1 and VNR monotherapy) and "after day 8" (period between VNR monotherapy and subsequent cycle initiation).

Results: Age under 65 years was significantly correlated with vasculitis and vascular pain occurrence (p = 0.003). The incidence rate was elevated during the "after day 8" period, with predominant manifestation during initial treatment cycles. Neither NSAIDs nor non-NSAID analgesics demonstrated significant prophylactic efficacy against these vascular adverse events.

Conclusion: Our findings identify age under 65 years as an independent risk factor for VNR associated with vasculitis and vascular pain. The markedly higher incidence observed during the "after day 8" period suggests that intravascular VNR concentration may be a critical pathophysiological determinant.

Purpose: Hilar nerve block has been recently described as a method of pain relief during percutaneous liver tumor ablation. We aim to evaluate the efficacy and safety of hilar nerve block.

Methods: In this retrospective cohort study, all patients who underwent image-guided percutaneous liver ablation with and without hilar nerve block from November 2022 to July 2024 in our institution were reviewed. Outcomes including technical success, complications, pain scores, intravenous analgesia and sedation requirements were compared between the nerve block and control groups.

Results: Thirty patients were included in the nerve block group and 33 patients were included in the control group. The nerve block group experienced less pain during ablation compared to the control group, both overall (mean pain score 3.9 vs 5.5 respectively, p = 0.018) and within the non-subcapsular tumor subgroup (mean pain score 3.5 vs 5.3 respectively, p = 0.018). The nerve block group required lower doses of fentanyl compared to the control group (mean dose 17.5 µg vs 35.6 µg, p = 0.001). Twelve patients in the nerve block group did not require any intravenous analgesia.

Conclusions: Hilar nerve block is a safe and effective technique for pain relief during percutaneous liver tumor ablation, which can lower the requirement for intravenous analgesics.

Aims: This study aimed to evaluate the effectiveness of cold pack therapy in reducing pain during intravenous cannulation in pediatric patients, focusing on whether this non-pharmacological intervention offers significant advantages over standard care.

Patients & methods: A quasi-experimental study was conducted using a post-eligibility block randomization method at a regional hospital in Bandung, Indonesia, involving 98 pediatric patients aged 3-6 years. Participants were purposively sampled and then randomly assigned into intervention (n = 49) and control (n = 49) groups using block randomization. The intervention group received cold pack therapy 2 minutes before intravenous cannulation, while the control group received standard care. Pain levels were assessed using the FLACC (Face, Legs, Activity, Cry, Consolability) Pain Scale. Statistical analysis was conducted using the Mann-Whitney U test.

Results: Pain levels in the intervention group (3.31 ± 1.63) were significantly lower than in the control group (4.33 ± 1.56), with a p-value of 0.002. Mild pain was reported in 46.9% of the intervention group, compared to moderate pain in 57.1% of the control group.

Conclusions: Cold pack therapy is an effective and simple method for reducing pain during intravenous cannulation in pediatric patients. Its integration into routine care could enhance patient comfort and minimize procedural distress.

Objective: Evaluate the real-world experience of ubrogepant versus triptans for the acute treatment of migraine among participants switching from an oral triptan.

Methods: UNIVERSE II was a prospective, longitudinal, survey-based, real-world study conducted in adult Migraine Buddy application users who self-reported a switch from an oral triptan to another oral triptan or ubrogepant. The 4-week study assessed treatment satisfaction, preference for the new treatment or previous triptan, and patient experience with new treatment against previous triptan.

Results: Of 694 participants, 211 were included after screening and accounting for dropouts (triptan, n = 100; ubrogepant, n = 111). At Day 30, significantly greater proportion of the ubrogepant cohort reported satisfaction with treating pain associated with migraine (69.4% vs 42.0%; adjusted odds ratio [OR] = 3.22; [95% confidence interval [CI], 1.80-5.88]; p < 0.001) and alleviating their most bothersome symptom (69.4% vs 42.0%; adjusted OR = 3.10; [95% CI, 1.75-5.60]; p < 0.001) compared with those who switched triptans. The ubrogepant cohort was more likely to prefer their new treatment to their prior triptan (75.7% vs 63.0%; adjusted OR = 1.93; [95% CI, 1.05-3.59]; p = 0.035) and reported better meaningful relief at 2 hours compared to prior triptan (75.7% vs 59.0%; adjusted OR = 2.30; [95% CI, 1.26-4.27]; p = 0.007).

Conclusion: This real-world study demonstrated people with migraine who switched from a triptan to ubrogepant reported better outcomes than those who switched to a different triptan.

Aims: This open-label non-placebo clinical trial was designed as an explorative test of a recent hypothesis suggesting a causative relation between neck muscle dyssynergia and pain in patients with chronic tension-type headache (TTH) and common whiplash (WL). A Dopamine agonist was used as test-treatment. The primary aim was to improve neck muscle dyssynergia and second to observe the effect on pain.

Patients & methods: Fifteen patients, comprising 8 tension-type headache and 7 common whiplash patients, all with significant neck muscle tenderness, were started on a standard Pramipexole treatment by 0.18 mg Pramipexole daily and increased by 0.18 mg weekly to 0.18 mg × 3 daily for maintenance. Weekly visits with measurements of head laser tracking (HLT) as indicator of neck muscle dyssynergia, total neck muscle tenderness score, and self-reported daily average headache and neck pain. Head laser tracking was compared to a control group of 8 untreated healthy persons.

Results: HLT normalized during treatment and clinical parameters of pain significantly improved.

Conclusion: This result provides preliminary support of the hypothesis of a pathogenetic relation between the dyssynergic neck muscle innervation and pain in TTH and common WL.

Clinical trial registration: EudraCT 2021-003574-31.