Pain management最新文献

Background: To evaluate efficacy and safety of ultrasound (US)-guided lumbar transforaminal epidural injection (TFEI) for relieving zoster-associated pain (ZAP) in lumbosacral nerves.

Methods: A retrospective observational cohort study was performed with 1:1 propensity matching to control cohort. Patients undergoing TFEI were included as a US cohort using US guidance and control cohort under fluoroscopy (FL) guidance. Primary endpoint was visual analog scale (VAS) pain scores at 1 month after the procedure with a non-inferiority margin of 10 mm. Secondary outcomes included sensory blockade, procedure time, radiation exposure, adverse events, rescue analgesics, post-herpetic neuralgia (PHN) incidence, and EuroQoL Five-dimension (EQ-5D) scores.

Results: US cohort reported a mean VAS score of 33.52 ± 14.30 mm at 1 month, which was non-inferior to control cohort. PHN occurred in 12.5% of US cohort and 11.1% of FL cohort at 3 months after rash onset (p = 0.796). Trends in EQ-5D scores improved similarly between cohorts over time (all p > 0.05). US approach was associated with wider anesthetic dermatomes (p = 0.031), shorter procedure times (p < 0.001) and lower radiation exposure (p < 0.001). No serious adverse events were observed in either cohort.

Conclusions: US-guided lumbar TFEI was non-inferior to FL procedures. Its unique benefits supported its use in clinical routine practice.

Background: Chronic nonspecific neck pain is a significant cause of disability among Hausa-speaking populations in northern Nigeria. While pain neuroscience education (PNE) is effective, previous local studies were limited.

Aim: This study aims to compare the effectiveness of translated standard PNE versus a culturally adapted PNE version for this population.

Methods: A single-blind randomized controlled trial will enroll 69 adults with chronic neck pain into three groups. All participants will receive 8 weeks of structured neck exercises (SNE), a standard physiotherapy regimen for chronic neck pain in the region focusing on range of motion, strengthening, and postural correction. Two groups will receive additional weekly sessions of either Standard Translated PNE or Culturally Adapted PNE, while the third group will receive Structured Neck Exercises only. Primary (neck-related disability) and secondary outcomes (pain intensity, pain comprehension, psychological factors, fear-avoidance beliefs and quality of life) will be measured at baseline, 4, 8, and 12 weeks.

Discussion: It is hypothesized that the culturally adapted PNE will yield superior outcomes due to its enhanced relevance and comprehension. The findings are expected to inform the development of effective, culturally tailored pain management strategies in sub-Saharan Africa, thereby advancing musculoskeletal care in the region.

Clinical trial registration: The Pan African Clinical Trial Registry (https://pactr.samrc.ac.za/) identifier is PACTR202503884900037.

Aims: This study aimed to explore what consumers valued in pain management programs delivered in small groups, and how frequently group-related factors were raised spontaneously in their feedback at a pain management unit in South Australia.

Methods: Qualitative content analysis of feedback survey data from 109 consumers explored what they valued most and how frequently the group itself was mentioned. All categories were developed inductively, with only group-related codes informed by a recent systematic review. Respondents had attended one of four different programs, delivered in small groups, facilitated primarily by either a physiotherapist or psychologist.

Results: Five categories were identified: program content, the group itself, program structure, the facilitator, and positive changes. The group itself was the second most prevalent category among coded responses, highlighting its relative importance. Findings suggest that peer interaction among similar others and feeling socially safe may positively influence consumer experiences, even within smaller groups than typically reported in group pain management literature. Optimising opportunities for peer interaction and incorporating off-boarding strategies may further enhance engagement and outcomes.

Conclusion: This study highlights the relative importance of the group itself in small group-delivered pain programs and may contribute to improving outcomes for individuals with chronic pain.

Endometriosis affects 10% of women of childbearing age and 25-50% of infertile women worldwide. Although most patients with endometriosis are completely asymptomatic, there is still a significant proportion of patients, whose quality of life is impaired by the disease, resulting in chronic pelvic pain. However, there is a poor correlation between objective findings of significant endometriosis and pain severity. Opioids typically form part of a postoperative analgesic regimen. However, opioid tolerance, adverse effects, contraindications, or a combination of these factors may limit their use. As part of the multimodal regime, ketamine may play a critical role for patients undergoing surgery when postoperative pain is expected to be severe. It is most commonly used for acute pain management in settings involving trauma, the exacerbation of chronic painful conditions, and postsurgical pain, particularly in opioid-tolerant patients, generally at subanesthetic doses. Notably, in therapy-refractory pharmacological situations, surgical treatment of endometriosis with intraoperative low-dose ketamine could be helpful and may constitute an effective strategy for limiting disease recurrence. However, it is important to evaluate the significance of ketamine in endometriosis surgery for preventing chronic pain syndrome, which in turn would result in an improvement in the quality of life of patients with endometriosis.Clinical trial registration: www.clinicaltrials.gov identifier is NCT06951802.

Introduction: There is a lack of consolidated evidence to definitively establish the efficacy and safety of ultrasound-guided erector spinae plane block (ESPB) for low back pain (LBP).Our review aimed to summarize the current published evidence regarding the analgesic efficacy and safety of ESPB in LBP.

Method: We conducted a systematic review in accordance with the PRISMA guidelines. The review protocol has been registered in PROSPERO.

Results: The literature search yielded 21 potentially relevant publications. 232 articles were excluded. The number of patients treated with ESPB was 501. The ESPB's efficacy in reducing the patient's perceived pain was demonstrated in 216 of 345 cases on the first day, 270 of 319 cases in the first month, and 265 of 295 cases in the third month. Exacerbation of pain was reported by 2 patients in the first month after ESPB. Side effects were reported in 5 cases.

Conclusion: Current evidence is limited to low-level studies. While preliminary findings showed that ESPB was a minimally invasive method that provided analgesia in patients with acute and chronic LBP with or without radicular pain, strong conclusions cannot be drawn. Future high-quality randomized controlled trials are necessary to guide clinical practice.

Protocol registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025646263 identifier is CRD42025646263.

Background: Anxiety, depression, and pain-related fears are highly prevalent among individuals with chronic low back pain (CLBP). While aquatic therapy is a promising treatment modality for CLBP, its effects on psychological factors remain poorly understood.

Objective: To compare the effects of aquatic therapy (AT) versus standard care (SC) on psychological outcomes, pain, and disability in CLBP.

Methods: In this two-arm randomized controlled trial, 34 participants with CLBP were assigned to AT (n = 18) or SC (n = 16). Both groups received bi-weekly individual sessions over 10 weeks. Pain, disability, quality of life, anxiety, depression, pain catastrophizing, kinesiophobia, and sleep disturbance were assessed using the following validated questionnaires; Numerical Pain Rating Scale, Modified Oswestry Low Back Pain Disability Index, Short-Form 12 Item Survey Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Insomnia Severity Index, respectively.

Results: Mixed-design analysis of covariance revealed no significant group*time interactions for any outcomes (all p > 0.05). Both groups improved significantly in pain, disability, quality of life, pain catastrophizing, and anxiety (all p < 0.05). Only AT demonstrated significant reductions in kinesiophobia (p = 0.002) and sleep disturbance (p = 0.001).

Conclusions: Aquatic therapy may offer a more comfortable treatment alternative to address psychological factors associated with CLBP.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT05823857.

Aims: The goal of this systematic review and meta-analysis was to compare outcomes between ultrasound-guided thread carpal tunnel release (TCTR) and other minimally invasive surgerical techniques (MIS), for the treatment of Carpal Tunnel Syndrome.

Materials/methods: This systematic review was conducted according to PRISMA 2020 guidelines. Randomized controlled trials, cohort studies, and case series examining TCTR or MIS in adults (≥18 years) diagnosed with CTS were examined. Included studies must have reported pain, sensation, or functionality scores.

Results/conclusion: Five studies met inclusion criteria, comprising 389 patients. Mean follow-up for functionality and symptom severity scores were 8 months and 3.25 months for pain outcomes. Both TCTR and MIS demonstrated significant improvements in all outcomes. While within-group analayese suggested greater statistical robust improvement for symptom severity in the TCTR group (p < 0.01, Hedge's G = -3.25 [-4.42, -2.08], I² = 83.1%) compared to MIS group (p = 0.05, Hedge's G = -2.16 [-4.32, -0.00], I² = 99.3%), subgroup analysis did not demonstrate significant differences between TCTR and MIS for any outcomes. TCTR demonstrates comparable clinical outcomes to other minimally invasive carpal tunnel release techniques, suggesting that TCTR represents a viable minimally invasive option to the surgical management of CTS.

Protocol registration: The www.crd.york.ac.uk/prospero identifier is CRD42024598274.

This systematic review with meta-analysis aimed to investigate the effects of respiratory muscle training (RMT) on symptoms of fibromyalgia (FM). Searches were conducted in Medline/PubMed, EMBASE, Web of Science, SCOPUS, CINAHL, and PEDro for studies published up to November 2025. Randomized controlled trials comparing RMT to control conditions in individuals with FM were included. Risk of bias was assessed using the Cochrane tool, and the quality of evidence was analyzed using the GRADE. Mean differences (MD) and 95% confidence interval (CI) were calculated. Four studies were included; with meta-analyses conducted on two of them. RMT was superior to the control group at improving pain (MD: -2.98; 95% CI: -3.17 to -1.60), quality of life (MD: -1.09; 95% CI: -1.61 to -0.56), fatigue (MD: -1.16; 95% CI: -1.69 to -0.63), anxiety (MD: -0.60; 95% CI: -1.10 to -0.03), and sleep quality (MD: -3.93; 95% CI: -7.06 to -0.80), and maximal occlusion pressure (MD: 2.08; 95% CI: 1.58 to 2.58). However, the certainty of evidence for these findings was very low according to the GRADE approach. In conclusion, RMT may lead to improvements in several FM-related symptoms, but the current evidence is insufficient for clinical recommendations, and high-quality trials are urgently needed.Protocol registration: https://www.crd.york.ac.uk/prospero identifier is CRD42023445488.

Wooden chest syndrome (WCS) is a rare, life-threatening complication of opioid use, characterized by chest wall rigidity and respiratory compromise. While most commonly associated with rapid intravenous fentanyl, we report a case of WCS following intravenous morphine and midazolam administration in a palliative care patient with metastatic lung sarcoma. The patient, who had a "do-not-intubate" (DNI) order, received morphine and midazolam for severe pain and dyspnea. Shortly after administration, he developed acute rigidity, including neck extension and trismus, consistent with WCS. Despite further sedative and analgesic administration, respiratory distress worsened leading to patient's death. The case highlights the diagnostic and therapeutic challenges of WCS in palliative care, particularly when airway interventions are limited by goals-of-care directives. It underscores the need for heightened clinical awareness and the development of alternative management strategies for WCS when intubation is contraindicated, as well as the potential role of the interaction between morphine and midazolam in triggering this syndrome.