Korean Journal of Pain最新文献

This study aims to define the efficacy of pregabalin in treating neuropathic pain in diabetic peripheral neuropathy (DPN), both as a monotherapy and in combination with other drugs that are commonly used to treat DPN in a clinical setting. Thus, physicians are able to make more informed decisions when choosing drugs to relieve DPN. Studies found on PubMed and Embase were evaluated for the role of pregabalin in DPN pain management, as well as its efficacy in comparison to other treatments. Search terms included "pregabalin," "diabetic," "peripheral," "neuropathy," and "pain." Experimental groups varied from amitriptyline, duloxetine, carbamazepine, venlafaxine, and Xiaoketongbi Formula (XF). Pregabalin was shown to have no difference when compared to amitriptyline; however, longer treatment regimens should be performed. Duloxetine is more effective at lower dosages, but pregabalin is more effective at higher dosages. Additionally, pregabalin was found to be more effective than carbamazepine and venlafaxine. Surprisingly, XF was found to be as effective as pregabalin, demonstrating a potential role of herbal treatments. Combination therapies did not have a significant advantage over pregabalin monotherapy in treating DPN. In terms of adverse effects, pregabalin was more tolerated among patients, though side effects were generally mild. Pregabalin remains an effective option for DPN pain management and is considered noninferior to current monotherapies and combination therapies.

A compound paradox has been identified in the revised (2020) International Association for the Study of Pain (IASP) definition of pain, such that it simultaneously prescribes a connection between pain and tissue damage and allows that prescription to be violated. In a narrative form, the objective of this paper is to reveal these paradoxes and to offer a pathway to their resolution, thus clarifying the definition of pain for the purposes of scientific study and clinical application. The first paradox is that contradictory true positions can be held, when the experiencer claims to be "in pain" and the observer cannot find the required association with tissue damage or, preferably as is argued, nociception. The second paradox is revealed by the construct of "nociplastic" pain, which contradicts the IASP definition to the extent that nociceptors have not been activated, yet at the same time is consistent with that definition to the extent that it "resembles" an experience associated with actual or potential tissue damage. In the interests of all concerned parties, the IASP definition of pain can be strengthened by removing the current ambiguity of interpretation, grounding the experience in a reconceptualisation of nociception as activation of a nociceptive apparatus, and clearly distinguishing it from suffering.

Background: Inadequate pain control after robot-assisted laparoscopic radical prostatectomy (RALP) can impair recovery and quality of life. The acetaminophen/ibuprofen combination is a useful component of opioid-sparing analgesia, but the optimal timing of administration remains unclear. This study aimed to compare preemptive and preventive administration of this combination in RALP patients.

Methods: Adult patients undergoing RALP under general anesthesia were enrolled. Patients were randomized in a 1:1 ratio to receive acetaminophen 1,000 mg and ibuprofen 300 mg in 100 mL solution either before incision (preemptive group) or at the end of surgery (preventive group). The primary outcome was cumulative fentanyl consumption via intravenous patient-controlled analgesia within 24 postoperative hours. Postoperative pain intensity was assessed using the 11-point numeric rating scale, and the Korean version of the Quality of Recovery-15 questionnaire (QoR-15K), liver function tests, and renal function tests were evaluated.

Results: Of 154 patients enrolled, 152 were included in the final analysis. Cumulative fentanyl consumption within 24 hours did not differ significantly between the preemptive and preventive groups (260 μg vs. 320 μg; median difference -60 μg (95% confidence interval [CI] -140 to 60), P = 0.409). Pain scores were generally comparable, but at 48 hours postoperatively the preemptive group showed lower scores (median difference -1.0 [95% CI -1.0 to 0.0], P = 0.040). Opioid use at other time points, QoR-15K scores, and laboratory tests showed no significant differences between the groups.

Conclusions: Postoperative opioid consumption was not significantly different between preemptive and preventive administration of acetaminophen/ibuprofen in patients undergoing RALP.

Background: Elderly patients with herpes zoster ophthalmicus (HZO) have a high risk to progress to postherpetic neuralgia (PHN). Thus, early implementation of optimal treatment could lower the prevalence of PHN.

Methods: We collected 50 elderly acute HZO patients treated with short-term peripheral nerve stimulation (PNS) or supraorbital nerve pulsed radiofrequency (PRF) from three hospitals from October 2022 to October 2023. All patients completed 12-month follow-up. The Visual Analog Scale (VAS), Barrow Neurological Institute (BNI) score and Pittsburgh Sleep Quality Index (PSQI) were used to assess the pain intensity and sleep quality.

Results: The pain intensity and sleep quality of all patients was significantly relieved after surgery. Following surgery, the PNS group's VAS and PSQI scores were statistically lower than those of the PRF group, and they also took less medication. At 3 months after surgery, the incidence of clinically significant PHN in the PNS group was lower than the PNS group. At 12 months after surgery, the BNI scores of the PNS group were better than the PRF group.

Conclusions: Early application of short-term PNS or PRF for acute-phase HZO in the elderly can relieve pain. Compared to PRF, PNS may offer superior pain management, enhance quality of life, and contribute to a downward trend in the incidence of PHN.

The brachioradialis (BR) muscle is a long, large, fusiform muscle on the lateral side of the forearm. It originates from the lateral distal humerus and inserts to the base of the styloid process of the radius. The function of the BR muscle is to flex the elbow, especially with the hand in a neutral position, to pronate and supinate the forearm, and to support wrist extension, especially gripping or picking up something. BR muscle pain arises from repetitive overuse, sudden overloading, and direct blow. Common painful daily activities include putting a cup back down after drinking, opening doors, shaking hands, and using a screwdriver or hammer. The two most common symptoms of BR muscle pain are a sharp and shooting pain during activity and an aching pain at rest from the lateral elbow through the forearm, back of the hand, and thumb and index finger, as well as tightness. Differential diagnosis considers lateral epicondylitis (tennis elbow), radial tunnel syndrome, de Quervain's tenosynovitis, carpal tunnel syndrome, trigger thumb, writer's cramp, and cervical radiculopathy. BR muscle pain is common in patients with subacromial impingement syndrome. Basic conservative treatment includes rest, ice, compression, and elevation (RICE), as well as medication. Stretching exercise for the BR muscle is helpful. Injection techniques, such as myofascial injection or botulinum muscle injection, are also recommended. BR muscle pain is one of the common sources of underdiagnosed and misdiagnosed forearm pain.

Background: There is converging evidence that indicates that the nucleus accumbens (NAc) plays a substantial role in pain modulation and analgesic drug responses. Here, the role of the NAc dopaminergic signaling in the development of morphine tolerance in a rat neuropathic pain model was explored.

Methods: Morphine tolerance was induced by twice daily administration of intrathecal morphine in spinal nerve-ligated animals. The extracellular dopamine level in the NAc was measured by microdialysis study and the effects of dopaminergic receptor agonists microinjected into the NAc on morphine analgesic tolerance were evaluated behaviorally. Using immunohistochemical techniques, dopaminergic fiber expression in the NAc was assessed. Additionally, the effects of microglial inhibitor minocycline on the extracellular dopamine level in the NAc and the development of morphine tolerance were investigated.

Results: Microdialysis study demonstrated that the extracellular level of dopamine in the NAc was decreased in morphine tolerant animals. A dopaminergic D1- or D2-like receptor agonist pretreated into the NAc improved analgesic response to morphine in the tolerant animals. By pretreating a microglial inhibitor minocycline with daily morphine administration, the level of extracellular dopamine in the NAc was partially recovered and the development of morphine tolerance was attenuated.

Conclusions: These observations indicate that the decreased dopaminergic neurotransmission in the NAc induced by microglial activation plays a significant role in the development of morphine tolerance. By delineating how alterations in dopamine transmission and related neuroadaptations within the NAc contribute to diminished opioid efficacy, future studies may identify novel molecular and cellular targets for therapeutic intervention.

Background: Pulsed radio frequency (PRF) is a novel therapeutic method for treating neuropathic pain (NP). This study aimed to elucidate the role of NF-E2-Related Factor 2 (Nrf2) in pain signal transduction associated with the mechanism of PRF analgesia action.

Methods: Establishing the spared nerve injury (SNI) rat model and PRF treated model (45 V5 minutes, 45 V15 minutes, 90 V15 minutes), the authors used behavioral testing, western blotting, and enzyme-linked immunosorbent assay methods to verify the analgesic effect of PRF. Secondly, behavioral testing and biomarker analyses were performed in SNI rats that received intrathecally injected calmodulin-dependent protein kinase type II (CaMKII) antagonist, calcitonin gene-related peptide (CGRP) antagonist, or Nrf2 activator.

Results: High-voltage, long-duration PRF significantly alleviated mechanical hypersensitivity in SNI rats. On the 9th day after PRF therapy, Nrf2 and heme oxygenase 1 (HO-1) expression were markedly upregulated, otherwise, CaMKII, phosphorylated level of CaMKII (p-CaMKII), NF-kappa B (NF-κB) p65, and CGRP content were downregulated. Otherwise, intrathecal CaMKII antagonist, CaMKII, p-CaMKII expression, and CGRP content were decreased. Intrathecal Nrf2 activator led to overexpression of Nrf2, while the expression of p-CaMKII, CaMKII, NF-κB p65, and CGRP content were significantly reduced. Additionally, administration of intrathecal CGRP antagonist decreased CGRP content. After the intrathecal injection of these three drugs, the SNI rats' mechanical hypersensitivity was ameliorated.

Conclusions: A novel therapeutic method employing high-voltage, long-duration PRF markedly ameliorated neuropathy, relieving central sensitization by activating the Nrf2 expression-regulated CaMKII/NF-κB signaling pathway blocking Ca²⁺ pain signal transmission.