Korean Journal of Pain最新文献

Background: Non-opioid analgesics are essential in multimodal analgesia and opioid-sparing strategies; however, their clinical use remains suboptimal. This study aimed to investigate trends in perioperative non-opioid analgesic administration and associated adverse effects in patients undergoing major abdominal surgery at a tertiary hospital.

Methods: Prescription data for acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) were retrospectively collected from January 2020 to December 2024. Actual administration was assessed at three perioperative phases: preemptive, intraoperative, and postoperative (postoperative day [POD] 0-3). The study period was divided into 20 quarters. Trends of administration rates over time were analyzed using a linear regression model. Postoperative drug-induced liver injury (DILI) and acute kidney injury (AKI) were evaluated, and Poisson regression was applied to adjust for covariates within each quarter.

Results: A total of 24,688 surgical cases involving 24,084 patients were analyzed. The administration rate of acetaminophen exhibited a significant upward trend throughout the study from the preemptive phase to POD 2. NSAID administration increased significantly, mainly up to POD 1, though the overall magnitude of the increase was modest. Postoperatively, less than 5% of patients received both analgesic classes concurrently. The analgesic administration rate was not significantly associated with DILI or AKI.

Conclusions: The use of non-opioid analgesics for major abdominal surgery has increased significantly over the past 5 years. However, their overall utilization, particularly postoperatively, remains limited. Further efforts are required to promote their broader integration into clinical practice.

Background: The erector spinae plane (ESP) block has gained attention as a regional anesthesia technique for pain management in vertebral surgeries. This umbrella review synthesizes data from systematic reviews (SRs) and meta-analyses to evaluate the effectiveness of the ESP block in reducing postoperative opioid consumption, pain, and postoperative nausea and vomiting (PONV) in patients undergoing vertebral surgeries.

Methods: A search was conducted in CENTRAL, Embase, PubMed Central, and Scopus from 2016 to 2025. The authors included SRs and meta-analyses that investigated the use of the ESP block in vertebral surgeries. Primary outcomes were opioid consumption at 24 postoperative hours (measured as milligrams of morphine equivalent), pain scores at 12 and 24 hours, PONV incidence, and the need for additional analgesics. Quality was assessed using the AMSTAR 2 tool.

Results: Thirteen SRs were included. The ESP block reduced opioid consumption at 24 postoperative hours (mean morphine equivalents difference, -8.70 to -18.69), although high heterogeneity was observed. Pain reduction at 12 and 24 hours was statistically significant but clinically modest, with most SRs reporting reductions of less than one point in Numeric Rating Scale or Visual Analog Scale pain scales. The ESP block also significantly reduced PONV and additional analgesic use. However, most SRs were rated as low quality due to inadequate pre-registration and justification for excluding studies.

Conclusions: The ESP block demonstrates potential as a multimodal analgesia component in vertebral surgeries, reducing opioid consumption, pain intensity, and PONV. However, high heterogeneity and low methodological quality highlight the need for further research.

This up-to-date review focused on the recent advances in the concept, interrelationship, and mechanisms of the polytrauma clinical triad (PCT), and intervention knowledge and approaches to its prevention and treatment from the perspective of military pain medicine, hoping to provide a scientific basis and reference of PCT. Many soldiers suffering from chronic pain coexist with post-traumatic stress disorder and traumatic brain injury. If the above three diseases exist, it is called PCT. Three diseases in this common triad are interrelated and reinforce each other. This triad is challenging to treat and often leads to chronic issues, especially if not adequately monitored and managed. Although each disease of this triad could occur in isolation, it is valuable to know whether the rest of PCT needs to be screened. Current treatment of this triad emphasizes accurate identification and assessment of each disease, the new interdisciplinary and multimodal system of care, individualized customization principles, and shared medical decisions. To maximize clinical success and military service, interdisciplinary providers may benefit from the joint development of complementary treatment and biopsychosocial approach supported by theoretical and empirical evidence. The management of the PCT should emphasize integrative medicine and new interdisciplinary, multimodal nursing. Furthermore, cognitive behavioral therapy, standard rehabilitation care, and integrated health therapy have yielded valuable efficacy. It also should encourage the establishment of harmonious treatment relationships, shared medical decisions, and individualized customization principles to care for military service members with these comorbidities.

Background: This study aimed to evaluate the 4-week clinical efficacy of the lumbar sympathetic ganglion block (LSGB), assess the perfusion index (PI) as a marker for the LSGB's technical success, and examine the relationship between the PI change and post-procedure pain relief.

Methods: In this prospective observational study, pain scores of 40 patients who underwent LSGB were measured using the Numeric Rating Scale (NRS) at pre-procedure, 20 minutes post-procedure, and at 1 and 4 weeks. The primary outcome was a positive LSGB response, defined as a reduction of ≥ 2 on the NRS at 20 minutes post-procedure. Skin temperature and PI were recorded every minute for 20 minutes post-procedure. The reliability of the PI was assessed using area under the curve (AUC) and receiver operating characteristic curves.

Results: An immediate positive response to the LSGB was observed in 72.5% of patients, with 30.8% responding at 1 week and 17.9% responding at 4 weeks. NRS scores significantly decreased from baseline to 4.1 ± 2.5 immediately post-procedure and to 5.9 ± 2.7 at 4 weeks. A Δ PI of > 1.6% in the ipsilateral foot was a reliable indicator of technical success (sensitivity: 90.0%; specificity: 90.0%; AUC: 0.925; P < 0.001). However, neither temperature increase (R = 0.091, P = 0.577) nor PI increase (R = 0.029, P = 0.859) correlated significantly with pain reduction.

Conclusions: Although the number of LSGB responders declined over 4 weeks, overall pain levels significantly decreased. The PI may serve as a quick and reliable indicator of technical success, but it does not correlate with post-procedure pain relief.

Background: Bone cancer pain (BCP), a major symptom impairing quality of life and mobility in cancer patients, is linked to microRNAs dysregulation. This study investigates the role of miR-298 in a mouse BCP model established by implanting tumor cells into the femoral marrow cavity.

Methods: Forty-eight male C3H/HeJ mice were randomized into sham or tumor groups, receiving intrathecal miR- 298 agonist/antagonist or controls. Behavioral assessments (paw withdrawal mechanical threshold [PWMT] and number of spontaneous flinches [NSF]) were performed before and after surgery (days 0, 4, 7, 10, 14, 21, 28). Astrocyte activation, inflammatory cytokines, and pathway proteins (MyD88, TAK1, p-p65) were analyzed via quantitative Reverse Transcription Polymerase Chain Reaction (qRT-PCR), Western blot, and immunofluorescence. Statistical analysis used one-way ANOVA with Tukey's test and independent t-tests (P < 0.05).

Results: Tumor-implanted mice showed significant mechanical hypersensitivity in PWMT and NSF versus sham controls (P < 0.001). MiR-298 expression was markedly downregulated in BCP mice (P < 0.001), confirmed by fluorescence in situ hybridization and qRT-PCR. Overexpression of miR-298 suppressed astrocyte proliferation (P = 0.005) and pro-inflammatory cytokines (tumor necrosis factor-α, interleukin-1β; P < 0.001), while enhancing apoptosis (P = 0.003). Luciferase assays confirmed MyD88 as a direct miR-298 target (P < 0.001). Intrathecal miR-298 agonist reduced NF-κB activation (phospho-p65, P < 0.001) and alleviated pain behaviors versus tumor controls (P < 0.001).

Conclusions: MiR-298 reduces BCP in mice by inhibiting astrocyte-mediated neuroinflammation and blocking the MyD88/NF-κB pathway.

Background: Chemotherapy is the basis of cancer treatment. Chemotherapy-induced peripheral neuropathy (CIPN) is a major adverse effect. CIPN has a high incidence rate and substantially affects the quality of life of cancer survivors. Despite this, no definitive treatment for persistent unmet medical needs is available. Glucagon-like peptide-1 receptor agonists (GLP-1RA), widely used to treat obesity and diabetes, have recently been reported to be efficacious in treating neuropathic pain. The authors aimed to confirm its effects on CIPN and elucidate its underlying mechanisms.

Methods: After differentiation, 50B11 dorsal root ganglion cells were treated with paclitaxel and GLP-1RA to confirm changes in oxidative stress, neuroinflammation, and neuronal damage. Immunofluorescence, flow cytometry, Western blotting, quantitative reverse transcription-polymerase chain reaction, cytokine quantitation by ELISA, and assessments of axonal degeneration and regeneration were performed to evaluate the effect of GLP-1RA on CIPN and confirm the associated mechanisms.

Results: After treatment with paclitaxel, the increased oxidative stress and inflammatory signals decreased with the administration of GLP-1RA. GLP-1RA also led to an increase in β-endorphin and μ-opioid receptors through IL-10. And administration of GLP-1RA had the effect of increasing neurite length. Additionally, the increased expression of the TRP family induced by paclitaxel treatment was restored with GLP-1RA administration.

Conclusions: GLP-1RA reduces oxidative stress and neuroinflammation, thereby alleviating paclitaxel-induced neurotoxicity. Additionally, GLP-1RA increases β-endorphin and μ-opioid receptors and reduces TRP family expression and promotes neuroregeneration, suggesting its effectiveness in mitigating chemotherapy-induced neuropathic pain.