Frontiers in pain research (Lausanne, Switzerland)最新文献

Background: Neck pain (NP) is a common musculoskeletal disorder that significantly affects the physical function and quality of life of patients. Thumbtack needle therapy is widely used to manage NP. However, previous studies have reported inconsistent clinical outcomes. This study aims to systematically evaluate the efficacy and safety of thumbtack needle therapy for NP.

Methods: A systematic search was conducted in the Cochrane Library, Web of Science, Embase, PubMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal (VIP), and Wanfang databases from their inception to 24 September 2023 for randomized controlled trials (RCTs) on thumbtack needle therapy for NP. Outcome measures included the visual analog scale (VAS) scores, neck disability index (NDI) scores, total effective rate, and adverse events. A meta-analysis was performed using Review Manager 5.3. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results: Seven RCTs involving 425 patients were included. Compared with the control group, thumbtack needle therapy significantly reduced VAS scores (MD = -1.33, 95% confidence interval (CI): -1.63, -1.03; Z = 8.65; P < 0.05), reduced NDI scores (MD = -5.54, 95% CI: -9.73, -1.35; Z = 2.59; P < 0.05), and improved the total effective rate (OR = 0.27, 95% CI: 0.10, 0.70; Z = 2.67; P < 0.05). Adverse events were not reported in several studies, limiting conclusions on safety. A subgroup analysis revealed that heterogeneity may be related to the variation in combination therapies and treatment course. A sensitivity analysis confirmed the robustness of the results. The overall quality of evidence ranged from very low to moderate.

Conclusions: This study found that thumbtack needle therapy can effectively relieve pain and improve cervical mobility in patients with NP. The reduction in VAS scores reached the level of the minimum clinically important difference, indicating that thumbtack needle treatment for neck pain has a clinically significant impact. In the future, high-quality RCTs are needed to further validate the clinical efficacy of thumbtack needle therapy for NP.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025632076, PROSPERO CRD42025632076.

Objective: The combination of the pericapsular nerve group (PENG) block and lateral femoral cutaneous nerve (LFCN) block has garnered increasing attention as a postoperative analgesic strategy following hip surgery. Nevertheless, the clinical efficacy of this approach remains a subject of ongoing debate. Through a meta-analysis, the effects of the combined PENG and LFCN block in patients who underwent hip surgery were investigated.

Methods: We conducted a systematic search of relevant clinical randomized controlled trials (RCTs) available in English via online databases and grey literature resources. Quantitative analyses were performed to assess pain scores, time to first rescue analgesia, consumption of rescue analgesics, incidence of quadriceps weakness, time to first ambulation, and postoperative nausea and vomiting (PONV) to comprehensively evaluate the effects of the combined PENG and LFCN block in patients after hip surgery.

Results: A total of 12 RCTs involving 823 patients were included in this study. The findings from the quantitative synthesis indicate that the combined PENG and LFCN block significantly decreases postoperative pain scores at rest (p < 0.001) and during movement (p = 0.021), increases the time to first rescue analgesia (p < 0.001), and reduces the consumption of rescue analgesics (p < 0.001). Additionally, this combination decreases the incidence of quadriceps weakness (p < 0.001), shortens the time to first ambulation (p < 0.001), and decreases the incidence of PONV (p = 0.020).

Conclusion: The combined PENG and LFCN block has favourable clinical efficacy for postoperative analgesia in hip surgery patients and is recommended for use. However, more high-quality, large-scale RCTs are needed to further validate our findings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251142338, PROSPERO CRD420251142338.

Introduction: Substantial evidence suggests that experiences of discrimination negatively influence sleep, depressive symptoms, stress, and pain. The purpose of this study was to evaluate the strength of the associations between discrimination and pain, and to determine which psychosocial risk factors help explain these associations.

Methods: Participants (N = 208) underwent two study sessions, where they completed the Everyday Discrimination Scale, Perceived Stress Scale, Centers for Epidemiological Studies Depression Scale, Insomnia Severity Index, and the Brief Pain Inventory-Short Form. Demographic data was also obtained from participants.

Results: Majority of the participants self-identified as women (55.3%), and Black (62%). There were positive associations between discrimination and insomnia (p < .001), depressive symptoms (p < .001), perceived stress (p < .001), pain severity (p < .001) and pain interference (p < .001). Hierarchical regressions showed that identifying as Black (p < .001), having greater depressive symptoms (p = .03), and greater insomnia symptoms (p < .001) were associated with greater pain severity in the past 24 h. Similarly, older age (p = .01), identifying as Black (p = .002), having lower education (p = .04), taking medications (p = .04), greater depressive (p < .001) and insomnia symptoms (p < .001) were associated with greater pain interference. The indirect effect of discrimination on pain severity was significant (β = .015, Bootstrap 95% CI.003-.030). Additionally, there was a significant indirect effect of discrimination on pain interference (β = .015, Bootstrap 95% CI.004-.031). Exploratory models showed an indirect effect of pain severity (β = .014, Bootstrap 95% CI.001-.029) and interference (β = .012, Bootstrap 95% CI.000 to .029) on discrimination via psychosocial risk factors.

Discussion: Our findings highlight the harmful associations between discrimination, mental health outcomes, pain severity, and reduced quality of life. Additionally, these findings emphasize the need for more stress engaged research to continue exploring these potential relationships, identify cause-effect and inform the development of future interventions focused on reducing the negative impact of stress on pain outcomes - especially for minority groups who are disproportionately affected by pain disparities.

Objective: Clinical guidelines recommend opioid use only in severe and unresponsive cases of low back pain. Limited evidence exists on pain levels and opioid use in spine-related diagnoses (SRD). This study assessed the association between self-reported pain severity and opioid use among U.S. adults with SRD.

Methods: We conducted a retrospective cross-sectional analysis using 2018-2021 Medical Expenditure Panel Survey (MEPS) data. Adults aged ≥18 with SRD diagnoses and pain prescriptions were included. Pain severity was assessed using the Veterans Rand-12 item on pain interference with routine work. Pain medication use was determined from prescription records. Multivariable logistic regression was used to evaluate the association after controlling for other factors.

Results: According to the MEPS, there were 1.91 million (95% CI: 1.71-2.11) adults with SRD receiving pain medications annually, among whom 63.92% received opioid prescriptions. Most of the SRD patients were <66 years (69.71%), females (63.14%), and non-Hispanic whites (76.25%). Over half reported high pain interference with their routine activities (52.06%) Multivariable logistic regression analysis revealed that SRD patients who reported high pain interference with their routine work had higher odds of opioid use compared to those who reported low pain interference with their routine work (OR = 2.92, 95%CI: 1.49-5.70).

Conclusion: Over half of SRD patients receiving pain medications reported high pain severity levels, and these high pain levels were associated with higher odds of opioid use. While this evidence aligns with the clinical recommendations, more research is needed to understand the opioid use in SRD.

This rapid review examines the emerging role of voice-based artificial intelligence (AI) technologies in the objective assessment of chronic pain. It highlights promising applications of vocal biomarkers in pain quantification, particularly for populations with communication challenges or poorly understood conditions. AI is transforming healthcare, particularly for early detection of cardiovascular diseases and some neurological disorders, and it holds promise for managing chronic pain. This rapid literature review explores the potential of voice-based AI technologies to identify and analyze biomarkers that can objectively assess pain for populations with chronic pain conditions. These conditions are often complex and would benefit from more precise, reproducible measures of pain. While traditional pain scales heavily rely on self-reports, voice biomarkers are a non-invasive, scalable alternative. Studies show that changes in vocal characteristics-such as pitch, loudness, and jitter-correlate with pain intensity and quality; therefore, they offer insights that traditional, subjective measures may overlook. Machine learning models applied to voice data have demonstrated promise in detecting pain, particularly in vulnerable populations, such as those with intellectual and developmental disabilities. The review highlights how AI-driven voice analysis can complement cognitive behavioral therapy in pain management, enhancing accessibility and clinical outcomes. Despite the promise of AI-based approaches, challenges remain in standardizing these technologies for routine clinical use. Future research is needed to validate voice biomarkers across diverse pain conditions and to integrate them into clinical workflows to improve early diagnosis and personalized care, thus offering an innovative approach to chronic pain management. Key words: Voice biomarkers, Artificial intelligence, Pain Management, Machine Learning, Chronic Pain, Digital Health, Objective Pain Assessment.

Background: Pediatric patients with sickle cell disease (SCD) experience a high level of pain, which is often chronic and recurrent and results in impaired health-related quality of life (HRQOL). Patients with SCD also report a significant degree of sleep disturbance and fatigue associated with their chronic disease. The objective of the present study is to investigate the effects of pain, sleep disturbance, and general fatigue in a serial (sequential) multiple mediator model analysis predicting overall generic HRQOL in pediatric patients with SCD from their perspective.

Methods: The Pain Scale from the PedsQL Sickle Cell Disease Module, General Fatigue Scale and Sleep Disturbance Item from the PedsQL Multidimensional Fatigue Scale, and the PedsQL 4.0 Generic Core Scales were completed in a multisite national study by 227 pediatric patients with SCD aged 5-18 years. Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the percent variability accounted for and the mediating effects of sleep disturbance and general fatigue in the association between SCD pain and generic HRQOL.

Results: Pain predictive effects on generic HRQOL were serially mediated by sleep disturbance and general fatigue. In a hierarchical multiple regression analysis controlling for age and sex, pain, sleep disturbance, and general fatigue accounted for 63% of the variance in pediatric patient-reported generic HRQOL (P < 0.001), demonstrating a large effect size.

Conclusion: The mechanisms of the predictive effects of SCD-specific pain on generic HRQOL in pediatric patients with SCD are explained in part by the serial multiple mediator effects of sleep disturbance and general fatigue. Recognizing the multiple mediators of SCD-specific pain on generic HRQOL from the perspective of pediatric patients with SCD may aid future clinical research and practice to address impaired daily functioning through more comprehensive treatment approaches that include targeted symptom-specific interventions for pain, sleep disturbance, and fatigue.

Background: The Neuropathic Pain Symptom Inventory (NPSI) is a commonly used assessment in neuropathic pain (NP) trials, yet a Minimal Clinically Important Difference (MCID) has not been established. An MCID would enhance the interpretability of NPSI scores, guiding clinicians and researchers in assessing clinically important improvements in NP symptoms. The aim of this study was to calculate an MCID from the available scientific research that used the NPSI.

Methods: We conducted a systematic review and meta-analysis of NP trials reporting the NPSI. Four distributional approaches were applied to estimate the MCID: 1) meta-regression on the set of standard deviation (SD) of change scores, 2) meta-regression on the set of baseline SD scores, 3) simple aggregation on the set of SD of change scores, and 4) simple aggregation on the set of baseline SD scores. Only treatment arms within Randomized Controlled Trials (RCTs) were examined for MCID estimation. Control arms were examined separately in a sensitivity analysis using the simple aggregation method for both SD of change and baseline SD sets. Bias for each included study was assessed using the Cochrane tool for quality assessment of randomized controlled trials.

Results: 323 trials were examined, 12 were selected for inclusion with a total of 17 treatment arms. The calculated MCID estimates for the NPSI total score (range 1-100) were 6.21 for the SD of change meta-regression and 7.1 for baseline SD meta regression. The MCID values aggregated using simple aggregation methods were 7.95 using pooled SD of change scores, 7.8 using pooled baseline SD. Control arms had a MCID of 8.04 for SD of Change and 8.71 for Baseline SD.

Conclusion: This study provides preliminary MCID estimates for the NPSI. Limitations include limited data for NP subtypes, highlighting the need for additional anchor-based and etiology-specific MCID research to refine these estimates. These findings can aid in future NP trial design and the interpretation of results.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025649343, PROSEPRO CRD42025649343.

Introduction: Cannabis has been decriminalized by many states and shows promise in treating both neuropathic and non-neuropathic pain through its interaction with the endocannabinoid system and anti-inflammatory effects. This study examines differences in cannabis use for adults whose most bothersome chronic pain condition is neuropathic vs. non-neuropathic.

Materials and methods: Survey data were collected from adults receiving care at a pain clinic. Participants completed demographic questions and standardized self-report measures (PROMIS Pain Intensity/Interference and the ID-Pain tool). Participants' most bothersome pain condition(s) were categorized as neuropathic or non-neuropathic pain based on ID-Pain scores. Linear regression models assessed differences in frequency and duration of cannabis product use between groups, adjusting for age and sex.

Results: A total of 113 individuals were recruited; following exclusions and missing data, 104 participants (61.5% female) were included in the final analysis. Of these, 36.5% reported neuropathic pain as their most bothersome, and 63.5% reported non-neuropathic pain. Those with neuropathic pain reported significantly more days per month of Tetrahydrocannabinol/Cannabidiol (THC/CBD) combination (b = 5.96, p = 0.02), Cannabidiol-only (CBD-only) (b = 8.82, p = 0.03), and Tetrahydrocannabinol-only (THC-only) products (b = 7.04, p = 0.02). They also used THC-only (b = 0.97, p < 0.05) and THC/CBD (b = 1.09, p < 0.01) products more frequently per day. Neuropathic pain was positively associated with pain intensity (b = 4.10, p < 0.001) and interference (b = 4.95, p < 0.001).

Discussion: Adults whose most bothersome pain condition(s) were neuropathic used cannabis, especially THC and THC/CBD combination products, more frequently than those whose most bothersome pain was non-neuropathic. Participants with neuropathic pain also reported higher levels of pain intensity and interference. Further longitudinal research is needed to confirm whether increased use of THC-rich cannabis provides symptom relief for adults with neuropathic pain.

Background: Cancer pain is a significant public health concern worldwide, necessitating effective management strategies. This study aimed to explore the effects of patient-controlled subcutaneous analgesia (PCSA) with hydromorphone hydrochloride injection on refractory cancer pain.

Methods: We conducted a retrospective observational study involving patients who received PCSA with hydromorphone hydrochloride injection at our hospital from December 2022 to May 2023. All patients in this study were initially hospitalized to undergo dose titration and safety assessment for subcutaneous hydromorphone PCSA, ensuring drug tolerance and stable pump operation. After achieving dose stabilization, most patients continued analgesic therapy at home using the pump, with dynamic monitoring and dose adjustments conducted via telephone follow-ups and outpatient visits. Pain was assessed using the numerical rating scale (NRS), while anxiety and depression were evaluated using the Edmonton Symptom Assessment Scale (ESAS-R) and sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). The incidence of adverse drug reactions was also documented.

Results: The treatment demonstrated significant improvement across all observed parameters. After the continuous subcutaneous injection of hydromorphone hydrochloride infusion for analgesia,the median NRS pain score decreased from 6 to 1 (p < 0.0001), the mean sleep quality score decreased from 13.85 to 7.488 (p < 0.0001), the median anxiety state score decreased from 5 to 1 (p < 0.0001), the median depression score decreased from a baseline of 3 to 0.5 (p < 0.0001), and the median equivalent oral morphine dose decreased from 140 mg to 52 mg (p < 0.0001).

Conclusions: PCSA with hydromorphone hydrochloride injection offers significant therapeutic benefits for refractory cancer pain. It effectively reduces pain intensity, decreases opioid dosage, mitigates certain adverse reactions, and is associated with reduced anxiety and depression as well as improved sleep quality.