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

Introduction: Chronic pain is highly prevalent among dementia family caregivers (henceforth "caregivers"). We used a nationwide sample of caregivers with chronic pain to identify the extent to which caregivers attribute pain to any difficulty they have with caregiving.

Methods: Caregivers (N = 269) reported if they experienced difficulty performing ten individual care tasks and if 'yes', how much of the difficulty they attributed to pain (0 = not a reason for my difficulty, 10 = the biggest reason for my difficulty). We ran ANOVA models to determine between-group differences in pain-attributed difficulty with care tasks.

Results: When asked about the extent to which pain contributed to the difficulty helping care recipients with a given care task, caregivers' average response was 6.81 for basic activities of daily living and 6.49 for instrumental activities of daily living. Compared to White caregivers, Black caregivers attributed less of their difficulty with basic activities of daily living to pain (estimate = -1.17, p = 0.04).

Discussion: Caregiver pain is not only highly prevalent may also be consequential to caregiving outcomes.

Background: Chronic non-specific neck pain (CNSNP) is the most common type of chronic neck pain encountered in clinical practice. Existing studies have demonstrated that intermediate frequency therapy can effectively alleviate neck pain symptoms. Among other conservative treatment modalities, Tai Chi, a typical mind-body exercise, may improve musculoskeletal function and postural control, but its effect on cervical stability and CNSNP remains unclear. The aim of this study was to compare the clinical efficacy of Tai Chi combined with intermediate frequency therapy vs. intermediate frequency therapy alone in patients with CNSNP.

Methods: According to the inclusion and exclusion criteria, patients with CNSNP were recruited from the rehabilitation medicine clinic of the Sixth People's Hospital of Kunshan City, resulting in the enrollment of 60 eligible participants. Patients were randomly assigned to either the experimental group (EG) or the control group (CG). The EG received Tai Chi combined with intermediate frequency therapy, while the CG received intermediate frequency therapy alone. The primary outcome was the visual analogue scale (VAS) for pain. Secondary outcomes included the Neck Disability Index (NDI), the D value of cervical physiological curvature measured by x-ray, and the cervical range of motion (ROM) score. The intervention lasted eight weeks, with sessions conducted five times per week, for a total of 40 sessions. Assessments were performed at baseline, at four weeks (mid-intervention), and at the end of eight weeks.

Results: During the study, one participant in the EG withdrew after missing one week of Tai Chi intervention. Two participants in the CG discontinued: one due to a change in their treatment plan, and one for personal reasons. Thus, 57 patients with CNSNP completed the study. Both groups showed significant improvements in VAS, NDI, cervical physiological curvature (D value), and ROM scores after treatment compared to baseline. Notably, the improvement in the D value was significantly greater in the EG than in the CG.

Conclusion: For patients with CNSNP, the combination of Tai Chi and intermediate frequency therapy appeared to alleviate pain and improve function. Compared to intermediate frequency therapy alone, this combined approach significantly improves the physiological curvature of the cervical spine in individuals with CNSNP. Furthermore, these findings suggest that Tai Chi may be a safe and beneficial adjunctive therapy, and may represent a promising alternative for the management of CNSNP. However, larger-scale long-term studies are still needed.Clinical Trial Registration: www. itmctr.ccebtcm.org.cn, identifier (TTM-CTR-2025000447).

Abdominal pain represents a frequent presenting symptom in emergency departments, with up to 20% of patient visits involving abdominal and/or flank pain. Recently published studies indicate that anterior cutaneous nerve entrapment syndrome (ACNES) is a more common cause of these symptoms than previously believed, with up to 2% of patients presenting to the emergency department at teaching hospitals being ultimately diagnosed with the condition. Importantly, ACNES is often misdiagnosed as another cause of abdominal pain. We present a 76-year-old patient whose a chief complaint was persistent abdominal pain localized to the right side of the umbilicus over a 6-week period, associated with a burning sensation of the skin. Following unremarkable laboratory, imaging, and endoscopy findings, the diagnosis of ACNES was confirmed with simple Carnett's sign. This is the first documented report to highlight that interventional treatment when combined with exogenous factors can contribute to the repair of nerve damage.

From an etiological perspective, the International Association for the Study of Pain (IASP) classifies pain into three categories: nociceptive pain (NcP), neuropathic pain (NeP), and nociplastic pain (NpP). In clinical practice, distinguishing between NpP and NeP can be particularly challenging. They share many clinical characteristics, including pain hypersensitivity and spontaneous pain. Currently, no evidence-based diagnostic method has been established for NpP, as defined by the IASP. Questionnaires had been developed before the IASP officially adopted NpP in 2017. Therefore, they cannot reliably distinguish between NpP and NeP. There is a previously unrecognized academic ambiguity arising from the coexistence of the unified concept of NeP including NpP and the separate concept of NeP excluding NpP. Moreover, NpP diagnosed using different criteria can coexist. There is currently no established guideline for either the pharmacological or the non-pharmacological treatment of NpP. The treatment of fibromyalgia, a typical NpP, closely resembles that of NeP. The theoretical concept of NpP has generated substantial uncertainty not only in pain research but also in clinical practice, particularly regarding diagnosis and treatment. To simplify diagnosis and treatment, resolve scholarly uncertainty, and improve the care of patients with pain, four provisional plans are proposed until an evidence-based method for diagnosing NpP has been established. (1) Integrate NpP into NeP and use the term NeP. (2) Classify NpP as a subcategory of NeP and use the term NeP. (3) Integrate NpP into NeP and use the term new NeP (nNeP). (4) Classify NpP as a subcategory of NeP and use the term nNeP. The recommended plan is (1). It is hoped that these four proposals will serve as constructive contributions toward advancing both the conceptual understanding of pain and its treatment.

Introduction: Concerns regarding the side effects of pharmacotherapy in the management of joint pain have led to increased interest in dietary supplements. Astragalus membranaceus root extract (AME) has been proposed as an alternative approach to relieving knee joint pain. The present study evaluated the efficacy and safety of a standardized AME in patients with functional knee joint pain.

Methods: A double-blind, randomized controlled trial was conducted with 90 adults (18-60 years of age) from Rajalakshmi Hospital and Research Center, Karnataka, India. Participants were randomly assigned to receive either 480 mg of AME (n = 45) or placebo (n = 45) for 28 days. The primary outcome was knee pain reduction, which was assessed using a visual analog scale (VAS) after a 6-min walk test. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Stair Climb Test (SCT), knee range of motion (ROM), and treatment compliance, evaluated at baseline and at follow-up on days 5, 14, and 28. Patient satisfaction and safety were also assessed.

Results: The AME group exhibited a significant 30% reduction in knee pain (p < 0.0001), with mean VAS scores dropping from 6.7 ± 0.5 to 1.2 ± 0.6. Significant improvements were observed in the WOMAC, SCT score, and ROM (p < 0.0001). Patient satisfaction was higher in the active-treatment group, and no serious adverse events were reported.

Discussion: AME was a safe and effective alternative for the management of knee joint pain and merits further longer-term investigation.

Clinical trial registration: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=OTE3MTU=&Enc=&userName=, identifier CTRI/2023/09/057317.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect in patients undergoing chemotherapy. Many commonly used chemotherapeutic agents simultaneously induce neurotoxicity and modulate the immune system. Emerging evidence highlights a critical role of the innate immune system in the development of various neuropathic pain conditions. As a natural immune defense mechanism formed during phylogenetic evolution, innate immunity elicits a robust response during CIPN pathogenesis. This review summarizes the roles of the innate immune system-including the skin barrier, innate immune cells, and innate immune molecules-in the context of CIPN.

Rheumatoid arthritis (RA) pain is one of the most common forms of chronic pain in clinic. A large number of RA-related literature has been reported. At present, although some analgesic measures are used in clinic, pain management after drug treatment remains suboptimal in real-world settings, and clinically meaningful pain after treatment is still reported. RA pain is a complex pathological process that involves inflammatory response, neuroimmune interaction, peripheral and central nerve sensitization, autoantibodies, structural damage, and other dimensions. Although inflammatory reaction is the most common cause of RA-induced pain, neuroimmune interaction is the key and core of RA pain, and autoantibodies are one of the significant characteristics of RA, which can directly or indirectly lead to pain. In addition, joint structural damage is the final pathological stage and a serious consequence in the late stage of RA. This article aims to summarize the mechanisms of RA pain, which is helpful to further clarify the diagnosis and provide targeted treatment.

Objective: To investigate the clinical efficacy of medical ozone injections into the intervertebral disc on relieving lumbosacral pain. through a systematic review and meta-analysis.

Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, and Web of Science for English-language randomized controlled trials (RCTs) published between January 2010 and January 2025. The study was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42023417837). Primary clinical outcomes included pain reduction assessed by Visual Analog Scale (VAS) scores and functional improvement assessed by the Oswestry Disability Index (ODI). Statistical analyses were performed using Review Manager 5.4.

Results: Eight RCTs involving 1,744 patients were included. Among them, 903 people received medical ozone injections into the intervertebral discs, while 841 people received other forms of treatment. Meta-analysis showed that medical ozone injections significantly reduced VAS scores (mean difference = -2.13, 95% CI: -2.33 to -1.93, p < 0.05) and improved ODI scores (mean difference = -0.79, 95% CI: -0.95 to -0.63, p < 0.05), indicating superior short-term efficacy compared to conventional treatments.

Conclusions: Ozone injection into the intervertebral discs is an effective non-invasive treatment method, which can effectively relieve pain in the lumbar and sacral regions, especially showing significant effects in the short term. However, Further long-term studies are warranted to evaluate the durability of clinical benefits.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023417837, PROSPERO CRD42023417837.

Myofascial pain syndrome (MPS) is a leading cause of chronic musculoskeletal pain, yet its mechanisms remain debated. Traditional models emphasized muscle contracture or central sensitization, but growing evidence highlights fascia as a biologically active, pain-relevant tissue. Pathological alterations such as densification, fibrosis, and inflammation may generate nociceptive input and sustain persistent symptoms. To explore this perspective, we conducted a conceptual narrative review of studies published between 2000 and 2025 in PubMed, Embase, Scopus, and Google Scholar. Eligible publications included anatomical, histological, imaging, biomechanical, and clinical investigations, and evidence was synthesized narratively into an integrative model of mechanisms. This mini-review followed the SANRA guidelines for narrative reviews. The literature demonstrates that fascia is richly innervated by nociceptors and sympathetic fibers and undergoes pathological changes in patients with MPS. Imaging and histological studies confirm fibrosis, densification, and inflammatory activity in symptomatic fascia. Mechanistic pathways linking fascia to pain include impaired sliding, abnormal mechanotransduction, and neuroinflammatory sensitization. Clinically, patients exhibit tenderness on fascial palpation, imaging evidence of stiffness, and symptomatic improvement after fascia-focused therapies. These findings suggest that fascia functions as a key peripheral driver in MPS. This concept was first formalized as the 'integrated hypothesis' by Simons in 2004. Integrating fascia into existing frameworks reconciles muscle-based and central sensitization models, providing a plausible substrate that initiates nociceptive signaling, perpetuates central adaptations, and interacts with psychosocial influences. This integrative model may explain the heterogeneity of MPS and supports multimodal treatment strategies that combine fascial therapies with central and psychosocial interventions. Although current evidence remains preliminary and heterogeneous, recognizing fascia as a central but interconnected contributor to MPS offers a more comprehensive understanding of this syndrome and a clinically relevant framework for future diagnostic and therapeutic innovation in pain medicine.

The complex relationship between pain and sleep has received increasing attention for its therapeutic potential. Over half of chronic pain patients suffer from sleep disorders, and poor sleep is a strong predictor for pain in clinical populations. Understanding the bidirectional relationship between pain and sleep is crucial for developing improved clinical treatment strategies. This review provides (1) a primer on preclinical methods used to measure sleep behaviors, (2) an overview of neural circuits at the intersection of pain and sleep, and (3) considerations for future pain and sleep investigations and treatment strategies.