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

Background: Pain is a common complication after combat injuries to the extremities. The role of nerve damage in the development of post-traumatic pain is recognized and described in the literature, superinfection as a potential factor has not been studied sufficiently.

Objective: To establish the relationship between the characteristics of the wound microbiota, the intake of different groups of antibiotics and the development of chronic pain in patients with traumatic injuries of the extremities.

Methods: We conducted a prospective study that included 56 patients. All participants were male, aged 25 years and older. In addition, a mandatory inclusion criterion in the study was the presence of prolonged wound healing, longer than 1 month. We performed a microbiological study of wound contents and assessed the frequency of use of different antibiotics to combat infection. At the same time, pain intensity was assessed using a numerical pain rating scale. Patients were divided into two groups: uncomplicated infection and superinfection. Statistical analysis was performed using t-tests, Fisher's exact test, and multiple linear regression.

Results: Superinfection was found in 50% of patients and was significantly associated with higher pain intensity (p < 0.01). Based on the results of the regression analysis, superinfection was found to be an independent predictor of pain severity (β = 1.31; p = 0.001). The use of aminoglycosides and carbapenems showed a trend towards increased pain scores, although statistical significance was not achieved.

Conclusions: Wound superinfection is a distinct predictor of the development of chronic pain after traumatic injury. Early microbiological monitoring and cautious use of neurotoxic antibiotics may reduce long-term pain in affected patients. For a deeper understanding of the processes and factors that contribute to and potentiate the development of pain syndrome, further studies are needed on microbial-neuroimmune interactions, taking into account the duration of antibiotic use and their combinations.

Background: Rhinosinusitis (RS) is a leading reason for antibiotic prescriptions but treatment satisfaction is low. Misdiagnosis may contribute to poor outcomes, as migraine-often underrecognized-can mimic RS symptoms, with studies showing overlap between RS and migraine diagnoses. Our aims were to explore the demographics and clinical features of facial pain or pressure (FPP), its relationship with migraine and RS, and distinguish symptoms between these overlapping conditions.

Methods: The HEADS Registry, a web-based survey, targets adults with head and/or neck symptoms. Participants who answered "yes" (FPP+) or "no" (FPP-) to experiencing recurrent facial or sinus pain/pressure were included in this analysis. The ID Migraine screening tool was used to classify participants as ID Migraine+ or ID Migraine-. Demographics, symptoms, disability, history of allergies, sinusitis, and antibiotic use were compared between 1) FPP+ and FPP- groups, 2) FPP+/ ID Migraine+ and FPP+/ID Migraine-, and 3) FPP+/ID Migraine- and FPP-/ID Migraine+ subgroups. Continuous variables were compared using independent samples t-test or Mann-Whitney U, and categorical variables were compared using chi-square or Fisher's exact test.

Results: The FPP+ group (n = 598) was younger, more often female, and reported higher rates of nasal, vestibular, and otologic symptoms compared to the FPP- group (n = 146). They also had more severe headaches, migraine-associated symptoms, and higher ID Migraine screening rates. The FPP+ group reported greater daily symptom interference, and more allergies, sinus infections, and antibiotic use. Those who screened positive for migraine (FPP+/ID Migraine+, n = 438) had more severe symptoms, greater disability, and more frequent forehead/eye pain. FPP+/ID Migraine- (n = 48) participants were more likely to report nasal symptoms, allergies, and sinus infections, while FPP-/ID Migraine+ (n = 85) participants reported more disabling headaches.

Conclusion: In this exploratory analysis, FPP was strongly associated with headache, including migraine, as well as allergies, rhinosinusitis, and antibiotic use. The low reported effectiveness of antibiotics suggests potential misdiagnosis. Findings that migraine, plus autonomic, vestibular, otologic symptoms are associated with FPP, highlight the need to expand the differential diagnosis beyond infectious causes. These insights, along with ongoing registry improvements, will support efforts to refine diagnostic accuracy and optimize treatment strategies for neurologic, otologic, and rhinologic conditions.

Background: Low back pain (LBP) is the leading cause of disability worldwide. Up to half of moderate-to-severe acute LBP (aLBP) progress to chronic (cLBP), with neuromotor, fascial, and muscle pathology contributing to inoperable mechanical disability. A novel thermomechanical stimulation (M-Stim) device delivering stochastic and targeted vibration frequencies relieved LBP in a pilot. Efficacy versus an active control, for cLBP prevention, or reversing disability was undetermined.

Methods: As part of a National Institutes of Health (NIH) double-blind, randomized controlled trial, 159 chiropractic patients with non-radiating moderate-to-severe LBP [Numeric Rating Scale (NRS) ≥4] were randomized to add either the multimodal M-Stim device or 4-lead transcutaneous electrical nerve stimulation (TENS) for 30 minutes daily to other therapies. Between June 2022 and July 2024, pain scores, analgesic use, and device adherence were recorded for 28 days, with weekly follow-up up to 6 months. Primary outcomes included PROMIS Pain Interference scores, NRS pain scores, and transition from aLBP to cLBP (Pain Interference ≥55 at 3 months). Exploratory analyses examined higher-severity subgroups, including those meeting NIH Research Task Force (RTF) criteria, obesity, longer pain duration, and an integrated analysis with common criteria for intractable inoperable mechanical cLBP.

Results: For 44 aLBP and 115 cLBP participants [mean age 42.6, 54% female, BMI 30.9 (SD 6.19), NRS 5.51 (SD 2.15)], M-Stim was noninferior to TENS for initial and 10-day relief. Over time, Linear Mixed Models (intention-to-treat) showed M-Stim significantly improved pain and disability for both aLBP and cLBP, (p < .001 to p = .024). With higher severity, 23.9% (11/46) M-Stim users reached "no disability" (PROMIS = 40.7) vs. 7.1% (2/28) TENS users [RR 0.81 (95% CI 0.66-0.99), p = 0.04]. M-Stim yielded significantly greater improvement than TENS in those with pain ≥5 years, BMI ≥30, or mechanical cLBP (all p < .05). Significantly fewer aLBP M-Stim users transitioned to cLBP at 3 months [31.8% vs. 72.7%, RR 0.44 (95% CI 0.23-0.85), NNT = 2.4, p = 0.015].

Conclusions: A multimodal M-Stim device reduced progression to cLBP significantly more than TENS. Both devices reduced pain initially, but M-Stim reduced pain and disability significantly more over time, particularly in cLBP subsets with higher severity, duration, or BMI.

Clinical trial registration: https://clinicaltrials.gov/study/NCT04494698, identifier NCT04494698.

Persistent pain remains a significant global health challenge, with prevailing biomedical and biopsychosocial models often falling short in capturing its full complexity. These models frequently lack conceptual and contextual coherence, overlooking the deeply subjective, cultural, and systemic dimensions of pain. As a result, care can become fragmented and suboptimal. This perspective article introduces an integral vision of pain, grounded in the All Quadrants, All Levels (AQAL) framework, which offers a multidimensional approach that integrates subjective experience, objective mechanisms, cultural meaning, spiritual perspectives, and systemic structures. The article outlines how a simplified AQAL framework can serve as a heuristic tool to synthesise individual and collective dynamics-including psychological development and socio-environmental conditions-thereby informing a more comprehensive understanding of pain and its persistence. This includes recognising the role of painogenic environments and the impact of evolutionary mismatch in shaping pain experiences. This integral perspective reframes persistent pain within a salutogenic social model of health, adopting a whole-person, whole-system approach that supports the co-creation of compassionate, community-driven, and context-sensitive care. Ultimately, it reconceptualises persistent pain not merely as a disease state or clinical symptom, but as a dynamic, relational, and meaning-laden experience embedded within the evolving journey of life. This integral vision challenges reductionist paradigms, advancing a more coherent, salutogenic, and humanistic model for understanding and addressing persistent pain.

Introduction: Neuropathic pain is characterized by mechanical allodynia and thermal (heat and cold) hypersensitivity, yet the underlying neural mechanisms remain poorly understood.

Methods: Using chemogenetic excitation and inhibition, we examined the role of inhibitory interneurons in the basolateral amygdala (BLA) in modulating pain perception following nerve injury.

Results: Chemogenetic excitation of parvalbumin-positive (PV⁺) interneurons significantly alleviated mechanical allodynia but had minimal effects on thermal hypersensitivity. However, inhibition of PV⁺ interneurons did not produce significant changes in pain sensitivity, suggesting that reductions in perisomatic inhibition do not contribute to chronic pain states. In contrast, bidirectional modulation of somatostatin-positive (SST⁺) interneurons influenced pain perception in a modality-specific manner. Both excitation and inhibition of SST⁺ interneurons alleviated mechanical allodynia, indicating a potential compensatory role in nociceptive processing. Additionally, SST⁺ neuron excitation reduced cold hypersensitivity without affecting heat hypersensitivity, whereas inhibition improved heat hypersensitivity but not cold responses.

Discussion: Our findings suggest that, in addition to PV⁺ neurons, SST⁺ interneurons in the BLA play complex roles in modulating neuropathic pain following nerve injury and may serve as a potential target for future neuromodulation interventions in chronic pain management.

Objective: This study aimed to compare the therapeutic effect of PRP and methylene blue injection in patients with discogenic low back pain.

Methods: A total of 40 patients with discogenic low back pain were randomly divided into two groups, with 20 patients in group A receiving platelet-rich plasma injections and 20 patients in group B receiving methylene blue injections. Visual analog scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, Pfirrmann grades, and MRI apparent diffusion coefficients (ADCs) were recorded in both groups before the injections and 6 months after the injections.

Results: Compared with group B, the postoperative VAS score of group A was significantly decreased, while the JOA score and ADC score were significantly increased (P < 0.05). There was no significant difference in Pfirrmann grade between the two groups after surgery (P > 0.05). In group A, the Pfirrmann grade after surgery was lower than before surgery (P < 0.05), and the ADC score was higher than before surgery (P < 0.05). There was no significant difference in Pfirrmann grade for the patients in group B before and after surgery (P > 0.05), and their ADC score was lower than that before surgery (P < 0.05).

Conclusion: Compared with a methylene blue injection, platelet-rich plasma can significantly reduce pain, improve the function of the lumbar spine, increase the diffusion ability of water molecules in the intervertebral disc, and improve the degree of intervertebral discogenic degeneration in patients with discogenic low back pain.

The use of non-opioid multimodal analgesics (NMA) may enhance pain relief and decrease opioid dependence in managing acute incisional pain, although this remains debated. A clinical trial found NMA ineffective compared to placebo, prompting us to investigate its impact on pain-like behaviors in animal models. In our study, 12 rats underwent plantar incision surgery and were divided into two groups: NMA and vehicle. NMA comprised acetaminophen, celecoxib, gabapentin, and dextromethorphan, with dosages based on human equivalents. We measured paw withdrawal latency (PWL), paw withdrawal threshold (PWT), and spontaneous foot lifting (SFL) behaviors. Before injection, there were no significant differences between the groups in PWL, PWT, or SFL. After treatment, PWL increased in NMA-injected rats (9.8 ± 2.2 s) compared to vehicle (5.9 ± 2.7 s; p = 0.02). SFL frequency decreased in NMA-injected rats (8.0 ± 5.0 count/20-min) vs. vehicle (30.7 ± 18.0 count/20-min; p = 0.013). However, PWT and SFL duration showed no significant changes. This research represents the first exploration of NMA's effects on incisional pain, suggesting it may effectively manage acute postsurgical pain with inflammatory and neuropathic components. Further clinical validation is needed, but our results indicate NMA could be a viable opioid alternative.

Introduction: Snijders Blok-Campeau Syndrome (SNIBCPS) is a neurodevelopmental disorder characterized by intellectual disability, developmental delays, speech impairment, hypotonia, and distinctive facial features. Little is known about pain perception in children with cognitive impairments, such as patients with SNIBCPS. Although it has been noted that some individuals with SNIBCPS have decreased pain sensation and response to painful stimuli, these reports are anecdotal. Therefore, the objective was to better understand this syndrome and the affected individual's perception and response to pain through proxy-reported observational assessments.

Methods: Fifteen caregivers of individuals with a diagnosis of SNIBCPS participated in this mixed-methods anonymous survey study between July and September 2024. The survey questionnaires included the Pediatric Pain Profile, a Pain Sensory Questionnaire, the Non-Communicative Children's Pain Checklist-Revised, and the Individualized Numerical Rating Scale.

Results: Almost a quarter of our respondents reported insensitivity in the affected individual to hard impacts or pressure. Our findings highlight early and past painful experiences in individuals with SNIBCPS who have a range of behaviors to express their pain.

Discussion: Our findings bring awareness about the proper examination of individuals with SNIBCPS. Despite the small sample size, our findings suggest that pain and injuries may go unreported in individuals with SNIBCPS, and individualized parental observational scales may be beneficial for their healthcare providers and their caregivers.

Objectives: The review aimed to evaluate the efficacy of pulsed radiofrequency (PRF) in treating chronic pain by analyzing recent literature.

Study design: This is a narrative review of relevant articles on the effectiveness of PRF for chronic pain.

Methods: Search for papers published between November 2014 and November 2024 in the PubMed database that use PRF to treat chronic pain. We used "Pulsed radiofrequency, PRF, Pulsed RF for Pain, chronic pain, neuropathic pain, cancer pain, and osteoarthritis pain" as search terms. Inclusion criteria are as follows: (1) Patients are clearly diagnosed with chronic pain according to the standards of the International Association for the Study of Pain; (2) Pulsed radiofrequency is used to treat chronic pain; (3) Follow-up assessments are conducted to evaluate the degree of pain relief after PRF treatment; (4) Review articles and articles not related to the treatment of chronic pain are excluded.

Results: Preliminary searches yielded 368 relevant articles. After reviewing the titles and abstracts and evaluating the full texts, we ultimately included 80 articles. These articles cover research on pulsed radiofrequency treatment for various chronic pain conditions, including neuropathic pain, osteoarthritis pain, and cancer pain. The study types are diverse, including randomized controlled trials, cohort studies, and case reports. The publication dates of the articles range from 2014 to 2024, ensuring the timeliness and comprehensiveness of the research findings, which reflect the latest advancements and outcomes in the field of pulsed radiofrequency treatment for chronic pain.

Limitations: This review did not include studies indexed in databases other than PubMed.

Conclusion: This article reviews the research progress of pulsed radiofrequency technology in the field of chronic pain treatment. By searching and analyzing relevant literature from recent years, it summarizes the research findings on the mechanisms of PRF in treating chronic pain, its clinical applications, efficacy evaluation, and safety, and discusses future research directions. This is helpful for clinical physicians to develop more scientific treatment plans when managing chronic pain patients.