Journal of Pain Research最新文献

{"title":"Exploring Racial Disparities in Chronic Pain Management.","authors":"Anthony J Vargas, Leah Tobey-Moore, Geoffrey M Curran, Rania Elkhateb, Kevin W Sexton, Brett J Bailey, Corey Nagel, Johnathan H Goree","doi":"10.2147/JPR.S493664","DOIUrl":"10.2147/JPR.S493664","url":null,"abstract":"<p><strong>Introduction: </strong>Addressing racial disparities in chronic pain management referrals and prescribing is critical for ensuring equitable healthcare outcomes. Understanding these disparities is crucial for developing effective, patient-centered treatment strategies.</p><p><strong>Patients and methods: </strong>A cross-sectional retrospective study of 19,919 patients diagnosed with chronic non-cancer pain between 7/1/2020 and 7/1/2022 was conducted at a major academic medical center. Patients' demographics, pain types, and treatment modalities were analyzed using chi-square tests and logistic regression models to evaluate racial differences in pain management referrals and opioid prescriptions.</p><p><strong>Results: </strong>Non-Hispanic Black (NHB) and Hispanic patients had significantly lower odds of receiving interventional pain (Odds Ratio [OR] = 0.72 and 0.40, respectively) and neurosurgical referrals (OR = 0.66 and 0.49, respectively) compared to Non-Hispanic White (NHW) patients. Conversely, NHB patients were more likely to receive orthopedic surgery (OR = 1.40) and physical therapy referrals (OR = 1.16). Additionally, both NHB and Hispanic patients had lower odds of receiving opioid therapy (OR = 0.75 and 0.47, respectively) compared to NHW patients.</p><p><strong>Conclusion: </strong>This study highlights significant racial disparities in chronic pain management, with NHB and Hispanic patients receiving fewer referrals to specialist care and lower opioid prescription rates compared to NHW patients. Strategies to address these disparities include provider education on implicit bias, cultural sensitivity training, and ensuring equitable access to healthcare resources. Further research is needed to explore the root causes of these disparities and develop targeted interventions to improve healthcare equity for all patients.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2901-2908"},"PeriodicalIF":2.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Percutaneous Endoscopic Cervical Discectomy for Single-Segment Cervical Spondylotic Radiculopathy: A Retrospective Study with Minimum 3-Year Follow-Up.","authors":"Xiangbin Wang, Tao Li, Yong Li, Yubin Long","doi":"10.2147/JPR.S519127","DOIUrl":"10.2147/JPR.S519127","url":null,"abstract":"<p><strong>Background: </strong>Posterior percutaneous endoscopic cervical discectomy (P-PECD) has been increasingly used for cervical spondylotic radiculopathy (CSR), while few studies have reported on its medium-long-term outcomes. This study aims to investigate the medium-long-term efficacy and imaging findings of P-PECD in the treatment of single-segment CSR.</p><p><strong>Methods: </strong>The data of 51 patients with single-segment CSR treated with P-PECD were retrospectively analyzed. Efficacy was evaluated using visual analog scale (VAS) scores of neck and arm, Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and modified Macnab criteria. Radiologic parameters were measured before and after the operation, including cervical Cobb angle, range of motion (ROM), intervertebral space height, as well as horizontal and angular displacement at the operative level.</p><p><strong>Results: </strong>The VAS scores of neck and arm, JOA score, and NDI were significantly improved postoperatively compared with those before the operation, and the differences were statistically significant (<i>P <</i>0.05). Based on the modified Macnab criteria at the final follow-up, 94.12% showed excellent to good outcomes. Postoperatively, the cervical Cobb angle was 10.63 ± 1.79^°, ROM was 6.33 ± 1.11^°, the intervertebral space height was 4.63 ± 0.85 mm, horizontal and angular displacement at the operative level were 0.88 ± 0.68 mm and 4.25 ± 1.04^°, respectively, and there were no significantly changed at the final follow-up.</p><p><strong>Conclusion: </strong>P-PECD for single-segment CSR has the advantages of less trauma, less bleeding, a low complication rate, faster postoperative recovery, and less impact on cervical mobility and stability, which has excellent medium-long-term efficacy.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2879-2888"},"PeriodicalIF":2.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acupuncture as an Adjunctive Therapy to Etoricoxib for Patients with Acute Gouty Arthritis: Protocol for a Multicenter Randomized Controlled Trial.","authors":"Yi-Ran Wang, Cun-Zhi Liu, Yan Cong, Ya-Wei Xi, Ying-Ying Xu, Bo Li, Yi Zhou, Jian-Feng Tu, Yi-Ming Fu, Wen Chen, Li-Qiong Wang, Guang-Xia Shi","doi":"10.2147/JPR.S523657","DOIUrl":"10.2147/JPR.S523657","url":null,"abstract":"<p><strong>Purpose: </strong>Acute gouty arthritis (AGA) is often managed with non-steroidal anti-inflammatory drugs. However, patients still tolerate severe pain before the analgesic takes effect. Early adjuvant analgesia is necessary in the pharmacological management of AGA. Acupuncture has the advantage of quick analgesia; nevertheless, the evidence to support the use of early-acupuncture as an adjunctive therapy for AGA is limited. This study aims to assess the efficacy of acupuncture compared with sham acupuncture on pain relief among AGA patients who are concurrently receiving etoricoxib.</p><p><strong>Patients and methods: </strong>In this multicenter, randomized, controlled trial, total 160 eligible patients with AGA will be randomly allocated into acupuncture group and sham acupuncture group in a 1:1 ratio. All patients will receive oral etoricoxib followed by 30-minute acupuncture or sham acupuncture for 1 session. The primary outcome is the change in pain intensity (Visual Analogue Scale) after the 30-minute acupuncture treatment from baseline. The secondary outcomes include tenderness of study joint, swelling of study joint, rescue medicine, credibility and expectation evaluation and blinding assessment. Adverse events will be recorded during the trial. All the patients who are randomized in this study will be included in the intention-to-treat analysis.</p><p><strong>Conclusion: </strong>The results of this study will provide evidence for acupuncture used in the treatment of acute gouty arthritis and promote clinical decisions to physicians and patients.</p><p><strong>Trial registration: </strong>The protocol has been approved by the Medical Ethical Committee of Beijing University of Chinese Medicine (2023BZYLL0103) and registered at International Traditional Medicine Clinical Trial Registry (ITMCTR2024000218; http://itmctr.ccebtcm.org.cn/zh-CN/UserPlatform/ProjectView?pid=1749b951-b101-418f-8f82-77be3c72ea00).</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2889-2900"},"PeriodicalIF":2.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cost Effectiveness Analysis of Spinal Cord Stimulation versus Conventional Medical Management for the Treatment of Low Back Pain Using Data from DISTINCT RCT and Medical Claims from a U.S. Commercial Payer Database.","authors":"Timothy Deer, Robert Heros, Keith Scarfo, Christopher Gilligan, Jessica Jameson, Julie G Pilitsis, Mehul J Desai, Thadchaigeni Panchalingam, Scott Goates, Alexander M Benison, Udoka Okaro, Steven Falowski","doi":"10.2147/JPR.S486759","DOIUrl":"10.2147/JPR.S486759","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the healthcare utilization (HCU) and costs for passive recharge burst Spinal Cord Stimulation (SCS) and conventional medical management (CMM) cohorts in patients with chronic low back pain (LBP) to a matched real-world cohort of similar indication. The null hypothesis is that SCS is equally or less cost-effective than CMM in treating LBP.</p><p><strong>Patients and methods: </strong>DISTINCT is a prospective, multi-center, randomized study. Data was collected during in-clinic visits at baseline, one, three, and six months. The DISTINCT \"completer cohort\" included 79 DISTINCT SCS patients and 55 DISTINCT CMM patients who completed the six-month visit. An external real-world cohort (n = 71) with similar characteristics to DISTINCT CMM patients was identified from a claims database (Optum's de-identified Market Clarity Data). Accessed data included healthcare resource utilization (HCU), pain-related medication usage, pain scale, and quality of life. HCU data covered physical therapy, chiropractic therapy, massage therapy, occupational therapy, acupuncture, injection treatments, radiofrequency ablation procedures, and opioid and anticonvulsant usage.</p><p><strong>Results: </strong>The DISTINCT study demonstrated superior outcomes in pain relief, function, and other symptoms with SCS compared to CMM in the treatment of persistent (at least 6 months) low back pain. DISTINCT SCS patients utilized fewer healthcare resources and incurred lower costs than DISTINCT CMM patients. Real-world CMM patients exhibited higher utilization of certain therapies, suggesting potential pre-crossover bias. SCS resulted in significant cost savings and improved quality of life compared to CMM. Including device costs, cost-effectiveness could be achieved within 2.7 years based on DISTINCT data. The real-world CMM arm used more high-priced interventional therapies, suggesting a pre-crossover bias in the CMM cohort.</p><p><strong>Conclusion: </strong>This analysis supports the long-term benefits and cost-effectiveness of SCS in managing chronic LBP compared to CMM.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2823-2838"},"PeriodicalIF":2.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Telemedicine-Supported Structured Exercise Program in Patients with Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial.","authors":"Yuan Feng, Chengsen Jia, Huizhen Liu, Tianjie Bao, Chongyang Wang, Zezhang Wang, Jielei Huang, Yiwen Jiang, Xiaoyi Wang, Ruishi Zhang, Yujia Zhang, Shaojun Zhang, Siyi Zhu, Chengqi He","doi":"10.2147/JPR.S518072","DOIUrl":"10.2147/JPR.S518072","url":null,"abstract":"<p><strong>Purpose: </strong>Telemedicine-based structured exercise programs have the potential to benefit patients with chronic low back pain (CLBP). However, evidence-practice gaps persist, including low exercise adherence and insufficient focus on mental health. Consequently, further research is warranted to clarify the impact of telemedicine-supported structured exercise programs on patients with CLBP.</p><p><strong>Patients and methods: </strong>This randomized controlled trial will include patients with CLBP who have not received exercise therapy in the past three months. Participants in the trial group will receive patient education, health coaching, and home-based exercise therapy via mobile health (mHealth) applications loaded with wearable device integration. Those in the control group will receive conventional treatment, comprising patient education and written instructions for home exercises. Disability including pain intensity will be assessed as primary outcomes using the Roland-Morris Disability Questionnaire (RMDQ) and the Numerical Rating Scale (NRS) at baseline, 4 weeks, and 8 weeks. Statistical analyses will depend on assumptions such as homogeneity of variance and sphericity: if met, a two-factor, three-level repeated measures analysis of variance will be used; otherwise, a linear mixed-effects model will be employed.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2809-2822"},"PeriodicalIF":2.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Analysis to Identify Predictive Factors of Caudal Epidural Pulse Radiofrequency in the Treatment of Coccygodynia.","authors":"Ender Sir, Sena Aydogan, Gul Didem Batur Sir, Alp Eren Celenlioglu","doi":"10.2147/JPR.S521331","DOIUrl":"10.2147/JPR.S521331","url":null,"abstract":"<p><strong>Background: </strong>This study aims to use machine learning (ML) to explore predictive parameters related to the efficacy of caudal epidural pulsed radiofrequency (CEPRF) treatment for coccygodynia.</p><p><strong>Methods: </strong>Five different ML methods were used to predict treatment success at 6 months after CEPRF. The findings generated by these algorithms are compared with respect to the accuracy of the results.</p><p><strong>Results: </strong>Symptom duration, angular deformation and NRS at admission are the most significant factors impacting therapy success in coccygodynia patients. Success rates are obtained for relatively short symptom durations to be 71.83%, for longer periods to be 16.67%; for short durations together with no angular deformity to be 79.55%, with angular deformity to be 59.26%; and for NRS level at admission less than 8 together with angular deformity to be 91.67%, with no angular deformity to be 33.33%.</p><p><strong>Conclusion: </strong>This research reveals the potential of ML methods to improve treatment outcome prediction in coccygodynia. When a new patient is admitted, the ML-generated decision trees provide a quick and precise assessment of the possible success rate of CEPRF treatment.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2839-2848"},"PeriodicalIF":2.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12154530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suzetrigine Approval Breaks a 25-Year Silence: A New Era in Non-Opioid Acute Pain Management.","authors":"Olivier Sibomana, Melody Okereke, Clyde Moono Hakayuwa","doi":"10.2147/JPR.S526851","DOIUrl":"10.2147/JPR.S526851","url":null,"abstract":"<p><p>Pain management remains a critical priority in clinical practice. Meanwhile, traditional analgesics, including non-opioid and opioid medications, often pose substantial risks, including adverse effects and potential for addiction. The recent approval of Suzetrigine by the US Food and Drugs Administration (FDA) represents a pivotal advancement in non-opioid analgesia for the treatment of moderate-to-severe acute pain. Suzetrigine, a selective NaV1.8 sodium channel inhibitor, provides effective pain relief by targeting peripheral pain pathways, minimizing the risk of addiction commonly associated with opioids, and has good safety profile according to clinical trials. Given the growing concerns surrounding opioid use, Suzetrigine offers a promising therapeutic alternative in acute pain management, with future research needed to assess its long-term effectiveness in diverse populations.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2805-2808"},"PeriodicalIF":2.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Review on Personalized Pain Assessment and Multimodal Interventions for Postoperative Recovery Optimization.","authors":"Jingying Xu, Xiaona Liu, Jinyan Zhao, Jingjing Zhao, Hao Li, Huanhuan Ye, Shuang Ai","doi":"10.2147/JPR.S516249","DOIUrl":"10.2147/JPR.S516249","url":null,"abstract":"<p><p>Postoperative pain management is an important determinant of patient recovery, as it directly influences rehabilitation efficiency, hospitalization duration, and the risk of postoperative complications. Despite its significance, traditional pain management strategies often fail to adequately address individual variability and the multidimensional nature of pain, thereby limiting their effectiveness. To address these limitations, we designed this comprehensive narrative review to systematically summarize relevant literature published between 2000 and 2024, from databases such as PubMed and Web of Science, with a particular focus on personalized pain assessment and multimodal interventions to optimize postoperative recovery. Personalized pain assessment, guided by the biopsychosocial model, captures the biological, psychological, and social dimensions of pain, offering a more comprehensive and individualized evaluation of patient needs. In parallel, multimodal interventions, which integrate pharmacological and non-pharmacological strategies, are designed to target multiple pain mechanisms simultaneously, thereby enhancing analgesic efficacy while minimizing adverse effects. Emerging evidence indicates that combining personalized pain assessment with multimodal interventions can significantly improve clinical outcomes, as demonstrated by reductions in postoperative pain scores by approximately 20-30%, shorter hospital stays by 1-2 days, and decreased opioid consumption by 25-40%. Notable clinical applications supporting these findings include the use of dynamic pain monitoring devices, virtual reality-based therapies, and prehabilitation programs to facilitate recovery. Building upon these findings, this review further discusses the theoretical foundations underlying personalized pain management, explores its clinical applications, and examines the practical challenges associated with its implementation. Additionally, future directions are proposed, including the development of AI-driven pain assessment tools, the promotion of interdisciplinary collaboration, and the establishment of standardized clinical protocols. Collectively, these advancements support the potential of personalized, multidimensional strategies to improve postoperative outcomes and enhance overall patient satisfaction.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2791-2804"},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Cord Stimulation Alleviates Sensitization of Neuropathic Pain by Upregulating G Protein-Coupled Receptors to Inhibit Overexpression of Cav2.2 and Its Downstream Excitatory Neurotransmitters.","authors":"Si-Liang Liu, Hong-En Zhang, Ji-Yu Kang, Huai-Yu Ji, Zhen-Hua Cai, Si-Hua Qi, Shan-Shan Liu, Hua-Cheng Zhou","doi":"10.2147/JPR.S514719","DOIUrl":"10.2147/JPR.S514719","url":null,"abstract":"<p><strong>Purpose: </strong>Spinal cord stimulation (SCS) is an effective treatment for various forms of neuropathic pain (NP), including postherpetic neuralgia, phantom limb pain, and painful diabetic neuropathy. Currently, although there have been studies on the analgesic mechanisms associated with SCS, the roles of ion channels in the therapeutic effects of SCS are still unclear.</p><p><strong>Methods: </strong>In this study, NP hyperalgesia was induced in a rat model using chronic constriction injury (CCI) of the sciatic nerve. Ten days after modeling, the rats were treated with SCS (50 hz, 200 μs, and 80% motor threshold) for 3 hours each day for 5 consecutive days. The role of ion channels in SCS-induced analgesia was investigated using bioinformatics, western blotting, and immunofluorescence assays.</p><p><strong>Results: </strong>Behavioral analysis showed that SCS treatment for 5 consecutive days increased both the mechanical and thermal pain thresholds of the CCI rats. The bioinformatics results indicated that N-type calcium channels (Cav2.2) were key in the induction of NP-associated hyperalgesia, with the opioid receptor-like 1 receptor (ORL-1) functioning as an upstream inhibitor of Cav2.2. The results also showed that SCS induced analgesia through upregulation of ORL-1 to inhibit overexpression of Cav2.2 and its downstream neurotransmitters, substance P and glutamate. This analgesic effect could be reversed by both Cav2.2 agonists and ORL-1 inhibitors.</p><p><strong>Conclusion: </strong>SCS alleviates hyperalgesia in NP through upregulation of ORL-1 to inhibit the overexpression of Cav2.2 and its downstream neurotransmitters. This may be one of the mechanisms through which SCS induces analgesia. The elucidation of the ion channel mechanism of SCS will improve the clinical application procedures of SCS.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2775-2790"},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Pain Management Strategies Following Peroral Endoscopic Myotomy (POEM): A Review.","authors":"Jun Lu, Wentao Ji, Chao Sang, Zhi Wang, Lulong Bo","doi":"10.2147/JPR.S511019","DOIUrl":"10.2147/JPR.S511019","url":null,"abstract":"<p><p>Peroral Endoscopic Myotomy (POEM) is a minimally invasive procedure for treating esophageal achalasia, but effective postoperative pain management remains a challenge. Pain following POEM is multifactorial, arising from mechanical, chemical, and thermal stimuli that activate nociceptive and neuropathic pain pathways. A multimodal analgesia approach, combining opioids, non-opioid analgesics, and regional anesthesia, is currently the most effective strategy. Opioids remain a cornerstone of pain management, but their side effects, such as nausea and constipation, highlight the need for alternatives. Non-opioid analgesics, including acetaminophen, COX-2 inhibitors, and magnesium, have shown promise in reducing pain and opioid use. Regional anesthesia techniques, such as thoracic paravertebral blocks and erector spinae plane blocks, have been explored, though their efficacy in POEM remains inconclusive. Despite advances, there are ongoing challenges in standardizing pain management protocols. Variability in clinical practices and limited high-quality research with small sample sizes complicate the development of universally applicable guidelines. Additionally, while current research primarily focuses on acute postoperative pain, long-term outcomes, such as chronic pain and quality of life, require further investigation. Addressing these gaps in knowledge will be key to improving pain management practices and optimizing recovery for POEM patients. Future studies should focus on refining multimodal analgesia strategies, exploring new analgesic agents, and evaluating long-term pain management outcomes to enhance patient care and improve clinical results.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2761-2773"},"PeriodicalIF":2.5,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}