Journal of Pain Research最新文献

{"title":"High Prevalence of Small-Fiber Neuropathy in Patients with Tarlov Cysts: Toward a More Comprehensive Clinical Understanding.","authors":"Mieke Hulens, Peter Zajonc, Frans Bruyninckx, Ricky Rasschaert, Peter De Mulder, Chris Bervoets, Wim Dankaerts","doi":"10.2147/JPR.S513705","DOIUrl":"https://doi.org/10.2147/JPR.S513705","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the prevalence of small-fiber neuropathy (SFN) and the clinical characteristics of patients with Tarlov cysts (PTCs), focusing on symptoms related to SFN and increased cerebrospinal pressure.</p><p><strong>Patients and methods: </strong>In this retrospective study, 126 surveys assessing symptoms in women (30-69 years) with Tarlov cysts (TCs) ≥ 7 mm seeking treatment for chronic back, pelvic or leg pain and skin biopsy results from 75 patients assessing intraepidermal nerve fiber density (IENFD) were reviewed.</p><p><strong>Results: </strong>IENFD < 5th percentile was documented in 80% of PTCs according to the normative reference data of Collongues et al and 72% according to the worldwide dataset of Lauria et al Questionnaires revealed high incidences of neuropathic pain (80%), allodynia (76%), pain while sitting (93%), anal sphincter (11%) and urinary sphincter (66%) problems, persistent genital arousal (27%), and restless legs (54%). Autonomic dysfunctions included early satiety (41%), bladder (93%) and bowel (88%) dysfunction, increased sweating (51%), and Raynaud's phenomenon (45%). Other symptoms potentially associated with increased cerebrospinal fluid pressure (CSFP) were headaches (57%), fatigue (86%), cognitive issues (86%), and pulsatile tinnitus (59%).</p><p><strong>Conclusion: </strong>This study revealed a high prevalence of SFN in PTCs (72-80%). Although the TCs may not cause radicular pain in the corresponding dermatomes directly, individuals with TCs frequently report a range of symptoms that have previously been linked to symptomatic TCs, including bladder, bowel, sphincter, and sexual symptoms, as well as local pain. Additionally, seemingly unrelated symptoms, such as headaches, fatigue, cognitive difficulties, neuropathic pain localized in other parts of the body, and autonomic dysfunctions, are commonly reported. These symptoms may be associated with elevated CSFP within the nerve root sheath. Elevated pulsatile CSFP underlies the formation of TCs at the dorsal root ganglion and may gradually contribute to small-fiber dysfunction by irritating, compressing and damaging small nerve fibers within the dorsal root ganglion.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2241-2263"},"PeriodicalIF":2.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998274","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":"Perspective Articles as Catalysts for Innovation: Addressing Critiques on Traditional Chinese Rehabilitation Exercise for Myofascial Pain [Response to Letter].","authors":"Xueen Liu, Jiale Zhang","doi":"10.2147/JPR.S534896","DOIUrl":"https://doi.org/10.2147/JPR.S534896","url":null,"abstract":"","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2265-2267"},"PeriodicalIF":2.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970537","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":"Risk Stratification for Postoperative Opioid Induced Respiratory Depression: A Retrospective Case-Control Analysis of Existing Validated Tools.","authors":"Sam Hutcheson, Aimee Pehrson, Robert B Gassert, Ethan Guffey, Paul C Shanahan, Laura Sisk, Samuel Patton, Che Antonio Solla","doi":"10.2147/JPR.S495181","DOIUrl":"https://doi.org/10.2147/JPR.S495181","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative opioid-induced respiratory depression (POIRD) is a preventable perioperative cause of morbidity and mortality. A validated POIRD risk stratification tool could reduce these complications. 3 pre-existing validated opioid tools; and specific risk factors identified from these tools; were examined in this retrospective case-control study to determine if they could assess POIRD risk in patients discharged to hospital floors from the Post-Anesthesia Care Unit (PACU).</p><p><strong>Patients and methods: </strong>Our dataset includes 126 matched patients who underwent surgery at the University of Tennessee Medical Center from January 2019 to December 2021. All patients that were related to active traumas or burns were excluded from this study. Escalation of care secondary to respiratory failure (an increase in respiratory support with movement to an intensive care unit/stepdown unit or patient expiration secondary to respiratory failure) with and without naloxone administration was the primary endpoint; with the subgroup that received naloxone being the surrogate POIRD endpoint. Escalation of care secondary to respiratory failure; regardless of naloxone use; was a secondary endpoint.</p><p><strong>Results: </strong>There was no association between the 3 opioid tools evaluated with the POIRD surrogate endpoint or escalation of care. Bipolar disorder (OR 3.68; 95% CI 1.11-9.56) and a history of substance abuse (OR 26.33; 95% CI 5.18-119.02) were significant risk factors that contributed to escalation of care secondary to respiratory failure. A history of substance abuse was found to have a significant association with escalation of care secondary to respiratory failure with naloxone administration (OR=6.886; 95% CI 2.02-23.56).</p><p><strong>Conclusion: </strong>While we were unable to identify a tool to stratify POIRD risk; patients with bipolar disorder and a history of substance abuse are at an increased risk of postoperative respiratory failure requiring escalation of care; with a history of substance abuse being associated with POIRD.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2233-2240"},"PeriodicalIF":2.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12047283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064093","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":"Radiofrequency for Chronic Knee Pain: A Literature Review.","authors":"Chao Shang, Ning Sun, Zixu Lv, Donghua Yin, Chunlin Feng","doi":"10.2147/JPR.S512813","DOIUrl":"https://doi.org/10.2147/JPR.S512813","url":null,"abstract":"<p><strong>Objective: </strong>This review aimed to explore the current applications of radiofrequency (RF) therapy in managing chronic knee pain and to compare different treatment strategies.</p><p><strong>Methods: </strong>A comprehensive review of recent literature was conducted, concentrating on variations in target selection, guidance techniques, and treatment parameters that influence therapeutic outcomes.</p><p><strong>Results: </strong>RF therapy is a minimally invasive and effective treatment for chronic knee pain, providing faster recovery compared with traditional interventions. However, differences in treatment options can lead to significant variability in the efficacy and safety.</p><p><strong>Conclusion: </strong>A thorough understanding of the distinct characteristics of various RF therapy strategies is required for optimizing chronic knee pain management. Future research should emphasize systematic evaluation of these approaches to refine clinical practice and establish evidence-based pain management protocols.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2203-2213"},"PeriodicalIF":2.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970640","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":"Comparative Evaluation of Efficacy and Complications Between Biportal Endoscopic Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis.","authors":"Qianqin Hu, Keyi Xiao, Jin-Niang Nan, Shang-Wun Jhang, Chien-Min Chen, Guang-Xun Lin","doi":"10.2147/JPR.S472975","DOIUrl":"https://doi.org/10.2147/JPR.S472975","url":null,"abstract":"<p><strong>Objective: </strong>To effectuate a comprehensive juxtaposition of the clinical implications, incidence of complications, and successful fusion rates observed in the context of biportal endoscopic lumbar interbody fusion (BE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).</p><p><strong>Methods: </strong>The present research initiative involved an exhaustive exploration of pertinent scholarly literature in renowned databases, which lasted until April 2023. The evaluative framework encompassed a diverse array of parameters, including but not limited to operation time, hospitalization, quantification of estimated blood loss, the assessment of outcomes via the application of the Visual Analog Scale (VAS) to gauge pain intensity, and the utilization of the Oswestry Disability Index (ODI) to measure functional impairment.</p><p><strong>Results: </strong>The current meta-analysis included ten studies with a total of 736 participants. In comparison of the BE-LIF and MI-TLIF techniques, no substantial differences were observed in the parameters studied, included VAS for leg pain (P > 0.05), as well as the assessment of complication rates (7.76% versus 7.97%; P = 0.71) and fusion rates (89.59% versus 88.60%; P = 0.90). However, the early postoperative VAS for back pain (P < 0.0001) and the early postoperative ODI score (P = 0.007) were significantly lower in the BE-LIF group than in the MI-TLIF group. Additionally, a significant difference in blood loss was observed (P < 0.0001), with less blood loss in the BE-LIF group compared to the MI-TLIF group. Furthermore, the complex surgical procedure of BE-LIF resulted in a longer duration of surgery (P = 0.02) but shorter hospitalization compared with MI-TLIF (P < 0.0001).</p><p><strong>Conclusion: </strong>Within the context of the management of lumbar degenerative diseases, BE-LIF surgery exhibits clinical effectiveness and incidence of complications comparable to MI-TLIF. In contrast to MI-TLIF, BE-LIF offers distinctive merits, including reduced blood loss, abbreviated hospitalization durations, expedited relief from postoperative back pain, and an accelerated trajectory towards functional recuperation.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2215-2231"},"PeriodicalIF":2.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018620","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":"Causal Relationship Between Psychosocial Factors and Neck Pain: A Two-Sample Mendelian Randomization Study.","authors":"Haibo Liang, Qihang Wu, Shu Yang, Shuhao Zhang, Jiansen Miao, Haiming Jin, Xiangyang Wang","doi":"10.2147/JPR.S508287","DOIUrl":"https://doi.org/10.2147/JPR.S508287","url":null,"abstract":"<p><strong>Purpose: </strong>Neck pain (NP) is a multifactorial disorder that leads to severe disability. This study aimed to investigate whether potential risk factors have a causal effect on NP at the genetic level using a two-sample Mendelian randomization (MR) analysis.</p><p><strong>Methods: </strong>Summary-level data for potential risk factors, including distress, anxiety disorder, depression, mood, sleep disorder, loneliness, education, alcohol consumption, smoking, time spent using the computer, and physical activity, as well as NP, were obtained from multiple large-scale Genome-Wide Association Studies (GWAS). Instrumental variables (IVs) were extracted from these datasets. We employed inverse variance weighting (IVW), weighted median, and MR-Egger regression methods to assess causal effects. Heterogeneity was evaluated using MR-Egger regression and IVW, while horizontal pleiotropy was assessed using MR-PRESSO analysis and MR-Egger regression.</p><p><strong>Results: </strong>The IVW results showed that major depressive disorder (OR = 1.51, 95% CI: 1.15, 1.98, p = 3.40×10^-3) and experiencing mood swings (OR = 2.73, 95% CI: 1.57, 4.75, p = 3.86×10^-4) were positively associated with NP and years of schooling (OR = 0.504, 95% CI: 0.410, 0.619, p = 6.55×10^-11) was negatively associated with NP. Additionally, loneliness (OR = 16.0, 95% CI: 1.29-198, p = 0.0307) showed a suggestive association with NP. As for the other factors we did not find a clear causal relationship (All p-values > 0.05).</p><p><strong>Conclusion: </strong>This two-sample MR study provides genetic evidence supporting a causal relationship between major depressive disorder, mood swings, and years of schooling with NP, while loneliness showed a potential association. These findings highlight the critical role of psychosocial factors, such as depression, mood swings, and education level, in the prevention and management of NP. Our results may offer new insights for clinicians to develop targeted intervention strategies aimed at reducing the incidence of NP.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2191-2201"},"PeriodicalIF":2.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064076","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":"\"Zhibian (BL54) to Shuidao (ST28)\" Acupuncture Manipulation Combined with Analgesics in Postoperative Pain Management for Patients with Mixed Hemorrhoids: A Randomized Controlled Trial Protocol.","authors":"Te Wang, Jun Qiang Gao, Min Chang, Ming Chen Ma, Yu Tong Wang, Tu Ning Guo, Yan Lin Zhang, Zhen Gao, Hai Jun Wang, Yu Xia Cao","doi":"10.2147/JPR.S519232","DOIUrl":"https://doi.org/10.2147/JPR.S519232","url":null,"abstract":"<p><strong>Purpose: </strong>Mixed hemorrhoids patients often face severe postoperative pain, typically treated with Non-steroidal anti-inflammatory drugs (NSAIDs) or opioids, which may lead to gastrointestinal and Central Nervous System (CNS) side effects. The \"Zhibian (BL54) to Shuidao (ST28)\" manipulation acupuncture combined with analgesics shows promise as a safe and effective alternative. Thorough randomized controlled trials (RCTs) are crucial for determining the effectiveness and safety when used in conjunction with pain relievers.</p><p><strong>Patients and methods: </strong>This double-blind randomized controlled trial aims to assess the effectiveness and safety of the acupuncture method connecting the \"Zhibian (BL54)\" and \"Shuidao (ST28)\" points combined with analgesics in alleviating pain following surgery for mixed hemorrhoids. A total of 104 patients who meet diagnostic criteria and undergo Milligan-Morgan open hemorrhoidectomy (MMH) will be randomized into control (n = 52) or acupuncture (n = 52) groups. The control group will receive diclofenac sodium, while the acupuncture group will additionally undergo the \"Zhibian (BL54) to Shuidao (ST28)\" manipulation acupuncture. The intervention will span a duration of five days, with data collection occurring both prior to and following the intervention. Primary outcomes include Visual analogue scale (VAS) scores for pain, with secondary outcomes assessing analgesic efficiency, increased pain medication use, and pain interference in daily activities. Statistical analysis will be conducted utilizing SPSS software, version 26.0.</p><p><strong>Discussion: </strong>This forward-looking, randomized study aims to assess the effectiveness of combining acupuncture with medication in alleviating postoperative pain for individuals suffering from mixed hemorrhoids, wih the goal of establishing a safe and potent therapeutic strategy and broadening the clinical applications of this intervention.</p><p><strong>Conclusion: </strong>This randomized study evaluates the effectiveness of combining acupuncture with medication to relieve postoperative pain in patients with mixed hemorrhoids, aiming to establish a safe and effective treatment strategy and expand its clinical use.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2163-2174"},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029987","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":"Analysis of Electroacupuncture Parameters for Irritable Bowel Syndrome: A Data Mining Approach.","authors":"Yang Tang, Xiao Tang, Qiao Wen","doi":"10.2147/JPR.S483750","DOIUrl":"https://doi.org/10.2147/JPR.S483750","url":null,"abstract":"<p><strong>Purpose: </strong>Irritable bowel syndrome (IBS), a prevalent functional bowel disorder, has increasingly seen acupuncture incorporated into its clinical management. Despite this, a comprehensive summary of electroacupuncture (EA) stimulation parameters and acupoint prescriptions tailored for IBS remains absent. This study endeavors to identify effective EA parameters for IBS through data mining methodologies.</p><p><strong>Methods: </strong>To retrieve randomized controlled trials (RCTs) on EA for IBS published between 2013 and 2024, a comprehensive search was conducted across nine databases. EA parameters from eligible studies were extracted and evaluated for quality using the Cochrane's risk of bias tool (RoB 2). Descriptive statistics were computed using MS-Excel^®. Association rule analysis was undertaken in SPSS Modeler, whereas complex network analysis and co-occurrence network analyses were performed using Gephi and Origin, respectively.</p><p><strong>Results: </strong>A total of 30 RCTs involving 2906 participants were included. All included studies exhibit a low to high risk of bias. Key methodologic weaknesses are mainly attributed to insufficient randomization and lack of blinding. The frequently reported EA stimulation parameters were a frequency of 2 hz, using either dilatational or continuous waves, with a treatment duration of 30 minutes, a 4-week course, and once daily treatment. Across 32 acupoint prescriptions, 27 acupoints were identified, with the stomach and bladder meridians being the most frequently targeted. Acupoints ST25, ST37, and ST36 were most frequently used. The most supported combination of acupoints could be (ST25→ST37); <i>k</i>-core hierarchical analysis of complex networks revealed the core acupoints for IBS treatment, including ST25, ST37, ST36, SP6, LR3, BL25, LI11 and RN4.</p><p><strong>Conclusion: </strong>A regimen combining dilatational/continuous waves, 2 hz, a 30-minute stimulus, a 4-week course, and the acupoint combination (ST25→ST37) may serve as a primary EA protocol for IBS. However, methodological constraints may undermine the robustness of these findings. Therefore, the clinical application of these therapeutic modalities requires further validation.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2175-2189"},"PeriodicalIF":2.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972360","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":"Opioid-Free versus Opioid-Sparing Anesthesia for Postoperative Pain and Early Recovery After Laparoscopic Cholecystectomy: A Randomized Controlled Trial.","authors":"Miaomiao Xiong, Yao Liu, Yingsi Liang, Hailang Wang, Lili Zhang, Zhongjun Zhang, Ming Fang","doi":"10.2147/JPR.S506147","DOIUrl":"https://doi.org/10.2147/JPR.S506147","url":null,"abstract":"<p><strong>Purpose: </strong>Enhanced recovery after surgery emphasizes effective analgesia while minimal opioid use. Opioid-free anesthesia (OFA) and opioid-sparing anesthesia (OSA) have been shown to enhance recovery by reducing opioid-induced side effects. This study compared the efficacy of OFA and OSA in managing postoperative pain and recovery after laparoscopic cholecystectomy (LC).</p><p><strong>Patients and methods: </strong>A single-center, randomized controlled trial was conducted with 86 adults undergoing LC. Patients received either OSA (sufentanil/remifentanil) or OFA (no opioids). Both groups received propofol, esketamine, dexmedetomidine, and erector spinae plane block. The primary outcome was pain area under the curve (AUCVAS) within 36 hours postsurgery. Secondary outcomes included hemodynamics, recovery times and bowel function.</p><p><strong>Results: </strong>Eighty-one patients (41 and 40 in the OFA and OSA groups, respectively) completed the study. The AUCVAS scores were similar between the OFA (7.3 ± 1.4) and OSA (6.9 ± 1.3) groups (P = 0.201), the difference in AUCVAS between the two groups was 0.384 (95% CI: -0.296, 1.064), which was significantly below the preset noninferiority threshold of 1.0, demonstrating the noninferiority of OFA. While early pain scores within the first 12 hours postanesthesia care unit (PACU) discharge were slightly higher in the OFA group, but overall pain control was sufficient in both groups. The VAS scores from PACU discharge to 36 hours postoperatively, intraoperative hemodynamic variables, and the need for rescue analgesia were comparable. OFA patients experienced a faster bowel recovery (13.8 ± 2.4 vs 15.5 ± 2.3 hours, P = 0.002). Recovery times, postoperative QoR-40 scores, and patient satisfaction were similar between the groups.</p><p><strong>Conclusion: </strong>OFA is noninferior to OSA in pain management and hemodynamic stability, with faster bowel recovery after LC.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2137-2146"},"PeriodicalIF":2.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997805","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":"Device Evaluation, Treatment, and Explantation Recommendations (DETER): Review and Best Practices for Managing Neuromodulation Device Infections.","authors":"Scott G Pritzlaff, Johnathan Heck Goree, Ryan Keith Dare, Ryan S D'Souza, David W Lee, Andrew Adams Dudas, Hemant Kalia, Vwaire Orhurhu, Naileshni Singh, Jonathan Michael Hagedorn, Arman Mousavi, Whitney James, Michael Spencer Leong, Kathleen W Meacham, Amitabh Gulati, Samir J Sheth, Israel Pena, Jarna R Shah, Melissa Zhu Murphy, Sara E Nashi, Morad Nasseri, Andrew M Khoury, Michael J Dorsi, Steven Michael Falowski, Erika A Petersen, Nestor D Tomycz, Sayed Wahezi, Krishnan V Chakravarthy, Jason E Pope, Michael E Schatman, Kasra Amirdelfan, Dawood Sayed, Timothy Ray Deer","doi":"10.2147/JPR.S509623","DOIUrl":"https://doi.org/10.2147/JPR.S509623","url":null,"abstract":"<p><p>Infections related to neuromodulation devices such as spinal cord stimulators (SCS) and intrathecal pumps (ITPs) present complex challenges due to potential complications such as localized infections, deep infections, sepsis, and neurological injury. Prompt diagnosis requires patients and providers to be educated on wound management and sepsis symptoms for immediate medical attention. Antibiotic therapy and duration vary based on infection severity, with deep infections often requiring device removal despite recent improvements in salvage rates with aggressive initial intervention. Deep infections necessitate timely diagnosis through imaging modalities such as magnetic resonance imaging (MRI) or computed tomography (CT), followed by device removal and culture-guided antibiotic therapy, often in collaboration with infectious disease specialists and spine surgeons. ITP infections pose similar challenges along with the risk of meningitis and may require careful management of medication withdrawal symptoms during emergent pump removal. Lab monitoring may aid treatment assessment, although negative cultures can occur due to post-antibiotic exposure. Postoperative recommendations stress standardized guidelines, patient education, and vigilant surveillance, with close follow-up crucial for early infection detection and intervention. Managing device-related infections demands a multi-specialty approach to minimize complications and optimize outcomes. This paper outlines best practices for diagnosing, managing, and treating neuromodulation device infections, focusing on guiding clinical decision-making from the onset of infection through treatment and potential reimplantation.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"2147-2161"},"PeriodicalIF":2.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018621","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}