Journal of Pain Research最新文献

{"title":"Exploring Perceived Barriers and Facilitators for Implementing Acute Pain Clinical Trials: A Mixed-Methods Analysis of Ketamine Infusions for Sickle Cell Pain.","authors":"Martha O Kenney, Alexander T Limkakeng, Timothy N Ochoa, Joacy G Mathias, Mitchell R Knisely, Francis Keefe","doi":"10.2147/JPR.S507983","DOIUrl":"10.2147/JPR.S507983","url":null,"abstract":"<p><strong>Objective: </strong>Vaso-occlusive events (VOEs) are the primary cause of acute pain in individuals with sickle cell disease (SCD), where high-dose opioids are the current standard treatment. Ketamine, a non-opioid analgesic, holds potential for managing acute SCD due to its opioid-sparing properties. This study aimed to explore the barriers and facilitators to an inpatient clinical trial of ketamine infusion for treatment of acute SCD pain.</p><p><strong>Methods: </strong>A mixed-methods design integrated quantitative survey data from 70 sickle cell and emergency medicine clinicians with qualitative insights from 10 patient focus group participants. Survey responses (n = 77 total, including seven registered nurses) were analyzed descriptively and via Fisher's exact and Mann-Whitney <i>U</i>-tests, while focus groups were thematically coded using themes from the Consolidated Framework for Implementation Research.</p><p><strong>Results: </strong>Clinicians showed varied comfort levels with ketamine, with significant differences between sickle cell and emergency medicine clinicians. Barriers to future trials included the lack of standardized protocols (50.6%) and providers' attitudes regarding ketamine (32.5%). Patients cited trust in providers and potential health benefits as key facilitators but also expressed concerns about safety, confidentiality, and time commitment of trial participation.</p><p><strong>Conclusion: </strong>Successful implementation of inpatient trials of pain interventions, such as ketamine infusions, requires a multidisciplinary approach, transparent communication about risks, strong clinical frameworks, and patient-centered trial designs. While study limitations, such as potential selection bias and low survey response rate, should be considered, these findings provide actionable insights to guide the design of future clinical trials and improve non-opioid pain management for SCD.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1465-1478"},"PeriodicalIF":2.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700720","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":"Non-Cognitive Behavioral Therapy Psychological Interventions May Not Make the Difference in Children and Adolescents With Chronic Pain.","authors":"Lauren Perlman, Naomi Malka, Oliver Terry, Alex Nguyen, Lucas Guimarães Ferreira Fonseca, Juan I Ingelmo, Pablo Ingelmo","doi":"10.2147/JPR.S503542","DOIUrl":"10.2147/JPR.S503542","url":null,"abstract":"<p><strong>Background and aim: </strong>Chronic pain in pediatric populations presents a multifaceted challenge with biopsychosocial impact, requiring a multidisciplinary approach including psychological treatment. At our interdisciplinary pain center, the SARS-CoV-2 pandemic-related disruptions led to the cessation of cognitive-behavioral therapy (CBT) and other psychological interventions during the pandemic. The aim of this retrospective cohort study with secondary retrospective matched case-control analysis was to evaluate the impact of interruption of non-CBT psychological interventions, namely psychoanalysis and psychodynamic psychotherapy, on children and adolescents with chronic pain conditions during the SARS-CoV-2 pandemic.</p><p><strong>Materials and methods: </strong>We included pediatric patients with primary and secondary chronic pain conditions evaluated by our team during the SARS-CoV-2 pandemic. We excluded patients who did not receive psychological intervention when available, those with incomplete data on initial evaluation or follow-up, and those who received outside psychiatric care or individual or group CBT. The primary outcome was a Patients' Global Impression of Change (PGIC) score of 6-7. Secondary outcome measures were pain intensity, use of pain medication, sleep, physical function, school attendance, the incidence of suicidality, and the reason for end of treatment.</p><p><strong>Results: </strong>The study included 146 patients, 77 who received non-CBT psychological interventions and 69 who did not receive any psychological interventions. We found no meaningful difference between the use of non-CBT psychological intervention and no treatment in the incidence of PGIC 6-7 points, pain intensity, school attendance, physical function, suicidality, and cause of end of treatment. Patients not receiving any psychological interventions were more likely to have normalized sleep at the end of treatment.</p><p><strong>Conclusion: </strong>Non-CBT psychological interventions, namely psychoanalysis and psychodynamic psychotherapy, were not associated with meaningful benefits for children and adolescents with chronic pain during the COVID-19 pandemic. Patients who did not receive psychological interventions reported normalization of their sleep at the end of treatment compared to those who participated in non-CBT interventions.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1451-1464"},"PeriodicalIF":2.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710350","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":"Detrimental Effects of Space Flight on the Lumbar Spine May Be Correlated to Baseline Degeneration: Insights From an Advanced MR Imaging Study.","authors":"Rakan Bokhari, Daniel G Bisson, Maryse Fortin, Marie Vigouroux, Juan Pablo Cata, Ken-Pin Hwang, Melissa M Chen, Guillermo Ceniza-Bordallo, Jean A Ouellet, Pablo M Ingelmo","doi":"10.2147/JPR.S492600","DOIUrl":"10.2147/JPR.S492600","url":null,"abstract":"<p><strong>Introduction: </strong>Pain in lower back is a common condition reported by astronauts, both during and after space missions. Investigating the alterations in the spine and the mechanisms driving these changes is essential for a deeper understanding of how microgravity impacts the human spine. This knowledge could also open pathways for therapeutic or preventive interventions. Nevertheless, there is a limited evidence regarding changes in intervertebral discs (IVDs) due to space travel.</p><p><strong>Materials and methods: </strong>In this study, 2 astronauts were enrolled in a space travel. Before the space flight, a lower back magnetic resonance imaging (MRI) scan was performed. We repeated an MRI instantly after 17-days space travel, and again 3 months after landing. The water content and glycosaminoglycan (GAGs) levels in the lumbar IVDs were evaluated using DIXON water-only phase imaging and T1rho MRI sequences. Additionally, alterations in the size and quality of the paraspinal muscles (PSMs), including fatty infiltration, were examined.</p><p><strong>Results: </strong>Varied alterations were observed in the IVDs and PSMs of both astronauts. One astronaut experienced a reduction in water and GAGs content, while the other showed an increase. These changes in the IVDs following spaceflight appeared to be linked to the degree of baseline degeneration. Regarding the PSMs, differences in size and fatty infiltration also varied between the two astronauts. Notably, these changes had not stabilized by the final follow-up at 3 months.</p><p><strong>Conclusion: </strong>Our findings offer initial evidence indicating that even brief exposures to microgravity might be linked to biochemical alterations in IVDs and changes in the quality of PSMs, which could continue evolving for more than 3 months after returning from space.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1375-1385"},"PeriodicalIF":2.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692418","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":"Evaluating Large Language Models for Burning Mouth Syndrome Diagnosis.","authors":"Takayuki Suga, Osamu Uehara, Yoshihiro Abiko, Akira Toyofuku","doi":"10.2147/JPR.S509845","DOIUrl":"10.2147/JPR.S509845","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models have been proposed as diagnostic aids across various medical fields, including dentistry. Burning mouth syndrome, characterized by burning sensations in the oral cavity without identifiable cause, poses diagnostic challenges. This study explores the diagnostic accuracy of large language models in identifying burning mouth syndrome, hypothesizing potential limitations.</p><p><strong>Materials and methods: </strong>Clinical vignettes of 100 synthesized burning mouth syndrome cases were evaluated using three large language models (ChatGPT-4o, Gemini Advanced 1.5 Pro, and Claude 3.5 Sonnet). Each vignette included patient demographics, symptoms, and medical history. Large language models were prompted to provide a primary diagnosis, differential diagnoses, and their reasoning. Accuracy was determined by comparing their responses with expert evaluations.</p><p><strong>Results: </strong>ChatGPT and Claude achieved an accuracy rate of 99%, while Gemini's accuracy was 89% (p < 0.001). Misdiagnoses included Persistent Idiopathic Facial Pain and combined diagnoses with inappropriate conditions. Differences were also observed in reasoning patterns and additional data requests across the large language models.</p><p><strong>Discussion: </strong>Despite high overall accuracy, the models exhibited variations in reasoning approaches and occasional errors, underscoring the importance of clinician oversight. Limitations include the synthesized nature of vignettes, potential over-reliance on exclusionary criteria, and challenges in differentiating overlapping disorders.</p><p><strong>Conclusion: </strong>Large language models demonstrate strong potential as supplementary diagnostic tools for burning mouth syndrome, especially in settings lacking specialist expertise. However, their reliability depends on thorough patient assessment and expert verification. Integrating large language models into routine diagnostics could enhance early detection and management, ultimately improving clinical decision-making for dentists and specialists alike.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1387-1405"},"PeriodicalIF":2.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692423","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":"Pain Intensity and Pain Catastrophizing Among Patients with Chronic Pain: The Mediating Effect of Self-Efficacy.","authors":"Jiayao Li, Yi Cui, Qiong Jia, Anping Ouyang, Yan Hua","doi":"10.2147/JPR.S504498","DOIUrl":"10.2147/JPR.S504498","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the mediating role of sense of self-efficacy in the relationship between pain intensity and pain catastrophizing among chronic pain patients.</p><p><strong>Methods: </strong>A questionnaire survey was administered to patients with chronic pain at the pain intervention departments of three tertiary hospitals in Shaanxi Province between July 2023 and July 2024. The visual analogue scale, chronic pain self-efficacy scale, and pain catastrophizing scale were used to assess the patients' pain intensity, self-efficacy, and pain catastrophizing degree, respectively. SPSS 27.0 and Mplus 8.3 software were used for statistical analysis.</p><p><strong>Results: </strong>This study included a total of 430 patients with chronic pain. The average score for catastrophizing pain among participants was 22.76 (score range 0-52), which is considered moderate. Pain intensity and pain catastrophizing were significantly and positively correlated, and the findings found that chronic pain self-efficacy mediated the correlation between pain intensity and pain catastrophizing after controlling for sociodemographic and disease-related variables. In addition, chronic pain self-efficacy was found to be an important mediator, accounting for 32.5% of the total effect.</p><p><strong>Conclusion: </strong>Among patients with chronic pain, chronic pain self-efficacy explains the relationship of pain intensity and pain catastrophizing. These findings imply that interventions that decrease pain intensity and increase patients' sense of self-efficacy are beneficial for improving pain catastrophizing in this population.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1361-1373"},"PeriodicalIF":2.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692342","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 Acupoint Selection Rules for Guasha Treatment of Primary Headaches Based on Data Mining [Response to Letter].","authors":"Xujie Zhang, Xinrui Huang, Feilin Ni, Danhua Yang, Min Xu","doi":"10.2147/JPR.S526394","DOIUrl":"https://doi.org/10.2147/JPR.S526394","url":null,"abstract":"","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1433-1434"},"PeriodicalIF":2.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692400","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":"High Pain Self-Efficacy Reduces the Use of Analgesics in the Early Postoperative Period After Total Knee Arthroplasty: A Retrospective Cohort Study.","authors":"Tatsuru Sonobe, Takuya Nikaido, Miho Sekiguchi, Yoichi Kaneuchi, Tadashi Kikuchi, Yoshihiro Matsumoto","doi":"10.2147/JPR.S511719","DOIUrl":"10.2147/JPR.S511719","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is an effective treatment for relieving pain and restoring physical function in individuals with severe knee osteoarthritis (KOA). However, the persistence of postoperative pain is an unresolved problem, and the use of postoperative analgesics to deal with this pain is increasing. The positive cognitive factor known as pain self-efficacy (PSE) has been shown to moderate the intensity of pain, but there are few reports of PSE concerning analgesic use after TKA. We sought to clarify the effect of PSE on postoperative analgesic use in TKA cases.</p><p><strong>Patients and methods: </strong>We conducted a retrospective cohort study of 60 patients who underwent bilateral TKA surgery for bilateral severe KOA. A multiple linear regression model including covariates and scaling estimation coefficients was used to investigate the effect of PSE on the patients' postoperative analgesic use. We identified the presence/absence of postoperative analgesic use at 3 and 6 months postoperatively, and other evaluation items such as the Pain Self-Efficacy Questionnaire (PSEQ) were evaluated at the time of the patients' admission for surgery.</p><p><strong>Results: </strong>In a multiple linear regression model, only high PSE had a significant impact on the postoperative 3-month use of nonsteroidal anti-inflammatory drugs (NSAIDs) (β: -0.27, 95% confidence interval [CI]: -0.51, -0.01). However, the significant difference had disappeared postoperative 6 months (β: -0.06, 95% CI: -0.19, 0.31).</p><p><strong>Conclusion: </strong>These results demonstrated that high pain self-efficacy reduced the analgesic use at 3 months postoperatively by patients who have undergone bilateral TKA surgery, but it did not affect analgesic use at 6 months postoperatively. Pain self-efficacy can be an intervention target for reducing the use of analgesics after TKA surgery. Further research is needed to clarify the relationship between pain self-efficacy and the post-TKA use of analgesics.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1407-1415"},"PeriodicalIF":2.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692429","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":"Ultrasound-Guided vs Non-Guided Pharmacopuncture for Cervical Myofascial Pain Syndrome: A Multi-Center Prospective Comparative Study Protocol.","authors":"Kwangho Kim, Juhwan Song, Hongmin Chu, Robin Kwon, Seongjun Park, Junhui Kwon, Hyeon Joon Hong, Youngyun Lee, Sanghyuk Kwon, Kyungho Kang, Jungtae Leem, Cheol-Hyun Kim","doi":"10.2147/JPR.S509236","DOIUrl":"10.2147/JPR.S509236","url":null,"abstract":"<p><strong>Purpose: </strong>Cervical Myofascial Pain Syndrome (CMPS) is a common musculoskeletal disorder that significantly impacts daily life due to pain and restricted movement. This study focuses on Ultrasound-Guided Pharmacopuncture(UGP) to release fascial restrictions and alleviate nerve compression. By utilizing real-time ultrasound imaging, UGP is expected to enhance treatment accuracy, reduce adverse events, and improve clinical outcomes. This study aims to assess the efficacy and safety of UGP compared to Non-Guided Pharmacopuncture (NGP) in patients with acute CMPS.</p><p><strong>Patients and methods: </strong>This multi-center prospective observational comparative study evaluates the efficacy and safety of UGP versus NGP in patients with acute CMPS. A minimum of 100 patients with acute CMPS (≤7 days since symptom onset) will be recruited from two hospitals and five Korean medicine clinics. Participants will be randomly assigned to either the UGP group (receiving ultrasound-guided pharmacopuncture with Hominis Placenta(HP) solution) or the NGP group (receiving non-guided pharmacopuncture with HP solution). A single treatment session will be conducted, with pre- and post-treatment assessments using the Numerical Rating Scale (NRS), Pressure Pain Threshold (PPT), and Range of Motion (ROM). Additionally, a follow-up safety assessment will be conducted via telephone 24-36 hours post-treatment.</p><p><strong>Discussion and conclusion: </strong>This study is the first to evaluate the efficacy and safety of ultrasound-guided HP pharmacopuncture for acute CMPS in a multi-center prospective comparative study. The findings are expected to provide comprehensive evidence supporting ultrasound-guided pharmacopuncture as an effective treatment for myofascial pain and may expand its clinical applications, particularly in Korean medicine clinics.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1417-1431"},"PeriodicalIF":2.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700742","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":"Association Between Spinopelvic Alignment and Reoperation Following Percutaneous Transforaminal Endoscopic Decompression: A Matched Case-Control Study.","authors":"Yang Ge, Aobo Wang, He Song, Ning Fan, Lei Zang","doi":"10.2147/JPR.S505372","DOIUrl":"10.2147/JPR.S505372","url":null,"abstract":"<p><strong>Purpose: </strong>Percutaneous transforaminal endoscopic decompression (PTED) is widely used for treating lumbar spinal stenosis (LSS), yet predictors of reoperation remain unclear. This study aimed to explore the association between spinopelvic alignment and the reoperation following PTED.</p><p><strong>Patients and methods: </strong>A 1:2 matched case-control study was conducted, involving patients who underwent single-level PTED for LSS at our institution from May 2014 to August 2022. Cases comprised patients requiring reoperation after initial PTED, while controls were those without reoperation during the follow-up. Measured radiological parameters included pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), mismatch between pelvic incidence and lumbar lordosis (PI-LL), disc height (DH), Pfirrmann classification, and Modic changes (MCs). Univariate and multivariate logistic regression analyses were performed to identify predictors. Receiver operating characteristic (ROC) curves were generated to determine cut-off points.</p><p><strong>Results: </strong>76 cases and 152 controls were selected from 1967 enrolled patients. Both groups had an average age of 61 years, a male-to-female ratio of 43:33, and a mean BMI of 25.95 kg/m². No significant differences in baseline characteristics were found between groups. Multivariate analysis identified PT (OR = 1.061, P = 0.007), PI-LL (OR = 1.057, P = 0.021), and DH (OR = 1.194, P = 0.015) as independent risk factors for the reoperation. ROC analysis revealed PI-LL with an area under the curve (AUC) of 0.662 at a cut-off of 12.95° (95% CI = 0.582-0.741), PT with an AUC of 0.685 at a cut-off of 21.98° (95% CI = 0.606-0.763), and DH with an AUC of 0.602 at a cut-off of 8.22° (95% CI = 0.521-0.683).</p><p><strong>Conclusion: </strong>PI-LL ≥ 12.95°, PT ≥ 21.98°, and DH ≥ 8.22° are independent risk factors for reoperation following PTED.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1351-1360"},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692414","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 Explantation and Chronic Pain: A Systematic Review and Technology Recommendations.","authors":"Sayed E Wahezi, Ugur Yener, Tahereh Naeimi, Joshua B Lewis, Sandeep Yerra, Philip Sgobba, Hatice Begum Ciftci, Amaresh Vydyanathan, Elisa Chiu, Denis Cherkalin, Jay Y Darji, Ryan Masterson, Danielle Lee, Atthakorn Jarusriwanna, Suwannika Palee, Nicole R Ortiz, Moorice Caparo, Eli Dayon, Camille Fontaine, Marom Bikson, Michael E Schatman, Scott G Pritzlaff, Timothy R Deer, Corey W Hunter","doi":"10.2147/JPR.S514732","DOIUrl":"10.2147/JPR.S514732","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain affects 20.5% of the US population, costing $296 billion annually in lost productivity. Spinal cord stimulation (SCS) has become a key treatment for refractory neuropathic and nociceptive pain, with increasing usage due to technological advancements. However, the durability of SCS therapy, including explantation rates, remains a concern. Understanding explantation causes is essential for improving patient selection and device effectiveness. This study aims to analyze SCS explantation rates and reasons, as well as evaluate the financial burden of these procedures on the healthcare system.</p><p><strong>Methods: </strong>Three primary screening methods were used: manual search with keywords, MeSH term query, and reference list screening. The search covered PubMed, Cochrane, and Web of Science databases from inception to November 2024, yielding 719 articles. After applying eligibility criteria, 72 articles were identified, and 25 were selected for analysis. Data extraction was done by independent reviewers, with a second reviewer ensuring accuracy. Discrepancies were resolved by the corresponding editor.</p><p><strong>Results: </strong>We reviewed data from 13,026 patients who underwent permanent SCS implantation between 1984 and 2024, across 25 studies. A total of 1882 patients (9.82%) underwent explantation. The most common reason was lack of efficacy and inadequate pain relief (38%), followed by lead failure (15%) and infection (14%). While SCS is generally effective, issues related to device longevity and patient satisfaction persist, with explantation rates due to technical failures and lack of efficacy being concerns.</p><p><strong>Conclusion: </strong>SCS efficacy varies, with explantation rates reaching up to 38%, often due to inadequate pain relief. Most explantations occur within the first year, despite SCS being a safe and effective treatment. High implantation costs ($35,000 to $70,000) and revision costs ($15,000 to $25,000) raise concerns among payors. The hardware-driven model limits waveform flexibility, highlighting the need for innovation.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"1327-1340"},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692347","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}