Journal of Pain Research最新文献

{"title":"The Short- and Long-Term Efficacy of Non-Invasive Brain Stimulation for Migraine: A Meta-Analysis.","authors":"Mengya Liu, Yongxia Yong, Hui Zou, Luping Yang, Jinghua Qian","doi":"10.2147/JPR.S529622","DOIUrl":"10.2147/JPR.S529622","url":null,"abstract":"<p><strong>Purpose: </strong>Non-invasive brain stimulation (NIBS) has shown promising potential in the treatment of migraine; however, its short- and long-term efficacy remains uncertain. This meta-analysis evaluated the effects of NIBS on multiple migraine-related clinical outcomes in both short- and long-term follow-ups.</p><p><strong>Methods: </strong>This PRISMA-compliant review (PROSPERO: CRD42024529488) included RCTs on NIBS for migraine. A comprehensive search was conducted in PubMed, Scopus, The Cochrane, EMBASE, Web of Science, CNKI, and VIP up to April 11, 2024. Outcomes consisted of headache frequency, pain intensity, duration, analgesic intake, and adverse effects. Analyses used RevMan 5.3 and STATA 17.0.</p><p><strong>Results: </strong>Thirteen studies (596 participants) were included. In terms of short-term outcomes, NIBS significantly reduced headache frequency (SMD = -1.47, 95% CI: -2.13 to -0.82) and pain intensity (SMD = -2.09, 95% CI: -3.36 to -0.83). During long-term follow-up, significant effects were still observed at <3 months (headache frequency: SMD = -1.13, 95% CI: -1.90 to -0.35; pain intensity: -0.66 95% CI: -1.02 to -0.30) and at 6-12 months (headache frequency: SMD = -3.95, 95% CI: -7.44 to -0.45; pain intensity: SMD = -2.55 95% CI: -4.73 to -0.36, with no significant improvements at 3-6 months. NIBS also provided short-term benefits in pain duration and analgesic use. Adverse event rates did not differ between groups. Meta-regression linked target and device to short-term efficacy.</p><p><strong>Conclusion: </strong>NIBS is an effective, preventive, and safe treatment for migraine but its long-term efficacy is not evident.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4883-4900"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149575","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 Reaffirmation to Our Call for Reform: Response to Rebuttal Letter Regarding \"A Call for Reckoning and Reform in Interventional Pain Medicine and Neuromodulation Research\" [Response to Letter].","authors":"Ryan S D'Souza, Michael E Schatman, Nasir Hussain","doi":"10.2147/JPR.S566855","DOIUrl":"10.2147/JPR.S566855","url":null,"abstract":"","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4871-4873"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137936","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":"Wrist-Ankle Acupuncture Relieves Postoperative Pain After Milligan-Morgan Hemorrhoidectomy for Mixed Hemorrhoids: A Randomized Controlled Clinical Trial.","authors":"Min Xu, Wenjuan Li, Xiaoyan Wang, Yulei Gao, Lingyi Qi, Liping Xu, Yuhua He, Changsheng Dong, Jing Zhang, Huachun Zhang, Jiawen Wang","doi":"10.2147/JPR.S542202","DOIUrl":"10.2147/JPR.S542202","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of wrist-ankle acupuncture in alleviating postoperative pain in patients undergoing Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids.</p><p><strong>Patients and methods: </strong>A total of 124 patients who underwent Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids at our center between January 2024 and December 2024 were randomly assigned to two groups (62 patients in each group). The control group received postoperative patient-controlled intravenous analgesia (PCIA), whereas the treatment group received wrist-ankle acupuncture in addition to PCIA. Pain relief was assessed at 6 h, 12 h, 24 h, 48 h, and 72 h postoperatively. Additional outcomes included PCIA usage, frequency of rescue analgesia for pain, and the incidence of postoperative complications.</p><p><strong>Results: </strong>The treatment group exhibited significantly lower Numerical Rating Scale (NRS) pain scores than the control group starting at 12 h postoperatively (<i>P</i> < 0.05). By 24 h, both PCIA usage and the frequency of rescue analgesia were significantly reduced in the treatment group compared with the control group (<i>P</i> < 0.05). The incidence of constipation and urinary retention was also lower in the treatment group (<i>P</i> < 0.05). No adverse events occurred in either group.</p><p><strong>Conclusion: </strong>Wrist-ankle acupuncture is a safe and effective adjunct for postoperative analgesia following Milligan-Morgan hemorrhoidectomy. It significantly alleviates pain, lowers the incidence of constipation and urinary retention, and is not associated with any adverse effects.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4875-4882"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131074","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":"Changes in Pain Catastrophizing and Related Outcomes Following a Single-Session Empowered Relief Intervention Delivered by Physical Therapists in Workers with Low Back Pain: A Pilot Study.","authors":"Junie S Carrière, Marie-France Coutu, Beth D Darnall, Guillaume Léonard, Marie-Pier Royer, Mei Yue Li, Martine Bordeleau, Marie-José Durand","doi":"10.2147/JPR.S527830","DOIUrl":"10.2147/JPR.S527830","url":null,"abstract":"<p><strong>Purpose: </strong>Low back pain is among the most prevalent pain conditions. Cognitive behavioral therapy reduces the negative effects of low back pain, but access to treatment is limited. Empowered Relief is a 2-hour single-session pain management skills intervention that has demonstrated efficacy at improving pain outcomes in individuals with chronic low back pain. The objectives were 1) to assess the acceptability of Empowered Relief delivered by physical therapists in a sample of French-Canadian workers with low back pain; and 2) to explore changes in pain catastrophizing and other pain-related outcomes following Empowered Relief and physical therapy.</p><p><strong>Methods: </strong>The study was an uncontrolled prospective pilot trial of Empowered Relief and physical therapy for low back pain. Participants were 63 French-Canadian individuals undergoing physical therapy for subacute and chronic low back pain (<1 year duration). Participants completed baseline measures of demographic and measure of pain catastrophizing, pain intensity, symptoms of anxiety and depression, physical function and pain interference before taking part in a single-session 2-hour Empowered Relief virtual course. Participants then completed a post-class acceptability questionnaire and a 4-week follow-up questionnaire assessing the same measures as baseline.</p><p><strong>Results: </strong>A 2-hour single-session of Empowered Relief demonstrated high acceptability among participants. Pain catastrophizing scores reduced by an average of 28 points, with 90% achieving clinically significant change. Participation in Empowered Relief and physical therapy was associated with reductions in pain intensity, and clinically meaningful improvements in symptoms of anxiety and depression, physical function and pain interference at 4-weeks follow-up. Effect sizes were moderate to large, and the largest changes were found in individuals with subacute low back pain.</p><p><strong>Conclusion: </strong>Empowered Relief, when delivered by physical therapists, may offer a rapid, scalable intervention to complement physical therapy and improve early outcomes in workers with low back pain. The results provide evidence to support a future randomized controlled trial evaluating the effect of Empowered Relief delivered by physical therapists for low back pain.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4845-4857"},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149586","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":"Can Ziconotide Be Used to Replace Opioids? Exploratory Clinical Experience in 5 Patients Treated in the Pain Unit.","authors":"Luz Canovas Martínez, Noelia Gago Diéguez, Jackeline Lucia Carrera Sieiro, Rocío López Díez, Cristina García González, Elena Ortolá Más, Susana Almenara","doi":"10.2147/JPR.S528946","DOIUrl":"10.2147/JPR.S528946","url":null,"abstract":"<p><strong>Background: </strong>Ziconotide and morphine are intrathecal (IT) drugs approved by the FDA and EMA for the treatment of chronic pain. The aim of this study was to determine whether opioid rescue can be achieved by gradually increasing doses of ziconotide, and to establish a practical protocol for its implementation.</p><p><strong>Methods: </strong>Five patients unresponsive to IT morphine due to lack of efficacy or adverse events such as endocrine dysfunction, constipation and tolerance were selected. All had refractory, neuropathic or mixed pain. Ziconotide was gradually introduced while maintaining or reducing morphine doses in proportion to the ziconotide titration. Dose adjustments were made every 2 weeks, with a weekly ziconotide increase of 0.5 μg.</p><p><strong>Results: </strong>Of the five patients, three were female and two were male, with ages ranging from 53 to 75 years. Two had cancer (one with colon cancer and one with osteosarcoma), two had persistent spinal pain syndrome type 2, and one had spastic paraparesis. After 6 weeks of ziconotide treatment, all individuals showed a substantial reduction in daily morphine dosage (from 10 to 5.5 mg/day), which was associated with improved control of adverse events. Similarly, notable reductions were observed in pain intensity (from 8.0 to 2.5, measured by VAS) and neuropathic symptoms (from 6.0 to 2.0, measured by DN4). The most frequently improved neuropathic symptoms included tingling (4 patients), hypoesthesia to touch (3 patients), and pain evoked by brushing (3 patients). The duration of the rescue protocol ranged from 5 to 11 weeks.</p><p><strong>Conclusion: </strong>Intrathecal opioid rescue with ziconotide emerges as a viable therapeutic option for patients with refractory pain and a neuropathic component, or for those who develop adverse events associated with IT morphine. Low doses and slow titration of ziconotide may help minimize adverse events while maintaining analgesic benefit.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4859-4870"},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124225","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":"Efficacy and Safety of Acupuncture and Acupuncture-Combined Therapies in the Treatment of Sciatica Caused by Lumbar Disc Herniation: A Network Meta-Analysis.","authors":"Dongyi Ni, Haiyang Tong, Shen Wei, Yitong Zheng, Wenyan Wu, Min Li, Yunpeng Dong","doi":"10.2147/JPR.S542831","DOIUrl":"10.2147/JPR.S542831","url":null,"abstract":"<p><strong>Purpose: </strong>Sciatica is a common complication of lumbar disc herniation (LDH). This network meta-analysis compared the efficacy of acupuncture monotherapies, acupuncture versus conventional rehabilitation, and acupuncture monotherapy versus combination therapies for LDH-related sciatica.</p><p><strong>Patients and methods: </strong>We systematically searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, CQVIP, and CBM. Bayesian network meta-analysis was performed using RStudio and GEMTC. STATA generated network and funnel plots. Treatment rankings were assessed using the Surface Under the Cumulative Ranking curve (SUCRA). Bias risk was evaluated with the Cochrane Risk of Bias tool 2.0.</p><p><strong>Results: </strong>According to SUCRA, in terms of total effective rate, the more effective intervention was electroacupuncture combined with cupping therapy (EA+Cupping, 92.93%); in terms of VAS, the better intervention was needle knife combined with rehabilitation therapy (NK+RT, 95.96%); in terms of ODI, the more effective intervention was electroacupuncture combined with cupping therapy (EA+Cupping, 98.03%); in terms of JOA, the best intervention was electrostimulation combined with rehabilitation therapy (ES+RT, 88.27%); in terms of IL-6 and TNF-α, the better intervention was electroacupuncture combined with electrostimulation (EA+ES, 99.99%).</p><p><strong>Conclusion: </strong>Acupuncture combined with other therapies demonstrates superior efficacy compared to rehabilitation treatment. Specifically, NK+RT is possibly a more effective intervention for pain relief; EA+Cupping shows a better benefit in improving disability and quality of life; ES+RT is likely a more effective strategy for promoting neurological recovery; and EA+ES is possibly better in reducing inflammatory responses.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4809-4832"},"PeriodicalIF":2.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113454","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":"Erector Spinae Plane versus Pectoralis Nerve Block for Mastectomy in Cancer Patients: A Retrospective, Multicenter Cohort Study.","authors":"Edward N Yap, Julia Wei, Curtis Darling, Elizabeth Linehan, Matthias Behrends, Kevin P Ng","doi":"10.2147/JPR.S538581","DOIUrl":"10.2147/JPR.S538581","url":null,"abstract":"<p><strong>Background: </strong>Mastectomy patients require effective acute postoperative pain management. Regional anesthesia techniques such as fascial plane blocks are important pain treatment modalities to address pain control. This study compared the effects of the erector spinae plane (ESP) block versus the pectoralis nerve (PECS) block in providing postoperative analgesia for mastectomy patients.</p><p><strong>Methods: </strong>This retrospective study included 517 breast cancer patients undergoing mastectomy from 2017 to 2020, with 428 receiving a PECS block and 89 an ESP block. The primary outcome examined was total opioid use during hospital stay measured in morphine milligram equivalents (MME). Secondary outcomes included length of hospital stay, post-anesthesia care unit (PACU) pain scores, PACU postoperative nausea and vomiting (PONV), 30-day readmission rates, and development of postmastectomy pain within six months of surgery.</p><p><strong>Results: </strong>No significant difference in median total opioid use between the ESP (53 MME (IQR: 38-80 MME)) and PECS (60 MME (IQR: 30-82.5 MME)) groups. Multivariable analysis confirmed no difference in total opioid consumption. There was no significant difference between the two groups in PACU average and maximum pain scores, PACU PONV, hospital length of stay, 30-day hospital readmission, and development of postmastectomy pain within six months of surgery.</p><p><strong>Conclusion: </strong>Compared to the PECS block, the ESP block demonstrated no significant difference in acute pain outcomes and recovery in patients undergoing mastectomy for breast cancer, with similar hospital discharge times and long-term outcomes.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4775-4785"},"PeriodicalIF":2.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113508","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":"Application of Intraoperative Awake Anesthesia and Three-Dimensional Reconstruction Technique in Percutaneous Microballoon Compression for Trigeminal Neuralgia.","authors":"Xingke Li, Yanfeng Fan, Ziyang Chen, Ou-Yang Hui, Min Guo, Guili Feng, Jianzhi Zhou, Yuhui Ling, Deliu Lin","doi":"10.2147/JPR.S534449","DOIUrl":"10.2147/JPR.S534449","url":null,"abstract":"<p><strong>Objective: </strong>To examine the role of intraoperative awake anesthesia and the three-dimensional reconstruction technique in percutaneous microballoon compression (PBC) for the treatment of trigeminal neuralgia.</p><p><strong>Methods: </strong>Seventy patients diagnosed with trigeminal neuralgia and admitted to Guangdong Sanjiu Brain Hospital from 2019 to 2022 were selected for the study.All patients were treated with PBC by three-dimensional (3D) reconstruction of preoperative and intraoperative images and intraoperative awake anesthesia. The duration of balloon compression during surgery was three minutes.After balloon compression during the procedure, the patient is awakened for effect assessment, allowing for real-time adjustments of the surgical strategy based on the evaluation.Postoperative pain relief was evaluated using the Brisman criteria.</p><p><strong>Results: </strong>Pain completely disappeared immediately post-operation in 68 patients, and was significantly alleviated in two patients, with an efficacy rate of 100% and a cure rate of 97.1%. 60 patients experienced facial numbness on the affected side postoperatively, which showed different degrees of remission or disappearance within 6-12 months after surgery. Eleven cases of herpes labialis (15.7%), one case of facial hematoma (1.4%), and three cases of postoperative psychiatric symptoms (4.3%) occurred, all of which recovered within 1-2 weeks after surgery. Weakness in the masticatory muscles on the affected side was observed in four patients (5.7%), and all cases returned to normal within six months post-surgery.During follow-up 36-60 months, there were five cases (7.1%) of pain recurrence on the affected side.</p><p><strong>Conclusion: </strong>Awake anesthesia combined with 3D reconstruction technology for PBC surgery may provide a safer and more effective alternative for the treatment of trigeminal neuralgia.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4833-4843"},"PeriodicalIF":2.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113463","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":"Pericapsular Nerve Group Block for Hip Fracture Pain Management: A Narrative Review of Emergency Applications.","authors":"Ya-Bei Li, Man Zuo, Jing-Ping Zhu, Ri-Liang Ma, Xiao-Zu Liao","doi":"10.2147/JPR.S528497","DOIUrl":"10.2147/JPR.S528497","url":null,"abstract":"<p><p>The pericapsular nerve group (PENG) block is a regional anaesthesia technique for acute pain management that is becoming frequently employed for emergency lower limb fractures, particularly hip injuries. While current evidence has been predominantly derived from postoperative randomized trials and case series, the results of recent clinical reports support the preprocedural utility of the PENG block in emergency settings for rapid analgesia 40-60% pain score reduction and preservation of motor function. This review synthesizes mechanistic insights and clinical outcomes from the literature, comparing the targeted sensory blockade of the hip capsule with the PENG block with that of systemic opioids (which risks inducing respiratory depression) and fascia iliaca block (which can induce motor impairment). Key advantages of PENG blockade include significant opioid-sparing effects (50-70% reduction morphine use) and almost no motor complications. Standardized ultrasound-guided protocols can address challenges related to anatomical variability. Preliminary evidence from case reports suggests that the efficacy of the PENG block to pelvic and femoral shaft fractures, although multicentre trials are needed to establish optimal doses and long-term functional outcomes. This evidence indicates that PENG blockade could serve as a promising emergency intervention, but further protocol refinement is warranted.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4801-4807"},"PeriodicalIF":2.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113443","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":"Single- versus Multiple-Injection Intertransverse Process Block for VATS: A Randomized Trial on Dermatomal Sensory Blockade.","authors":"Kittitorn Supphapipat, Artid Samerchua, Prangmalee Leurcharusmee, Panuwat Lapisatepun, Tanyong Pipanmekaporn, Nichagoon Konkarn, Kullaphun Prapussarakul, Thidarut Jinadech, Mullika Wanvoharn","doi":"10.2147/JPR.S545731","DOIUrl":"10.2147/JPR.S545731","url":null,"abstract":"<p><strong>Purpose: </strong>While the intertransverse process (ITP) block can enhance chest wall analgesia, the optimal injection technique remains unclear. This study compared the efficacy of single versus multiple injections of the ITP block, hypothesizing that multiple injections would provide superior sensory blockade.</p><p><strong>Patients and methods: </strong>Forty patients undergoing video-assisted thoracic surgery were randomized to receive single or multiple ultrasound-guided ITP block injections with 30 mL of 0.25% bupivacaine and 1% lidocaine with epinephrine (5 μg/mL). The single-injection group received 30 mL at the T4-5 level, while the multiple-injection group received 10 mL/injection at the T3-4, T4-5, and T5-6 levels. The primary outcome was dermatomal sensory changes on the anterolateral chest wall. Secondary outcomes included block performance time, complications, and postoperative analgesia.</p><p><strong>Results: </strong>The median (interquartile range [IQR]) dermatomal sensory levels were 2 (2-4) for single-injection and 3 (1.5-3.5) for multiple-injection (median difference: 0, 95% confidence interval [CI]: -1 to 1, <i>p</i> = 0.91). The single-injection group had a shorter median (IQR) block performance time than the multiple-injection group [7 (5.2-8.4) min versus 9.1 (7.8-11.2) min; median difference: -1.9 min; 95% CI: -4 to -0.1 min; <i>p</i> = 0.01]. Intraoperative hypotension occurred in 63.2% of the single-injection group and 65% of the multiple-injection group (<i>p</i> = 0.91). There was no statistically significant difference in postoperative pain intensity between groups.</p><p><strong>Conclusion: </strong>Single- and multiple-injection ITP blocks showed no significant difference in sensory changes or analgesic effect. The shorter performance time of the single-injection technique suggests it may be a more practical option. However, larger, higher powered studies are required to confirm equivalence and establish definitive recommendations.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":"18 ","pages":"4791-4800"},"PeriodicalIF":2.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113611","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}