Pain Medicine最新文献

{"title":"Pilates combined with Cognitive Functional Therapy in women with chronic nonspecific low back pain: A three-arm randomized controlled trial on physical and psychological outcomes.","authors":"Ali Yalfani, Zahra Raeisi, Nahid Bigdeli, Niloofar Rahimi","doi":"10.1093/pm/pnag139","DOIUrl":"https://doi.org/10.1093/pm/pnag139","url":null,"abstract":"<p><strong>Design: </strong>Chronic nonspecific low back pain (CNLBP) is a leading cause of functional disability in adults. This randomized controlled trial evaluated the effectiveness of combining Cognitive Functional Therapy (CFT) with Pilates compared to Pilates alone and a control group. The primary outcome was pain intensity. Secondary outcomes included disability, fear of movement, trunk muscle endurance, and postural sway.</p><p><strong>Setting: </strong>This single‑blind, three‑arm trial enrolled 120 women aged 20-50 years with mild to moderate CNLBP. Participants were randomly assigned to CFT+Pilates, Pilates, or control groups. Interventions were delivered over 8 weeks. Trained assessors assessed outcomes pre‑ and post‑intervention. Statistical analyses were performed using repeated‑measures ANOVA to examine group × time interactions, followed by Bonferroni post‑hoc tests for pairwise comparisons. Effect sizes were calculated using partial eta‑squared, and clinical relevance was assessed using the MCID.</p><p><strong>Results: </strong>Significant group×time interactions were observed for pain intensity (F = 165.85, p ≤ 0.001), disability (F = 89.04, p ≤ 0.001), kinesiophobia (F = 196.48, p ≤ 0.001), and all trunk endurance and postural sway outcomes (p ≤ 0.001). Both intervention groups improved significantly compared with the control group for pain, disability, kinesiophobia, trunk endurance, and postural sway measures (p ≤ 0.001), except for total movement of the COP in the anterior-posterior direction in the Pilates group (p ≥ 0.05). However, Pilates+CFT did not differ significantly from Pilates alone for pain intensity (p = 0.871), disability (p = 1.000), or postural sway parameters (p ≥ 0.05). Significant between-group differences favoring Pilates+CFT were observed for kinesiophobia (p = 0.001), trunk flexion endurance (p = 0.003), and lateral-flexion endurance (p = 0.001).</p><p><strong>Conclusion: </strong>Both Pilates-based interventions improved pain, disability, kinesiophobia, trunk endurance, and postural control compared with the control condition. Adding Cognitive Functional Therapy to Pilates provided additional benefits for kinesiophobia and selected trunk endurance outcomes, but not for pain, disability, or most postural sway measures. These findings should be interpreted cautiously given the mild to moderate baseline symptoms and inclusion of women aged 20-50 years.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences and Treatment Outcomes of a Whole Health Interdisciplinary Team Program for Chronic Pain Among Rural Veterans: the PREVAIL Cohort Study.","authors":"Rena E Courtney, Kathryn Bower, Alicia J Lozano, Mary J Schadegg, Jody Caretti Fredericks, Beth D Darnall, Stephanie Smith, Rendelle Bolton, H Ryan Wagner, Krisann K Oursler, Jennifer Naylor","doi":"10.1093/pm/pnag137","DOIUrl":"https://doi.org/10.1093/pm/pnag137","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty-Eight-Day Pain Trajectories After Standardized Three-Position Coccygeal Infiltration: A Prospective Observational Study of 274 Patients.","authors":"Loreto C Pulido, Philipp Koehl, Alexander Schuh, Achim Benditz","doi":"10.1093/pm/pnag142","DOIUrl":"https://doi.org/10.1093/pm/pnag142","url":null,"abstract":"<p><strong>Objective: </strong>To characterize daily pain trajectories after standardized three-position coccygeal infiltration and explore differences by clinical and radiographic subgroups.</p><p><strong>Design: </strong>Prospective, single-arm observational cohort study.</p><p><strong>Setting: </strong>Specialized orthopedic and spine care setting.</p><p><strong>Subjects: </strong>Patients had chronic coccygodynia with symptomatic coccygeal instability confirmed clinically and on paired standing and seated lateral radiographs. Of 668 treated patients receiving a diary, 274 returned complete diaries and were analyzed (41.0%); 394 did not return a diary (59.0%).</p><p><strong>Methods: </strong>Patients were treated prone without procedural imaging guidance. Through one skin entry, a 23-gauge needle was directed sequentially to the symptomatic mobile segment, coccygeal tip, and immediately lateral to the coccyx. The standard injectate was mepivacaine 1% (5 mL) plus triamcinolone 40 mg. NRS pain was recorded before infiltration (day 0) and daily through post-injection day 27. Responder thresholds were ≥30%, ≥50%, and, supplementarily, ≥2-point improvement.</p><p><strong>Results: </strong>Mean NRS was 5.55 at baseline, increased transiently on post-injection days 1 and 2, and was below baseline on day 3. By day 27, mean NRS was 1.99 (paired change, -3.56; 95% CI, -3.90 to - 3.22; P < 0.001; Cohen dz = 1.24); 220 patients (80.3%) achieved ≥30% improvement and 192 (70.1%) achieved ≥50% improvement. Mean pain decreased further from 3.51 in diary week 3 to 2.73 in diary week 4 (change, -0.78; 95% CI, -0.95 to - 0.61; P < 0.001; Cohen dz = 0.55). More than half of day-20 nonresponders achieved responder status by day 27.</p><p><strong>Conclusions: </strong>Three-position coccygeal infiltration was followed by substantial pain reduction through day 27, including further improvement during diary week 4. Causal efficacy cannot be established without a comparison group, and responder estimates may not represent the entire treated population because 59.0% did not return diaries.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perineural or intravenous dexamethasone for adductor canal and iPACK blocks in total knee arthroplasty: A randomised trial.","authors":"Tomasz Reysner, Alicja Bartkowska-Śniatkowska, Jowita Rosada-Kurasińska, Katarzyna Wieczorowska-Tobis, Przemysław Daroszewski, Malgorzata Reysner","doi":"10.1093/pm/pnag140","DOIUrl":"https://doi.org/10.1093/pm/pnag140","url":null,"abstract":"<p><strong>Introduction: </strong>Total knee arthroplasty causes substantial postoperative pain. Combined adductor canal and interspace block between the popliteal artery and posterior knee capsule (iPACK) provides motor-sparing analgesia, but its duration is limited. We compared perineural and intravenous dexamethasone as adjuncts to these blocks in older patients undergoing primary total knee arthroplasty.</p><p><strong>Methods: </strong>In this prospective, randomised, quadruple-blind, parallel-group trial, 90 patients aged 65-100 years were allocated equally to receive adductor canal and iPACK blocks with ropivacaine plus perineural dexamethasone 4 mg in total (2 mg per block), intravenous dexamethasone 4 mg, or placebo. The primary outcome was time to first rescue opioid analgesia within 48 h. Secondary outcomes included opioid consumption, pain scores, inflammatory markers, blood glucose, quadriceps strength, and neurological safety.</p><p><strong>Results: </strong>Time to first rescue opioid analgesia differed between groups (log-rank p < 0.001). Median time (95% CI) was 4.5 (4.5-5.5) h with placebo, 13.9 (12.5-14.7) h with intravenous dexamethasone, and 18.5 (16.5 to not reached) h with perineural dexamethasone. The proportions remaining opioid-free at 48 h were 0%, 23.3%, and 36.7%, respectively. Opioid consumption and pain scores were lower with both dexamethasone routes than with placebo; perineural administration resulted in the lowest opioid consumption and lower pain scores than intravenous administration at later timepoints. Perineural dexamethasone was associated with lower postoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, whereas intravenous dexamethasone was associated with higher blood glucose. No motor weakness or nerve injury occurred.</p><p><strong>Discussion: </strong>Perineural dexamethasone prolonged analgesia and reduced opioid requirements more than intravenous dexamethasone, without neurological or motor impairment. The inflammatory-marker findings were exploratory and do not establish independent clinical benefit.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicare and Medicaid Professional Fee Reimbursement for Spinal Cord Stimulation: An Analysis of National and State-level Trends.","authors":"Evan J Mizerak, Jay Karri, David A Provenzano, Lisa Goudman, Ryan S D'Souza","doi":"10.1093/pm/pnag138","DOIUrl":"https://doi.org/10.1093/pm/pnag138","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) is an important modality for treating chronic pain in patients who have failed conservative therapy and a substantial portion of the population rely on fee-for-service Medicare or Medicaid for coverage. We aimed to determine physician professional fee reimbursement rates and the ratio of Medicaid to Medicare professional fee reimbursement (MMI) for three common Current Procedural Terminology (CPT) codes related to SCS therapy (63650, 63685, and 63655) across states. Secondarily, we explored trends in utilization and reimbursement of these procedures by Medicare at the national level between 2013 and 2023.</p><p><strong>Methods: </strong>Medicaid professional fee reimbursement data were extracted from publicly available fee schedules where available for individual states, while Medicare reimbursement data were extracted from the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule. Baseline and wage-adjusted MMI values were calculated for each state.</p><p><strong>Results: </strong>Medicaid reimbursed 11.5-21.0% less than Medicare across the evaluated CPT codes after wage adjustment, with differences of 11.8% for CPT 63650 (facility), 18.0% for CPT 63650 (non-facility), 11.5% for CPT 63685 (facility), and 21.0% for CPT 63655 (facility). Medicaid MMI values ranged from 0.397-1.87 across codes and settings. State-level Medicaid professional fee reimbursement varied substantially, ranging from $194.52-$639.38 for CPT 63650 (facility), $978.72-$2,781.65 for CPT 63650 (non-facility), $160.82-$558.00 for CPT 63685 (facility), and $375.97-$1,045.15 for CPT 63655 (facility); Medicare reimbursement was substantially less variable. From 2013-2023, Medicare utilization, rendering providers, beneficiaries, and standardized payments generally increased, although trends varied by CPT code and site of service.</p><p><strong>Conclusions: </strong>Medicare physician professional fee reimbursement largely exceeds Medicaid physician professional fee reimbursement for three of the most common SCS procedural codes, suggesting potential access barriers to chronic pain procedures. Medicaid reimbursement shows considerable variation across states and among procedural codes, suggesting substantial interstate heterogeneity in Medicaid rate-setting that may reflect differences in state policy priorities or other factors not analyzed in this study.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeated High-Concentration Capsaicin Applications in Older Adults With Postherpetic Neuralgia: A Real-World Study Including Trigeminal Involvement.","authors":"François Jedryka, Myriam Mezzarobba, Nathalie Maignaut-Licata, Natacha Monnier, Aranzazu Diaz-Garcia, Eric Viel","doi":"10.1093/pm/pnag136","DOIUrl":"https://doi.org/10.1093/pm/pnag136","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal Clinically Important Differences in Pain Extent on Self-Reported Body Maps.","authors":"Sean P McDermott, Benedict J Alter, Rebecca DeSensi, Brian O'Connell, Elizabeth M Leimer, Ajay D Wasan","doi":"10.1093/pm/pnag134","DOIUrl":"https://doi.org/10.1093/pm/pnag134","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PROmoting Pain Self-Management for Chronic Musculoskeletal Pain in the Military Health System, comparing health coaching to Empowered Relief: the PROs trial protocol.","authors":"Julie M Fritz, Daniel I Rhon, Nora Fino, Tom H Greene, Tina A Greenlee, Deydre S Teyhen, Danielle Cook, Beth D Darnall","doi":"10.1093/pm/pnag133","DOIUrl":"https://doi.org/10.1093/pm/pnag133","url":null,"abstract":"<p><strong>Background: </strong>Chronic musculoskeletal pain is a major problem for military beneficiaries, with incident rates increasing more than 3-fold from 2009 to 2018. Guidelines recommend nonpharmacologic, holistic approaches within a stepped care framework. Two promising strategies, Empowered Relief (ER), a lower-intensity single-session pain self-management intervention, and Move-to-Health (M2H), a higher-intensity holistic health-coaching program, offer scalable options. However, comparative effectiveness data and optimal sequencing of these two interventions within stepped care remain unknown.</p><p><strong>Objectives: </strong>(1) Compare the effectiveness of ER and M2H as first-line care; (2) compare each intervention to usual care (UC); (3) evaluate a stepped-care strategy of ER followed by M2H for non-responders; and (4) examine implementation outcomes using the RE-AIM framework.</p><p><strong>Design: </strong>The PROs trial is a pragmatic, Type I hybrid effectiveness-implementation trial enrolling 608 adult TRICARE beneficiaries with chronic musculoskeletal pain from four military hospitals. Participants are randomized 2.3:2.3:1 to ER, M2H, or UC. Non-responders to Phase I ER receive M2H in Phase II. The primary outcome is pain interference on the PEG-3 at 14 weeks. Secondary outcomes include PROMIS health domains, pain catastrophizing, self-efficacy, global improvement, healthcare utilization, and opioid use. Implementation outcomes follow the RE-AIM framework.</p><p><strong>Discussion: </strong>The PROs trial will generate critical evidence on strategies for delivering holistic pain care in the Military Health System, evaluating both the comparative effectiveness of two nonpharmacological interventions and the value of a stepped-care adaptive treatment approach. Findings will inform future pain management policies in military, veteran, and civilian health systems.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06940986.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-rich plasma versus corticosteroid injections for facet and sacroiliac joint pain: a systematic review and meta-analysis with trial sequential analysis.","authors":"Dawood Alatefi, Malik Alkabazi, Ahmed Alanzi, Bano Alsaleh, Salsabeel Al Mubaidin, Majed Amro, Mohammad K Nofal, Ibrahim Gamal, Mikhail Kuzin, Abdulhakim Hezam","doi":"10.1093/pm/pnag072","DOIUrl":"10.1093/pm/pnag072","url":null,"abstract":"<p><strong>Introduction: </strong>Facet and sacroiliac joint (SIJ) pathology are common causes of chronic low back pain. Corticosteroid (CS) injections provide short-term relief but limited durability. Platelet-rich plasma (PRP), an autologous biologic, may offer longer-lasting benefit. We performed a systematic review and meta-analysis of randomized and quasi-randomized controlled trials comparing PRP with corticosteroids.</p><p><strong>Material and methods: </strong>PubMed, Cochrane Library, Scopus, Embase, Web of Science, CINAHL Complete, Virtual Health Library, and ScienceDirect were searched up to June 21, 2025. Eligible studies were randomized or quasi-randomized controlled trials comparing intra- or peri-articular PRP with corticosteroids for facet or sacroiliac joint pain. Primary outcome was the mean pain scores changes from baseline to first, third, and sixth months using a scale of 10 scores (0 = no pain, and 10 = worst pain). Secondary outcome was disability using Oswestry Disability Index (ODI) or Modified ODI (MODQ). Data were pooled using mean difference (MD) for pain scores outcome, and standardized mean difference (SMD) for disability outcome. Random-effects meta-analysis was performed using 'Meta' package in R (RStudio version 4.4.3), with subgroup analyses by joint (facet vs SIJ) to facilitate further interpretation.</p><p><strong>Results: </strong>Ten randomized and quasi-randomized controlled trials (6 facet, and 4 SIJ) enrolling 392 patients (mean age 47.04 years, 50.6% male) were included. At one month, pain outcomes favored PRP but did not reach statistical significance (MD -0.35, 95% CI -1.30 to 0.60; P = .4696; I2 = 90.6%). At 3 months, PRP significantly reduced pain versus corticosteroids (MD -1.32, 95% CI -2.14 to -0.50; P = .0015), with consistent benefit across facet and SIJ subgroups. Superiority persisted at 6 months (MD -1.70, 95% CI -3.10 to -0.30; P = .0171). Disability outcome showed no significant difference at one month (SMD 0.05, 95% CI -0.45 to 0.54), and at 3 months (SMD -0.63, 95% CI -1.29 to 0.03; P = .0613).</p><p><strong>Conclusion: </strong>PRP appears to be a promising intervention; however, current evidence remains inconclusive. Available data suggest that PRP may provide superior medium- and long-term pain reduction compared with corticosteroid injections for facet and SIJ, supporting its potential role as a biologic therapy in spinal pain management. Nevertheless, the certainty of this evidence is limited, and further well-designed, adequately powered studies with standardized PRP protocols are required to confirm these findings.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1108-1122"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond postdural puncture headache: differential diagnosis and complications after labor epidural analgesia.","authors":"Salvador Sierra, Lynn R Kohan, Mohamed Tiouririne, Priyanka Singla","doi":"10.1093/pm/pnag073","DOIUrl":"10.1093/pm/pnag073","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"1151-1153"},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}