Pain Medicine最新文献

{"title":"Diagnostic precision in lumbar radiculopathy: Impact of transitional vertebrae on treatment level selection and outcomes.","authors":"Bart Liebrand, Selina van der Wal, Marjan Slob, Arthur Boon, Dylan Henssen, JanVan Zundert, Walter van der Weegen, Kris Vissers","doi":"10.1093/pm/pnaf061","DOIUrl":"10.1093/pm/pnaf061","url":null,"abstract":"<p><strong>Background: </strong>In patients with lumbosacral transitional vertebrae, discrepancies indetermining the correct vertebral level of lumboradicular pain occur. This study evaluates the consequences of the real-world diagnostic process and subsequent treatment differences due to misidentified levels.</p><p><strong>Methods: </strong>This retrospective analysis used prospectively collected data on involved spinal levels (February 2016 to October 2022) reported in the referrals, MRI- and treatment reports. Variables analyzed included the number of referrals, consultations, invasive treatments, duration of treatment, radiographs, operations, and hospitalization. Independent clinical researchers conducted vertebral counting, transitional vertebra classification, and wrong level determination using standard methods.</p><p><strong>Results: </strong>Of a total of 4184 patients assessed, 214 included patients (5.1%) with lumbosacral transitional vertebrae were divided into 3 groups: Correct level determination (72), wrong level determination (36) andambiguous level diagnosis (106).Theambiguous levelgroup had more consultations, interventional treatments, radiographic diagnostics, longer treatment duration and more referrals to other hospitals (P < .04) at the pain management department and significantly less consultations of other specialisms (P < .01-.02) compared to the other groups due to uncertain level diagnosis. Discrepancies between reported MRI- and treatment levels in the records increased the chance for wrong level treatment (P < .001).</p><p><strong>Conclusion: </strong>In patients with lumbosacral transitional vertebrae and lumboradicular pain, discrepancies between referral, MRI, and treatment levels are common, leading to uncertain diagnoses and treatment due to incorrect leveldetermination. Interdisciplinary consultation to reach consensus on the most appropriate spinal level for treatment and clear spine images may prevent such discrepancies. Amulticentre study with a larger patient sample is strongly recommended.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"681-688"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132560","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":"Impact of Prior Lumbar Medial Branch Radiofrequency Ablation on Surgical Outcomes Following Single-Level Posterior Lumbar Fusion: A Propensity Score-Matched Analysis.","authors":"Yu Chang, Chia-En Wong, Po-Hsuan Lee, Hong-Min Lin, Jung-Shun Lee, Chi-Chen Huang","doi":"10.1093/pm/pnaf131","DOIUrl":"https://doi.org/10.1093/pm/pnaf131","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192285","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":"Topical analgesics for neuropathic pain: An Evidence-Informed guide for the practicing clinician.","authors":"Erin Lawson, Priyanka Singla, Jeremy Adler, Charles E Argoff, Jeffrey J Bettinger, Arun Bhaskar, Hance Clarke, Anthony Eidelman, Salman Hirani, W Michael Hooten, Jordan Tishler, Mark S Wallace, Antje M Barreveld","doi":"10.1093/pm/pnaf130","DOIUrl":"https://doi.org/10.1093/pm/pnaf130","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate available evidence regarding efficacy and safety of topical analgesics for neuropathic pain and offer treatment guidance.</p><p><strong>Methods: </strong>An expert panel searched PubMed (Medline) and reference lists of published articles for available literature assessing 8 categories of topical analgesics used to treat various neuropathic pain conditions. The panel rated the level of analgesic efficacy evidence for each treatment and considered safety, ease of use, and cost. Degree of consensus among panelists regarding recommendations was measured.</p><p><strong>Results: </strong>There was strong evidence and high consensus that capsaicin 8% is effective for diabetic peripheral neuropathy and postherpetic neuralgia, and lidocaine is effective for postherpetic neuralgia. There was strong evidence and moderate consensus that capsaicin 8% may be effective for HIV-induced neuropathy. There was moderate evidence and high consensus that lidocaine is likely effective for diabetic peripheral neuropathy, idiopathic neuropathy, and post-surgical neuropathy and that capsaicin 8% may be effective for chemotherapy-induced peripheral neuropathy and complex regional pain syndrome. Evidence was weak for other topical medications, though the panel strongly agreed that antidepressants may help with postherpetic neuralgia, complex regional pain syndrome, post-surgical neuropathy, and post-traumatic neuropathy; that non-steroidal anti-inflammatory drugs may help with post-surgical neuropathy; and that gabapentin may benefit vulvodynia. There was less agreement whether antidepressants may benefit diabetic peripheral neuropathy, chemotherapy-induced peripheral neuropathy, and vulvodynia and whether capsaicin 8% could be effective for post-surgical neuropathy.</p><p><strong>Conclusions: </strong>Recommendations were based on a survey and grading of existing literature and, when strong evidence was lacking, the collective clinical expertise of panelists.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186452","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":"Quantitative Sensory Testing of Pain in Persons with Opioid Use Disorder on Opioid Agonist Treatment: A Scoping Review.","authors":"Debora Oliveira, Gabriel P A Costa, Rodrigo Fontenele, Mateo A Córdoba-Delgado, Melissa C Funaro, Claudia M Campbell, David A Fiellin, Gustavo A Angarita, Joao P De Aquino","doi":"10.1093/pm/pnaf132","DOIUrl":"https://doi.org/10.1093/pm/pnaf132","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the use of quantitative sensory testing (QST) in assessing pain responses and mechanisms among individuals with opioid use disorder (OUD) receiving opioid agonist treatment (OAT).</p><p><strong>Design: </strong>Scoping review following PRISMA-ScR guidelines.</p><p><strong>Setting: </strong>Systematic literature search across five major databases.</p><p><strong>Subjects: </strong>Studies investigating QST outcomes in adults with OUD receiving OAT (methadone, buprenorphine, or other opioid agonists) with or without co-occurring chronic pain.</p><p><strong>Methods: </strong>We searched Ovid MEDLINE, Embase, APA PsycINFO, Cochrane Library, and Web of Science from inception through March 2025. Eligible studies included original research employing QST methodologies in adults with OUD receiving OAT. Data extraction focused on study characteristics, QST methodologies, and pain-related outcomes.</p><p><strong>Results: </strong>Of 45 included studies, 64.4% employed cross-sectional designs with limited protocol standardization. Static QST measures predominated, with thermal stimuli most common. The most consistent finding was reduced cold pain tolerance in individuals with OUD compared to controls (60% of studies). Dynamic QST measures (3 studies) revealed altered pain modulation suggestive of central sensitization. Pain processing abnormalities frequently persisted despite prolonged abstinence from non-OAT opioids, suggesting lasting neuroadaptive changes. Methodological heterogeneity and inconsistent reporting of clinical variables limited synthesis.</p><p><strong>Conclusions: </strong>QST demonstrates potential for enhancing clinical understanding of pain mechanisms in individuals receiving OAT. Future research should prioritize protocol standardization, longitudinal designs tracking pain sensitivity changes, and exploration of QST's predictive value for treatment responses to facilitate clinical integration.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131599","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":"Pudendal Nerve Compression by Mucoid Cyst.","authors":"Rayan Fawaz, François Gouin, Aicha Ltaief-Boudrigua, Manon Duraffourg","doi":"10.1093/pm/pnaf126","DOIUrl":"https://doi.org/10.1093/pm/pnaf126","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092218","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":"If you build it, they might come: Lessons learned from the development of a digital intervention for chronic pain.","authors":"Susan E Jarquin, Benedict J Alter, Brian O'Connell, Rebecca S DeSensi, Megan Kenney, Andrew Watson, Ajay D Wasan","doi":"10.1093/pm/pnaf128","DOIUrl":"10.1093/pm/pnaf128","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092297","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":"Nitazenes: Are Pain Physicians Aware of the Risks?","authors":"Ryan Mortman, Shravani Durbhakula, Trent Emerick","doi":"10.1093/pm/pnaf127","DOIUrl":"https://doi.org/10.1093/pm/pnaf127","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092284","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":"Trauma-responsive pain management: A survey of patient characteristics and preferences.","authors":"Hallie Tankha, Jolin B Yamin, Shoshana Krohner, Amanda J Shallcross","doi":"10.1093/pm/pnaf121","DOIUrl":"https://doi.org/10.1093/pm/pnaf121","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030251","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":"Sensorimotor Cortical Integration Remains Unchanged After Dorsal Root Ganglion Pulsed Radiofrequency.","authors":"Ahmet Başarı, Çağrı Cansu, İlker Arslan, Güngör Enver Özgencil, Hanzade Aybüke Ünal, Hasan Kılınç, Bülent Cengiz","doi":"10.1093/pm/pnaf125","DOIUrl":"https://doi.org/10.1093/pm/pnaf125","url":null,"abstract":"<p><strong>Background: </strong>Dorsal root ganglion (DRG) pulsed radiofrequency (PRF) is a minimally invasive neuromodulation technique used for the management of chronic radicular pain. While its analgesic effects are well-documented, its impact on sensorimotor integration at the cortical level remains unclear. This study aimed to investigate whether DRG PRF modulates sensorimotor integration via the cholinergic system using the Short-Latency Afferent Inhibition (SAI) paradigm.</p><p><strong>Methods: </strong>This prospective, two-center study included 30 patients with chronic lumbosacral radicular pain who underwent DRG PRF at the L4-5 and L5-S1 levels. SAI was assessed using paired electrical stimulation of the tibial nerve and transcranial magnetic stimulation (TMS) of the motor cortex before and two weeks after DRG PRF. SAI measurements were conducted at three interstimulus intervals (ISIs: -2 ms, 0 ms, +2 ms of N20 latency). Data were analyzed using repeated measures ANOVA and paired t-tests.</p><p><strong>Results: </strong>The SAI paradigm confirmed significant sensorimotor inhibition at baseline in all three ISIs (p < 0.001). However, no statistically significant difference was found between pre- and post-DRG PRF SAI values at any ISI (p > 0.05). These results suggest that DRG PRF did not significantly modulate cholinergic-driven sensorimotor integration in lower limbs.</p><p><strong>Conclusion: </strong>DRG PRF effectively reduces pain in chronic radicular pain patients, but its effect on cortical cholinergic modulation, as measured by SAI, appears to be limited. This finding suggests that DRG PRF primarily exerts its effects through non-cholinergic mechanisms, such as GABAergic, glutamatergic, or noradrenergic pathways. Further studies are warranted to clarify the broader neurophysiological effects of DRG PRF.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006469","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":"A Novel Low-Profile Self-Expanding Epidural Lead Array System that is Fully Collapsible, Deployable, and Retrievable.","authors":"Hassan Beheshti Seresht, Trent D Emerick, Gaurav Chauhan, Mohamed S Ibrahim, Youngsoo Jung, Jung-Kun Lee, Youngjae Chun","doi":"10.1093/pm/pnaf124","DOIUrl":"https://doi.org/10.1093/pm/pnaf124","url":null,"abstract":"<p><strong>Objective: </strong>Introduced in 1970s, Spinal Cord Stimulator (SCS) devices have played a crucial role in managing a wide range of complex and refractory chronic pain, particularly back/leg pain as well as neuropathic pain. Currently, two primary types of leads, cylindrical and paddle leads, are prevalent in pain management. While both effectively alleviate pain, cylindrical leads, due to their small size, are susceptible to movement and migration as well as a smaller surface area for coverage, leading to device displacement and failure to provide pain relief. On the other hand, paddle leads offer a larger surface area and secure placement but require a relatively large incision for device insertion. To address the limitations of existing SCS devices, a novel SCS device has been developed with a low-profile, deployable, and retrievable design based on the human epidural anatomy.</p><p><strong>Methods and results: </strong>A prototype SCS has been successfully designed, fabricated, and tested in vitro. This innovative design features a laser-trimmed nitinol mesh structure as the self-expanding deployable frame, an ultrathin ePTFE membrane isolating the conductive metallic frame, and platinum-iridium materials which can be seamlessly integrate with an external battery pack for the delivery of efficient electrical potential. The anatomical nitinol mesh frame allows the entire device to collapse into a size smaller than that of a 14-gauge needle (1.5-1.6 mm in diameter) and its corresponding delivery sheath. Additionally, mechanical and electrochemical tests were carried out to assess the performance of the developed device. The mechanical tests demonstrated the backbone's ability to expand within the epidural space. Similarly, electrochemical tests on the electrodes underscored that the selected materials were indeed appropriate.</p><p><strong>Conclusion: </strong>This novel SCS design effectively prevents device dislocation and migration showing great wall apposition while providing a larger surface area for pain management. These results support its potential as a next-generation platform for effective chronic pain management.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993089","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}