Pain Medicine最新文献

{"title":"Responding to the Letter to the Editor from Drs. Pope and Goree.","authors":"Krishnan Chakravarthy, Vwaire Orhurhu","doi":"10.1093/pm/pnag127","DOIUrl":"https://doi.org/10.1093/pm/pnag127","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081535","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":"Mapping Genicular Nerve Endings for Optimal Pain Management: A Comparative Cadaveric Analysis Between Native Versus Prosthetic Knee.","authors":"Gaspary Fodjeu, Loic Fonkoué, Cedric Dongmo Mayopa, Julie Manon, Freddy Bombah, Christine Detrembleur, Olivier Cornu, Catherine Behets","doi":"10.1093/pm/pnag130","DOIUrl":"https://doi.org/10.1093/pm/pnag130","url":null,"abstract":"<p><strong>Background: </strong>Chronic knee pain, often due to osteoarthritis (OA), is frequently treated with genicular nerve blocks, radiofrequency ablation (RFA) or genicular artery embolization (GAE). However, the intracapsular distribution of nerve endings and vascular networks key pain parameters remains poorly defined in native and prosthetic knees.</p><p><strong>Questions/purposes: </strong>We compared the distribution of intracapsular nerve endings and vascular density in native versus prosthetic knee capsules across five genicular nerve targets in relation to knee pain.</p><p><strong>Methods: </strong>Ten native and ten prosthetic cadaveric knees were analyzed. Capsular samples (20 × 5 mm) were harvested from regions innervated by the superior medial, superior lateral, and inferior genicular nerves, the recurrent fibular nerve, and the infrapatellar branch of the saphenous nerve. Nerve endings and vascular densities were quantified after histologic and immunohistochemical analysis comparatively.</p><p><strong>Results: </strong>Native knees had higher free nerve ending (FNE) density (p < 0.001), while prosthetic knees showed greater vascular density (p = 0.001) and increased Pacini (p = 0.006), Golgi (p = 0.01), and unclassified endings (p = 0.019). Correlation between FNE and vascular density was modest in native knees (r = 0.41) and negligible in prosthetic knees (r = 0.09). Patterns were consistent across all nerve targets. All five nerve targets showed no difference in their mechanoreceptor and vascular density distribution.</p><p><strong>Conclusion: </strong>Dense FNE populations in native knees support genicular nerve-targeted interventions for OA pain. The increased vascularity and mechanoreceptor innervation identified in prosthetic knees suggest that inflammatory, angiogenic, and sensory mechanisms may contribute to persistent post-surgical pain. Whether interventions targeting these pathways, such as radiofrequency ablation or genicular artery embolization, provide better clinical benefit together remains to be established.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070052","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":"Assessment and Treatment of Acute Low Back Pain (ALBP): A Systematic Review.","authors":"Andrea C Skelly, Roger Chou, Erika D Brodt, Ian Blazina, Esther K Choo, Tracy Dana, Andrea Diulio-Nakamura, Rongwei F Fu, Yun Yu, Nancy A Carney, Annette Totten, Kim Mauer, Dakota Riopelle, Shay Stabler-Morris","doi":"10.1093/pm/pnag131","DOIUrl":"https://doi.org/10.1093/pm/pnag131","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To synthesize evidence on the evaluation and management of acute low back pain (ALBP) (&lt;6 weeks duration) to support clinical guideline development.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Electronic databases (Ovid® MEDLINE®, PsycINFO®, Embase®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews) to March 2025, and reference lists. A targeted bridge search was completed on May 29, 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Review methods: &lt;/strong&gt;We selected systematic reviews (SRs) on diagnostic accuracy of factors for serious spine pathology and predictors of chronicity (Key Question [KQ] 1), and randomized controlled trials (RCTs) for imaging (KQ 2) and of treatment options (KQs 3-8). Full economic studies (cost-effectiveness analyses [CEA] or cost utility analyses [CUA]) on imaging (KQ 2d) and treatment (KQ 9) were sought. Meta-analyses were conducted when sufficient evidence was available, and strength of evidence (SOE) was assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 105 studies (in 111 publications) formed the evidence base for the clinical guideline: KQ 1a (4 SRs, 1 nonrandomized study of interventions [NRSI]), KQ 1b (1 SR, 14 NRSIs), KQ 2 (3 RCTs, 3 NRSIs, 1 CEA), KQ 3 (5 RCTs), KQ 5 (25 RCTs), KQ 6 (34 RCTs), KQ 7 (1 RCT), KQ 8 (9 RCTs) and KQ 9 (2 CUA, 2 CEAs). No studies met inclusion criteria for KQ 4. Two trials identified through the bridge search evaluated heat and transcutaneous electrical stimulation. Few patient characteristics or clinical exam factors were considered highly informative for identifying or ruling out serious spine pathology (red flags). Stronger predictors included cancer history, saddle anesthesia, urinary retention, procedure-related infection, and age (KQ 1a). Maladaptive pain coping behaviors, low general health status, and presence of psychiatric comorbidities were associated with an increased likelihood of developing persistent disabling low back pain (KQ 1b). RCTs of early imaging versus no imaging found no difference in function or pain in patients without signs of serious spine pathology (KQ 2). Opioids generally showed similar pain and function improvement versus placebo and were associated with increased risk for adverse events (KQ3). Oral nonsteroidal anti-inflammatory drugs [NSAIDs] and muscle relaxants improved function and/or pain versus placebo in the first few weeks, however acetaminophen did not (KQ 5). In patients with radiculopathy, systemic steroids (KQ 5) and epidural steroid injections [ESI] (KQ 7) improved function (and back pain for ESI) versus placebo or usual care. Nonpharmacologic treatments (KQ 6) that improved function and/or pain versus sham or usual care included manipulation and mobilization, acupuncture, and advice to stay active. Results from exercise-specific trials were mixed. Early referral to physical therapy, which included similar forms of exercise, improved pain and function versus usual care (KQ 8). Pain or function i","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063332","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":"Ultrasound-Guided Superficial Piriformis Plane Injection: A Preliminary Cadaveric and Radiological Evaluation.","authors":"Burhan Dost, Alper Kilicaslan, Ahmet Fevzi Kekec, Turgut Emre Erdem, Ayse Gulbin Arici, Garip Kilic, İlker Onguc Aycan, Muzaffer Sindel, Kardelen Sobay, Madan Narayanan","doi":"10.1093/pm/pnag132","DOIUrl":"https://doi.org/10.1093/pm/pnag132","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063345","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":"Identifying the Impact of Centralized Pain on Pain Outcomes after Spinal Cord Stimulator Trials (POST).","authors":"Paddison Lowe, Anamika Ratri, Md Robiul Islam Talukder, Jinxiang Hu, Emily Schulze, Miranda Mc Millan, Fatima Asif, Bryan Kwon, Andrea L Chadwick","doi":"10.1093/pm/pnag129","DOIUrl":"https://doi.org/10.1093/pm/pnag129","url":null,"abstract":"<p><strong>Objective: </strong>Chronic pain affects over 100 million people in the United States. Central sensitization contributes to many chronic pain syndromes and may reduce the effectiveness of peripherally directed interventions. Although spinal cord stimulation (SCS) is effective for many patients, identifying those less likely to benefit could improve patient selection and reduce unnecessary procedures. We hypothesized that centralized pain features are associated with failure to achieve meaningful analgesia during an SCS trial.</p><p><strong>Methods: </strong>Participants completed validated questionnaires before SCS trial implantation and within 48 hours of trial removal. Measures included the Brief Pain Inventory (BPI), Central Sensitization Inventory (CSI), 2016 Fibromyalgia Diagnostic Criteria Survey, PROMIS-29 v2.0, PainDETECT, Perceived Stress Scale, PANAS, Childhood Traumatic Events Scale, CSQ-CAT, and Patient Global Impression of Change (PGIC).</p><p><strong>Results: </strong>67 patients were enrolled; 51 completed follow-up. Mean age was 63.5 years, with 67.2% female participants. Baseline average and worst BPI pain severity scores were 6.4 and 8.6, respectively, and mean fibromyalgianess score was 12.5. Following SCS, average and worst pain severity scores improved significantly (p < 0.001), as did all PROMIS domains (p < 0.001-0.002). Responders (≥50% reduction in worst pain) did not differ demographically from non-responders but had significantly lower fibromyalgianess (p = 0.03), CSI scores (p = 0.02), and presence of widespread pain (p = 0.03).</p><p><strong>Conclusions: </strong>Patients with greater centralized pain features experienced less analgesic benefit despite overall improvements in pain and function, supporting our hypothesis that nociplastic pain burden influences SCS response. These findings suggest that pre-procedural pain phenotyping may improve patient selection.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063347","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":"Scrambler Therapy in Chronic Neuropathic Pain: Mechanisms, Evidence, and Practical Considerations for Trainees.","authors":"Min Ju Kim, Kevin S Batti, Joshua Lewis, Trent Emerick","doi":"10.1093/pm/pnag128","DOIUrl":"https://doi.org/10.1093/pm/pnag128","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025701","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 qualitative analysis of chronic pain treatment determinants among women of reproductive age.","authors":"Samantha M McKetchnie, Elizabeth Loynd, Maggi Price, Conall O'Cleirigh, Samantha M Meints, Scott D Easton","doi":"10.1093/pm/pnag126","DOIUrl":"https://doi.org/10.1093/pm/pnag126","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025719","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":"Guided Respiration Mindfulness Therapy for Chronic Low Back Pain: A Single-arm Pilot Study of an 8-week Integrative Breathwork Intervention.","authors":"Steven D Pratscher, Lloyd Lalande, Mark A Lumley, Irene M Estores, Adam W Hanley, Kimberly T Sibille, Roger B Fillingim","doi":"10.1093/pm/pnag124","DOIUrl":"https://doi.org/10.1093/pm/pnag124","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017474","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":"Analysis of Complications Associated with Basivertebral Nerve Ablation for Vertebrogenic Low Back Pain: A Multicenter Retrospective Cohort Study of 1,145 Patients.","authors":"Bryan C Hoelzer, Acelan Obray, Ramana Naidu, Amanda N Cooper, Zachary L McCormick, Napatpaphan Kanjanapanang, Greg Moore, Yeng F Her, Thomas P Pittelkow, Oludare Olatoye, Eric Freeman, Mikayla Parker, Ellie A Mitchell, Lucas Peterson, Bryson Childs, Erik Eckstrom, Petra V Ekstrom, Lindsey A Haugen, Ashley L Hamann, Grace G Carson, Alyssa S Mayeri, Candance M Peterson, Hayden E Fortin","doi":"10.1093/pm/pnag122","DOIUrl":"https://doi.org/10.1093/pm/pnag122","url":null,"abstract":"<p><strong>Objective: </strong>Low back pain (LBP) is a leading cause of pain and disability worldwide. Recent studies demonstrate a vertebrogenic model involving the basivertebral nerve (BVN) as a cause of chronic LBP. Vertebral endplates are highly innervated by the BVN, and literature shows type 1 and 2 Modic changes at vertebral endplates are a source of vertebrogenic low back pain (VBP). As a result, intraosseous radiofrequency ablation of the BVN is a minimally invasive outpatient procedure used to treat VBP. We conducted a retrospective review of 1,145 patients that have undergone BVN ablation to assess for safety and complication management.</p><p><strong>Methods: </strong>Chart reviews were conducted to obtain demographic and pre-procedural information regarding patient gender, age at the time of BVN ablation, duration of LBP, and BMI. Post-procedure information derived from chart notes included vertebral levels ablated and post-BVN ablation complications, which were categorized as increased LBP > 7 days, increased radicular pain > 7 days, lower extremity weakness, infection, vertebral compression fracture, superficial bleeding, spinal or epidural hematoma, serious neurological injury, visit to the ER, and deep vein thrombosis/clot.</p><p><strong>Results: </strong>1,145 patient charts were reviewed showing an overall complication rate of 3.2% (37 complications). Increased radicular pain was the most common complication at 2.2% (25 complications) and resolved completely in all but one patient. The overall complication rate fell to 1.1% (13 complications) when the 24 cases of transient radicular pain were not counted as adverse events.</p><p><strong>Conclusions: </strong>In this multicenter retrospective review, the overall rate of complications related to BVN ablation was low (3.2%). The most common complication was temporary radicular pain that resolved with conservative care. These findings suggest that BVN ablation is a safe treatment for VBP in real-world clinical settings.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012712","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":"Culturally Adapted Pain Science Education for Chronic Low Back Pain in India: A Feasibility Randomized Controlled Trial.","authors":"V Selva Ganapathy, Palani Velu, Mayank Sharma, Mariamma Philip, Nupur Pruthi, Cynthia Srikesavan","doi":"10.1093/pm/pnag123","DOIUrl":"https://doi.org/10.1093/pm/pnag123","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990912","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}