Pain Medicine最新文献

{"title":"Central Sensitization and Cognitive Vulnerability: A Neurobiological Framework for CNS Resilience and Brain Aging.","authors":"Kevin V Hackshaw","doi":"10.1093/pm/pnag114","DOIUrl":"https://doi.org/10.1093/pm/pnag114","url":null,"abstract":"<p><strong>Objective: </strong>Preservation of central nervous system (CNS) resilience during midlife is increasingly recognized as an important determinant of healthy cognitive aging, as biological processes contributing to Alzheimer's disease and related dementias (ADRD) may begin decades before clinically apparent impairment. Identifying measurable physiological states associated with diminished CNS resilience during this period is therefore an important objective of brain-aging research. Central sensitization is a neurophysiological process characterized by enhanced CNS responsiveness, impaired inhibitory modulation, and altered nociceptive processing that may occur within broader biological contexts involving neuroimmune activation, autonomic dysregulation, metabolic stress, and network dysfunction.</p><p><strong>Methods: </strong>This narrative review examines whether persistent sensitization-related physiology may represent one measurable component of diminished CNS resilience. We synthesize epidemiologic evidence linking chronic pain with adverse cognitive outcomes and review areas of biological convergence involving neuroimmune signaling, mitochondrial dysfunction, autonomic regulation, synaptic plasticity, and functional brain network organization. Fibromyalgia is considered as one extensively studied but biologically heterogeneous clinical disorder in which sensitization-related mechanisms are frequently observed, rather than as a surrogate for central sensitization itself. Emerging approaches for characterizing sensitization-related physiology, including quantitative sensory testing, neuroimaging, metabolomics, blood-based vibrational spectroscopy, and multimodal biomarker strategies, are also discussed.</p><p><strong>Findings: </strong>Current evidence demonstrates biological overlap between sensitization-related physiology and processes implicated in brain aging but does not establish that central sensitization independently accelerates cognitive aging or causes neurodegenerative disease.</p><p><strong>Conclusions: </strong>We propose a hypothesis-generating framework in which persistent sensitization-related physiology represents one candidate component of systems-level CNS resilience. Prospective longitudinal studies integrating objective physiological measures with cognitive and biological phenotyping will be required to determine whether this framework contributes meaningfully to understanding cognitive trajectories or precision brain health.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819246","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":"Response to \"Considerations Regarding Comparator Selection and Long-Term Interpretation of Auricular Point Acupressure for Chronic Low Back Pain\".","authors":"Jennifer Kawi, Nada Lukkahatai, Hulin Wu","doi":"10.1093/pm/pnag111","DOIUrl":"10.1093/pm/pnag111","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819263","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":"Celiac Plexus Block with versus without Botulinum Toxin Type A for Pancreatic Cancer Pain: A Retrospective Comparative Study.","authors":"Kaehong Lee, Seungpyo Nam, Seungcheol Yu, Jeongsoo Kim","doi":"10.1093/pm/pnag108","DOIUrl":"https://doi.org/10.1093/pm/pnag108","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether the addition of botulinum toxin type A (BTX) to celiac plexus block (CPB) is associated with improved analgesic outcomes in patients with pancreatic cancer pain.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Single-center tertiary hospital.</p><p><strong>Subjects: </strong>A total of 60 patients with pancreatic cancer pain who underwent fluoroscopy-guided CPB between January 2022 and November 2025.</p><p><strong>Methods: </strong>Patients were divided into CPB only (n = 34) and CPB with BTX (n = 26) groups. Pain intensity (numerical rating scale, NRS), opioid consumption (morphine milligram equivalents, MME), and need for rescue interventions were assessed at 4, 8, and 12 weeks. The primary outcome was the proportion of positive responders at 4 weeks, defined as ≥ 2-point reduction in NRS from baseline, no increase in opioid use, and no additional interventions.</p><p><strong>Results: </strong>The proportion of positive responders at 4 weeks was significantly higher in the CPB + BTX group compared to the CPB only group (65.4% vs. 8.8%, p < 0.001), with sustained differences at 8 and 12 weeks. The CPB + BTX group showed significantly lower pain scores at all follow-up time points and required fewer rescue interventions, including no cases of neurolysis. Kaplan-Meier analysis demonstrated a longer duration of analgesic response in the CPB + BTX group (p < 0.001). In multivariable analysis, BTX use was independently associated with treatment success (OR = 20.75, p < 0.001), while distant metastasis was a negative predictor. No serious adverse events were observed.</p><p><strong>Conclusions: </strong>CPB with BTX was associated with improved analgesic outcomes for pancreatic cancer pain compared to CPB only. The addition of BTX resulted in higher responder rates, sustained pain reduction, and reduced need for rescue interventions. BTX may represent a non-destructive adjunct to CPB and warrants further prospective validation.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796391","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":"Comparison of the Effects of Phenol Neurolysis and Conventional Radiofrequency Thermocoagulation Applied to the Genicular Nerves on Pain in Patients Who Underwent Knee Arthroplasty: A Prospective, Controlled Study.","authors":"Devran Ertilav, Esra Ertilav","doi":"10.1093/pm/pnag104","DOIUrl":"https://doi.org/10.1093/pm/pnag104","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare conventional radiofrequency thermocoagulation (RFT) with chemical neurolysis in patients who underwent knee arthroplasty and continued to experience pain.</p><p><strong>Materials and methods: </strong>This was a prospective, quasi-randomized controlled trial. A total of 109 patients who underwent knee arthroplasty were evaluated and assigned to two groups according to the interventional procedures applied to the genicular nerves: Group 1 included patients who underwent conventional RFT, and Group 2 included patients who underwent chemical neurolysis of the genicular nerves using phenol. The Numeric Rating Scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to assess pain intensity before the procedure and at 1, 3, and 6-month follow-ups.</p><p><strong>Results: </strong>The demographic and clinical characteristics were similar between the conventional RFT and phenol groups. At one month, the mean NRS was 4.09±0.73 in the RFT group and 3.67±0.73 in the phenol group, significantly lower in the phenol group (p = 0.015)[d = 0.503; 95% CI]. The mean NRS scores were 5.57±0.81 and 4.64±0.75, respectively, at the third month (p < 0.001)[d:1.195 95%CI], and 6.52±1.38 and 5.02±1.46 at the sixth month (p < 0.001)[d:1.055 95%CI]. At three months, the NRS ≥50% improvement rate was 29.6% in the RFT group and 49.1% in the phenol group, with a significant difference in favor of the phenol group (p = 0.038)[OR:2.290 95% CI]. At six months, the NRS ≥50% improvement rate was 18.5% and 43.6%, respectively, and the difference was statistically significant in favor of the phenol group (p = 0.005)[OR:3.406 95% CI]. NRS≥30% improvement rate was similar at 1 month, at 98.1% in the RFT group and 98.2% in the phenol group (p = 1.000)[OR: 1.019 95% CI]. At three months, these rates were 83.3% and 90.9%, respectively, with no statistically significant difference (p = 0.237)[OR: 2.000 95% CI]. At six months, NRS ≥30% improvement was observed in 72.2% of the RFT group and 87.3% of the phenol group, with a borderline statistically significant difference (p = 0.050)[OR: 2.637 95% CI]. The complication rate was 3.7% in the RFT group and 5.5% in the phenol group, with no significant difference between the two groups (p = 1.000) [OR: 1.500 95% CI].</p><p><strong>Conclusion: </strong>Phenol neurolysis and conventional RFT of the genicular nerves are effective treatments for patients with persistent pain after knee arthroplasty. The results demonstrating the short-term efficacy of phenol neurolysis in patients undergoing arthroplasty should be supported by long-term follow-up studies.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796412","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":"Response to letter to the editor concerning - \"Image-guided combined ultrasound and fluoroscopy technique for stellate ganglion blocks\".","authors":"Simon Yang, Ratan Banik","doi":"10.1093/pm/pnag090","DOIUrl":"10.1093/pm/pnag090","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713459","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":"Re: \"Image-Guided Combined Ultrasound and Fluoroscopy Technique for Stellate Ganglion Blocks\".","authors":"Rodrigo Díez-Tafur, Carlos Restrepo-Garces, Laura López-Agudelo","doi":"10.1093/pm/pnag103","DOIUrl":"https://doi.org/10.1093/pm/pnag103","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713452","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":"Postoperative opioid use and survival outcomes in patients with head and neck adenoid cystic carcinoma. A retrospective study.","authors":"Paloma L Aveni-Strafile, Nicolas A Cortes-Mejia, Dhananjay K Sah, Jinwen Cao, Lei Feng, Emilia Scalco Wachter, Renata Ferrarotto, Andrew Sikora, Michelle Williams, Yu Leo Lei, Juan P Cata","doi":"10.1093/pm/pnag100","DOIUrl":"https://doi.org/10.1093/pm/pnag100","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the incidence and risk factors of chronic opioid use following head and neck adenoid cystic carcinoma (HNACC) surgery and explore the association between postoperative opioid use and survival outcomes.</p><p><strong>Design: </strong>Observational retrospective cohort study.</p><p><strong>Settings: </strong>Perioperative care of cancer patients at the UT - MD Anderson Cancer Center.</p><p><strong>Subjects: </strong>Adults (≥18 years) who underwent HNACC surgery with curative intent were included; while those with recurrent or metastatic disease at the time of surgery or who received palliative treatment were excluded.</p><p><strong>Methods: </strong>Multivariable logistics and Cox regression analyses were performed to identify predictors of chronic opioid use and explore associations with recurrence-free survival (RFS) and overall survival (OS). Chronic opioid use was defined as an active opioid prescription documented and reconciled by a clinician on postoperative day 90 (POD90).</p><p><strong>Results: </strong>Among 102 subjects included in the study, 47.1% were taking opioids chronically after surgery. Preoperative opioid use was associated with more than double the odds of chronic postoperative opioid use, whereas older age and ASA class 1-2 were associated with reduced odds. Positive surgical margins, bone graft procedures, and neck dissection were independently associated with poorer prognosis. No statistically significant association between opioid use an RFS and OS was observed.</p><p><strong>Conclusions: </strong>These findings suggest that patients with HNACC exhibit several risk factors for chronic opioid use, underscoring the importance of careful opioid prescribing and monitoring in this population.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670228","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":"Corrigendum to: Efficacy and safety of pregabalin and duloxetine in painful diabetic neuropathy: a systematic review and meta-analysis.","authors":"","doi":"10.1093/pm/pnag091","DOIUrl":"https://doi.org/10.1093/pm/pnag091","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670087","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":"What predicts postoperative opioid prescribing and consumption? A statewide analysis of surgical quality registry data.","authors":"Jiyeon Song, Yi Li, Jennifer F Waljee, Vidhya Gunaseelan, Chad M Brummett, Michael Englesbe, Mark C Bicket","doi":"10.1093/pm/pnag101","DOIUrl":"10.1093/pm/pnag101","url":null,"abstract":"<p><strong>Objective: </strong>Tailoring postoperative opioid recommendations to patient needs requires nuanced understanding of factors contributing to post-discharge opioid use. The study aims to identify key predictors of opioid prescribing and consumption while exploring the interplay between clinical factors that underlie these phenomena.</p><p><strong>Design: </strong>We analyzed Michigan Surgical Quality Collaborative registry from 2017- 2019 to identify factors predicting sequential opioid-related outcomes following surgery: 1) prescription receipt, 2) likelihood of consumption, and 3) amount consumed.</p><p><strong>Methods: </strong>To enhance predictive accuracy, we used a three-part model applying machine learning methods (random forests, support vector machines, extreme gradient boosting) and ranking predictive factors by variable importance scores.</p><p><strong>Results: </strong>: Among 34,505 patients (57% female, mean age 56 years), 10,572 (31%) received no prescription, 6,069 (18%) received a prescription but reported no opioid consumption, and 17,864 (52%) received a prescription and reported some consumption. The most important factors predicting prescription receipt included younger age, procedure type, inpatient/outpatient location, urgent/emergent status, and higher body mass index (BMI). Top factors for likelihood to consume included younger age, prescription quantity, higher BMI, smoking, and procedure type. For amount consumed, prescription quantity was the most important factor, with lesser contributions from preoperative opioid prescriptions, younger age, surgery type, and smoking.</p><p><strong>Conclusions: </strong>: These findings suggest an overlapping set of key factors of age, procedure type, BMI, prescription quantity, and smoking influence post-discharge opioid use. These factors may help identify patients at higher risk for post-discharge use and inform targeted opioid stewardship strategies, including interventions focused on modifiable factors such as prescription quantity.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670303","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":"Intravenous Lidocaine Does Not Provide Additional Pain Reduction Beyond Placebo in Probable Nociplastic Chronic Low Back Pain: A Randomized Controlled Trial- An Infographic.","authors":"Subrata Pahari, Sandipan Hazra, Partha Pratim Das","doi":"10.1093/pm/pnag099","DOIUrl":"https://doi.org/10.1093/pm/pnag099","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670158","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}