Pain Medicine最新文献

{"title":"Intravenous Lidocaine Does Not Provide Additional Pain Reduction Beyond Placebo in Probable Nociplastic Chronic Low Back Pain: A Randomized Controlled Equivalence Trial.","authors":"Subrata Pahari, Sandipan Hazra, Partha Pratim Das","doi":"10.1093/pm/pnag093","DOIUrl":"https://doi.org/10.1093/pm/pnag093","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether repeated intravenous lidocaine infusions provide clinically meaningful benefit beyond placebo for pain reduction in probable nociplastic chronic non-specific low back pain.</p><p><strong>Methods: </strong>In this prospective, randomized, double-blind, placebo-controlled equivalence trial, 84 adults with CNSLBP and probable nociplastic pain features were randomized equally to receive either intravenous lidocaine (1 mg/kg bolus followed by 4 mg/kg infusion weekly for 4 weeks) or placebo saline infusion. All participants received background multimodal pain management consisting of amitriptyline and aerobic exercise. The primary endpoint was the between-group difference in VAS pain intensity at 3 months. Therapeutic equivalence was assessed using a prespecified equivalence margin of ± 1.5 VAS units and the two one-sided tests (TOST) framework. Secondary outcomes included sleep quality (PSQI) and functional disability (QBPDS).</p><p><strong>Results: </strong>At 3 months, the between-group difference in VAS was 0.24 (90% confidence interval -0.33 to 0.81), entirely within the predefined equivalence bounds, confirming therapeutic equivalence (TOST p < 0.001). Both groups improved significantly over time without a significant group × time interaction. Improvement in sleep quality was greater in the lidocaine group (mean difference in change score 1.81; 95% CI 0.49-3.14; p = 0.027). Functional improvement numerically favored lidocaine, although continuous disability outcomes were not significantly different. Adverse events were more common in the lidocaine group but were mild, transient, and self-limiting.</p><p><strong>Conclusion: </strong>Repeated intravenous lidocaine infusions did not provide additional analgesic benefit over saline infusions administered alongside multimodal pain management in patients with probable nociplastic chronic non-specific low back pain.</p>","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":"148670162","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":"Reducing intravenous opioid reliance with subcutaneous administration in the emergency department.","authors":"Monisha Dilip, Wendy W Sun, Suresh K Pavuluri, Vivek Parwani, Adam Ackerman, Beth Liebhardt, Reinier Van Tonder, Arjun K Venkatesh, Rohit B Sangal","doi":"10.1093/pm/pnag025","DOIUrl":"10.1093/pm/pnag025","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"942-944"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207512","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":"Onboarding and retaining advanced practice providers in pain management: a call for practice management recommendations.","authors":"Oluwatobi O Hunter, Heather J Jackson, Kimberlee M Bayless, Jennifer E Grimmer, Katherine B Cloud, Lynn Kohan, Edward R Mariano","doi":"10.1093/pm/pnag038","DOIUrl":"10.1093/pm/pnag038","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"859-862"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434622","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":"Steroid injections for arthropathy, tendinopathy and myopathy in the pediatric population: a systematic review.","authors":"David S Jevotovsky, Andres Gronda, Gabrielle Avancena, Anish Rana, Brandon Burg, Chun Maung, Salman Hirani, Salvador Portugal, Tracy Espiritu McKay","doi":"10.1093/pm/pnag036","DOIUrl":"10.1093/pm/pnag036","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effectiveness and safety of corticosteroid injections (CSI) for pediatric patients with non-rheumatologic peripheral musculoskeletal pain conditions.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Central was performed through August 2024 in alignment with PRISMA 2020 guidelines. Eligible studies included pediatric patients receiving CSI for peripheral musculoskeletal pain unrelated to rheumatologic disease. Primary outcomes were pain relief and functional improvement; secondary outcomes consisted of safety and adverse events. MASTER and GRADE scales evaluated risk of bias and certainty of evidence.</p><p><strong>Results: </strong>In brief, 1061 studies were identified, six of which met inclusion criteria, encompassing 267 pediatric patients. Interventions targeted hip pain related to dislocation or femoroacetabular impingement (n = 4 studies), sacroiliac pain (n = 1), and acute anterior cruciate ligament tears (n = 1). Across most studies, CSI provided short-term pain relief and functional improvement, with post-injection follow-up ranging from 5 days to 5 years. However, the randomized controlled trial in ACL tear patients found no significant difference between CSI and saline placebo. Rare adverse events were reported, including localized swelling, pain flare, and one transient sciatic nerve block post-SI joint injection. There were no long-term complications reported. Evidence certainty was rated \"very low\" due to small sample sizes, heterogeneity, and risk of bias.</p><p><strong>Conclusions: </strong>CSI may provide temporary pain relief for select pediatric peripheral musculoskeletal conditions, albeit with limited and low quality supporting evidence. Despite current data suggesting a favorable short-term safety profile, longer-term effects and standardized dosing guidelines are insufficient. Larger, higher-quality trials with more varied pediatric pathologies are required in order to elucidate the role of CSI in non-rheumatologic pediatric pain management.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"893-903"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147459381","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":"Emotional awareness and expression therapy for migraine: a preliminary randomized controlled trial.","authors":"Dan Kaufmann, John A Sturgeon, Susan Mirow, George Zinkhan, Naomi Schlesinger, Brandon C Yarns, Kathy Kommit, Annie Miller, Mark A Lumley","doi":"10.1093/pm/pnag034","DOIUrl":"10.1093/pm/pnag034","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"948-951"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317640","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":"Pregabalin and duloxetine in painful diabetic neuropathy: comparative evidence and the need to advance towards combination therapies.","authors":"Antonio Alcántara Montero","doi":"10.1093/pm/pnag015","DOIUrl":"10.1093/pm/pnag015","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"952-953"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113741","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":"Subfailure capsule strain as the cause of cervical zygapophysial joint pain after whiplash: a scoping review.","authors":"Nikolai Bogduk, John MacVicar","doi":"10.1093/pm/pnag030","DOIUrl":"10.1093/pm/pnag030","url":null,"abstract":"<p><strong>Background: </strong>The cause of neck pain after whiplash is regarded as unknown, but Bioengineers have published studies implicating subfailure injuries of the cervical zygapophysial joints as a leading cause of pain.</p><p><strong>Objectives: </strong>A scoping review was undertaken to determine the size and nature of the evidence for subfailure injuries as a cause of pain after whiplash.</p><p><strong>Eligibilty: </strong>Considered eligible were any articles that provided evidence on the nature of subfailure injuries and their ability to evoke pain or elicit nociceptive activity in the nervous system.</p><p><strong>Sources: </strong>Articles were sought in the databases of PubMed and EMBASE. Searches were performed in March 2025 and repeated in September 2025.</p><p><strong>Results: </strong>The searches yielded 49 articles that described the microscopic structure of subfailure injuries, their ability to evoke pain behaviors in experimental animals, and features of persistent nociception and hypersensitivity in dorsal roots, dorsal root ganglia, the dorsal horn, and in the thalamus.</p><p><strong>Conclusions: </strong>There is an abundant literature that defines subfailure injuries and shows that they evoke features of persistent nociception in the peripheral and central nervous system. Overlooked in the clinical literature, this evidence warrants greater recognition in the literature and practice of pain medicine.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"883-892"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220764","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 novel 14 gauge needle for 2 lead access for percutaneous spinal cord stimulator trials and permanent implants.","authors":"Trent Emerick, Gordon Amelia, Barber Brandon, Natalie Ceccarelli, Gaurav Chauhan","doi":"10.1093/pm/pnag037","DOIUrl":"10.1093/pm/pnag037","url":null,"abstract":"<p><p>There are numerous clinical problems with the current 2-needle approach to spinal cord stimulator (SCS) epidural space access for both percutaneous trials and percutaneous permanent lead placement. These problems include the placement of 2 separate 14 Gauge needles to access the epidural space twice-once for each lead, prolonged anesthesia and procedure time, increased dural puncture risk, and increased risk of pain from additional needle sticks or incisions. We have designed a unique and novel 14 Gauge epidural access needle to allow 2 SCS leads, one at a time, to advance through the same epidural access needle. This needle can dramatically reduce the time for placement of 2 SCS trial and permanent leads and may reduce complications simultaneously.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"917-920"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434588","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":"Opioid use disorder diagnosis after low back pain diagnosis in active duty, retired, and veteran service members: A time-to-event cohort study.","authors":"Corinne N Kacmarek, Letitia E Travaglini, Krista B Highland, Alexander Velosky, Patricia K Carreño, Rachel Gabor, Megan O'Connell","doi":"10.1093/pm/pnag045","DOIUrl":"10.1093/pm/pnag045","url":null,"abstract":"<p><strong>Objective: </strong>This study quantified time-to-opioid use disorder diagnosis after low back pain diagnosis in military-connected patients and evaluated predictors of opioid use disorder over time.</p><p><strong>Design: </strong>Time-to-event cohort.</p><p><strong>Setting: </strong>Data obtained from the Department of War and Veterans Administration Infrastructure for Clinical Intelligence.</p><p><strong>Subjects: </strong>National sample of active duty, retired, and veteran service members diagnosed with low back pain July 2016-March 2023.</p><p><strong>Methods: </strong>The primary outcome was time-to-opioid use disorder diagnosis up to 52 weeks after low back pain diagnosis. Fixed covariates: Patient characteristics, diagnosis site, and comorbidity scores. Time-dependent covariates: Co-occurring substance use, psychiatric, and medical conditions, and pharmacological and non-pharmacological pain treatments.</p><p><strong>Results: </strong>Among 3 444 921 patients, 20 076 (0.6%) received an opioid use disorder diagnosis within 52 weeks after low back pain diagnosis. Average hazard ratios for opioid use disorder were significantly higher for retired service members and veterans versus active duty personnel, and for those with nicotine dependence, other substance use, and psychiatric comorbidities. Statistically significant time-varying variables included veteran status, greater medical comorbidities, purchased care system for low back pain diagnosis; substance use disorder, other pain, and obesity; days supply of opioids; days of secondary and tertiary pain therapies; and number of antidepressant, sedative, and non-opioid prescriptions.</p><p><strong>Conclusions: </strong>Findings highlight the need for opioid use disorder mitigation efforts for veterans and retired service members with low back pain, particularly those with co-occurring substance use and psychiatric diagnoses, who are prescribed opioids, or who receive intensive pain treatment close to their low back pain diagnosis date.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"867-878"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504476","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":"Reply to letter to the editor about the article \"efficacy and safety of pregabalin and duloxetine in painful diabetic neuropathy: a systematic review and meta-analysis\".","authors":"Ahmed Mansour, Ahmed Farid Gadelmawla, Ahmed Mostafa Amin, Ahmed Elbataa, Anas Mansour, Mohamed Ismail Elnady, Muhammad Ashraf Husain, Omar Abdulrahman Saad, Amr Elshahat, Abdallah Abbas, Ahmed Elshahat, Youssef Mahmoud, Sohaila Mansour Abdelsatar, Mohamed Yasser Elnaggar, Ayman E Fayk, Abdullah Farahat Elbanna, Alaa Abd-Elsayed","doi":"10.1093/pm/pnag020","DOIUrl":"10.1093/pm/pnag020","url":null,"abstract":"","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":"954-955"},"PeriodicalIF":4.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284624","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}