Pain physician最新文献

{"title":"Nerve Block Efficacy and Safety for Acute Thoracic Herpes Zoster: A Systematic Review and Meta-analysis.","authors":"Chiao-Ming Chuang, Chung-Ren Lin, Yu-Lien Hsieh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Acute zoster-related pain affects more than 90% of patients with acute herpes zoster. While nerve blocks with local anesthetics and steroids are commonly used to manage acute postoperative and chronic pain, their efficacy and safety in treating acute herpes zoster remain underexplored.</p><p><strong>Objectives: </strong>Our systematic review and meta-analysis aimed to evaluate the efficacy and safety of various nerve blocks for managing acute herpes zoster.</p><p><strong>Study design: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist.</p><p><strong>Methods: </strong>A comprehensive search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify studies of patients with acute herpes zoster who received nerve blocks. Study quality was assessed using risk-of-bias tools for randomized and nonrandomized studies. The primary outcome was analgesic efficacy; secondary outcomes included postherpetic neuralgia (PHN) incidences, analgesic consumption, and adverse events.</p><p><strong>Results: </strong>Thirteen studies (9 RCTs, n = 815; 4 observational studies, n = 253) were included. Nerve blocks administered were  paravertebral blocks (PVB), erector spinae plane (ESP) blocks, epidural blocks, and intercostal nerve blocks. The meta-analysis, which included 6 RCTs, indicated that at 4 weeks postprocedure, nerve blocks significantly reduced Visual Analog Scale pain scores. The blocks also reduced the need for acetaminophen and pregabalin compared with the control group. However, no differences in Visual Analog Scale pain scores were observed at 12 weeks. Both PVB and ESP blocks significantly decreased the PHN incidences at 3 and 6 months postprocedure. Five studies demonstrated that ultrasound-guided ESP blocks significantly reduced pain severity, duration, and the incidence of PHN without notable adverse events. Eight studies found PVBs to be effective in reducing pain scores and PHN incidences, though adverse events such as dizziness, drowsiness, and pain at the injection site were reported. Four observational studies comparing epidural or intercostal nerve blocks with other techniques provided weak evidence for their use.</p><p><strong>Limitations: </strong>Our study's limitations include its small sample size with only 6 RCTs, significant heterogeneity in study designs, and variations in the interventions. Subjectivity in measuring pain and the lack of blinding introduces potential bias. Additionally, limited evidence on intercostal and epidural blocks for acute herpes zoster highlights the need for more high-quality RCTs.</p><p><strong>Conclusion: </strong>In conclusion, nerve blocks with local anesthetics and steroids provide effective analgesia, reduce analgesic consumption, and lower PHN incidences in ","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"83-96"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of the Minimally Invasive Lumbar Decompression (MILD®) Procedure: A PRISMA-compliant Systemic Review and Meta-analysis.","authors":"Xin-Yu Zhang, Jian-Li Zhao, Ya-Jing Wang, Jie Luan, Hong-Qi Lin, Dajie Wang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spinal stenosis is the most common cause for spinal surgery of older adults. It is associated with pain in the legs and back as well as impaired ambulation. Minimally Invasive Lumbar Decompression (MILD®, Vertos Medical) is a percutaneous, image-guided lumbar decompression technique for central canal stenosis secondary to a hypertrophied ligamentum flavum. However, whether MILD can achieve adequate beneficial results in patients with lumbar spinal stenosis remains undetermined.</p><p><strong>Objective: </strong>To assess the efficacy and complications of MILD for lumbar spinal stenosis.</p><p><strong>Study design: </strong>A systematic review and meta-analysis.</p><p><strong>Methods: </strong>Electronic databases were searched to identify all clinical trials of patients undergoing MILD surgery. Primary outcomes included Visual Analog Scale scores (VAS) or Oswestry Disability Index scores (ODI) at baseline, < 6 months posttreatment, = one year posttreatment. Secondary outcomes included postoperative complications. For continuous variables, the treatment effects were calculated by weighted mean difference and 95% CI. The statistical significance was defined as P < 0.05.</p><p><strong>Results: </strong>There were 334 trials identified; 12 of them, with data from 500 patients, were included in our analysis. MILD treatment resulted in a significant decrease in the mean pain score compared to the baseline (P < 0.01). There is a consistent pattern of decreased mean ODI scores following MILD compared to the baseline (P < 0.01).</p><p><strong>Limitations: </strong>The included MILD clinical trials did not have the same exclusion and inclusion criteria. While all clinical trials in this study adopted conservative treatments prior to MILD, there were no standardized treatment modalities and length of time. All of the studies employed subjective outcome tools including VAS and ODI. However, these self-reported outcome tools are subject to bias.</p><p><strong>Conclusions: </strong>Our study suggests MILD is an effective and safe surgical technique for patients with stenosis from ligamentum flavum hypertrophy. This technique resulted in significant clinical improvement, as indicated by changes in pain scores and ODI scores. In addition, adverse events were low compared to other surgical decompression techniques. To further confirm this, more well designed and powered randomized trials are needed.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"71-81"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Imaging in Dynamic Spondylolisthesis: Emerging Strategies and Understanding for Pain Physicians: A Systematic Review.","authors":"Mihir Jani, Eli Dayon, Nimesha Mehta, Kunal Aggarwal, Joseph D Fortin, Karoline Zektser, Joshua Lewis, Marco Lawandy, Ricky Ju, Ugur Yener, Jonathan D Krystal, Reza Yassari, Alan D Kaye, Sayed E Wahezi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain (CLBP) is prevalent, with lumbar spondylolisthesis a common cause of the condition. Spondylolisthesis, the displacement of one vertebra over another, can have various causes. Isthmic and degenerative forms are the most common. Clinicians need to evaluate whether the condition is fixed or dynamic, since dynamic cases may cause vertebral instability and nerve compression, necessitating surgery. Traditional flexion-extension x-rays have been the standard diagnostic tool, but recent studies suggest that alternative imaging methods, such as magnetic resonance imaging or computed tomography, may offer more accurate detection.</p><p><strong>Objective: </strong>Spondylolisthesis, often described as the slipping forward of one of the vertebrae, is a common etiology for CLBP. Generally, spondylolisthesis can be categorized as either stable or unstable. Unstable or dynamic spondylolisthesis is usually diagnosed based on the visualization of sagittal translation of the vertebral body on flexion-extension x-rays. However, it has been reported that flexion-extension x-rays may not be the most reliable method for determining the presence of an unstable spondylolisthesis. The present investigation aimed to identify the extent of the literature that discussed alternative imaging techniques for diagnosing dynamic spondylolisthesis.</p><p><strong>Study design: </strong>A retrospective systematic review of original research done on spondylolisthesis from 2000 to 2023.</p><p><strong>Methods: </strong>A review protocol was followed based on PRISMA guidelines and conducted across 3 databases for relevant articles published between the years 2000 and 2023. Two reviewers screened and characterized the articles independently, and 3 additional reviewers performed full-text analysis and data extraction.</p><p><strong>Results: </strong>The search yielded 13 articles with differences in origin, study design, sample size, and outcomes. Most of the articles were retrospective studies. Of the 13 articles, 11 showed promising results in utilizing alternative imaging to diagnose dynamic spondylolisthesis.</p><p><strong>Limitations: </strong>The lack of a formally registered protocol and potential publication bias were the limitations for this review.</p><p><strong>Conclusion: </strong>The present investigation analyzed the current literature and determined that alternative imaging techniques could adequately diagnose the dynamic instability of the spine. Further research is warranted to establish an in-depth analysis that elucidates the most reliable and sensitive imaging sequence for diagnosing dynamic spondylolisthesis.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"97-103"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropathic Pain Management in France: A Comparison of French Recommendations Using Case-Vignette Surveys.","authors":"Paul Elhomsy, Stephane Sanchez, Catherine Doussot, Philippe Rault","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of clinical practice guidelines, suboptimal adherence among general practitioners (GPs) in pain management remains a concern. The French Pain Society issued revised guidelines for pain management in 2020.</p><p><strong>Objectives: </strong>This study aimed to evaluate the current adherence of French doctors to the updated guidelines for pain management.</p><p><strong>Study design: </strong>A non-interventional, cross-sectional study.</p><p><strong>Setting: </strong>  A panel of doctors from France, participated in an online questionnaire.</p><p><strong>Methods: </strong>Two selected vignettes describing patients with chronic neuropathic pain (central and peripheral) were completed. The ability to correctly prescribe appropriate first- and second-line treatments according to the 2020 French Pain Society guidelines was assessed.</p><p><strong>Results: </strong>A total of 191 physicians were recruited from a database of 3,380, representing a response rate of 5.7%. Of the participants, 182 (95.3%) completed the survey correctly and were included in the final analysis. Among those participants, 64% were general practitioners (GPs). Adherence to the guidelines for the management of l ocalized peripheral neuropathic pain was reported by 15.38% of participants, while 21% reported adherence for central neuropathic pain. A significant disparity was observed in the prescription of medications, with pregabalin being prescribed by 32.9% of participants and gabapentin by 22.5% for localized neuropathic pain. For central neuropathic pain, pregabalin use was reported by 30.7% of respondents and gabapentin by 26.3%. Following the failure of a second-line therapy, 66% of participants considered reorientation to be a viable treatment option for localized peripheral neuropathic pain, compared to 45% for central neuropathic pain.</p><p><strong>Limitations: </strong>The number of participants is one of the main limitations in this study.</p><p><strong>Conclusions: </strong>Despite the participants' low adherence to guidelines, substantial variation in medication use, and limited support for reorientation after failed treatment, this study offers insight into management practices for neuropathic pain among French GPs in Burgundy.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E157-E164"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Local Skin Precooling on Alleviating Injection Site Pain in Patients With Androgenetic Alopecia Receiving a Scalp Nerve Block.","authors":"Rashid M Rashid, Kenneth D Candido, Shariq Ibrahim, Bangda Chai, Ling Gao, Yanling Song, Yue Wang, Xiaowen Pan, Wenjun Le, Weiting Liu, Zhongmin Liu","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Scalp platelet-rich plasma (PRP) mesotherapy is commonly used to increase hair density and improve scalp health in patients with androgenetic alopecia. While PRP therapy is favored for its lower risk of adverse effects and reduced treatment frequency compared to other methods, the potential for injection site pain remains a significant challenge, potentially reducing patient compliance and treatment continuation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the effectiveness of local skin precooling in reducing injection site pain during scalp PRP mesotherapy in patients with androgenetic alopecia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A single-center retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was conducted at the Precision Health Management Center of the Shanghai East Hospital, Tongji University School of Medicine, People's Republic of China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were collected from 100 patients (82 men, 18 women) aged 18-50 years who underwent scalp PRP mesotherapy from August 2020 through July 2024. Patients were divided into 2 groups: Group A (n = 50) received local skin precooling administered using sterile gloves by way of soft ice packs for 2 minutes pre scalp nerve block; Group B (n = 50) did not receive local skin precooling pre scalp nerve block. All patients received scalp PRP mesotherapy. Pain perception was measured using a 100-mm Visual Analog Scale (VAS) at multiple time points: 30 seconds post scalp nerve block at 2 nerve points, at immediate posttreatment, and at one- and 24-hours posttreatment. Demographic data and Positive and Negative Affect Schedule scores were also collected. Safety outcomes included the incidence of adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VAS scores were significantly lower in Group A compared to Group B at all measured time points. At 30 seconds post scalp nerve block, Group A showed a 34.08% pain reduction at the supraorbital nerve and the supratrochlear nerve and an 18.86% pain reduction at the greater occipital nerve compared to Group B. VAS scores for Group A at immediate posttreatment, and one and 24 hours posttreatment were significantly lower than those for Group B (P &lt; 0.05). The primary adverse reactions reported were mild. They included headache, injection site pain, and scalp sensitivity, all of which resolved quickly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The retrospective nature of the study, limited data collection, small sample size, and short follow-up period are notable limitations. Larger-scale prospective studies with extended follow-up periods are recommended for future research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;local skin precooling is a simple and effective technique for reducing injection site pain during a scalp nerve block. PRP mesotherapy, thereby enhancing patient comfort and compliance. Our study is the first to analyze the analgesic effects of local skin precooling on scalp nerve block injection site p","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"155-165"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Computed-Tomography-guided Percutaneous Bilateral Neurolytic Celiac Plexus Block with Alcohol for Upper Abdominal Visceral Cancer Pain\".","authors":"Qiuju Yi, Hui Zhong, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E227-E228"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dilution of Ziconotide for Intrathecal Trial: The Effect of Dilution on the Incidence of Side Effects and Pain Relief: A Single-center Retrospective Case-control Study.","authors":"Anna Lynne Carpenter, Joseph Aaron McGuire, Edward Charles Nemergut, Kelsey Marie Bauer, Yeshvant Ashok Navalgund, David Carmine Scalzo, Richard Martin Vaglienti, Corinne Michel Layne-Stuart","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The optimal dosing and delivery strategies for intrathecal ziconotide are debated.  Previous research suggests that high volume, low concentration dosing techniques may decrease side effects and enhance analgesic effect. Previous studies that have investigated the effects of diluting ziconotide have examined continuous infusions of the medication through an intrathecal pump.</p><p><strong>Objectives: </strong>This study investigates the trial phase to determine if diluting the bolus dose leads to improved outcomes. The hypothesis of the authors is that the dilution of ziconotide will improve the trial outcomes.</p><p><strong>Study design: </strong>This single-center, retrospective, case-control study included 62 patients with chronic pain refractory to conservative therapy who received a one-time intrathecal bolus dose of ziconotide.</p><p><strong>Methods: </strong>The study included 62 patients who received a single outpatient trial dose of ziconotide. The study was approved by an institutional review board. Data were collected from electronic medical records. Doses ranged from a total of 2.5 µg-5 µg in a volume of 0.5 mL-5 mL. The primary endpoints were the number of patients that achieved significant pain relief (>= 50%) and the presence or absence of side effects. Statistical analysis was performed using a c2 test to evaluate side effects and meaningful pain relief and an unpaired, 2-tailed t test to evaluate pain relief percentage.</p><p><strong>Results: </strong>There were no differences in side effects experienced by the patients in the Undiluted Group compared to the patients in the Diluted Group (21% vs 25%; P = 0.679). There were no differences in pain relief in the Undiluted Group compared to the Diluted Group (59% vs 61%; P = 0.880). The mean (SD) pain relief in the Undiluted Group was 46% (± 40%) compared to 51% (± 41%) in the Diluted Group (P = 0.645). A power analysis revealed a 68% power to detect a difference between the groups.</p><p><strong>Limitations: </strong>These results are limited by the accuracy of the chart review and sample size; therefore, additional investigation may be warranted.</p><p><strong>Conclusion: </strong>This study demonstrates there is no substantial difference between diluted and undiluted bolus doses of intrathecal ziconotide in regard to analgesic effect or side effects.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"147-154"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Causal Relationship Between Opioid Use and Obstructive Sleep Apnea: A Bidirectional Mendelian Randomization Study.","authors":"Guoliang Shan, Yufeng Ma, Yanwu Jin","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Opioid medications are widely used for pain management, but their impact on obstructive sleep apnea (OSA) remains controversial. Given the high prevalence of OSA and the increasing use of opioids, understanding the causal relationship between the condition and this type of medication is critical.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aims to investigate the causal relationship between opioid use and OSA using a bidirectional 2-sample Mendelian randomization (MR) analysis. Specifically, the study seeks to determine whether exposure to opioid use increases the risk of developing OSA and whether OSA influences the likelihood of opioid use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;The study employed a bidirectional 2-sample MR analysis to explore the causal relationship between opioid use and OSA. Genetic variants from large-scale genome-wide association studies (GWAS) were used as instrumental variables to ensure robust causal inference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study utilized data from 2 large-scale GWAS datasets. Opioid use data were obtained from the UK Biobank, while OSA data were sourced from the FinnGen study. Both datasets predominantly included patients of European ancestry with similar demographic characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study employed a 2-sample bidirectional Mendelian randomization (MR) approach to investigate the causal relationship between opioid use and obstructive sleep apnea (OSA). Genetic instruments for opioid use and OSA were selected from large-scale genome-wide association studies (GWAS) conducted in European populations, ensuring consistency in genetic backgrounds. The inverse variance-weighting (IVW) method was used as the primary analysis to estimate causal effects, supplemented by the weighted median, MR-Egger, simple mode, and weighted mode methods to ensure robustness. Sensitivity analyses, including MR-Egger regression, leave-one-out analysis, and MR-PRESSO, were conducted to assess pleiotropy, heterogeneity, and the influence of individual SNPs on the results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The IVW method demonstrated a significant causal effect of opioid use on the risk of developing OSA, with a causal effect size of 0.28 (OR = 1.32, 95% CI = 0.09 to 0.46, P-value = 0.004). This association was supported by the weighted median method, though the MR-Egger, simple mode, and weighted mode methods did not achieve statistical significance but showed a consistent direction of effect. Conversely, no significant causal relationship was observed between OSA and opioid use across all methods, suggesting that OSA did not significantly influence opioid use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The primary limitations of this study include the use of binary phenotypes for opioid use and OSA, which precludes the assessment of dose-response relationships. Additionally, the genetic data were derived predominantly from European populations, limiting the general","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E147-E156"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gray Matter Alterations in Medication Overuse Headache: A Voxel-Based Morphometry Meta-Analysis.","authors":"Weiming Luo, Yuke Teng, Xingyao Chen, Nuo Chen, Xinyue Zhang, Jun Zhou, Siyuan Tao, Peng Lai, Qian Song, Xinyu Hao, Fanrong Liang, Zhaoxuan He, Zhengjie Li","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Medication overuse headache (MOH) is a secondary headache disorder associated with the chronic use of pain-relieving medications, leading to significant alterations in brain structure and function. Previous studies have shown inconsistent findings in gray matter (GM) changes in MOH patients, making it necessary to conduct a comprehensive meta-analysis to synthesize these results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The objective is to conduct a thorough review and meta-analysis of the consistency among voxel-based morphometry (VBM) neuroimaging studies that focus on MOH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This meta-analysis examined all VBM studies that involved the whole-brain alterations of MOH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search of neuroimaging studies was conducted across 6 databases, including EMBASE, PubMed, Web of Science, Wan-Fang Database, China National Knowledge Infrastructure (CNKI), and Chongqing VIP, covering publications from the inception thereof to December 1, 2023. Two independent researchers performed quality assessment, data extraction, and study selection. Researchers performed a thorough examination of GM data in MOH, utilizing both activation likelihood estimation (ALE) and Anisotropic effect size-signed differential mapping (AES-SDM). Additionally, the research included clinical variables correlation analysis and subgroup analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 8 studies were selected for analysis based on stringent screening criteria, resulting in the inclusion of 378 patients (comprising 191 patients with MOH and 187 healthy patients). The 2 different neuroimaging meta-analysis methods both revealed that MOH patients had increased amounts of GM in their cerebellar vermis, left red nuclei, and right medial dorsal nuclei. Additionally, MOH patients showed reductions in the GM of their left superior frontal gyri, left inferior frontal gyri, right precunei, and bilateral middle frontal gyri. Correlation analysis findings indicated that numerous cerebral areas were linked to clinical variables of MOH, including the duration of the condition, frequency of headaches, and patient age. MOH patients using different medications exhibited partially inconsistent GM alterations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The limited number of neuroimaging studies and the variability in methodologies across studies might have affected the robustness of the findings. Future research should address these gaps by exploring both structural and functional neuroimaging in diverse MOH subtypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Significant alterations in GM across various brain regions associated with pain processing, modulation, and reward have been observed in association with MOH. These observations contribute to a better understanding of the neural mechanisms underlying MOH and may potentially guide the developm","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E115-E127"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Tragedy of Chronic Pain and Its Psychosocial Impact: A Commentary on the Case of Luigi Mangione.","authors":"James Giordano","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This commentary explores the tragic case of Luigi Mangione, as detailed in Melanie Thernstrom's Wall Street Journal article, to address the complex interplay between chronic pain, psychological distress, and systemic inadequacies in healthcare. Chronic pain, as a biopsychosocial phenomenon, profoundly impacts not only physical functionality but also identity, cognition, and behavior, often leading to psychological destabilization and despair. Neurobiological evidence illustrates how chronic pain alters neural structures and functions, amplifying emotional reactivity and impairing judgment. Mangione's descent into violence exemplifies the detrimental cycle of pain, frustration, and alienation, exacerbated by systemic barriers such as inequitable healthcare access and insurance inadequacies. The discussion highlights the broader ethical implications for pain management, emphasizing the necessity of empathetic engagement, equitable care, and individualized therapeutic approaches. While advances in neurotechnology offer new diagnostic and interventional possibilities, their accessibility and integration into practice raise critical ethical concerns. Additionally, responsible opioid prescribing, informed by nuanced understanding of chronic pain, remains essential to addressing the dual challenges of effective pain relief and the opioid epidemic. This analysis calls for a comprehensive paradigm shift in pain care, integrating biopsychosocial methodologies, healthcare reforms, and ethical innovation. By addressing systemic inequities and prioritizing both high- and low-technology solutions, researchers, clinicians, and policymakers can better support patients and mitigate the far-reaching consequences of unaddressed chronic pain. Ultimately, this tragedy underscores the urgent need for actionable reform to prevent further individual and societal harm.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 2","pages":"E215-E218"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}