Pain physician最新文献

{"title":"Lipocalin-2 in the Anterior Cingulate Cortex Contributes to Remifentanil-Induced Postoperative Hyperalgesia.","authors":"Jing Shen, Yilong Wang, Weijie Xie, Qing Luo, Fanhua Meng, Henry Liu, Zeyong Yang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Opioids, which are widely used during surgery in perioperative settings, may cause hyperalgesia, especially when the opioid employed is remifentanil. Opioid-induced hyperalgesia may increase the length of a patient's hospital stay and negatively affect enhanced recovery after surgery and the patient's prognosis. Currently, there is no consensus on treatment strategies for remifentanil-induced postoperative hyperalgesia (RIPH).</p><p><strong>Objectives: </strong>This study aimed to test the hypothesis that upregulation of lipocalin-2 (LCN2) in the anterior cingulate cortex (ACC) contributes to RIPH.</p><p><strong>Study design: </strong>A controlled animal study.</p><p><strong>Setting: </strong>A university laboratory.</p><p><strong>Methods: </strong>The RIPH mouse model was established through the subcutaneous infusion of remifentanil in mice undergoing plantar incision surgery. The von Frey test and the Hargreaves test were used to measure the pain threshold. By combining RNA sequencing, Western blotting, in vivo pharmacology, and the construction of adeno-associated virus vectors that modulated the expression level of LCN2 specifically, the role of LCN2 in the occurrence of RIPH in mice was explored.</p><p><strong>Results: </strong>Compared to the mice that were subjected to the combination of incisions and saline (inci + saline), mice subjected to incisions and remifentanil (inci + remi) did not experience a significant reduction in the mechanical pain threshold of their ipsilateral hind paws. The mechanical pain threshold of the contralateral hind paws of the inci + remi mice was significantly reduced compared to those of the inci + saline mice. According to transcriptome analysis, LCN2 expression was significantly upregulated in RIPH-model mice. Furthermore, the Western blotting analysis also showed a significant increase in the level of LCN2 in the ipsilateral ACC of RIPH-model mice. An intra-anterior cingulate cortex injection of LCN2 mAb could attenuate hyperalgesia in mice. Knockdown of LCN2 expression in the ACC significantly alleviated mechanical hyperalgesia in mice. Additionally, the overexpression of LCN2 in the ACC could directly induce mechanical hyperalgesia without affecting thermal nociception.</p><p><strong>Limitations: </strong>Future research needs to explore more potential mechanisms of affecting pain sensitivity through LCN2 upregulation.</p><p><strong>Conclusions: </strong>Our results demonstrated that the upregulation of LCN2 in the ACC plays a crucial role in the occurrence of RIPH, suggesting that LCN2 potentially be a therapeutic target for alleviating RIPH.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E49-E59"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190145","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":"Pregabalin Combined With Opioids for Managing Neuropathic Pain in Patients With Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Chuanbing Wen, Maoying Wang, Maotong Liu, Chenyu Zhu, Jinlong Zhao, Qing Jiang, RuRong Wang, Jun Li, Li Song","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cancer-related neuropathic pain significantly affects patients' quality of life. Despite existing treatments, pain control remains inadequate for many of these patients. There is a lack of strong evidence for the efficacy of the combination of pregabalin, which is often used to treat neuropathic pain, and opioids for treating cancer-related neuropathic pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the analgesic effects and safety of pregabalin combined with opioids for managing cancer-related neuropathic pain through high-quality evidence analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A systematic review and meta-analysis of pregabalin combined with opioids for cancer-related neuropathic pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We systematically searched the PubMed, Web of Science, Embase, Cochrane Library and Cochrane Central Register of Controlled Trials databases from their inception through October 5, 2023. Two reviewers independently selected studies and extracted articles that met the inclusion and exclusion criteria. Quality assessments of the included studies were performed using the modified Cochrane Collaboration tool; data analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre for The Cochrane Collaboration).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 8 studies were included in our qualitative synthesis, and 6 studies were included in the meta-analysis (6 studies with 757 patients, including 342 in the experimental group and 415 in the control group). The results showed a significant difference between the pregabalin combined with opioids group and the opioids alone group in terms of Numeric Rating Scale (NRS-11) pain scores (weighted mean difference [WMD] = -1.00; 95% CI, -1.29 to -0.70; P &lt; 0.001). However, no significant difference in the NRS-11 score was observed between the pregabalin combined with opioids group and active comparator combined with opioids group (WMD = -0.47; 95% CI, -1.05 to 0.11; P = 0.11). There was a significant difference between the pregabalin combined with opioids group and the active comparator combined with opioids group in terms of extra morphine milligram equivalents (relative risk [RR] = 0.37; 95% CI, 0.20 to 0.70; P = 0.002). No significant difference was observed in quality of life (WMD = -2.01; 95% CI, -5.29 to 1.27; P = 0.23). In general, the frequency of adverse events in the pregabalin combined with opioids group was greater than that in the opioids alone group, but the frequency of adverse events between the pregabalin combined with opioids group and the active comparator combined with opioids group was unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The limited number of articles and sample size are the limitations of this meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pregabalin combined with opioids reduces cancer-related neuropathic pain but increases dizziness, somnolence, and peripheral edema, thus supporting its use in the c","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"1-10"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190156","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 \"Comparative Study Between the Analgesic Effect of Prednisolone and Pregabalin in Managing Post Dural Puncture Headache after Lower-limb Surgeries\".","authors":"Qiang Wang, Jiang Zhu, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E107-E108"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189999","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":"Jie Zhang, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E93-E94"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190033","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":"In Response to Comment on \"Older and Better: A Narrative Review of Successful Aging and Adaptation to Pain in Late Life\".","authors":"Emanuel Narcis Husu","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E110"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190137","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":"Prophylactic Perioperative Fluid Infusion Strategy During Splanchnic Nerve Neurolysis to Prevent Systemic Hypotension: A Case Series of 70 Patients With Cancer.","authors":"Tetsumi Sato, Yuichiro Nishibori, Motoki Sekikawa, Ryoken Nara, Tetsu Sato, Yoshiko Kamo, Rei Tanaka","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;When performing splanchnic nerve neurolysis (SNN), systemic hypotension may occur due to upper abdominal sympathetic blockade; therefore, appropriate periprocedural fluid resuscitation is crucial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The aims of this retrospective observational study were: 1) to validate the efficacy and safety of our prophylactic periprocedural fluid resuscitation in order to prevent systemic hypotension post-SNN, and 2) to explore the indicators that predict the need for additional fluid administration post-SNN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This was a retrospective observational study using medical records from electronic medical charts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;All patients who received SNN in the Division of Palliative Medicine of Shizuoka Cancer Center from April 2016 through November 2022 in order to relieve pain caused by upper abdominal cancer and/or abdominal paraaortic lymph node swelling, had their electronic medical charts reviewed. Pancreatic cancer (n = 41) was the primary pain origin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;SNN was performed with the patient prone. Under fluoroscopic guidance a transdiscal approach using a 22G nerve block needle was utilized. The patients maintained their prone position for an hour postprocedure and rested in bed until the following morning. Urine output and blood pressure were measured every postprocedure 4 hours. One thousand mL of dextran 40 solution and 1,000 mL of lactated Ringer's solution were administered as basic fluids during the perioperative 24 hours; additional lactated Ringer's solution was adminstered when oliguria and/or hypotension was observed post block. We recorded patient background data, including the primary malignancy site, clinical classification of pain mechanism, performance status (Eastern Cooperative Oncology Group), presence of diabetes mellitus, hypertension, serum albumin level, hemoglobin level, hematocrit level, C-reactive protein level, estimated glomerular filtration rate, glomerular filtration ratio, presence of celiac plexus invasion and/or peritoneal dissemination,  neurolytic agent dose, postblock pyrexia, and survival time post-SNN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventy cases (68 patients, 62.5 ± 12.0 years, 32 men and 36 women, duplicated in 2) were analyzed. The volume of anhydrous ethanol administered as the neurolytic agent was 16.8 ± 2.6 mL. Fourteen patients (21%) received 250 - 1,250 mL of lactated Ringer's solution as additional postprocedure fluid due to oliguria. No systemic hypotension was observed at pre- or  postprocedure. No clinical signs of excessive fluid, such as pleural effusion, ascites, edema, and/or dyspnea, was observed. The only indicator to predict the need for additional fluid administration was the dose of neurolytic agent (anhydrous ethanol).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The limitations of this study include, firstly, its single-center retrospective observational desig","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"51-57"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190160","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":"Clinical Trial of Ozonated Water Enema for the Treatment of Fibromyalgia: A Randomized, Double-Blind Trial.","authors":"Qianhao Hou, Jinyuan Zhang, Zehua Su, Xiaomei Wang, Hongwei Fang, Shuwen Qian, Haobing Shi, Qing Wang, Yuling Li, Jiaqi Lin, Xiangrui Wang, Zetian Wang, Lijun Liao","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The pathogenesis of fibromyalgia (FM) is currently unknown. Many patients with this condition are not effectively treated, and disorders of the intestinal dysbiosis have been identified in patients with FM. This trial aimed to investigate whether ozonated water enema could alleviate the symptoms of FM by improving intestinal dysbiosis in these patients.</p><p><strong>Objective: </strong>This trial aims to evaluate the therapeutic advantages of ozonated water enema therapy for patients suffering from FM.</p><p><strong>Study design: </strong>A single-center, double-blind, randomized controlled trial.</p><p><strong>Setting: </strong>Department of Pain Management, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.</p><p><strong>Methods: </strong>This is a randomized, double-blind trial conducted on FM patients (n = 66). The selected patients were randomly categorized into the O3 and control groups. The patients in the O3 and control groups received an ozonated and deionized water enema, respectively, at the same dose and frequency. After the treatment, the scores on the numerical rating scale (NRS), widespread pain index (WPI), Hamilton anxiety scale (HAMA), and the Pittsburgh sleep quality index (PSQI) were compared between the 2 groups, as were the doses of duloxetine, to evaluate the treatment effect. Furthermore, the effectiveness of the treatment was assessed by comparing fecal samples from the O3 group collected before and after treatment with 25 healthy individuals from the physical examination department of Shanghai East Hospital.</p><p><strong>Results: </strong>The patients in the O3 group indicated significant relief in pain and reduced NRS, HAMA, PSQI, and WPI scores at each follow-up time point (P < 0.001) when compared to the control group. In addition, the patients in the O3 group used lower doses of duloxetine than did those the control group (P < 0.001). Moreover, FM patients treated with ozonated water indicated improvements to their gut microbiome.</p><p><strong>Limitations: </strong>The trial's findings might be affected by confounding factors, including medicines, diet, and environmental circumstances. Also, this trial was limited by its sample size, and the symptom severity scores (SSS) of the patients at 3 months after treatment at the given follow-up period were not assessed.</p><p><strong>Conclusion: </strong>This trial confirmed that the symptoms of pain, anxiety, and sleep disorders in FM patients were effectively relieved after treatment with an ozonated water enema. Furthermore, the ozonated water enema was associated with a significant reduction in duloxetine dosage and improved gut microbiome disorder, suggesting that the enema could target disorders related to the gut microbiome and therefore serve as a therapeutic intervention for FM.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E13-E22"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189992","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":"Adjuvants to Conventional Management of Postdural Puncture Headache Following Obstetric Surgery Under Spinal Anesthesia: Mirtazapine vs. Sumatriptan.","authors":"Tarek Mohamed Ashoor, Ahmed Maher Abd ElKader, Raouf Ramzy Gadalla, Ibrahim Mamdouh Esmat, Ahmad Mahmoud Hasseb","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postdural puncture headache (PDPH) is a debilitating, life-altering complication of the administration of obstetric spinal anesthesia (SA). The lack of evidence-based treatment for PDPH necessitates the implementation of new treatment modalities. Mirtazapine is a noradrenergic and specific serotonergic antidepressant that has been used as a prophylactic treatment for chronic tension-type headaches. Few previous studies have assessed the efficacy of sumatriptan in the treatment of PDPH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The purpose of this study was to assess the hypothesis that an adjunctive therapy that involved adding mirtazapine or sumatriptan to conventional management (CM) would be more effective in reducing the incidence of refractory PDPH after obstetric surgery under SA than would CM alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A prospective randomized study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was carried out at Ain-Shams University Maternity Hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two hundred and ten American Society of Anesthesiologists (ASA) physical status II  women who complained of PDPH after obstetric SA were randomly allocated to one of 3 groups. Each group consisted of 70 women. The intervention treatment for every group was continued for 3 days, as was the CM of PDPH. Every day at 8 p.m., patients in the mirtazapine group (the M-group) took 30 mg mirtazapine tablet, patients in the sumatriptan group (the S-group) took 50 mg sumatriptan tablet, and patients in the control group (the C-group) took placebo tablets. The primary outcome was the incidence of refractory headache 72 hours after the ingestion of the first dose of the intervention drugs. The incidences of side effects of the study drugs, the hospital length of stay (LOS), and the patient satisfaction score were secondary outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients in the C-group had higher means of headache intensity, lower rates of complete response to medical treatment, more increased incidences of refractory PDPH 72 hours after intervention, and a greater need for epidural blood patches than did patients in either of the intervention groups (P &lt; 0.001), with comparable efficacy between the M- and S-groups (P &gt; 0.05). Incidences of nausea, vomiting, and the need for antiemetics were least frequent in the M-group (P &lt; 0.001). More patients in the C-group had a high prevalence of photophobia and neck stiffness than did patients in the other 2 groups (P &lt; 0.001). Meanwhile, patients in the M- and S-groups had lower hospital LOS and higher patient satisfaction scores (P &lt; 0.001), with no significant differences between the intervention groups (P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This was a single-center study. This study did not determine the optimal dose of mirtazapine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Adding either mirtazapine or sumatriptan to the CM of PDPH following obstetric SA was associated with lower me","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"39-49"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190025","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 \"Efficacy Analysis of Temporary Spinal Cord Stimulation in the Treatment of Refractory Postherpetic Neuralgia\".","authors":"Hui Li, XiaoDong Liu, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E97-E98"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190111","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 \"Research Status of Different Adjuvants on Nerve Block's Effect\".","authors":"Dingping Zhou, Nijuan Li, Ling Ye","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":"28 1","pages":"E105-E106"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190118","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}