Pain and Therapy最新文献

{"title":"Automated Neural Dosing for Fast-Acting Subperception Therapy: Sustained Spinal Cord Stimulation Outcomes from a Multicenter Study.","authors":"Richard Ferro, James North, Andy Kranenburg, Stephen Pyles, Clay Dorenkamp, Jason Poston, John Schneider, Kacey Auten, Edward Goldberg","doi":"10.1007/s40122-025-00758-y","DOIUrl":"https://doi.org/10.1007/s40122-025-00758-y","url":null,"abstract":"<p><strong>Introduction: </strong>Therapy habituation is a barrier to sustained success with spinal cord stimulation (SCS). Fast-acting subperception therapy (FAST) is a low-frequency, subperception waveform that can achieve rapid wash-in pain relief via the surround inhibition mechanism. FAST-Autodose is an automated neural dosing schedule designed to provide effective pain relief while potentially reducing habituation and maintaining therapy within an efficient therapeutic window-thus eliminating the need for manual patient adjustments. We assessed the efficacy of FAST-Autodose and provide preliminary long-term outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective review of consecutive patients from a multicenter, observational study in the USA who had received SCS and used FAST-Autodose to manage their chronic pain of the low back and/or lower limbs. The numerical rating scale (NRS) evaluated the overall pain intensity until the last follow-up postimplantation.</p><p><strong>Results: </strong>Data were collected from 73 patients who had used FAST-Autodose for 11.9 ± 6.8 months on average. At the last follow-up visit (average 1.8 ± 1.5 years after implantation), the NRS score for overall pain decreased by 5.1 ± 2.8 points, to a mean of 2.1 ± 2.0 (p < 0.0001) and 69% of patients reported minimal pain (NRS ≤ 2/10). In total, 23 patients had been implanted for more than 3.5 years and had used FAST-Autodose for a mean of 17.7 ± 5.9 months; in these patients, the mean NRS pain score decreased by 6.1 ± 2.0 points to 1.6 ± 1.2 points (p < 0.0001).</p><p><strong>Conclusions: </strong>FAST-Autodose is a novel, automated, subperception paradigm for SCS. In our study, this program delivered significant and sustained pain relief in patients with chronic low back and/or leg pain who had been implanted with SCS for up to 3.6 years. These preliminary results constitute a promising rationale for larger, prospective studies on the long-term efficacy of FAST-Autodose.</p><p><strong>Clinical trial registration: </strong>Trial registered at clinicaltrials.gov (ID: NCT01550575).</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554100","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":"Neurotransmitter Imbalance in Tension-Type Headache: A Systematic Review of Mechanisms and Therapeutic Targets.","authors":"Lanfranco Pellesi, Aidin Yangjeh, Ibrahim Hajjaj, Mousbah Lababidi, Fezan Sarwar, Wei Wang, Paolo Martelletti","doi":"10.1007/s40122-025-00761-3","DOIUrl":"https://doi.org/10.1007/s40122-025-00761-3","url":null,"abstract":"<p><strong>Introduction: </strong>Tension-type headache (TTH) is the most prevalent primary headache disorder worldwide, yet its neurobiological underpinnings remain partially understood. Neurotransmitter and neuropeptide alterations have been proposed as contributing factors, but evidence remains inconsistent. This systematic review aims to synthesize the available evidence on peripheral and central neurotransmitter alterations in patients with TTH, and to identify potential neurochemical targets for future investigation.</p><p><strong>Methods: </strong>We searched PubMed and Embase (Ovid) for studies reporting levels of neurotransmitters or neuropeptides in human samples from individuals with TTH. A total of 30 studies were included. Data on study design, sample type, and measured neuromodulators were extracted and narratively synthesized.</p><p><strong>Results: </strong>No single neurotransmitter or neuropeptide emerged as a consistent biomarker or central mediator of TTH. However, some systems showed recurring alterations. Substance P levels were elevated in both salivary and platelet samples. Findings on endogenous opioids were mixed, with β-endorphins often reduced and methionine-enkephalin (MET) elevated, possibly reflecting compensatory responses. Serotonin data were heterogeneous and inconclusive, whereas nitric oxide may play a role in headache induction, independent of calcitonin gene-related peptide (CGRP).</p><p><strong>Conclusions: </strong>Despite variability in results, substance P, endogenous opioids, and nitric oxide emerged as the most promising targets for further studies. Future research should prioritize standardized methodologies to clarify the role of these pathways in TTH pathophysiology.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529154","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":"Gepants in Primary Care: A Targeted Approach to Acute and Preventive Treatment of Migraine.","authors":"Maureen A Moriarty, Carol A Barch","doi":"10.1007/s40122-025-00757-z","DOIUrl":"https://doi.org/10.1007/s40122-025-00757-z","url":null,"abstract":"<p><p>With 80% of migraines diagnosed and managed by primary care clinicians, a knowledge of standard of care and novel therapy is essential for those caring for people with this chronic disease. This review describes a new class of medication, calcitonin gene-related protein (CGRP) antagonists, known as gepants and their use with the focus on the general class of gepants rather than any specific type. These medications were developed specifically for acute and preventive treatment of migraine and appear to be more tolerable with fewer side effects than standard-of-care medications. Previous standard-of-care medications were developed for managing non-migraine disorders but were found to demonstrate efficacy in migraine control despite not directly targeting migraine pathophysiology. Evidence-informed review of the literature and real-world application of gepants is presented to provide a solid understanding of the class and guidance for use.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512271","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":"Expanding Horizons of Buprenorphine: A Comprehensive Narrative Review of Its Pharmacological Properties and Clinical Applications in Chronic Pain.","authors":"Diego Fornasari, Arturo Cuomo","doi":"10.1007/s40122-025-00753-3","DOIUrl":"10.1007/s40122-025-00753-3","url":null,"abstract":"<p><p>Buprenorphine has gained significant attention for its unique pharmacological properties, making it a valuable tool in chronic pain management. Unlike traditional opioids, buprenorphine's partial and biased agonist actions at the μ-opioid receptor provide potent analgesia while minimizing risks such as respiratory depression, tolerance, and dependence. Its favorable pharmacokinetic profile provides the potential for expanding its clinical use in different patient populations. A literature search was conducted in PubMed, Web of Science, and Google Scholar to identify peer-reviewed studies on recent developments in the pharmacological features and new clinical applications of buprenorphine, including original research, reviews, and consensus statements. This comprehensive review explores the expanding clinical applications of buprenorphine, emphasizing its role in managing chronic pain in elderly patients, individuals with cardiac conditions, and those with renal impairments. Emerging evidence highlights its utility in addressing chronic pain in younger adults and its potential in mitigating side effects associated with aromatase inhibitor therapy in patients with breast cancer. Additionally, buprenorphine's lower endocrine side-effect profile and antidepressant properties open new therapeutic avenues for pain-associated depression. With its unique pharmacodynamics, transdermal formulations for sustained drug release, and reduced adverse effects, buprenorphine represents a promising option for tailored, multimodal pain management strategies, especially in populations with complex medical needs. Further studies are warranted to confirm its broad therapeutic potential.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369125","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 Missing Link: Integrating Interventional Pain Management in the Era of Multimodal Oncology.","authors":"Alberto Corriero, Mariateresa Giglio, Rossana Soloperto, Angela Preziosa, Cristina Stefanelli, Mariapaola Castaldo, Federica Gloria, Antonella Paladini, Vittorio A Guardamagna, Filomena Puntillo","doi":"10.1007/s40122-025-00755-1","DOIUrl":"https://doi.org/10.1007/s40122-025-00755-1","url":null,"abstract":"<p><p>Cancer-related pain (CrP) is one of the most frequent and debilitating issues that affect the quality of life of patients with cancer. Systemic analgesics, particularly opioids, have been the cornerstone of pain management. However, the following shortcomings of the mentioned therapies, such as side effects, tolerance, and inadequate relief in refractory cases, make implementing a more complete, multimodal treatment plan necessary. Interventional pain management (IPM) uses specific invasive procedures, with different degree of invasiveness, such as nerve blocks, neurolysis, neuromodulation, and intrathecal drug delivery systems to provide effective pain relief with reduced adverse effects compared with opioids. These approaches are frequently underutilized due to delayed referrals, insufficient awareness, and logistic inefficiencies, which delay access to pain management centers specializing in care for patients in pain. Recent technological advancements offer the potential to overcome these barriers, including artificial intelligence-driven decision support systems and automated referral pathways, enabling early intervention and individualized pain treatment plans. The future of CrP management should shift from the current reactive model to a proactive approach, enabling the earlier incorporation of interventional techniques into treatment plans. The integration of interdisciplinary collaboration and technological innovations will enhance cancer pain management and progress from current outdated approaches to provide more effective and timely pain relief for patients with chronic refractory cancer pain.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317606","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":"Understanding the Anatomy of Posterior Cervical Interfascial Space: Implications for Regional Blocks and Pain Management. A Narrative Review.","authors":"Yufeng Zhang, Huili Li, Songchao Xu, Ruijuan Guo, Danxu Ma, Yun Wang","doi":"10.1007/s40122-025-00754-2","DOIUrl":"https://doi.org/10.1007/s40122-025-00754-2","url":null,"abstract":"<p><p>The posterior cervical area exhibits a complex anatomy comprising fascia, nerves, and muscles. With the widespread adoption of ultrasound in regional anesthesia, numerous posterior cervical interfascial plane block techniques have been developed in recent years. The injectate spreads along the fascial plane, blocking nerves that traverse the interfascial space after being injected into the target plane. The posterior cervical interfascial blocks have been manifesting the great potential for perioperative analgesia and chronic pain management in the head, neck, and shoulder regions. However, a comprehensive review of these methods as well as their indications, contraindications, and complications remain lacking. This article summarizes the anatomy of the posterior cervical musculofascial layers, highlighting the characteristics of interfascial plane block techniques and their potential limitations. By using the fascial anatomy as an entry point for studying interfascial plane blocks, it enhances our understanding of the mechanisms underlying the efficacy and complications of these block techniques. It not only reviews well-studied blocks such as trapezius plane (TP), multifidus cervicis plane (MCP), inter-semispinal plane (ISP), and erector spinae plane (ESP) block but also includes recently developed techniques from the past 5 years, such as the retrolaminar cervical block, serratus posterior superior intercostal plane (SPSIP) block, and C2 dorsal root ganglion (DRG) \"three-in-one\" block. The available evidence suggests that while posterior cervical interfascial plane blocks effectively target the dorsal rami of cervical nerves, non-posterior cervical block techniques also exhibit analgesic potential for the posterior cervical region. This review aims to provide insights for further exploration of novel approaches in this emerging field. In conclusion, posterior cervical interfascial plane blocks demonstrate significant clinical value and warrant further development and optimization.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302696","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":"Progressive Response of Repeated Treatment with High-Concentration (179 mg) Capsaicin Patch in Peripheral Neuropathic Pain After Surgical or Traumatic Nerve Injury: Findings from the 12-Month German CASPAR Registry Study.","authors":"Michael A Überall, Christian Simanski, Mike Zellnig, Mariëlle Eerdekens, Sylvia Engelen, Myriam Heine, Fabienne Percot, Rita Freitas, Lucia Garcia Guerra, Tamara Quandel","doi":"10.1007/s40122-025-00752-4","DOIUrl":"https://doi.org/10.1007/s40122-025-00752-4","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral neuropathic pain after nerve injury (PNI) caused by surgery or trauma can severely impact daily life. The high-concentration capsaicin patch (HCCP, 179 mg) is a topical therapy approved for peripheral neuropathic pain, including PNI. This study utilizes data from the German Pain e-Registry (GPeR) to investigate the real-world effectiveness of HCCP in managing PNI across multiple treatments over 1 year.</p><p><strong>Methods: </strong>CASPAR is a retrospective, non-interventional cohort study investigating patients with peripheral neuropathic pain treated with HCCP. The present analysis included 499 patients with PNI who received ≥ 1 HCCP with ≥ 12 months of follow-up. Key measures included pain intensity, quality of life (QoL), affective distress, sleep disturbances, and overall functioning. Furthermore, analgesic use and adverse events associated with HCCP treatment were evaluated.</p><p><strong>Results: </strong>The mean average daily pain intensity (API) decreased from 52.5 mm on the visual analog scale (VAS) at baseline to 21.5 mm at month 12 in patients receiving four HCCPs. At month 12, a ≥ 30% reduction in API was observed in 25.8%, 44.9%, 85.3%, and 97.8% of patients receiving one, two, three, and four HCCP treatments, respectively. Significant improvements were also noted in physical and mental QoL, sleep, mood, and daily functioning. Patients receiving three or four HCCP treatments maintained pain relief and symptom improvements over the 12-month period, whereas those who discontinued treatment after one or two treatments experienced symptom rebound. In addition, repeated HCCP treatments were associated with a marked reduction in concomitant analgesic use and an increase in days of normal activities. Adverse events were mild-to-moderate application-site reactions, consistent with the well-established safety profile of HCCP.</p><p><strong>Conclusions: </strong>HCCP treatment is associated with reductions in pain intensity and improvements in sleep, mood, and overall QoL in patients with PNI. These benefits are amplified with continued treatment and are accompanied by reduced use of concomitant analgesics and more days of usual activities, although a direct causal relationship cannot be confirmed within the context of this observational study.</p><p><strong>Clinical trial registration: </strong>EU PAS number: EUPAS1000000106.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302695","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":"Efficacy of Combined High-Intensity Laser Therapy and Collagenase Chemonucleolysis in Lumbar Disc Herniation Management: a Prospective Randomized Controlled Trial.","authors":"Peng Song, Chao Ma, Chenchen Xu, Yongjun Zhang, Yan Yuan","doi":"10.1007/s40122-025-00756-0","DOIUrl":"https://doi.org/10.1007/s40122-025-00756-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Lumbar disc herniation (LDH) is a prevalent degenerative spinal disorder. While collagenase chemonucleolysis is effective in long-term LDH management, delayed symptom relief remains a limitation. Recent studies suggest that high-intensity laser therapy (HILT) may enhance tissue repair and pain modulation, providing a rationale for exploring its synergistic effects with collagenase therapy. This study aimed to investigate whether combining HILT with collagenase chemonucleolysis could accelerate early postoperative recovery in patients with lumbar disc herniation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-blind randomized controlled trial was conducted at the Department of Pain Management, The First People's Hospital of Changzhou, between October 2023 and October 2024. This single-center, single-blind randomized controlled trial finally enrolled 60 eligible patients with lumbar disc herniation; participants were randomly assigned to the experimental (HILT + collagenase) or control (collagenase alone) group using a computer-generated randomization sequence with 1:1 allocation. Group assignments were concealed in sealed opaque envelopes until intervention initiation. All participants underwent collagenase chemonucleolysis, with the control group receiving standard postoperative care combined with sham laser therapy, while the experimental group received additional high-intensity laser irradiation alongside conventional treatment. The primary endpoints comprised visual analog scale (VAS) pain scores and clinical efficacy rates evaluated using modified MacNab criteria, while secondary outcomes included the Oswestry Disability Index (ODI), straight-leg-raising angle measurements, and 36-Item Short Form Health Survey (SF-36) quality of life assessments, with standardized evaluations conducted at five predefined intervals: preoperative baseline, 1 week, 1 month, 3 months, and 6 months postoperatively. Statistical analyses were performed using SPSS 20.0. Continuous variables were compared via independent t-tests or Mann-Whitney U tests, while categorical variables were analyzed using chi-squared tests. All tests were two-tailed, with P &lt; 0.05 considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 60 patients (30 per group) with a mean age of 57.15 ± 9.18 years completed the study. Baseline characteristics including age, gender, body mass index (BMI), herniation level, and symptom duration showed no significant intergroup differences (all P &gt; 0.05). No significant baseline differences were observed between groups regarding age (58.00 ± 7.13 versus 57.06 ± 9.08 years), gender distribution (male: 53.3% versus 50.0%), or disease duration (5.17 ± 3.45 versus 5.73 ± 3.07 months) (all P &gt; 0.05). The results showed that there was no statistically significant difference in baseline data between the two groups of patients. At 1 week and 1 month postoperatively, the experimental group demonstrated signific","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275579","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":"Addressing Gabapentinoids' Access Challenges in Saudi Arabia Under New Prescription Regulations: An Expert View.","authors":"Khaled K Aldossari, Yazed AlRuthia, Ashraf Amir, Mohammed Alshurem, Hussein Elbadawi, Abdullah Kaki","doi":"10.1007/s40122-025-00749-z","DOIUrl":"https://doi.org/10.1007/s40122-025-00749-z","url":null,"abstract":"<p><p>Gabapentinoids, notably gabapentin and pregabalin, are crucial for managing neuropathic pain in conditions like diabetic neuropathy and specific types of cancer-related pain where opioids are ineffective or undesirable. However, the misuse potential of pregabalin has led to stricter regulatory controls in many regions, including Saudi Arabia. This expert opinion presents insights from multidisciplinary experts about the impact of these regulations on clinical practice, patient care, and misuse patterns in Saudi Arabia. Pregabalin's rapid onset of action and probable euphoric effects make it more prone to misuse, especially among younger individuals and those with a history of substance abuse. Gabapentin, in contrast, has a lower abuse potential. Experts discussed the implementation of the National Platform for Narcotic Drugs and Psychotropic Substances (Raqeeb) in Saudi Arabia, a system designed to monitor prescriptions of controlled substances. While effective in curbing over-prescription, it has also introduced unintended challenges. Physicians, fearing scrutiny, often hesitate to prescribe gabapentinoids, leading to delays in treatment and greater reliance on less appropriate alternatives. Moreover, stigma associated with controlled substances has further discouraged patients from seeking treatment, resulting in undertreated pain and a diminished quality of life. This expert opinion highlights the need for a more balanced approach to gabapentinoid regulation. It advocates for improved physician education on the management of neuropathic pain, and public awareness initiatives to curb misuse, reduce stigma, and promote the safe use of medications. Refining the Raqeeb platform could alleviate administrative burdens while ensuring robust oversight. Finally, adopting a risk-stratified approach to prescription would allow close monitoring of high-risk patients for substance abuse while ensuring that low-risk patients maintain access to essential treatments. Addressing these challenges would enable healthcare authorities to prevent abuse while ensuring effective pain relief for patients with legitimate medical needs.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209112","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":"Electrode Placement Affects Clinical Outcome in Transcutaneous Electrical Nerve Stimulation for Knee Osteoarthritis: A Combined Cadaver Study and Randomized Controlled Trial.","authors":"Yu Xu, Yanfu Bai, Meimin Deng, Xuyi Hu, Manqin Lian, Zhisheng Huang, Lingling Su","doi":"10.1007/s40122-025-00750-6","DOIUrl":"https://doi.org/10.1007/s40122-025-00750-6","url":null,"abstract":"<p><strong>Introduction: </strong>Transcutaneous electrical nerve stimulation (TENS) is a widely used physical therapy for knee osteoarthritis (OA) pain management. However, the optimal electrode placement for TENS in knee OA remains unclear. Given that TENS delivers stimulation via electrodes to cutaneous nerves, placing electrodes in areas with high nerve density should be the precondition to exert its therapeutic effects. However, high-density nerve areas around the knee and corresponding electrode placement strategies have yet to be investigated.</p><p><strong>Methods: </strong>An anatomic study was conducted on 20 adult formalin-fixed cadavers to identify the high-density nerve areas around the knee. Then, to standardize electrode placement, the patellar width was used as a reference to determine distances from the patellar borders. Subsequently, 80 patients with Kellgren-Lawrence grade 2 or 3 knee OA were enrolled in a randomized, double-blinded trial. Participants received TENS therapy with electrodes placed either on the identified high-density nerve areas (study cohort, n = 40) or on traditional pain areas (control cohort, n = 40).</p><p><strong>Results: </strong>Four high-density nerve areas were identified: the quadriceps tendon, patellar ligament, medial joint line area, and superior medial area of the knee. Over the follow-up period, patients in the study cohort showed significantly greater improvements in VAS score and WOMAC index total score, as well as in pain, stiffness, and function subscales compared with those in the control cohort (all P < 0.05).</p><p><strong>Conclusions: </strong>These findings suggest that positioning electrodes over high-density nerve areas allows TENS more effectively activate sensory afferents, thereby enhancing pain relief.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry identifier, ChiCTR2500098200, 4 March 2025, retrospectively registered.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209113","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}