Pain and Therapy最新文献

{"title":"Long-Term Efficacy and Safety of Treatments for Chronic Peripheral Neuropathic Pain: A Systematic Review and Narrative Synthesis.","authors":"Mariëlle H Eerdekens, Charlotte Both, Rita L Freitas","doi":"10.1007/s40122-026-00884-1","DOIUrl":"https://doi.org/10.1007/s40122-026-00884-1","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral neuropathic pain (PNP) is a chronic condition that often requires long-term treatment. In 2025, the Neuropathic Pain Special Interest Group (NeuPSIG) updated its recommendations for treatment of neuropathic pain based on data from double-blind, randomized controlled trials (RCTs) with a duration of ≥ 3 weeks. To complement the existing body of evidence, we reviewed the long-term efficacy/safety of NeuPSIG-recommended treatments for PNP.</p><p><strong>Methods: </strong>We conducted a systematic literature review including clinical trials and observational studies of any design. Two literature searches were performed using PubMed and Embase (December 2024, May 2025). We included studies that enrolled ≥ 50 adult patients with PNP receiving ≥ 1 treatment recommended in the 2025 NeuPSIG guidance and with duration of ≥ 13 weeks. A supplemental search for long-term studies on high-concentration capsaicin 8% patch (HCCP) was performed. Results were synthesized narratively due to heterogeneity in study designs and outcomes.</p><p><strong>Results: </strong>We included 34 articles in our analysis (31 studies) varying in design, including interventional (RCTs and open-label studies) and observational studies. Most studies had a duration of 26-52 weeks. Four treatments (HCCP, duloxetine, gabapentin, pregabalin) were evaluated in ≥ 5 studies. HCCP was evaluated in the greatest number of long-term studies (n = 13) and in various PNP conditions, followed by duloxetine (n = 7) in painful diabetic peripheral neuropathy (pDPN) only, gabapentin (n = 6) in various PNP conditions and pregabalin (n = 5) mostly in pDPN. Collected data support long-term efficacy of all products. The lowest rates of discontinuations due to adverse events were reported with HCCP.</p><p><strong>Conclusions: </strong>The findings from this literature review emphasize the importance of expanding long-term evidence for chronic pain therapies. The review determined that the largest body of evidence is available for HCCP. Finally, it highlights the need for more standardized long-term evidence studies for chronic pain therapies.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866334","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 Leiden-Nice Consensus (2024-2025)-Technical Standardization and Clinical Algorithms for Pulsed Radiofrequency for Chronic Pain.","authors":"Daniel de Moraes Ferreira Jorge, Olav Rohof, Alexandre Teixeira, Tolga Ergönenç, Luis Josino Brasil, Ahmed Elhalwagy, Paulo Renato Barreiros da Fonseca, Jonas Lenzi de Araujo, Francesca Marsili","doi":"10.1007/s40122-026-00885-0","DOIUrl":"https://doi.org/10.1007/s40122-026-00885-0","url":null,"abstract":"<p><p>Pulsed radiofrequency (PRF) has emerged as a safe, minimally invasive clinical strategy for the management of acute and chronic pain syndromes. Over the past two decades, its range of clinical applications has expanded across spinal, peripheral nerves, and intra-articular interventions. Despite the growing evidence supporting the clinical efficacy of PRF, two major challenges remain: (a) the lack of standardized technical parameters and the absence of structured clinical algorithms guiding physicians in selecting the targets and therapeutic strategies. In April 2024, an international panel of pain specialists convened in Leiden, the Netherlands to propose standardized technical guidelines for PRF procedures, resulting in the Leiden Consensus 2024, which focuses on reproducible parameters such as voltage, exposure time, electrode configuration, and procedural technique. Subsequently, during expert consensus discussions held in Nice, France, in 2025, the same international workgroup addressed a second critical gap in the field: clinical decision-making in interventional pain management. The Nice 2025 Consensus therefore developed practical diagnostic and therapeutic algorithms for common chronic pain conditions, including cervical facet pain, shoulder pain, knee osteoarthritis, sacroiliac pain, hip pain, thoracic pain, and central sensitization syndromes. This integrated consensus manuscript combines both initiatives into a comprehensive clinical framework. The Leiden Consensus proposes reproducible technical standards for PRF procedures, while the Nice Consensus provides stepwise clinical pathways emphasizing diagnosis-driven interventions and prioritizing nondestructive neuromodulation strategies. A central principle of the consensus is that PRF may be considered the first-line interventional treatment for peripheral nerve-related chronic noncancer pain, reserving ablative radiofrequency techniques for cases that are refractory to neuromodulation. The present document represents a living consensus intended to guide clinical practice worldwide while stimulating future research and evidence generation in the rapidly evolving field of PRF pain therapy.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831546","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 and Safety of Oral Zavegepant in Migraine Prevention: A Phase 2/3 Randomized, Double-Blind, Placebo-Controlled Study in Patients with Chronic Migraine.","authors":"Robert J Fountaine, Sergey Dubrovin, Linda Mosher, Jing Liu, Mohamed H Shahin, Terence Fullerton","doi":"10.1007/s40122-026-00861-8","DOIUrl":"https://doi.org/10.1007/s40122-026-00861-8","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess the efficacy and safety of once daily oral zavegepant as a preventive treatment for chronic migraine.</p><p><strong>Methods: </strong>This multicenter, randomized, double-blind, placebo-controlled phase 2/3 study consisted of a 12-week double-blind treatment (DBT) phase and a 52-week open-label extension (OLE). Adults with ≥ 1-year history of chronic migraine (with or without aura), ≥ 15 headache days/month, ≥ 8 migraine days/month, and ≥ 1 headache-free day/month during the 3 months prior to screening were randomly assigned 2:2:1:1 to zavegepant 100 mg, 200 mg, placebo for zavegepant 100 mg, or placebo for zavegepant 200 mg. Following a 28-day observation phase (OP), participants took the study treatment every calendar day. The primary endpoint was mean change from the OP in number of migraine days/month in the DBT phase. This study was stopped prematurely due to recruitment challenges.</p><p><strong>Results: </strong>Of 1753 screened participants, 522 were treated and 411 completed the DBT phase. Participants were predominantly female (n = 391, 79.5%) and mean (SD) age of chronic migraine onset was 26.5 (11.7) years. The mean (97.5% CI) changes from the OP in number of migraine days/month in the DBT phase were - 7.0 (- 8.10, - 5.92), - 6.3 (- 7.45, - 5.10), and - 5.6 (- 6.80, - 4.37) for zavegepant 100 mg, 200 mg, and placebo groups, respectively. The corresponding least squares (LS) mean change differences (zavegepant-placebo pooled; 97.5% CI) were - 1.4 (- 2.72, - 0.12) and - 0.7 (- 2.07, 0.69) for zavegepant 100 mg and zavegepant 200 mg groups, respectively. During DBT, 21 (12.1%) and 14 (8.0%) participants had at least one adverse event considered zavegepant-related in the zavegepant 100 mg and 200 mg groups, respectively, with corresponding rates of nine (5.8%) and nine (6.3%) participants during the OLE.</p><p><strong>Conclusions: </strong>Oral zavegepant had a favorable safety and tolerability profile for up to 200 mg daily. Additional research is needed to determine the effectiveness of oral zavegepant as a preventive migraine treatment.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov number: NCT04804033.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831518","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":"Quadratus Lumborum Block versus Thoracic Paravertebral Block for Postoperative Recovery Quality after Percutaneous Nephrolithotomy: A Randomized Noninferiority Trial.","authors":"Wenjun Lin, Qingfu Zhang, Feifei Zheng, Linshan Huang, Weitao Gao, Jinsheng Guan, Guisheng Ding","doi":"10.1007/s40122-026-00882-3","DOIUrl":"https://doi.org/10.1007/s40122-026-00882-3","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to determine whether anterior quadratus lumborum block (QLB) at the lateral supra-arcuate ligament is noninferior to thoracic paravertebral block (TPVB) for postoperative recovery quality after percutaneous nephrolithotomy (PCNL).</p><p><strong>Methods: </strong>A total of 72 adults (American Society of Anesthesiologists physical status I-II) undergoing elective unilateral PCNL were randomized to QLB (n = 36) or TPVB (n = 36). Before general anesthesia, patients received ultrasound-guided anterior QLB (0.5% ropivacaine, 30 mL) or TPVB (0.5% ropivacaine, 20 mL), with standardized multimodal analgesia including patient-controlled intravenous morphine. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h; noninferiority required the lower bound of the 95% confidence interval (CI) for the difference (QLB minus TPVB) to exceed the prespecified margin of -6 points in both the modified intention-to-treat and per-protocol populations. Secondary outcomes were pain intensity, morphine consumption, patient satisfaction, and adverse events.</p><p><strong>Results: </strong>Median QoR-15 scores at 24 h were 124 (interquartile range [IQR], 118-128) for QLB and 122 (IQR, 117-125) for TPVB (median difference, 2; 95% CI, -1 to 5; p < 0.001 for noninferiority), robust at stricter margins and confirmed per protocol. In secondary and exploratory analyses, QLB prolonged time to first analgesia (from postanesthesia care unit [PACU] admission; restricted mean survival time difference, 7.9 h; 95% CI, 5.9 to 9.8; time-averaged hazard ratio, 0.18; 95% CI, 0.10 to 0.31; p < 0.001), reduced 24-h morphine consumption (-4 mg; 95% CI, -6 to 0; p = 0.035), and lowered pain area under the curve at rest (-10 cm·h; 95% CI, -15 to -4) and on movement (-15 cm·h; 95% CI, -22 to -8; both p < 0.001). Hypotension occurred in 4 of 35 patients (11%) with QLB versus 13 of 36 (36%) with TPVB (relative risk, 0.32; 95% CI, 0.11 to 0.88; p = 0.015).</p><p><strong>Conclusions: </strong>Anterior QLB was noninferior to TPVB for postoperative recovery quality after PCNL. Associated reductions in pain and opioid use, and a lower observed incidence of hypotension, seen in secondary and exploratory analyses, are hypothesis-generating and warrant confirmation. Graphical abstract available for this article.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2100044431.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796448","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":"Phenotypic Factors and Celecoxib Efficacy in Knee OA: A Post‑hoc Pooled Analysis of Two Randomized, Double‑Blind, Placebo‑Controlled Trials.","authors":"Jean-Yves Reginster, Nicholas Fuggle, Egbert Biesheuvel, Srinivasan Venugopal, Sagar Suresh Kumbhar, Raffaella Maria Rita Chiaese, Chris Walker, Ernest Choy","doi":"10.1007/s40122-026-00879-y","DOIUrl":"https://doi.org/10.1007/s40122-026-00879-y","url":null,"abstract":"<p><strong>Introduction: </strong>Knee osteoarthritis (OA) is a major cause of disability worldwide and disproportionately affects women and individuals with obesity. Treatment response might vary by sex and body mass index (BMI). This study assessed whether celecoxib pain reduction differs across sex (male versus female) or BMI (obese ≥ 30 kg/m² versus nonobese < 30 kg/m²) in knee OA patients, using change from baseline in Visual Analog Scale (VAS) pain at Week 6 as primary endpoint.</p><p><strong>Methods: </strong>This post hoc pooled analysis included two randomized, double-blind, placebo-controlled trials (NH49-96-02-060; NH49-98-02-087). Adults with knee OA flare and baseline VAS pain ≥ 40 mm received placebo, 100 mg of celecoxib twice daily (BID), or 200 mg once daily (OD) for 6 weeks. Mild baseline pain was excluded to align with original trial criteria. The full analysis set (FAS) included patients with ≥ 1 dose and ≥ 1 post-baseline assessment. Primary subgroups were assessed using analysis of covariance (ANCOVA) with last observation carried forward (LOCF) for missing data, with longitudinal evaluation at Week 2 and 6 using mixed model for repeated measures (MMRM). Sensitivity analyses using alternative imputation methods were also performed.</p><p><strong>Results: </strong>A total of 1360 participants (427 men, 933 women) were included. Baseline VAS pain score was higher in women and patients with obesity (both p < 0.0001), who also showed greater placebo response. At Week 6, both celecoxib regimens significantly reduced pain versus placebo across sex and BMI subgroups. Women had greater observed pain reductions with similar efficacy between sexes, and obese participants showed comparable benefit with both doses. Similar findings were observed in MMRM analyses. Celecoxib provided rapid, sustained OA pain relief across the two subpopulations.</p><p><strong>Conclusions: </strong>100 mg of celecoxib BID and 200 mg OD showed consistent analgesic efficacy across sex and BMI subgroups, despite higher baseline pain and stronger placebo response in women and obese participants. These findings support the use of either regimen across diverse OA patient profiles and suggest that baseline pain differences do not necessarily reduce response to cyclooxygenase (COX)-2 inhibition.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796457","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":"Management of Musculoskeletal Injuries with an Inflammatory Damage-Associated Molecular Pattern (DAMP) Etiology.","authors":"Ryan J Love, Jay Sheridan, Christopher Funk, Jody-Lynn Young","doi":"10.1007/s40122-026-00880-5","DOIUrl":"https://doi.org/10.1007/s40122-026-00880-5","url":null,"abstract":"<p><strong>Introduction: </strong>Musculoskeletal injuries (MSKI) often progress from acute tissue damage to chronic pain and dysfunction when mechanical overload and microdamage sustain sterile inflammation and neuroimmune sensitization. These processes amplify nociception, impair loading tolerance, and limit the efficacy of rehabilitation, underscoring the need for mechanism-based strategies that interrupt the transition from acute injury to chronic musculoskeletal disease.</p><p><strong>Methods: </strong>This etiological review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. A comprehensive search of PubMed/MEDLINE and Google Scholar (1990-2026) identified mechanistic, translational, and therapeutic research reports that examined damage-associated molecular pattern (DAMP) signaling, innate immune activation, stromal cell responses, nociceptor sensitization, and interventions targeting these pathways. Eligible studies addressed DAMP-related mechanisms in musculoskeletal tissues or evaluated therapies that modulate the underlying inflammatory and mechanobiological drivers of chronic MSKI. Information was synthesized thematically to construct an integrated model of how DAMPs contribute to chronicity.</p><p><strong>Results: </strong>Across tendon, cartilage, ligament, muscle, and fibrocartilage, mechanical overload and microdamage trigger the release of DAMPs that activate Toll-like receptors (TLRs), receptor for advanced glycation end-products (RAGE), and inflammasome pathways, thereby sustaining cytokine production, stromal cell activation, and nociceptor sensitization. Persistent DAMP signaling is strongly associated with impaired inflammation resolution, failed tissue healing, and progression to chronic tendinopathy, osteoarthritis, and mechanical low back pain. Emerging therapeutic approaches, including targeted loading, regenerative injections, metabolic modulation, and immune-modifying strategies, demonstrate potential to attenuate DAMP activity, promote resolution, and restore tissue homeostasis.</p><p><strong>Conclusions: </strong>Sterile inflammation driven by DAMPs provides a unifying mechanistic framework explaining why many musculoskeletal injuries fail to resolve and instead evolve into chronic, refractory conditions. Therapies that modulate DAMP signaling, enhance inflammatory resolution, and normalize mechanobiological loading represent promising avenues for preventing or reversing chronic MSKI pathology. A mechanistically informed approach may improve clinical outcomes by addressing the etiological drivers rather than the downstream symptoms of chronic musculoskeletal disease.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796466","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":"Suzetrigine as Part of Multimodal Therapy Enables Opioid-Free Recovery after Laparoscopic or Arthroscopic Procedures.","authors":"Ashraf S Habib, Daneshvari Solanki, Jeremy Hoff, Dominick D'Aunno, George Konis, Jeffrey Moore, William Bortcosh, Lanju Zhang, Jaideep Mehta, Darin J Correll, Richard Scranton, Scott G Weiner","doi":"10.1007/s40122-026-00865-4","DOIUrl":"https://doi.org/10.1007/s40122-026-00865-4","url":null,"abstract":"<p><strong>Introduction: </strong>Suzetrigine, a non-opioid voltage-gated sodium channel 1.8 (Na_V1.8) pain signal inhibitor with no addiction potential, is approved in the USA for moderate-to-severe acute pain.</p><p><strong>Methods: </strong>In this phase 4, single-arm study, suzetrigine (100 mg preoperatively, then 50 mg every 12 h) was administered as part of multimodal therapy (MMT) for ≤ 14 days. Participants (N = 47) underwent arthroscopic or laparoscopic procedures wherein opioids are commonly used ≥ 72 h postoperatively for pain management. Pre- and postoperative MMT was prespecified as suzetrigine, acetaminophen, and ibuprofen. Oxycodone or hydromorphone were permitted as opioid rescue. The primary endpoint was the proportion of participants reporting good/very good/excellent on a patient global assessment (PGA) for pain control after treatment. Opioid rescue and safety were also assessed.</p><p><strong>Results: </strong>Participants had various surgeries, the most common being arthroscopic knee procedures (38.3%) or rotator cuff repair (17.0%), and laparoscopic hernia repair with mesh (29.8%). Most participants (90.9%) rated suzetrigine as part of MMT as good/very good/excellent on a PGA for pain control at end of treatment; results were consistent across surgeries. A majority of participants (76.1%) did not require opioid rescue; those who did received 2.2 tablets (mean) after surgery (mean: 1.7 days). Suzetrigine was generally safe and well tolerated. One participant had a serious adverse event (aspiration) considered unrelated to suzetrigine. Adverse events were consistent with postoperative settings.</p><p><strong>Conclusions: </strong>Suzetrigine demonstrated effective pain management and enabled opioid-free recovery for most participants when initiated preoperatively and as part of MMT in arthroscopic or laparoscopic procedures wherein opioids are commonly used postoperatively for pain management. In studies of similar surgeries, < 50% did not require opioids. Graphical abstract available for this article.</p><p><strong>Trial registration: </strong>NCT06887959.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697625","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 Neuromodulation Therapy for Neuropathy Symptom Reduction and Functional Improvement.","authors":"Stephen M Erle, Madelyn J Reilly, Andrew Lang, Alaa Abd-Elsayed","doi":"10.1007/s40122-026-00875-2","DOIUrl":"https://doi.org/10.1007/s40122-026-00875-2","url":null,"abstract":"<p><strong>Introduction: </strong>Targeted neuromodulation therapies are increasingly used for the management of peripheral neuropathy; however, data on symptom and functional outcomes following standardized treatment courses remain limited. This report evaluates the efficacy of NeuroGen Neuromodulation treatments administered at the National Neuropathy Center, focusing on changes in sensory symptoms and functional task performance from the first treatment (T1) to the twelfth treatment (T12) over a mean treatment duration of 36 sessions.</p><p><strong>Methods: </strong>Patients completing a standardized 12-treatment course using the NeuroGen Neuromodulation device were analyzed. Outcomes included patient-reported sensory symptoms (tingling, numbness, and pain) and measures of functional task performance. Changes from baseline (T1) to posttreatment (T12) were assessed to determine treatment effectiveness, response patterns, and areas for clinical optimization.</p><p><strong>Results: </strong>Patients demonstrated clear and measurable benefits following completion of 12 treatments. The greatest improvements were observed in sensory symptoms, with tingling, numbness, and pain each improving by approximately one point on the severity scale. More than half of patients achieved clinically meaningful relief in these sensory domains. Functional improvement was more modest, with meaningful gains observed in approximately one-quarter to one-third of patients. Nonresponse rates were low, although residual symptoms and functional limitations remained common.</p><p><strong>Conclusions: </strong>The standard NeuroGen Neuromodulation treatment protocol provides substantial relief of sensory neuropathic symptoms, with consistent benefits across patients. While functional gains were less pronounced, the low nonresponse rate supports overall treatment effectiveness. Persistent symptoms in some patients suggest a potential role for maintenance therapy and adjunctive interventions to optimize long-term outcomes.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679544","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":"Microfragmented Adipose Tissue in Pain Management: Bridging Regenerative Biology and Clinical Therapeutics.","authors":"Y Van Tran, Phong Van Pham, Miguel Narvaez Encinas, Piercarlo Sarzi Puttini, Dariusz Myrcik, Pierfrancesco Dauri, Giacomo Farì, Christopher G Gharibo, Matteo Luigi Giuseppe Leoni, Marco Mercieri, Giustino Varrassi","doi":"10.1007/s40122-026-00877-0","DOIUrl":"https://doi.org/10.1007/s40122-026-00877-0","url":null,"abstract":"<p><p>Regenerative medicine has emerged as a transformative paradigm in contemporary healthcare, shifting the therapeutic focus from symptomatic management toward the restoration of tissue structure and function through biologically active interventions. Within this framework, adipose-derived products have attracted substantial interest owing to their relative abundance, ease of harvesting, and rich cellular and paracrine composition, including mesenchymal stromal cells, pericytes, and bioactive mediators with immunomodulatory potential. Among these technologies, microfragmented adipose tissue (MFAT) constitutes an innovative, minimally manipulated approach because it preserves the native stromal vascular niche and extracellular matrix architecture while avoiding enzymatic processing. This characteristic not only maintains biological integrity but also facilitates regulatory compliance in multiple jurisdictions. This narrative review provides a comprehensive synthesis of the current evidence on microfragmented adipose tissue in pain management, integrating biological rationale, mechanistic insights, and clinical applications across musculoskeletal disorders and chronic pain conditions. Particular attention is devoted to its capacity to modulate inflammatory pathways, promote angiogenesis, and support tissue regeneration within complex pathological environments. In addition, the review critically appraises the methodological limitations of existing clinical studies, including heterogeneity of design and limited high-quality randomized evidence. Finally, future perspectives are explored, emphasizing the integration of precision medicine approaches, biomarker-driven patient stratification, and combinatorial regenerative strategies to optimize therapeutic outcomes.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664300","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":"Liposomal Bupivacaine Incisional Infiltration for Postoperative Analgesia After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Randomized Placebo-Controlled Trial.","authors":"Haijing Zhang, Zhexuan Gong, Yan Li, Bing Li, Yang Yu, Gang Liu, Zhonghe Ji, Huan Zhang, Siyi Yan","doi":"10.1007/s40122-026-00876-1","DOIUrl":"https://doi.org/10.1007/s40122-026-00876-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Moderate-to-severe postoperative pain is common after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Evidence that liposomal bupivacaine provides clinically important advantages over conventional local anesthetics is inconsistent, and evidence in CRS + HIPEC remains limited. This trial evaluated the incremental efficacy and safety of liposomal bupivacaine incisional infiltration added to patient-controlled intravenous analgesia (PCIA) compared with saline infiltration plus PCIA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this single-center, randomized, participant- and assessor-blinded, placebo-controlled trial, adults aged 18-65 years scheduled for elective CRS + HIPEC were assigned 1:1 to standardized PCIA plus liposomal bupivacaine incisional infiltration (PCIA-LB) or PCIA plus normal saline infiltration (PCIA-NS). The primary endpoint was the incidence of moderate-to-severe movement-evoked incisional pain (numeric rating scale &gt;  = 4) within 72 h. The prespecified primary efficacy analysis used the per-protocol set (PPS), with a conservative intention-to-treat (ITT) sensitivity analysis. PCIA followed an institutional standard operating procedure. Monitoring was continuous in the intensive care unit (ICU); after transfer to the ward, pulse oximetry was continued through postoperative day 3, with intermittent electrocardiography and noninvasive blood pressure monitoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The PPS included 94 patients (PCIA-NS, n = 48; PCIA-LB, n = 46). Moderate-to-severe movement-evoked pain within 72 h was less frequent with PCIA-LB than with PCIA-NS (19.6% versus 70.8%, P &lt; 0.001). The conservative ITT sensitivity analysis supported the same conclusion (26.0% versus 68.0%, P &lt; 0.001). PCIA-LB also produced a modest reduction in cumulative 72-h study-recorded oral morphine milligram equivalents (556.8 [473.4, 600.0] versus 600.0 [557.4, 630.0] mg, P = 0.002) and reduced rescue analgesia (30.4% versus 54.2%, P = 0.020). QoR-15 scores did not differ significantly. Overall analgesia-related adverse events occurred in 23.9% and 10.4% of the PCIA-LB and PCIA-NS groups, respectively (P = 0.143). No participant required naloxone, emergency airway intervention, or ventilatory support for a clinically recognized opioid-related respiratory event, and no local anesthetic systemic toxicity, incisional infection, or fat liquefaction was observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Compared with saline infiltration, liposomal bupivacaine incisional infiltration reduced early movement-evoked incisional pain and rescue analgesia and produced a statistically significant but quantitatively modest reduction in 72-h opioid consumption captured by the study records after CRS + HIPEC. It did not improve QoR-15. These findings do not establish superiority over plain bupivacaine, ropivacaine, or catheter-based regional techniques, and the study was not powered to establish safety.&lt;/p&gt;&lt;p&gt;&lt;s","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654047","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}