Pain and Therapy最新文献

{"title":"Pudendal Neuralgia in a Tertiary Pain Clinic: Presentation, Treatment, and Factors Associated with Neuromodulation in 224 Adults.","authors":"Paz Kelmer, Shachar Zion Shemesh, Philip Rossovsky, Yotam Hadari, Itay Goor-Aryeh, Lior Ungar","doi":"10.1007/s40122-026-00902-2","DOIUrl":"https://doi.org/10.1007/s40122-026-00902-2","url":null,"abstract":"<p><strong>Introduction: </strong>Pudendal neuralgia is an under-recognized cause of chronic, disabling neuropathic perineal pain affecting both women and men. Real-world data on its presentation, its treatment within a specialty pain service, and the factors that accompany escalation to interventional therapy are scarce. We hypothesized that an iatrogenic (postsurgical) origin and relief after a diagnostic pudendal nerve block would identify the patients who reach neuromodulation.</p><p><strong>Methods: </strong>We performed a retrospective manual review of the complete electronic records of all adults with documented pudendal neuralgia, pudendal neuropathy, or pudendal nerve entrapment managed at a single tertiary pain clinic between 2009 and 2026. Demographics, clinical presentation, presumed etiology, treatments, and outcomes were abstracted from the free-text record. Ascertainment was in two stages: variables were first identified by structured text screening of the free-text record, and the two variables most susceptible to false-positive screening, a postsurgical etiology and receipt of neuromodulation, were then verified against the source charts by manual review of every screen-positive record. The chart-verified definitions are used throughout. Associations between binary variables were tested by the chi-squared test, with odds ratios (OR) and 95% confidence intervals (CI); factors associated with neuromodulation were assessed by multivariable logistic regression.</p><p><strong>Results: </strong>Among 224 patients (138 women [61.6%], 86 men [38.4%]; median age 48.5 years, interquartile range 35-64), pain was worse when sitting in 57.6% and burning in 39.3%, and involvement was bilateral in 21.9%. Text screening identified a possible postsurgical onset in 46.4%, but chart re-adjudication confirmed a named operation preceding the pain in only 31 patients (13.8%), of whom 6 had undergone a clearly non-pelvic procedure; confirmed postsurgical onset was therefore less frequent than documented entrapment features (24.1%) and comparable to childbirth (15.9% of women). Care was heavily interventional: 59.4% received a pudendal nerve block, 28.6% pulsed radiofrequency, and 9.4% underwent surgical decompression. Neuromodulation was documented in the record of 64 patients (28.6%), but an electrode was placed in only 26 (11.6%) and a permanent device implanted in 18 (8.0%): spinal cord stimulation in 14, sacral neuromodulation in 2, dorsal root ganglion stimulation in 1, and pudendal nerve stimulation in 1. Three factors were independently associated with documented neuromodulation: relief after a diagnostic block (adjusted OR 4.88, 95% CI 1.91-12.46%), a refractory course (2.92, 1.52-5.60%), and chart-confirmed postsurgical onset (2.83, 1.17-6.82%); c-statistic 0.76. In an exploratory model restricted to the 18 implanted patients, a refractory course (7.40, 1.98-27.61%) and postsurgical onset (4.24, 1.29-13.94%) remained associated with the outcom","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149371290","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":"Antipsychotic Co-prescription and Pain Trajectories in Hospitalized Internal Medicine Patients: A Retrospective Cohort Study.","authors":"Nicola Grignoli, Mauro Frigeri, Sébastien Sare, Alessandro Merler, Angela Greco, Marilù Garo, Andrea Raballo, Luca Gabutti","doi":"10.1007/s40122-026-00901-3","DOIUrl":"https://doi.org/10.1007/s40122-026-00901-3","url":null,"abstract":"<p><strong>Introduction: </strong>Pain management in hospitalized internal medicine patients is challenging due to multimorbidity, polypharmacy, and behavioral symptoms. Antipsychotics are frequently co-prescribed with analgesics in this population alongside other central nervous system-active medications, yet their relationship with acute pain trajectories remains poorly understood. This retrospective cohort study examined whether antipsychotic co-prescription was associated with pain trajectories and rehospitalization among hospitalized medical patients receiving analgesic therapy, including an opioid-treated subgroup.</p><p><strong>Methods: </strong>Internal medicine inpatients receiving in-hospital analgesic therapy were included. Pain outcomes comprised mean, maximum, and last visual analog scale (VAS) scores and peak-to-last change in VAS (ΔVAS); all-cause rehospitalization was assessed after discharge. Propensity score matching accounted for demographic and clinical factors. Additional analyses examined timing of antipsychotic exposure and co-treatment with other central nervous system-active medications.</p><p><strong>Results: </strong>Among 18,387 patients hospitalized for ≥ 48 h, 6166 with at least one VAS assessment within the first 2 days of hospitalization formed the analgesic-treated cohort, including 2388 receiving opioids. After matching, antipsychotic co-prescription was associated with lower mean and maximum VAS scores in the analgesic-treated cohort, particularly among older adults. The association was most evident among patients already receiving antipsychotics at admission, whereas findings among those initiated during hospitalization were limited. No consistent differences in pain outcomes were observed in the opioid subgroup, while associations in the broader analgesic cohort persisted across central nervous system (CNS) co-medication strata. Antipsychotic co-prescription was not associated with sustained increases in rehospitalization risk.</p><p><strong>Conclusions: </strong>Antipsychotic co-prescription was associated with lower peak pain intensity in the broader analgesic-treated cohort, particularly among older adults, but not in the opioid subgroup. This context-dependent pattern differed according to analgesic treatment and timing of antipsychotic exposure and may reflect differences in multidimensional pain processing. These findings highlight the importance of considering central nervous system-active co-medications in pain management and warrant prospective investigation.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149334811","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":"Application of Virtual Reality in Pain Management of Patients with Postherpetic Neuralgia: A Randomized Controlled Trial.","authors":"Huishi Li, Guohui Wang, Wenjie Zhang, Yan Li, Xuesen Su","doi":"10.1007/s40122-026-00896-x","DOIUrl":"https://doi.org/10.1007/s40122-026-00896-x","url":null,"abstract":"<p><strong>Introduction: </strong>Postherpetic neuralgia (PHN) is the most frequent chronic complication of herpes zoster (HZ), the incidence of PHN gradually increases with age, and the persistent pain brings a heavy burden to patients with PHN. Virtual reality (VR) is an emerging tool for relieving acute and chronic pain. However, there is currently no research on applying VR to patients with PHN. This study aimed to explore the effectiveness and safety of VR in reducing the pain levels of patients with PHN. Providing an evidence-based medical rationale for the use of VR in pain management for patients with PHN.</p><p><strong>Methods: </strong>Fifty patients with PHN were randomly divided into the experimental group and the control group, with 25 cases in each group. The control group received PHN conventional therapy. The experimental group received VR therapy plus conventional therapy, namely 10-min VR sessions twice daily for five consecutive days (T1~T5). Primary outcome measure was patients reported pain levels at the sixth day after admission (T6). We also measured anxiety, depression and self-efficacy levels, as well as inflammatory factor levels of patients in both groups. Patients reported side effects and satisfaction in the experimental group were also recorded.</p><p><strong>Results: </strong>Significant improvements were observed for pain (2.48 ± 1.23 vs 3.28 ± 1.37, P = 0.035), anxiety (31.44 ± 3.89 vs 33.72 ± 3.80, P = 0.041), depression (34.00 ± 5.91 vs 37.64 ± 5.02, P = 0.023), self-efficacy (32.68 ± 3.60 vs 29.92 ± 5.38, P = 0.038), IL-2 (3.30 ± 0.59 vs 2.67 ± 0.27, P<0.001), IL-6 (2.94 ± 1.38 vs 4.13 ± 2.43, P = 0.038), IL-10 (6.36 ± 1.03 vs 5.26 ± 1.09, P = 0.001), TNF-α (1.76 ± 0.48 vs 2.10 ± 0.59, P = 0.033), and INF-γ (3.82 ± 1.06 vs 3.00 ± 0.48, P = 0.001). No participants complained of severe side effects and patients' satisfaction with VR reached 80%.</p><p><strong>Conclusions: </strong>This study suggests that VR can be efficacious and safe for patients with PHN. This clinical trial has been registered in the Chinese Clinical Trial Registry with the registration number: ChiCTR2400085999.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196041","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":"Safety and Analgesic Effectiveness of Adding Butorphanol to Multimodal Intravenous Patient-Controlled Analgesia After Gynecologic Surgery: A Retrospective Cohort Study.","authors":"Yingchao Ye, Chengyao Feng, Yangxin Dong, Feixiang Wu, Han Gong, Youmei Wu, Fangfang Xia","doi":"10.1007/s40122-026-00897-w","DOIUrl":"https://doi.org/10.1007/s40122-026-00897-w","url":null,"abstract":"<p><strong>Introduction: </strong>Butorphanol is sometimes added to multimodal intravenous patient-controlled analgesia (PCA), but its incremental analgesic benefit and adverse symptom burden when combined with an established sufentanil-based regimen remain uncertain.</p><p><strong>Methods: </strong>This single-center retrospective cohort study used routinely collected perioperative, postoperative PCA follow-up, and hospital billing data from July 2022 to June 2025. Patients who underwent gynecologic surgery and received one of four eligible base PCA regimens were included. Movement-evoked pain on postoperative day 1 was the primary effectiveness outcome, and any dizziness was the primary safety outcome. Propensity score overlap weighting was used for the primary analysis.</p><p><strong>Results: </strong>The cohort included 1557 PCA treatment records, of which 239 contained butorphanol and 1318 did not. After overlap weighting, the adjusted mean differences were 0.01 points [95% confidence interval (CI) - 0.09 to 0.10; P = 0.935] for movement-evoked pain, 0.07 points (95% CI - 0.02 to 0.16; P = 0.139) for resting pain, and - 0.78 mL (95% CI - 3.17 to 1.60; P = 0.539) for PCA volume delivered. Dizziness occurred in 13.6% of butorphanol-containing records and 6.0% of controls [adjusted risk difference 7.7 percentage points, 95% CI 3.3-12.5; odds ratio (OR) 2.49, 95% CI 1.53-4.03; P < 0.001]. Higher odds were also observed for nausea (OR 1.76, 95% CI 1.22-2.47; P = 0.005) and co-occurring dizziness and nausea (OR 5.85, 95% CI 3.10-11.41; P < 0.001).</p><p><strong>Conclusion: </strong>In the measured overlap population, adding butorphanol did not materially improve early analgesic outcomes but was associated with more dizziness and nausea. Residual confounding precludes definitive causal conclusions.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148774","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":"Neuraxial Medication Administration Errors During Anaesthesia and Perioperative Management, Consequences, Contributing Human and Systemic Factors and Their Prevention: A Systematic Review.","authors":"Santosh Patel","doi":"10.1007/s40122-026-00889-w","DOIUrl":"https://doi.org/10.1007/s40122-026-00889-w","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review aimed to investigate neuraxial administration errors, examine their contributing factors, and evaluate clinical outcomes using a novel harm scale.</p><p><strong>Methods: </strong>The author searched PubMed, Web of Science, Scopus, EBSCOhost, and Google Scholar for reports from 1981 to 2025 in any language. Exclusions were reviews, overdose incidents, and non-neuraxial administrations. Harm was classified using a novel five-level scale, and contributing factors were identified using the Human and Systemic Factors Analysis Classification System (HFACS).</p><p><strong>Results: </strong>The search revealed 50 reports (54 patients), mainly involving the epidural route (38 vs 16 intrathecal), non-obstetric patients (35 vs 17 obstetric), and female gender (73%). Medications were grouped into nine divisions: IV fluids/total parenteral nutrition/insulin, anticholinergics, antiseptics, antiemetics, anticoagulants, non-steroidal anti-inflammatory drugs, opioids, Syntocinon, and others. Atropine (6 patients) was the most common, followed by remifentanil (4), Syntocinon (4), chlorhexidine (3), and water (3). Level 4 events (irreversible paraplegia or quadriplegia, 4 patients) and level 5 events (death, 4 patients) were mostly due to accidental antiseptic bolus administration. Inadvertent neuraxial drug administration occurred at different locations and during various stages of clinical care. The Human Factors Analysis Classification System (HFACS) identified unsafe acts related to skill-based errors and misidentification of routinely used objects. Additional deficiencies included organisational processes, resources, supervision, and task execution for neuraxial anaesthesia or analgesia.</p><p><strong>Conclusions: </strong>Level 4 and 5 harm was mainly associated with the administration of antiseptic solutions. The HFACS framework-based analysis suggested multiple modifiable institutional and individual deficiencies. Multidisciplinary improvements of organisational safety procedures, relevant preconditions, and neuraxial clinical practices may help prevent these serious incidents.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128270","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":"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":"1607-1622"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623807/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MR-107A-02 in Acute Postoperative Pain Management Following Bunionectomy: Results from a Multicenter, Placebo- and Active-Controlled, Phase 3 Trial.","authors":"Todd Bertoch, Jessica C McCoun, Ira Gottlieb, Susanne Vogt, Scott Haughie, Kathleen M Ocasio, Chris Walker, Jeffrey P Smith","doi":"10.1007/s40122-026-00870-7","DOIUrl":"10.1007/s40122-026-00870-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;MR-107A-02 is a novel, fast-absorbing oral meloxicam formulation designed to deliver effective analgesia in moderate-to-severe acute pain settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This phase 3, randomized, double-blind, placebo- and active-controlled, parallel-group study assessed the efficacy and safety of MR-107A-02 in participants following bunionectomy. Participants with a postoperative pain numerical rating scale at rest (NRS-R) score ≥ 4 and a moderate or severe qualifying categorical pain score were randomized in a 1:1:1 ratio to receive MR-107A-02 15 mg (BID), placebo, or tramadol 50 mg (q6h). The primary endpoint was the summed pain intensity difference over 48 h (SPID&lt;sub&gt;0-48&lt;/sub&gt;) for MR-107A-02 versus placebo, based on NRS-R. Tramadol was included as an active control for assay sensitivity and comparisons between MR-107A-02 and tramadol were exploratory. Key secondary endpoints included the use of opioid rescue medication, proportion of opioid-free participants and time to perceptible and meaningful pain relief.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 410 randomized participants, 397 completed the study. Baseline NRS-R scores were similar across groups. MR-107A-02 met the primary endpoint, with a significantly greater SPID&lt;sub&gt;0-48&lt;/sub&gt; than placebo (183.9 vs. 101.2; difference, 82.7; p &lt; 0.001). Assay sensitivity was confirmed with tramadol versus placebo (difference, 58.0; p &lt; 0.001). In an exploratory, post hoc analysis that was not powered for hypothesis testing in this protocol, the estimated SPID&lt;sub&gt;0-48&lt;/sub&gt; was numerically higher with MR-107A-02 in comparison to tramadol (174.3 vs. 148.1; difference, 26.2; nominal p = 0.013). MR-107A-02 reduced opioid rescue use by 59% versus placebo (p &lt; 0.001), with more participants remaining opioid-free in the MR-107A-02 group than in the placebo (56.9% vs. 33.1%; difference 23.8%; p &lt; 0.001). The median time to perceptible (0.7 h vs. 0.9 h, p = 0.037) and meaningful pain relief (2.4 h vs. 5.1 h, p = 0.012) were earlier in the MR-107A-02 than the placebo. MR-107A-02 was well-tolerated. In the MR-107A-02 group, all treatment emergent adverse events (TEAEs) were mild or moderate in severity, and no severe TEAEs, serious adverse events, or study discontinuations due to TEAEs were reported. The incidence of opioid-related adverse events in the MR-107A-02 group was 16.1%, which was lower than that observed with tramadol (46.0%), and was comparable to placebo (16.9%) during the first 48 h of treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;MR-107A-02 provided statistically significant analgesic efficacy, faster onset of action, good tolerability, and reduced opioid rescue medication compared with placebo, highlighting its opioid-sparing potential. These findings should be interpreted within the constraints of the bunionectomy model, and confirmation in broader surgical settings is warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical trial registration: &lt;/strong&gt;ClinicalTrials.go","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1483-1498"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering Neuropathic Pain in CANVAS: Lessons from a Case-Based Literature Review.","authors":"Panayiota Neophytou, Stefania Kalampokini, Constantinos Avraam, Andreas Anagiotos, Constantinos Deltas, Christiana Ioannou, Christiana Polydorou, Georgios M Hadjigeorgiou, Panagiotis Zis","doi":"10.1007/s40122-026-00867-2","DOIUrl":"10.1007/s40122-026-00867-2","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebellar ataxia with neuronopathy and vestibular areflexia syndrome (CANVAS) is a rare, late-onset neurodegenerative disorder caused by biallelic intronic AAGGG repeat expansions in the RFC1 gene. Its phenotype is heterogeneous, ranging from isolated sensory neuronopathy to the full clinical triad. Although neuronopathy is present in the majority-if not all-of the cases, the prevalence and clinical significance of neuropathic pain remain insufficiently characterized.</p><p><strong>Methods: </strong>We report a genetically confirmed case of CANVAS in a 58-year-old woman presenting predominantly with asymmetrical neuropathic pain. Clinical, neurophysiological, vestibular, and genetic assessments were performed, with longitudinal follow-up over 3 years. Additionally, a case-driven systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted in May 2026 in two databases (MEDLINE and Scopus) that identified cohorts of CANVAS cases with data on pain. Fourteen studies met our inclusion criteria. Pooled prevalence of neuropathic pain was calculated using a random-effects model.</p><p><strong>Results: </strong>The systematic review included 445 patients with CANVAS. The pooled prevalence of neuropathic pain was 43.2% (95% confidence intervals 34.0-52.9%) with moderate heterogeneity across these studies (I² = 65%). Evidence from included studies suggests that pain may occur early and represents a significant contributor to disease burden.</p><p><strong>Conclusions: </strong>Neuropathic pain is a frequent and potentially early manifestation of CANVAS, likely reflecting underlying sensory neuronopathy. CANVAS should be considered in patients with idiopathic sensory neuronopathy, even when pain is present. Early recognition and targeted genetic testing are essential to improve diagnosis and optimize patient management in this underdiagnosed condition.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1209-1219"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Esketamine Combined with Pulsed Radiofrequency on Neuropathic Pain in Herpes Zoster Patients: A Randomised Clinical Trial.","authors":"Dong Wang, Qi Gai, Yanfeng Zhang, Zhe Yan, Bingwei Hu, Zhiying Feng","doi":"10.1007/s40122-026-00868-1","DOIUrl":"10.1007/s40122-026-00868-1","url":null,"abstract":"<p><strong>Introduction: </strong>Zoster-related neuralgia (ZRN) remains challenging to treat with current analgesics and interventional therapies. Esketamine, an N-methyl-D-aspartate receptor antagonist, offers potent analgesic effects. This study evaluated the efficacy and safety of low-dose esketamine combined with pulsed radiofrequency (PRF) for ZRN.</p><p><strong>Methods: </strong>In this randomized controlled trial, 60 patients with ZRN scheduled for PRF were assigned to receive either continuous esketamine (0.02 mg/kg/h for 48 h) or saline alongside standard PRF and anticonvulsants. Pain (NRS, ID-pain), anxiety (HAMA), depression (HAMD-24), sleep quality (PSQI), and dissociative symptoms (CADSS) were assessed at baseline (T0), 48 h post-treatment (T1), 48 h post-treatment (T1), 1 week (T2), 2 weeks (T3), 1 month (T4), and 3 months (T5) post-treatment. Vital signs, CADSS scores (measuring dissociative symptoms), and other relevant clinical data were recorded at pre-medication (t0), 1 h (t1), 12 h (t2), 24 h (t3), and 48 h (t4) post-medication.</p><p><strong>Results: </strong>Sixty patients completed the study. The esketamine group showed significantly lower NRS and ID-pain scores at all post-treatment time points (P < 0.01). HAMD-24 and PSQI scores were significantly improved from 48 h through 12 weeks (P < 0.05), while HAMA scores improved significantly from 1 week onward (P < 0.05). No significant differences in CADSS scores or adverse events were observed between groups.</p><p><strong>Conclusion: </strong>Low-dose esketamine combined with PRF provides effective pain relief and improves mood and sleep quality in ZRN patients with a favorable safety profile.</p><p><strong>Trial registration: </strong>ChiCTR2400093061.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1539-1552"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral Decubitus Positioning Increases Pleura-Plexus Distance in Ultrasound-Guided Supraclavicular Brachial Plexus Targeting.","authors":"Carl P C Chen, Areerat Suputtitada","doi":"10.1007/s40122-026-00856-5","DOIUrl":"10.1007/s40122-026-00856-5","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate whether lateral decubitus positioning increases the pleura-plexus distance at the supraclavicular level and to characterize its role as a modifiable anatomical factor relevant to ultrasound-guided interventions.</p><p><strong>Methods: </strong>This prospective observational ultrasound study included 90 adults comprising individuals with complex regional pain syndrome, cervical spine stenosis, and healthy controls. Pleura-plexus distance was measured at end expiration in three standardized positions: semi-reclined supine, 45° lateral tilt, and lateral decubitus. Positional effects were assessed using mixed repeated-measures analysis of variance, and associations with demographic variables were examined using correlation and multivariable linear regression.</p><p><strong>Results: </strong>Pleura-plexus distance increased progressively across positions in all groups. Compared with the semi-reclined position (0.37-0.46 cm), lateral decubitus positioning more than doubled the distance (0.82-1.04 cm; p < 0.001), with a significant group interaction. Body mass index independently predicted pleura-plexus distance in the lateral position (+0.028 cm per kg/m², p < 0.001), whereas age was not significantly associated.</p><p><strong>Conclusions: </strong>Lateral decubitus positioning was consistently associated with increased pleura-plexus distance at the supraclavicular level across all study groups. These findings suggest that patient positioning represents a measurable and potentially modifiable anatomical factor that may influence anatomical conditions relevant to ultrasound-guided supraclavicular procedures.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1499-1512"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}