Pain and Therapy最新文献

{"title":"Effect of Esketamine Combined with Lidocaine on Opioid Requirements in the Elderly Undergoing Laparoscopic Colorectal Cancer Surgery: A Randomized, Double-Blind, Controlled Trial.","authors":"Jin-Xi Xie, Xue Wang, Yang Li, Ye Zhang, Tao Liu, Ming-Ming Liu, Jun-Li Liu, Li-Wen Zhou","doi":"10.1007/s40122-025-00809-4","DOIUrl":"10.1007/s40122-025-00809-4","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative pain after surgery for colorectal cancer (CRC) is prone to multiple complications, and opioids are accompanied by significant side effects. There is still unclear evidence regarding the combination of esketamine and lidocaine. This trial was designed to get into the bottom of the synergistic effect of esketamine and lidocaine on reducing opioid requirements in the elderly undergoing CRC surgery.</p><p><strong>Methods: </strong>This study enrolled 151 patients to establish the control group (group C, n = 50), the esketamine group (group S, n = 50), and the esketamine + lidocaine group (group SL, n = 51). The primary endpoint was the total sufentanil consumption within 24 h post-surgery.</p><p><strong>Results: </strong>During the first 24 h postoperatively, compared with group C {103.22 μg (103.22 morphine milligram equivalents [MME]), 98.30-108.25 μg}, both group S (100.29 μg [100.29 MME], 99.60-104.43 μg) and group SL (95.13 μg [95.13 MME], 95.20-100.40 μg) had reduced dosage of sufentanil (mean, interquartile range [IQR]) (P < 0.001); while at the remaining time points, groups S/SL were also lower than group C (P < 0.05). The numeric rating scale (NRS) pain scores in the two postoperative days were lower in groups S/SL than in group C, even lower in group SL than group S (P < 0.001). The intraoperative heart rate and mean blood pressure were more likely to be elevated in group S than in group C, while it was lower in group SL than in group S (P < 0.05). Group SL had an accelerated recovery of gastrointestinal function and higher subjective postoperative recovery quality scores on the third and seventh postoperative days than group C (P < 0.05), as well as lower rate of postoperative nausea and vomiting (P = 0.022).</p><p><strong>Conclusions: </strong>Esketamine combined with lidocaine may reduce opioid consumption, improve postoperative analgesia, and better maintain hemodynamic stability during CRC surgery in elderly patients.</p><p><strong>Trial registration information: </strong>Chinese Clinical Trial Registry (registration no. ChiCTR2300078997; registration date: 22 December 2023).</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"391-416"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810722","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":"Real-World Data on the Efficacy of OnabotulinumtoxinA Injections as Prophylactic Treatment for Migraine: A Retrospective Study from Jeddah, Saudi Arabia (2016-2024).","authors":"Ahmed Attar, Yasser Aladdin, Alqassem Hakami, Abdalmajed Alqsair, Sulaiman Baeisa, Ahmed Alzahrani, Ahmed Alsimsimi, Sarah Alzebaidi","doi":"10.1007/s40122-025-00805-8","DOIUrl":"10.1007/s40122-025-00805-8","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trials have established onabotulinumtoxinA as an effective prophylactic treatment for chronic migraine. However, real-world evidence in the Saudi population remains limited. This study aimed to evaluate the clinical effectiveness of onabotulinumtoxinA injections in patients with chronic migraine treated at a tertiary care center in Jeddah, Saudi Arabia between 2016 and 2024.</p><p><strong>Methods: </strong>A retrospective analysis was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Migraine Disability Assessment Test (MIDAS) was used. Data on patients' demographics, number of onabotulinumtoxinA doses (155 U for each dose), pain level, days of headache in the 3 months following the last injection, and side effects experienced after each injection session were gathered.</p><p><strong>Results: </strong>Among 133 patients studied, 85% were female, 56.4% were aged ≤ 40 years, and 66.9% had ≤ 14 headache days in the 3 months following the last injection. The median MIDAS score decreased from 28 (severe disability) to 8 (mild disability). Median headache days were reduced from 60 to 10 days. Patients with MIDAS Grade I had a significant higher number of onabotulinumtoxinA doses. A significant negative correlation was found between number of onabotulinumtoxinA doses and the MIDAS grade, pain level, and days of headache in the 3 months post injection. Side effects were experienced by 13.5% of patients, with ptosis being the most common.</p><p><strong>Conclusion: </strong>OnabotulinumtoxinA resulted in meaningful reductions in migraine-related disability, headache frequency, and pain intensity in patients with chronic migraine treated in a tertiary care center. These findings reinforce its role as an effective long-term preventive therapy and highlight the importance of maintaining consistent treatment cycles to sustain clinical benefit.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"367-377"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145763464","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 Diagnosis and Management of Pudendal Neuralgia.","authors":"Mohammed Ahmed, Periklis Zavridis, Despina Hadjiconstanti, Panagiotis Zis","doi":"10.1007/s40122-025-00803-w","DOIUrl":"10.1007/s40122-025-00803-w","url":null,"abstract":"<p><strong>Introduction: </strong>Pudendal neuralgia (PN) is a chronic neuropathic pain syndrome affecting the pudendal nerve, often presenting with perineal or pelvic pain exacerbated by sitting. The aim of this systematic review was to summarize the existing knowledge on the diagnosis and management of PN.</p><p><strong>Methods: </strong>A PubMed database search identified 475 articles, of which 35 met the inclusion criteria. Nine studies focused on diagnostic strategies, and 26 on management.</p><p><strong>Results: </strong>Diagnosis of PN is largely clinical, with the Nantes criteria providing a widely adopted framework. Imaging modalities such as MRI and MR neurography, along with neurophysiological tests including quantitative sensory testing, have been explored as adjuncts, though their roles remain limited. Pudendal nerve blocks are both diagnostic and therapeutic, with response rates up to 94%. Management follows a stepwise approach, beginning with conservative therapies and progressing to nerve blocks, and extending to neuromodulation or surgery when necessary. Pulsed radiofrequency and nerve stimulation techniques demonstrate promising results, with reported pain reduction in up to 95% of refractory cases, though long-term durability remains uncertain. Surgical decompression remains the most common operative option, with several techniques described.</p><p><strong>Conclusions: </strong>Despite the established recognition of PN, there is a paucity of high-quality comparative studies and randomized controlled trials assessing diagnostic accuracy and treatment efficacy. Current evidence suggests conservative measures and nerve blocks are sufficient for most patients, with stimulation techniques and decompression surgery reserved for refractory cases. Emerging modalities may offer future therapeutic options, but require validation in larger cohorts.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"97-129"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743665","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":"Prevalence and Patterns of Off-Label Transmucosal Immediate-Release Fentanyl Use in French General Practice: A Mixed-Methods Study Based on a Voluntary Online Survey.","authors":"Virginie Guastella, Emeline Gueganno, Célian Bertin, David Balayssac, Bruno Pereira, Nicolas Authier","doi":"10.1007/s40122-025-00801-y","DOIUrl":"10.1007/s40122-025-00801-y","url":null,"abstract":"<p><strong>Introduction: </strong>Prescriptions of transmucosal immediate-release fentanyl (TIRF) have increased in recent years, driven by their rapid onset and ease of administration compared to other opioids like morphine and oxycodone, especially for breakthrough pain. A 2022 study reported high rates of off-label TIRF use, particularly among general practitioners (GPs). This study aimed to assess the prevalence and patterns of off-label TIRF use by GPs, and perceived efficacy for predictable pain associated with medical procedures. Secondary objectives included evaluating its use in other specific contexts such as swallowing or alertness disorders, acute pain, and overall tolerability.</p><p><strong>Methods: </strong>A mixed-methods study was designed to combine qualitative interviews exploring clinical contexts with a quantitative cross-sectional survey assessing the prevalence of off-label use of TIRF among French GPs. Data were collected through a national online survey.</p><p><strong>Results: </strong>A total of 682 completed questionnaires were analyzed. The study focused exclusively on off-label prescribing of TIRFs. Off-label use was reported by 46% of GPs across a variety of clinical indications. Specifically, 244 GPs (36%; 95% CI 32-40) reported prescribing TIRFs for procedural pain. Other off-label indications were also reported, including use for alertness disorders (24%; 95% CI 21-27), swallowing disorders (32%; 95% CI 28-35), and acute rheumatological pain (12%; 95% CI 9-14). These findings highlight a substantial level of off-label prescribing, with varying perceptions of efficacy and tolerability across different clinical contexts.</p><p><strong>Conclusions: </strong>This study confirms widespread off-label TIRF use in well-defined clinical situations. While many GPs report positive outcomes, important concerns remain, including limited training, difficulty with dose titration, and the risk of use disorder. Targeted education and clearer prescribing guidelines could help ensure a safer and more appropriate use of TIRF in GPs practice.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"311-324"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725156","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":"Association Between Smoking and Opioid Requirement and Pain Intensity in the Early Postoperative Period: A Meta-Analysis.","authors":"Istvan S Szilagyi, Torsten Ullrich, Christoph Klivinyi, Kordula Lang-Illievich, Connor T A Brenna, Brigitte Messerer, Helmar Bornemann-Cimenti","doi":"10.1007/s40122-025-00804-9","DOIUrl":"10.1007/s40122-025-00804-9","url":null,"abstract":"<p><strong>Introduction: </strong>Effective postoperative pain management is crucial for patient recovery and satisfaction. Smoking may impact pain perception and analgesic requirements, but its effects on postoperative opioid needs remain unclear. The objective of this study was to determine whether patients who smoke have different postoperative opioid requirements compared to nonsmokers in the first 24 and 48 h after surgery.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of studies comparing postoperative opioid use between smokers and nonsmokers. A comprehensive literature search was performed in Web of Science and PubMed databases. Opioid doses were converted to morphine equivalents for comparison. Random effects meta-analysis was used to calculate pooled effect sizes.</p><p><strong>Results: </strong>Eight studies (784 patients) were included for the primary 24-h outcome and seven studies (1164 patients) for the 48-h outcome. Meta-analysis showed significantly higher opioid requirements in smokers compared to nonsmokers at both 24 h (standardized mean difference [SMD] 0.90, 95% CI 0.74-1.06, p < 0.00001) and 48 h postoperatively (SMD 0.61, 95% CI 0.48-0.74, p < 0.00001). On average, smokers required 33.7% more opioids than nonsmokers. Smokers also reported significantly higher pain scores 24 h after surgery (SMD 0.59, 95% CI 0.26-0.92, p < 0.001).</p><p><strong>Conclusions: </strong>Despite low-quality evidence due to non-randomized study designs, this meta-analysis demonstrates that patients who smoke have significantly higher postoperative opioid requirements and pain scores than nonsmokers. These findings highlight the need to consider smoking status when developing postoperative pain management strategies. Further research is needed to elucidate the mechanisms underlying this relationship and optimize pain control in smokers.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"341-365"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743668","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 Sacral Erector Spinae Plane Block: A Narrative Review.","authors":"Burhan Dost, Madan Narayanan, Francesco Marrone, Alessandro De Cassai, Serkan Tulgar, Can Aksu, Peter Merjavy, Ki Jinn Chin","doi":"10.1007/s40122-025-00807-6","DOIUrl":"10.1007/s40122-025-00807-6","url":null,"abstract":"<p><strong>Introduction: </strong>The sacral erector spinae plane (S-ESP) block is a recently described regional anesthesia technique that targets sacral dermatomes. First reported in 2019, it has been increasingly explored as a potential option for perioperative analgesia in surgeries involving the sacral, perineal, and pelvic regions. This review aims to summarize and critically appraise the current anatomical, technical, and clinical evidence on the S-ESP block, outlining its mechanisms of action, approaches, efficacy, and safety while identifying research gaps and future directions.</p><p><strong>Methods: </strong>We performed a narrative review integrating anatomical descriptions, sonographic techniques, and available randomized controlled trials (RCTs) evaluating the clinical efficacy of the S-ESP block. A comprehensive literature search was conducted in PubMed, Embase, Scopus, Web of Science, and Ovid (Medline) from inception to July 21, 2025, without language or date restrictions. Full-text RCTs investigating ultrasound-guided S-ESP blocks for perioperative analgesia were reviewed and summarized.</p><p><strong>Results: </strong>Fourteen RCTs (published 2023-2025) were included, conducted predominantly in Turkey, India, and Egypt, spanning pediatric (6 months to 12 years) and adult populations undergoing circumcision, hypospadias repair, hemorrhoidectomy, pilonidal sinus surgery, transurethral resection of prostate, lumbar discectomy, and total hip arthroplasty. Most pediatric trials compared midline S-ESP with caudal or penile blocks, generally demonstrating a longer time to first rescue analgesia and reduced postoperative analgesic consumption, although one study reported a superior duration with caudal block. In adults, the S-ESP block consistently reduced pain scores and opioid requirements.</p><p><strong>Conclusions: </strong>Current evidence suggests that both midline and paramedian S-ESP techniques are technically feasible, appear safe in the short term, and provide clinically relevant postoperative analgesia in selected pediatric urogenital, adult anorectal, and orthopedic surgeries. However, heterogeneity in techniques, small single-center samples, and a narrow range of indications limit its generalizability. Large, multicenter RCTs with standardized protocols are needed to clarify the optimal approaches, dosing strategies, and comparative role of S-ESP block versus established neuraxial and peripheral techniques.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"131-147"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810750","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":"Shared Mechanisms and Integrated Management of Post-Stroke Pain and Depression: A Comprehensive Review.","authors":"Yujia Jin, Fan Wu, Meng Jin, Lili Tang, Yuxiao Chen, Zhiming Xu, Wei Wang, Jian Wu","doi":"10.1007/s40122-025-00795-7","DOIUrl":"10.1007/s40122-025-00795-7","url":null,"abstract":"<p><p>Post-stroke pain (PSP) and post-stroke depression (PSD) represent two major neuropsychiatric complications that frequently co-occur, with comorbidity rates ranging from 34 to 65.6%. Despite their high prevalence and profound impact on functional recovery and quality of life, the shared mechanisms and optimal management of this complex comorbidity remain poorly understood. We conducted a systematic review of clinical and preclinical evidence to explore the epidemiological characteristics, diagnostic challenges, neurobiological underpinnings, and therapeutic strategies for comorbid PSP and PSD. Special emphasis was placed on neuroinflammatory cascades, glial cell dysfunction, monoaminergic system dysregulation, and maladaptive neural circuit remodeling. We found PSP and PSD exhibit overlapping pathophysiological mechanisms, including microglial activation, astrocytic reactivity, pro-inflammatory cytokine release (e.g., TNF-α, IL-1β, IL-6), and dysregulation of cortico-limbic circuits involving the anterior cingulate cortex, amygdala, and ventral tegmental area. Pharmacotherapies such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and NMDA receptor antagonists (e.g., ketamine), as well as neuromodulation approaches (e.g., repetitive transcranial magnetic stimulation [rTMS], transcranial direct current stimulation [tDCS]), demonstrate efficacy in both conditions, likely through anti-inflammatory and neural circuit-modulating effects. We speculate that the comorbidity of PSP and PSD is underpinned by convergent neuroimmune and neural circuit mechanisms. Targeting these shared pathways-such as with cytokine inhibitors, glial modulators, and circuit-specific neuromodulation-holds promise for developing integrated, mechanism-based therapies. Future research should prioritize multimodal treatment strategies tailored to the neurobiological signatures of this debilitating post-stroke syndrome. Infographic available for this article.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"19-39"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541795","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":"Patient-Reported Outcomes During the Acute Treatment of Migraine with Zavegepant Nasal Spray: Results from a 52-Week, Open-Label Study.","authors":"Richard B Lipton, Linda Mosher, Robert J Fountaine","doi":"10.1007/s40122-025-00800-z","DOIUrl":"10.1007/s40122-025-00800-z","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess changes in patient-reported outcomes during open-label acute treatment of migraine with zavegepant for up to 52 weeks.</p><p><strong>Methods: </strong>Data were from a phase 2/3, open-label, long-term safety study of zavegepant for the acute treatment of migraine. Participants with migraine treated migraine attacks of any intensity as needed with one dose of zavegepant 10 mg nasal spray, up to once per day and up to eight times per 28 days, for up to 52 weeks. Pre-specified exploratory endpoints included change in number of migraine days/month, change in Migraine Disability Assessment (MIDAS) Scale, change in Migraine-Specific Quality of Life version 2.1 (MSQ v2.1), and Satisfaction with Medication.</p><p><strong>Results: </strong>A total of 603 treated participants were analyzed. Zavegepant treatment was associated with mean reductions of 1.7 migraine days/month of any pain intensity and 1.1 migraine days/month of moderate or severe pain intensity. Zavegepant treatment was associated with improvement in mean MIDAS total score of - 8.2 (95% CI - 9.89, - 6.55) at week 12 and - 8.8 (95% CI - 11.13, - 6.50) at week 52. At week 12 and week 52, respectively, zavegepant treatment was associated with improvements in mean MSQ Role Function Restrictive domain score of 8.6 (95% CI 7.09, 10.16) and 13.8 (95% CI 11.76, 15.85), improvement in Role Function Preventive domain score of 6.7 (95% CI 5.25, 8.11) and 10.1 (95% CI 8.08, 12.13), and improvement in Emotional Function domain score of 6.8 (95% CI 4.87, 8.72) and 11.3 (95% CI 8.99, 13.70). At week 52, 44.2% (125/283) of participants were completely or very satisfied with zavegepant and 28.6% (81/283) were somewhat satisfied; 124 participants did not complete the Satisfaction with Medication scale at week 52.</p><p><strong>Conclusion: </strong>Through the 52-week study, acute treatment with zavegepant was associated with reduction in mean number of migraine days/month, improvements in migraine-related disability and migraine-specific quality of life, and high levels of patient satisfaction.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT04408794.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"325-340"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725035","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":"Machine Learning-Based Prediction for Axial Pain Following Expansive Unilateral Open-Door Laminoplasty: A Retrospective Cohort Study.","authors":"Kelun Huang, Sheng Li, Yile Dai, Dingjun Xu, Guoliang Chen, Yaozhi He, Ziwei Fan, Honglin Teng","doi":"10.1007/s40122-025-00802-x","DOIUrl":"10.1007/s40122-025-00802-x","url":null,"abstract":"<p><strong>Introduction: </strong>Axial pain is a common complication following expansive unilateral open-door laminoplasty (ELAP); however, traditional statistical methods are unable to effectively predict this complication. This study developed machine learning (ML) models to predict post-ELAP axial pain and identify key predictors.</p><p><strong>Methods: </strong>This retrospective study enrolled 851 cervical spondylotic myelopathy (CSM) patients undergoing ELAP, split into training (n = 714) and temporal validation sets (n = 137). Demographic, imaging, clinical, and surgical data were collected. Predictive features were selected by the least absolute shrinkage and selection operator (Lasso) regression, followed by ML model development with grid search optimizing hyperparameters. The top-performing model underwent temporal validation, and SHapley Additive exPlanations (SHAP) analyzed predictor contributions.</p><p><strong>Results: </strong>The training set included 218 axial pain cases; the test set had 47. Key predictors (C7 laminoplasty, cervical kyphosis, etc.) were identified to develop ML model. Post-optimization, extreme gradient boosting (XGBoost) achieved superior performance (internal validation area under the receiver [AUC] = 0.948; 95% confidence interval [CI] 0.918-0.978), maintained in temporal validation (AUC = 0.906; 95% CI 0.858-0.954). Through SHAP analysis, the predictors were ranked in descending order of importance as follows: C7 laminoplasty, quantity-based surgical segment classification, cervical kyphosis, angle of lamina open-door, cervical lordosis, and occupying rate of cervical spinal canal.</p><p><strong>Conclusions: </strong>ML models coupled with SHAP analysis effectively predict post-ELAP axial pain, identifying the key predictors. Performing segment-selective ELAP, avoiding unnecessary C7 laminoplasty, and maintaining optimal open-door angle are critical factors in avoiding the occurrence of axial pain following ELAP.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"291-309"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715328","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":"Radiofrequency Ablation of Pericranial Nerves for Treating Headaches: 10-Year Follow-Up.","authors":"Alaa Abd-Elsayed, Madelyn J Reilly, Nina Hashimoto, Mohan Xu, Barnabas T Shiferaw, Lukas J Henjum","doi":"10.1007/s40122-025-00792-w","DOIUrl":"10.1007/s40122-025-00792-w","url":null,"abstract":"<p><strong>Introduction: </strong>Headaches are among the most prevalent and disabling sources of pain, affecting nearly half of adults worldwide. Many patients experience debilitating headaches refractory to conservative treatments, including pharmacotherapy, steroid injections, or other interventional therapies. Radiofrequency ablation (RFA) is a minimally invasive technique that uses controlled thermal energy to create targeted tissue necrosis, disrupting the nociceptive signaling within targeted sensory nerves, and is a promising therapy for patients with chronic headaches refractory to conservative treatments. The objective of this study is to evaluate the clinical efficacy of thermal RFA for chronic headache management by examining changes in pain scores and the duration and degree of symptom relief.</p><p><strong>Methods: </strong>This retrospective chart review of this study investigates patients who received thermal RFA of the occipital, supraorbital, supratrochlear, infraorbital, infratrochlear, and/or anterior ethmoid nerves between 2015 and 2025. Preoperative and postoperative pain scores were assessed using the Visual Analogue Scale (VAS). Additionally, the duration of relief and any adverse events associated with the procedures were recorded. Paired t-tests were performed between preoperative and postoperative VAS pain scores to determine statistical significance, with a p-value of ≤ 0.05 denoting significance.</p><p><strong>Results: </strong>In total, 940 procedures were reviewed; 108 were excluded, and 832 procedures from 464 patients were included. The 464 patients comprised 369 female and 95 male patients, with a mean age of 44.83 ± 15.99 years and body mass index (BMI) of 29.65 ± 7.44 kg/m². Average preoperative and postoperative VAS scores were 5.34 ± 2.01 and 3.04 ± 2.33, respectively, representing a statistically significant reduction (p < 0.001). Quantitative or qualitative improvement was reported in 68.63% of procedures, and 13.10% noted complete remission for a total of 81.73% experiencing pain relief, whereas 18.27% saw no change. Among effective cases, the mean improvement was 60.20 ± 28.54%, lasting an average of 7.47 ± 9.78 months. A total of 12 adverse events were reported.</p><p><strong>Conclusions: </strong>These findings suggest that thermal RFA of pericranial nerves can offer meaningful, lasting relief for patients with neuralgic headaches that resist traditional treatments. As a minimally invasive option with limited side effects, RFA may reduce the need for ongoing pharmacologic management and improve the quality of life for chronic headache sufferers.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"161-173"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422393","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}