Pain and Therapy最新文献

{"title":"Efficacy of Different Acupuncture Techniques for Pain and Dysfunction in Patients with Knee Osteoarthritis: A Randomized Controlled Trial.","authors":"Jing Sun, Yi Liang, Kai-Tao Luo, Xiao-Mei Shao, Ming-Qi Tu, Xiao-Ting Wu, Fang Liu, Xin-Wei Li, Yi-Dan Chen, Qi-Fei Zhang, Cong-Hua Ji, Rong-Rong Li, Xiao-Yu Li, Fu Xu, Jian-Qiao Fang","doi":"10.1007/s40122-025-00713-x","DOIUrl":"10.1007/s40122-025-00713-x","url":null,"abstract":"<p><strong>Introduction: </strong>Various acupuncture techniques are widely applied in clinics for pain control and dysfunction relief in patients with knee osteoarthritis (KOA). The purpose of this trial was to investigate whether the different acupuncture techniques were more effective in treating joint pain and dysfunction than were sham acupuncture or drug treatment in patients with KOA and to determine the differences in efficacy among them.</p><p><strong>Methods: </strong>In this multi-center, single-blind, randomized, controlled trial, participants were randomly assigned to the manual acupuncture (MA), electroacupuncture (EA), warm-needling acupuncture (WA), mild moxibustion (MM), sham acupuncture (SA), or drug treatment (Celebrex) groups. Each participant in the above groups received individual treatments for 4 consecutive weeks. The primary outcome measures included the visual analog scale score (VAS) and the physical function score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).</p><p><strong>Results: </strong>Compared with the SA group, the acupuncture technique groups (MA, EA, WA, and MM) had markedly lower patient VAS scores (- 0.61; 95% CI - 1.09 to - 0.13; P = 0.01) and lower WOMAC physical function scores (- 13.84; 95% CI - 21.14 to - 6.54; P < 0.01). Compared with Celebrex, EA had a significant advantage in reducing the VAS score (1.14; 95% CI 0.55 to 1.72; P < 0.01) and WOMAC physical function score (14.81; 95% CI 5.69 to 23.93; P < 0.01).</p><p><strong>Conclusions: </strong>The observed acupuncture techniques effectively relieve pain and ameliorate knee joint dysfunction in patients with KOA. EA is the most effective method of alleviating pain intensity in treating KOA.</p><p><strong>Trial registration: </strong>The trial was registered on ClinicalTrials.gov (NCT03563690).</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"737-751"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441602","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":"Lasmiditan and Different Triptans in Menstrual Migraine: A Bayesian Network Meta-analysis.","authors":"Zhaoming Song, Yanao Guo, Jingyu Gu, Chen Yang, Ruisi Qu, Jian Li, Zhouqing Chen, Zhong Wang","doi":"10.1007/s40122-025-00705-x","DOIUrl":"10.1007/s40122-025-00705-x","url":null,"abstract":"<p><strong>Introduction: </strong>Menstrual migraine (MM) is a common subtype of migraine that greatly affects a woman's quality of life. A number of different drugs are used to treat menstrual migraine, but it is not known which is more effective.</p><p><strong>Methods: </strong>In this study, we searched all randomized controlled trials that satisfied the inclusion and exclusion criteria up to December 2023 on PubMed, Embase and Cochrane Library using a suitable search strategy. We constructed a suitable network model for analysis after evaluating the heterogeneity among the included direct, indirect and pooled evidence. Odds ratio (OR) and corresponding 95% confidence intervals (CI) were used as valid indicators for this network meta-analysis.</p><p><strong>Results: </strong>In the Bayesian network model we constructed, we found that lasmiditan (vs. placebo OR, 14; 95% CI 3.1-100) was better than rizatriptan (vs. placebo OR, 1.9; 95% CI 1.2-3.3) in terms of the rate of sustained freedom from pain. There was no statistically significant difference between lasmiditan and different triptans in terms of the rate of being pain-free at 2 h (2-h pain-free) and the rate of pain relief at 2 h (2-h pain relief). Regarding safety, the probability of adverse events was significantly higher for rizatriptan (OR, 2.7; 95% CI 1.1-7.3) than for placebo.</p><p><strong>Conclusion: </strong>In terms of treatment efficacy for MM, lasmiditan was not worse than different triptans and was even better than some of the triptans in the rate of sustained freedom from pain. As an emerging treatment, lasmiditan is promising for the treatment of MM. However, more research needs to be carried out because of the lack of safety analysis for lasmiditan.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"639-653"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483877","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":"State-of-the-Art Personalized Therapy Approaches for Chronic Non-Specific Low Back Pain: Understanding the Mechanisms and Drivers.","authors":"Andrey Danilov, Alexey Danilov, Anastasiia Badaeva, Anastasiia Kosareva, Ksenia Popovskaya, Viacheslav Novikov","doi":"10.1007/s40122-025-00706-w","DOIUrl":"10.1007/s40122-025-00706-w","url":null,"abstract":"<p><p>Chronic non-specific low back pain (CNSLBP) is a debilitating condition that affects millions of people worldwide, significantly impacting quality of life and imposing a substantial socioeconomic burden. Traditional treatment approaches often rely on a one-size-fits-all strategy, failing to account for individual variations in pathophysiological mechanisms, drivers, and the principles of personalized medicine. Furthermore, an overemphasis on biomechanical findings from imaging may lead to ineffective interventions and unnecessary surgical procedures, obscuring other important factors that contribute to pain perception. While highlighting the limitations of universal treatment approaches, in this review we present a practical clinical approach aimed at elucidating the main pathophysiological mechanisms and various factors underlying the development and maintenance of CNSLBP in order to create a personalized treatment program. In conclusion, this review underscores the need for personalized therapeutic strategies that take into account the unique characteristics of each patient, recognizing the complex interaction of biological, psychological, social, and other factors that contribute to the development of individual pain. By combining a comprehensive understanding of the complexities of this condition, we aim to improve clinical outcomes and provide information on the development of effective personalized treatment algorithms, particularly in the field of neurological practice.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"479-496"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067242","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":"Headache Phenotype and the Psychosocial Burden of Cluster Headaches: An Analysis of Patients Prior to Hospitalization.","authors":"Carl Hartmut Göbel, Britta Koch, Katja Heinze-Kuhn, Axel Heinze, Anna Cirkel, Hartmut Göbel","doi":"10.1007/s40122-025-00715-9","DOIUrl":"10.1007/s40122-025-00715-9","url":null,"abstract":"<p><strong>Introduction: </strong>The specific headache phenotype, accompanying symptoms and psychological impact that lead to admission of patients with cluster headache are not yet known. The aim of this study was therefore to analyze the characteristics of patients who were admitted to a tertiary headache center in 2018, 2019 and 2020 due to cluster headache.</p><p><strong>Methods: </strong>A total of 207 patients with cluster headache were examined, who were admitted to the Kiel Headache Center, a tertiary headache center in Germany, in the years 2018, 2019, and 2020. A retrospective cohort study was conducted to analyze the phenotype and psychosocial impact of cluster headaches in a standardized manner. The data were collected based on information from the standardized Kiel Headache Questionnaire, the Migraine Disability Assessment (MIDAS) questionnaire, and the World Health Organization (WHO) Disability Assessment Schedule (WHODAS 2.0).</p><p><strong>Results: </strong>Most of the patients had a chronic course of disease over many years, and 71.5% had had the disease for more than 5 years. Cluster headache attacks occurred in 98.6% of the patients, with strong to very strong pain intensity, and more than 78% of the patients experienced three or more attacks per day. Nighttime occurrence led to severe sleep disturbances with exhaustion, a lack of energy, and an inability to work. In 31.4% of the patients, persistent pain in the area also contributed to the inability to work. A total of 94.7% of the patients had a MIDAS score of grade 4. The analysis of the WHODAS 2.0 score revealed that 92.7% of the patients with cluster headaches experienced severe limitations in their health and functionality. These individuals were particularly severely affected by the accompanying psychological symptoms and the psychosocial impact of cluster headaches. The highly stressful complications of cluster headaches were particularly evident in the high frequency of suicidal ideation in more than 40% of the patients examined. Severe illness affected almost all areas of professional, social, and family life and caused a very high level of suffering.</p><p><strong>Conclusions: </strong>The results revealed a pronounced, severe symptom complex in patients with cluster headaches that went far beyond the purely diagnostic criteria. The psychosocial impact of cluster headaches should be given close attention in the care of these patients.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"753-767"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493068","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":"Pharmacology and Mechanism of Action of Suzetrigine, a Potent and Selective Na_V1.8 Pain Signal Inhibitor for the Treatment of Moderate to Severe Pain.","authors":"Jeremiah D Osteen, Swapna Immani, Tim L Tapley, Tim Indersmitten, Nicole W Hurst, Tiffany Healey, Kathleen Aertgeerts, Paul A Negulescu, Sandra M Lechner","doi":"10.1007/s40122-024-00697-0","DOIUrl":"10.1007/s40122-024-00697-0","url":null,"abstract":"<p><strong>Introduction: </strong>There is a high unmet need for safe and effective non-opioid medicines to treat moderate to severe pain without risk of addiction. Voltage-gated sodium channel 1.8 (Na_V1.8) is a genetically and pharmacologically validated pain target that is selectively expressed in peripheral pain-sensing neurons and not in the central nervous system (CNS). Suzetrigine (VX-548) is a potent and selective inhibitor of Na_V1.8, which has demonstrated clinical efficacy and safety in multiple acute pain studies. Our study was designed to characterize the mechanism of action of suzetrigine and assess both nonclinical and clinical data to test the hypothesis that selective Na_V1.8 inhibition translates into clinical efficacy and safety, including lack of addictive potential.</p><p><strong>Methods: </strong>Preclinical pharmacology and mechanism of action studies were performed in vitro using electrophysiology and radiolabeled binding methods in cells recombinantly expressing human Na_V channels, human proteins, and primary human dorsal root ganglion (DRG) sensory neurons. Safety and addictive potential assessments included in vitro secondary pharmacology studies, nonclinical repeat-dose toxicity and dependence studies in rats and/or monkeys, and a systematic analysis of adverse event data generated from 2447 participants from phase 3 acute pain studies of suzetrigine.</p><p><strong>Results: </strong>Suzetrigine is selective against all other Na_V subtypes (≥ 31,000-fold) and 180 other molecular targets. Suzetrigine inhibits Na_V1.8 by binding to the protein's second voltage sensing domain (VSD2) to stabilize the closed state of the channel. This novel allosteric mechanism results in tonic inhibition of Na_V1.8 and reduces pain signals in primary human DRG sensory neurons. Nonclinical and clinical safety assessments with suzetrigine demonstrate no adverse CNS, cardiovascular or behavioral effects and no evidence of addictive potential or dependence.</p><p><strong>Conclusions: </strong>The comprehensive pharmacology assessment presented here indicates that suzetrigine represents the first in a new class of non-opioid analgesics that are selective Na_V1.8 pain signal inhibitors acting in the peripheral nervous system to safely treat pain without addictive potential.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"655-674"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952723","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":"Effects of TTP-PECS Block Under Opioid-Sparing General Anesthesia on Postoperative Analgesia and Early Recovery Quality in Patients Undergoing Modified Radical Mastectomy.","authors":"Yu Ma, Chunpei Wu, Zhengxia Sun, Lin Zhang, Miao Zhou, Jiaqi Chang, Hui Liu, Qingming Bian","doi":"10.1007/s40122-025-00708-8","DOIUrl":"10.1007/s40122-025-00708-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Potent analgesics such as sufentanil and remifentanil play a pivotal role in general anesthesia, but these medications have disadvantages, including respiratory depression, nausea, vomiting, immune system suppression, and gastrointestinal function inhibition. This study aimed to evaluate the effects of the transversus thoracic muscle plane-pectoral nerves (TTP-PECS) block on postoperative analgesia, immune function and early postoperative recovery quality in patients undergoing modified radical mastectomy under opioid-sparing general anesthesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 100 patients scheduled for modified radical mastectomy under general anesthesia were randomly divided into the TTP-PECS block combined with opioid-sparing general anesthesia group (TO group, n = 50) or the conventional general anesthesia group (GA group, n = 50). The TO group underwent TTP-PECS block prior to induction, using oxycodone as the analgesic during induction instead of sufentanil, no additional continuous infusion of analgesic was performed intra-operatively. Visual analogue scale (VAS) scores at rest and during movement at different time points were recorded in both groups, and the levels of T cell subsets, natural killer (NK) cells were measured before the surgery and at 24 h and 48 h after the surgery. Quality of Recovery-40 (QoR-40) scores were assessed at 24 h postoperatively, and the incidence of peri-operative adverse reactions was also observed in both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Except for 48 h postoperatively, patients in the TO group had significantly lower VAS scores than those in the GA group at 2 h, 6 h, 12 h, and 24 h postoperatively at rest and during movement (P &lt; 0.05). At 24 h and 48 h postoperatively, the expression of CD4&lt;sup&gt;+&lt;/sup&gt; T cells and the CD4&lt;sup&gt;+&lt;/sup&gt;/CD8&lt;sup&gt;+&lt;/sup&gt; ratio were significantly higher in the TO group than in the GA group (P &lt; 0.05). The QoR-40 scale, assessed at 24 h postoperatively, showed that the TO group significantly outperformed the GA group in total scores as well as in sub-scores for emotional state, physical comfort, physical independence, psychological support, and pain (P &lt; 0.05). In addition, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were lower at time points T1-T4 than at T0 in both groups (P &lt; 0.05), but the differences between the two groups were not statistically significant(P &gt; 0.05). The incidence of cough reflex during induction and postoperative nausea and vomiting were significantly lower in the TO group than in the GA group (P &lt; 0.05). There was no statistically significant difference between the two groups in the incidence of other adverse reactions (P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The combination of TTP-PECS block and oxycodone-propofol opioid-sparing general anesthesia can provide superior postoperative analgesia and reduce the incidence of postoperative nausea and vomiting. It a","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"709-722"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256318","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":"Impact of Headache and Over-the-Counter Treatment on Pain and Functional and Cognitive Parameters: A Real-World Study across Three Geographies.","authors":"Peter J Goadsby, Andreas Straube, Mamoru Shibata, Mario Fernando Prieto Peres, Caroline Amand, Chris Colby, Mary Kay Margolis, Valentine Polivka, Andrew Stewart, Luminita Constantin","doi":"10.1007/s40122-024-00703-5","DOIUrl":"10.1007/s40122-024-00703-5","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with headache choose over-the-counter (OTC) medications to relieve pain and associated symptoms. This real-world evidence study investigated the effect of three OTC headache treatments on headache intensity and the associated impairment of cognitive and functional parameters in headache sufferers in Germany, Brazil, and Japan.</p><p><strong>Methods: </strong>This prospective, multinational, observational eDiary-based study included adults experiencing headache for ≥ 6 months, with ≥ 2 headache episodes per month requiring treatment and using one of the three OTC headache treatments (Germany: ibuprofen 400 mg + caffeine 100 mg; Brazil: dipyrone 1 g; Japan: ibuprofen 100 mg + caffeine 40 mg). The primary endpoint was change in headache intensity (11-point numeric rating scale [NRS]) from baseline (headache onset) to 2 h post-treatment. Secondary endpoints were association between NRS scores for headache intensity and for cognitive and functional parameters and change in these parameters from baseline to 2 h post-treatment.</p><p><strong>Results: </strong>Of the 32,623 individuals screened, 1239 were enrolled in the study, with 607 having their first headache episode treated using one of the OTC treatments. Baseline demographics and characteristics were similar across the cohorts. At 2 h post-treatment, headache intensity significantly improved, with the mean change from baseline being 3.4 (3.1, 3.7, 95% confidence interval), 4.2 (3.9, 4.5), and 3.0 (2.7, 3.3) for German, Brazilian, and Japanese cohorts, respectively. Improvement was observed in all cognitive and functional parameters. The NRS score for headache intensity significantly predicted NRS scores of all cognitive and functional parameters (P < 0.0001).</p><p><strong>Conclusions: </strong>The study shows that headache intensity significantly affects cognitive and functional aspects, as well as overall quality of life, for sufferers globally. It confirms the effectiveness of OTC medications and suggests using headache intensity as a self-assessment tool for symptom severity, highlighting the need for new parameters in the OTC domain to improve public health benefits.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"691-707"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075080","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":"Can Spinal Cord Stimulation be Considered as a Frontier for Chronic Pain in Diabetic Foot?","authors":"Ying Zhang, Huifeng Zhang, Kaizhong Wang, Xiangyan Liu, Zhonghai Li","doi":"10.1007/s40122-025-00710-0","DOIUrl":"10.1007/s40122-025-00710-0","url":null,"abstract":"<p><p>Chronic pain in the diabetic foot (DF) is a common complication of diabetes, bringing a significant burden to patients, their families, and even society. There is no very effective treatment for it, traditional treatments such as medication, lumbar sympathetic nerve block, and alternative therapies are often not very effective and have more adverse effects. The emergence of neuromodulation technology has brought new hope for the treatment of DF, among which spinal cord stimulation (SCS) is a hotspot in current research and has achieved remarkable efficacy in the study of DF treatment by blocking pain signaling and improving circulation and other mechanisms. This article reviews the SCS technique and clinical trails of SCS for chronic DF pain, and describes the prospects and current challenges of SCS.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"589-616"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256317","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 Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions.","authors":"Sebastiano Mercadante, Giorgio Sapienza, Alessio Lo Cascio, Alessandra Casuccio","doi":"10.1007/s40122-025-00728-4","DOIUrl":"https://doi.org/10.1007/s40122-025-00728-4","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit.</p><p><strong>Methods: </strong>Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information regarding opioids, and route of administration, prescribed prior to admission, during admission, and at time of discharge was recorded. Opioids, doses, and routes were changed according to the clinical need to obtain the maximum benefit, individualizing the treatment. The opioid escalation index was calculated in milligrams (OEImg) and as a percentage (OEI%).</p><p><strong>Results: </strong>A total of 113 patients were assessed. The mean pain intensity at admission and at time of discharge was 6.4 (SD 1.8) and 2.3 (SD 1.4), respectively (P < 0.0005). The mean opioid dose expressed as oral morphine equivalent (OME) by patients who were receiving opioids before admission was 128 mg/day (SD 120). There was no statistical difference in OME between admission and discharge time. Sixty-one and 20 patients were prescribed a second and a third opioid/route, respectively. Mean OEI% and OEImg were 9.3% (SD = 22.5) and 4.0 mg/day (SD = 24.1), respectively. Only a minority of patients had a breakthrough pain prescription at admission. Intravenous morphine was more frequently prescribed at beginning, then replaced by oral morphine and fentanyl preparations at discharge.</p><p><strong>Conclusions: </strong>An intensive and careful use of opioids in the APCU allows for the achievement of adequate analgesia in all examined patients within a short time, without increasing OME. These findings should encourage further studies in APCUs as well as in other palliative care settings.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743565","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":"Genicular Nerve Ultrasound-Guided Cryoanalgesia for the Treatment of Chronic Knee Joint Pain: An Observational Retrospective Study.","authors":"Giuliano Lo Bianco, Francesco Paolo D'angelo, Guillherme Ferreira Dos Santos, Agnes Stogicza, Matteo Luigi Giuseppe Leoni, Andrea M Trescot, Robert Jason Yong, Christopher L Robinson","doi":"10.1007/s40122-025-00727-5","DOIUrl":"https://doi.org/10.1007/s40122-025-00727-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Chronic knee pain caused by osteoarthritis (OA) is a prevalent source of disability in the adult population. Total knee arthroplasty (TKA) is an effective surgical treatment for advanced disease, but many patients continue to suffer from chronic post-surgical pain (CPSP). In recent years, minimally invasive techniques targeting peripheral nerves have been explored. Cryoanalgesia of the genicular nerves (GNCryo) is one such intervention that disrupts sensory input by applying extremely low temperatures to the target nerves, potentially leading to sustained pain relief without the need for neurodestructive heat lesions. This study aims to evaluate the effectiveness of ultrasound-guided GNCryo in patients with chronic knee pain due to primary OA or CPSP after TKA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective, single-center study included 90 patients who underwent GNCryo between September 2021 and February 2023. Inclusion criteria were patients over 18 years of age, symptomatic knee OA or CPSP after TKA, and a positive response (≥ 50% pain relief) to diagnostic genicular nerve blocks. Ultrasound guidance was used to optimize needle placement and reduce complications. Clinical outcomes were assessed at baseline and at 1, 3, 6, and 9 months post-procedure. Outcome measures included the Visual Analog Scale (VAS, 0-10) for pain intensity, the Western Ontario and McMaster Universities Arthritis Index (WOMAC, 0-100) for assessing pain, stiffness, and physical function related to OA, the Douleur Neuropathique en 4 Questions (DN4, 0-10) for neuropathic pain, and the EuroQol 5-Dimension (EQ-5D, 0-100) for quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ninety patients completed the 9 months follow-up. The median VAS score decreased from 7.0 (6.0, 8.0) at baseline to 4.0 (3.0, 5.0) at 1 month, remained at 4.0 (3.0, 5.0) at 3 months, and increased slightly to 5.0 (4.0, 5.0) at 6 months and 5.0 (4.0, 6.0) at 9 months, yet pain relief remained lower than baseline. WOMAC scores decreased from 65 (55, 71) at baseline to 35 (30, 40) at 1 month and 35 (30, 40) at 3 months, increased to 40 (35, 50) at 6 months and 55 (45, 65) at 9 months. DN4 scores decreased from 7 (5, 8) at baseline to 4 (3, 4) at 1 month and 3 (2, 4) at 3 months, increased to 3.5 (3, 5) at 6 months and 5 (4, 6) at 9 months, yet remained lower than baseline. EQ-5D scores increased from 64.5 (47, 84) at baseline to 42 (32, 58) at 1 month, 43.5 (31, 59) at 3 months, 45.5 (35, 60) at 6 months, and 52 (41, 72) at 9 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Ultrasound-guided GNCryo is a promising minimally invasive treatment for chronic knee pain, providing pain relief and improved quality of life for up to 9 months. Although some outcomes showed a trend toward baseline over time, pain relief remained lower than baseline, consistent with potential nerve regeneration or recovery. Larger prospective, controlled trials are necessary to confirm these findings and to","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721025","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}