Pain and Therapy最新文献

{"title":"Durable Outcomes and Intervention Avoidance in Low Back Pain Up to 5 Years After Percutaneous 60-Day Peripheral Nerve Stimulation.","authors":"Samir J Sheth, Denise D Lester, Jaudat Mahmood, Sarah E Trampota, G Lawson Smith, Raheleh Rahimi Darabad, Brandon D Swan, Meredith J McGee, Joseph W Boggs","doi":"10.1007/s40122-026-00858-3","DOIUrl":"10.1007/s40122-026-00858-3","url":null,"abstract":"<p><strong>Introduction: </strong>Low back pain (LBP) is a leading cause of disability worldwide, and treatment often necessitates invasive interventions that carry significant risks and economic burdens. While prior studies demonstrated durable benefit following percutaneous 60-day peripheral nerve stimulation (PNS), real-world data are needed to characterize long-term outcomes across routine clinical practice. This survey evaluated the durability of patient-reported improvements among a real-world cohort of patients with LBP who responded to 60-day PNS.</p><p><strong>Methods: </strong>A cross-sectional follow-up survey was administered to patients who previously responded to 60-day PNS targeting the lumbar medial branch nerves. Outcomes assessed included patient-reported percent pain relief and impression of change in quality of life (QoL), physical function, mood, and sleep. Participants also reported use or avoidance of other LBP treatments or interventions since completing 60-day PNS.</p><p><strong>Results: </strong>The survey was completed by 602 participants, with follow-up durations ranging from 6 to 68 months. Overall, 79% (475/602) of participants required no radiofrequency ablation (RFA), permanent implant, or surgery following 60-day PNS. Among participants who avoided subsequent interventions, 79% (376/475) reported durable improvements in at least one domain (≥ 50% pain relief and/or clinically meaningful improvement of QoL, physical function, mood, and/or sleep) at follow-up. Among participants without a prior permanent neurostimulator implant, 92% (309/336) of those who sought to avoid permanent implantation succeeded. Among those without prior low back surgery who wanted to avoid it, 95% (353/370) avoided surgery through follow‑up.</p><p><strong>Conclusions: </strong>These findings suggest that patients with LBP who respond to percutaneous 60-day PNS may experience durable relief, with benefits sustained by some for 5+ years. Participants reported reductions in pain leading to improvements in other health domains, and avoidance of subsequent interventions, including surgery, permanent implants, and/or RFA, through long-term follow-up, highlighting the potential use of percutaneous 60-day PNS as a minimally invasive, short-term treatment capable of producing long-lasting benefits in patients with LBP.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1345-1361"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353161","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":"Long-Term Efficacy and Safety of Treatments for Chronic Peripheral Neuropathic Pain: A Systematic Review and Narrative Synthesis.","authors":"Mariëlle H Eerdekens, Charlotte Both, Rita L Freitas","doi":"10.1007/s40122-026-00884-1","DOIUrl":"10.1007/s40122-026-00884-1","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral neuropathic pain (PNP) is a chronic condition that often requires long-term treatment. In 2025, the Neuropathic Pain Special Interest Group (NeuPSIG) updated its recommendations for treatment of neuropathic pain based on data from double-blind, randomized controlled trials (RCTs) with a duration of ≥ 3 weeks. To complement the existing body of evidence, we reviewed the long-term efficacy/safety of NeuPSIG-recommended treatments for PNP.</p><p><strong>Methods: </strong>We conducted a systematic literature review including clinical trials and observational studies of any design. Two literature searches were performed using PubMed and Embase (December 2024, May 2025). We included studies that enrolled ≥ 50 adult patients with PNP receiving ≥ 1 treatment recommended in the 2025 NeuPSIG guidance and with duration of ≥ 13 weeks. A supplemental search for long-term studies on high-concentration capsaicin 8% patch (HCCP) was performed. Results were synthesized narratively due to heterogeneity in study designs and outcomes.</p><p><strong>Results: </strong>We included 34 articles in our analysis (31 studies) varying in design, including interventional (RCTs and open-label studies) and observational studies. Most studies had a duration of 26-52 weeks. Four treatments (HCCP, duloxetine, gabapentin, pregabalin) were evaluated in ≥ 5 studies. HCCP was evaluated in the greatest number of long-term studies (n = 13) and in various PNP conditions, followed by duloxetine (n = 7) in painful diabetic peripheral neuropathy (pDPN) only, gabapentin (n = 6) in various PNP conditions and pregabalin (n = 5) mostly in pDPN. Collected data support long-term efficacy of all products. The lowest rates of discontinuations due to adverse events were reported with HCCP.</p><p><strong>Conclusions: </strong>The findings from this literature review emphasize the importance of expanding long-term evidence for chronic pain therapies. The review determined that the largest body of evidence is available for HCCP. Finally, it highlights the need for more standardized long-term evidence studies for chronic pain therapies.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1313-1343"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Leiden-Nice Consensus (2024-2025)-Technical Standardization and Clinical Algorithms for Pulsed Radiofrequency for Chronic Pain.","authors":"Daniel de Moraes Ferreira Jorge, Olav Rohof, Alexandre Teixeira, Tolga Ergönenç, Luis Josino Brasil, Ahmed Elhalwagy, Paulo Renato Barreiros da Fonseca, Jonas Lenzi de Araujo, Francesca Marsili","doi":"10.1007/s40122-026-00885-0","DOIUrl":"10.1007/s40122-026-00885-0","url":null,"abstract":"<p><p>Pulsed radiofrequency (PRF) has emerged as a safe, minimally invasive clinical strategy for the management of acute and chronic pain syndromes. Over the past two decades, its range of clinical applications has expanded across spinal, peripheral nerves, and intra-articular interventions. Despite the growing evidence supporting the clinical efficacy of PRF, two major challenges remain: (a) the lack of standardized technical parameters and the absence of structured clinical algorithms guiding physicians in selecting the targets and therapeutic strategies. In April 2024, an international panel of pain specialists convened in Leiden, the Netherlands to propose standardized technical guidelines for PRF procedures, resulting in the Leiden Consensus 2024, which focuses on reproducible parameters such as voltage, exposure time, electrode configuration, and procedural technique. Subsequently, during expert consensus discussions held in Nice, France, in 2025, the same international workgroup addressed a second critical gap in the field: clinical decision-making in interventional pain management. The Nice 2025 Consensus therefore developed practical diagnostic and therapeutic algorithms for common chronic pain conditions, including cervical facet pain, shoulder pain, knee osteoarthritis, sacroiliac pain, hip pain, thoracic pain, and central sensitization syndromes. This integrated consensus manuscript combines both initiatives into a comprehensive clinical framework. The Leiden Consensus proposes reproducible technical standards for PRF procedures, while the Nice Consensus provides stepwise clinical pathways emphasizing diagnosis-driven interventions and prioritizing nondestructive neuromodulation strategies. A central principle of the consensus is that PRF may be considered the first-line interventional treatment for peripheral nerve-related chronic noncancer pain, reserving ablative radiofrequency techniques for cases that are refractory to neuromodulation. The present document represents a living consensus intended to guide clinical practice worldwide while stimulating future research and evidence generation in the rapidly evolving field of PRF pain therapy.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1167-1185"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Treatment Patterns in People with Burden of Migraine: A Subgroup Analysis of the OVERCOME Japan 2nd Study.","authors":"Satomi Ooba, Daisuke Danno, Ryotaro Ishii, Tsubasa Takizawa, Moemi Miura, Yumi Kang, Yoshinori Tanizawa, Satoshi Osaga, Leo J Philip Tharappel, Chie Hashimoto","doi":"10.1007/s40122-026-00857-4","DOIUrl":"10.1007/s40122-026-00857-4","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of migraine on an individual's life is associated with an individual's background. However, limited evidence in Japan exists on the association of age, sex, employment, income, and family caregiving with patient-reported outcomes (PROs) and migraine treatment patterns. This analysis of the ObserVational survey of the Epidemiology, tReatment, and Care Of MigrainE (OVERCOME [Japan]) 2nd study describes the migraine burden and treatment usage of individuals with migraine across these demographic subgroups.</p><p><strong>Methods: </strong>Participants self-reported demographic and clinical characteristics, and PRO instrument responses, such as Headache Impact Test-6, Migraine Disability Assessment Scale (MIDAS), Migraine-Specific Quality of Life Questionnaire version 2.1, Migraine Interictal Burden Scale-4 (MIBS-4), and Impact of Migraine on Partners and Adolescent Children Scale. They also reported use of over-the-counter and prescription drugs for migraine, and headache-related expenses. Descriptive statistics were reported according to sex, employment status, menstrual-related migraine status and frequency, annual personal and family income, age, and family caregiving status for the elderly.</p><p><strong>Results: </strong>Female sex, unemployment, presence of menstrual-related migraine, low personal or family income, and family caregiving for elders appeared to increase migraine burden and impact prescription drug use. Specifically, men tended to have higher triptan (11.7% vs. 8.7%) and preventive medication use (18.3% vs. 11.2%) than women; unemployed women had the highest proportion of MIDAS grade IV (14.1%); women with menstrual-related migraine appeared to have greater MIBS-4 severe burden (36.3% vs. 27.8%) than those without; and family caregivers tended to have higher MIBS-4 severe burden (39.2% vs. 26.0%) and prescription drug use than non-caregivers. Respondent sex further appeared to influence migraine burden and treatment patterns within the employment and income subgroups.</p><p><strong>Conclusion: </strong>These data suggest certain sociodemographic groups may suffer from greater migraine burden and have reduced access to effective treatment and care. We hope this study's results will help healthcare providers and societies identify such populations with migraine and address potential clinical care gaps.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1401-1432"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437536","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":"Phenotypic Factors and Celecoxib Efficacy in Knee OA: A Post‑hoc Pooled Analysis of Two Randomized, Double‑Blind, Placebo‑Controlled Trials.","authors":"Jean-Yves Reginster, Nicholas Fuggle, Egbert Biesheuvel, Srinivasan Venugopal, Sagar Suresh Kumbhar, Raffaella Maria Rita Chiaese, Chris Walker, Ernest Choy","doi":"10.1007/s40122-026-00879-y","DOIUrl":"10.1007/s40122-026-00879-y","url":null,"abstract":"<p><strong>Introduction: </strong>Knee osteoarthritis (OA) is a major cause of disability worldwide and disproportionately affects women and individuals with obesity. Treatment response might vary by sex and body mass index (BMI). This study assessed whether celecoxib pain reduction differs across sex (male versus female) or BMI (obese ≥ 30 kg/m² versus nonobese < 30 kg/m²) in knee OA patients, using change from baseline in Visual Analog Scale (VAS) pain at Week 6 as primary endpoint.</p><p><strong>Methods: </strong>This post hoc pooled analysis included two randomized, double-blind, placebo-controlled trials (NH49-96-02-060; NH49-98-02-087). Adults with knee OA flare and baseline VAS pain ≥ 40 mm received placebo, 100 mg of celecoxib twice daily (BID), or 200 mg once daily (OD) for 6 weeks. Mild baseline pain was excluded to align with original trial criteria. The full analysis set (FAS) included patients with ≥ 1 dose and ≥ 1 post-baseline assessment. Primary subgroups were assessed using analysis of covariance (ANCOVA) with last observation carried forward (LOCF) for missing data, with longitudinal evaluation at Week 2 and 6 using mixed model for repeated measures (MMRM). Sensitivity analyses using alternative imputation methods were also performed.</p><p><strong>Results: </strong>A total of 1360 participants (427 men, 933 women) were included. Baseline VAS pain score was higher in women and patients with obesity (both p < 0.0001), who also showed greater placebo response. At Week 6, both celecoxib regimens significantly reduced pain versus placebo across sex and BMI subgroups. Women had greater observed pain reductions with similar efficacy between sexes, and obese participants showed comparable benefit with both doses. Similar findings were observed in MMRM analyses. Celecoxib provided rapid, sustained OA pain relief across the two subpopulations.</p><p><strong>Conclusions: </strong>100 mg of celecoxib BID and 200 mg OD showed consistent analgesic efficacy across sex and BMI subgroups, despite higher baseline pain and stronger placebo response in women and obese participants. These findings support the use of either regimen across diverse OA patient profiles and suggest that baseline pain differences do not necessarily reduce response to cyclooxygenase (COX)-2 inhibition.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1623-1635"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quadratus Lumborum Block versus Thoracic Paravertebral Block for Postoperative Recovery Quality after Percutaneous Nephrolithotomy: A Randomized Noninferiority Trial.","authors":"Wenjun Lin, Qingfu Zhang, Feifei Zheng, Linshan Huang, Weitao Gao, Jinsheng Guan, Guisheng Ding","doi":"10.1007/s40122-026-00882-3","DOIUrl":"10.1007/s40122-026-00882-3","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to determine whether anterior quadratus lumborum block (QLB) at the lateral supra-arcuate ligament is noninferior to thoracic paravertebral block (TPVB) for postoperative recovery quality after percutaneous nephrolithotomy (PCNL).</p><p><strong>Methods: </strong>A total of 72 adults (American Society of Anesthesiologists physical status I-II) undergoing elective unilateral PCNL were randomized to QLB (n = 36) or TPVB (n = 36). Before general anesthesia, patients received ultrasound-guided anterior QLB (0.5% ropivacaine, 30 mL) or TPVB (0.5% ropivacaine, 20 mL), with standardized multimodal analgesia including patient-controlled intravenous morphine. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h; noninferiority required the lower bound of the 95% confidence interval (CI) for the difference (QLB minus TPVB) to exceed the prespecified margin of -6 points in both the modified intention-to-treat and per-protocol populations. Secondary outcomes were pain intensity, morphine consumption, patient satisfaction, and adverse events.</p><p><strong>Results: </strong>Median QoR-15 scores at 24 h were 124 (interquartile range [IQR], 118-128) for QLB and 122 (IQR, 117-125) for TPVB (median difference, 2; 95% CI, -1 to 5; p < 0.001 for noninferiority), robust at stricter margins and confirmed per protocol. In secondary and exploratory analyses, QLB prolonged time to first analgesia (from postanesthesia care unit [PACU] admission; restricted mean survival time difference, 7.9 h; 95% CI, 5.9 to 9.8; time-averaged hazard ratio, 0.18; 95% CI, 0.10 to 0.31; p < 0.001), reduced 24-h morphine consumption (-4 mg; 95% CI, -6 to 0; p = 0.035), and lowered pain area under the curve at rest (-10 cm·h; 95% CI, -15 to -4) and on movement (-15 cm·h; 95% CI, -22 to -8; both p < 0.001). Hypotension occurred in 4 of 35 patients (11%) with QLB versus 13 of 36 (36%) with TPVB (relative risk, 0.32; 95% CI, 0.11 to 0.88; p = 0.015).</p><p><strong>Conclusions: </strong>Anterior QLB was noninferior to TPVB for postoperative recovery quality after PCNL. Associated reductions in pain and opioid use, and a lower observed incidence of hypotension, seen in secondary and exploratory analyses, are hypothesis-generating and warrant confirmation. Graphical abstract available for this article.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2100044431.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1637-1651"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microfragmented Adipose Tissue in Pain Management: Bridging Regenerative Biology and Clinical Therapeutics.","authors":"Y Van Tran, Phong Van Pham, Miguel Narvaez Encinas, Piercarlo Sarzi Puttini, Dariusz Myrcik, Pierfrancesco Dauri, Giacomo Farì, Christopher G Gharibo, Matteo Luigi Giuseppe Leoni, Marco Mercieri, Giustino Varrassi","doi":"10.1007/s40122-026-00877-0","DOIUrl":"10.1007/s40122-026-00877-0","url":null,"abstract":"<p><p>Regenerative medicine has emerged as a transformative paradigm in contemporary healthcare, shifting the therapeutic focus from symptomatic management toward the restoration of tissue structure and function through biologically active interventions. Within this framework, adipose-derived products have attracted substantial interest owing to their relative abundance, ease of harvesting, and rich cellular and paracrine composition, including mesenchymal stromal cells, pericytes, and bioactive mediators with immunomodulatory potential. Among these technologies, microfragmented adipose tissue (MFAT) constitutes an innovative, minimally manipulated approach because it preserves the native stromal vascular niche and extracellular matrix architecture while avoiding enzymatic processing. This characteristic not only maintains biological integrity but also facilitates regulatory compliance in multiple jurisdictions. This narrative review provides a comprehensive synthesis of the current evidence on microfragmented adipose tissue in pain management, integrating biological rationale, mechanistic insights, and clinical applications across musculoskeletal disorders and chronic pain conditions. Particular attention is devoted to its capacity to modulate inflammatory pathways, promote angiogenesis, and support tissue regeneration within complex pathological environments. In addition, the review critically appraises the methodological limitations of existing clinical studies, including heterogeneity of design and limited high-quality randomized evidence. Finally, future perspectives are explored, emphasizing the integration of precision medicine approaches, biomarker-driven patient stratification, and combinatorial regenerative strategies to optimize therapeutic outcomes.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1221-1248"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Note: Pain Characteristics of the Posterior Longitudinal Ligament in Percutaneous Endoscopic Lumbar Discectomy and its Significance: A Retrospective Study.","authors":"Kaining Zhang, Yun Yang, Wen Yu, Yubin Qi, Yanjun Ren, Yingguang Wu, Wa Shan, Fengxiang Zhu, Feifei Chen","doi":"10.1007/s40122-026-00878-z","DOIUrl":"10.1007/s40122-026-00878-z","url":null,"abstract":"","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1685"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606287","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":"Ultrasound-Guided Greater Occipital Nerve Block Across Headache Phenotypes: Outcomes and Determinants of Response in a Prospective Cohort.","authors":"Mariateresa Giglio, Alberto Corriero, Carlo Tramacere, Angela Preziosa, Fara Fornarelli, Filomena Galdini, Alfonso Pilolla, Salvatore Grasso, Giustino Varrassi, Antonella Paladini, Filomena Puntillo","doi":"10.1007/s40122-026-00881-4","DOIUrl":"10.1007/s40122-026-00881-4","url":null,"abstract":"<p><strong>Introduction: </strong>Greater occipital nerve blocks (GONBs) are used across headache phenotypes, but short-term effectiveness and predictors of response in mixed real-world cohorts remain uncertain.</p><p><strong>Methods: </strong>We conducted a prospective observational study of adults with chronic headache phenotypes receiving a single ultrasound-guided proximal (C2) GONB. Primary outcomes were T0 → T1 (1-month) changes in pain (NRS), headache impact (HIT-6), sleep (PSQI), and monthly attacks (crises) using paired Wilcoxon tests. We defined HIT-6 responders as ≥ 10-point reduction. Predictors of response were evaluated with multivariable logistic regression; continuous reductions were modeled with multivariable linear regression.</p><p><strong>Results: </strong>Twenty-nine patients were included (chronic migraine n = 10; cluster n = 5; occipital neuralgia n = 7; cervicogenic n = 7; 69% female; mean age 58.2 ± 13.7 years). At 1 month, all outcomes had improved significantly: HIT-6 median 66 → 52 (Δ - 12; 95% CI - 15 to - 8; p < 0.001), PSQI 12 → 8 (Δ - 3.5; p < 0.001), monthly (crises) 24 → 12 (Δ - 14.0; 95% CI - 20.0 to - 10.0; p < 0.001), and NRS 8 → 4 (Δ - 3; p < 0.001). In the logistic model, higher baseline pain independently predicted HIT-6 response (OR 3.38, 95% CI 1.22-13.47; p = 0.017), whereas symptom duration was not associated. In multivariable linear models, cluster headache was associated with greater improvements (ΔNRS, ΔHIT-6, Δcrises), while a rheumatic comorbidity predicted smaller improvements across outcomes.</p><p><strong>Conclusion: </strong>Across chronic headache phenotypes, a single ultrasound-guided proximal (C2) GONB was associated with clinically meaningful 1-month improvements in pain, impact, sleep, and attack frequency. Response, however, was not uniform: higher baseline pain intensity and the cluster phenotype identified the patients most likely to benefit, whereas a rheumatic comorbidity marked probable non-responders. These predictors offer a practical basis for patient selection and should be confirmed prospectively.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1513-1526"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631114","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 Complication Profiles of Fully and Semi-Implanted Intrathecal Drug Delivery Systems for Cancer Pain: A Large Single-Center Chinese Cohort.","authors":"Zikun Ning, Zheng Zou, Shunxin Liu, Hui Pan, Huaiming Wang, Pengjiu Feng, Aimin Zhang","doi":"10.1007/s40122-026-00862-7","DOIUrl":"10.1007/s40122-026-00862-7","url":null,"abstract":"<p><strong>Introduction: </strong>Intrathecal drug delivery systems (IDDS) are used for selected patients with refractory cancer pain. Fully implanted and semi-implanted systems differ in implantation pathway, maintenance requirements, external component exposure, and tissue-device interaction. This study aimed to describe real-world complication profiles of these two IDDS models in a large single-center Chinese cohort.</p><p><strong>Methods: </strong>This retrospective registry-based cohort study included 409 patients with advanced cancer who underwent initial IDDS implantation at Sichuan Cancer Hospital between 1 January 2023, and 31 December 2025. Complications were classified into level I categories and level II subtypes. Each level II complication subtype was counted once per affected patient. Frequencies were reported as counts, patient-level proportions using the device group as denominator, and event-level proportions using recorded complication events as denominator. Because detailed baseline characteristics, standardized follow-up durations, mortality timing, event timing, and paired efficacy outcomes were not systematically available, analyses were descriptive and hypothesis-generating.</p><p><strong>Results: </strong>Among 409 patients, 38 received fully implanted systems and 371 received semi-implanted systems. A total of 101 complications were recorded: 10 in the fully implanted group and 91 in the semi-implanted group. In the semi-implanted group, postdural puncture headache occurred in 38 patients (10.2% of 371; 41.8% of 91 events), cerebrospinal fluid leak in 22 patients (5.9%; 24.2%), and catheter blockage in 17 patients (4.6%; 18.7%). In the fully implanted group, skin erosion occurred in four patients (10.5% of 38; 40.0% of 10 events), and inadequate analgesia occurred in two patients (5.3%; 20.0%). Findings in the fully implanted group were based on single-digit subtype counts and should not be interpreted as stable comparative risk estimates.</p><p><strong>Conclusions: </strong>Fully implanted and semi-implanted IDDS showed different recorded complication profiles in this real-world Chinese cohort. Semi-implanted systems were characterized mainly by puncture-related and catheter-pathway events, whereas fully implanted systems showed tissue-integrity and treatment-adaptation events among the small number of recorded complications. These findings support individualized device selection but cannot establish device superiority or time-dependent risk because baseline, follow-up, mortality, event-timing, and efficacy data were incomplete.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1363-1375"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369463","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}