Pain and Therapy最新文献

{"title":"In-Hospital Pain and Opioid Consumption After Primary Total Knee Arthroplasty Compared to Primary Total Hip Arthroplasty: Results from 7330 Patients Treated in a Fast-Track Setting.","authors":"Janne Kristin Hofstad, Tina Strømdal Wik, Pål Klepstad, Kari Hanne Gjeilo, Siri Bjørgen Winther, Olav A Foss","doi":"10.1007/s40122-025-00716-8","DOIUrl":"10.1007/s40122-025-00716-8","url":null,"abstract":"<p><strong>Introduction: </strong>Differences in in-hospital pain and consumption of opioids after primary total hip arthroplasty (THA) and knee arthroplasty (TKA) have been rarely studied in a setting where the patient course is otherwise similar. The aim of this study was to compare early pain intensity and opioid usage between patients who have undergone THA and TKA to identify potential implications for outpatient surgery.</p><p><strong>Methods: </strong>This institutional register study included 4655 patients receiving THA and 2675 patients receiving TKA. Pain at rest and during mobilization were collected once preoperatively, and postoperatively at five time-points, twice on the Day of surgery, once each on day 1 and day 2 after surgery, and at discharge, on a numeric rating scale (NRS) 0-10. Rescue opioids in oral morphine-equivalent doses (MME) were consecutively registered. Postoperative mobilization was registered twice daily.</p><p><strong>Results: </strong>Overall mean pain were 2.0 (Cl 2.0-2.0) after THA and 2.3 (Cl 2.3-2.4) after TKA at rest, and 3.3 (Cl 3.3-3.3) and 3.7 (Cl 3.7-3.8) during mobilization, respectively. Patients undergoing TKA had a transient increase in pain intensity the day after surgery, whereas patients undergoing THA had improved pain levels. Outpatient criteria for pain (NRS < 5 during mobilization) were feasible for 37% of THA and 35% of TKA. Total median MME was 30.0 (0-573) after THA and 52.5 (0-390) after TKA. Patients undergoing TKA were less mobilized during hospitalization.</p><p><strong>Conclusion: </strong>A comparable number of THA and TKA cases were eligible for same-day discharge based on outpatient discharge criteria for pain. Patients receiving TKA can expect an increase in pain intensity and opioid needs on the day after surgery.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"971-983"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634398","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 Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review.","authors":"Martina Rekatsina, Philip W H Peng","doi":"10.1007/s40122-025-00731-9","DOIUrl":"10.1007/s40122-025-00731-9","url":null,"abstract":"<p><strong>Introduction: </strong>Image-guided spinal injections are commonly performed by pain physicians and supported by literature. A recent survey showed that half of the Canadian providers still perform landmark-guided injections. This comprehensive review aims to describe the evidence supporting imaging modalities (fluoroscopy, computed tomography (CT) and ultrasound) in improving the accuracy and safety in several commonly performed spine injections. Relevant anatomy and pitfalls of landmark-guided injections are also discussed.</p><p><strong>Methods: </strong>An extensive literature search was conducted in PubMed, Medline and Embase databases, complemented by a manual search. Search terms included all spine interventions and imaging modalities.</p><p><strong>Results: </strong>Literature shows that incorrect needle placement without imaging guidance can reach 50% in caudal, 30.4% in lumbar interlaminar and 53% in cervical interlaminar epidural steroid injections. Lumbar and cervical transforaminal steroid injections require imaging to identify intravascular or intradiscal needle placement; misplacement rates can be as high as 20% at cervical, 8% at thoracic, 6-15% at lumbar and 16.5-21% at sacral levels. Imaging techniques for sacroiliac joint steroid injections are superior to non-imaging techniques, while medial branch blocks and facet joint injections require image guidance.</p><p><strong>Conclusion: </strong>Image guidance is a mandatory requirement when performing spinal procedures for pain management. Fluoroscopy enhances the safety and accuracy of spinal injections, with stored images benefiting patient records. Ultrasound also has an increasingly important role either alone or with fluoroscopy. CT is also effective but with limited accessibility.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"841-863"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764598","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":"Evaluating an early Interdisciplinary Multimodal Assessment for Patients at Risk of Developing Chronic Pain: Results of a Multicentre RCT in Germany.","authors":"Daniel Szczotkowski, Sandra Meyer-Moock, Thomas Kohlmann, Karin Deppe, Anne Gärtner, Greta Hoffmann, Thomas Isenberg, Gabriele Lindena, Ursula Marschall, Carolin Martin, Beatrice Metz-Oster, Lena Milch, André Möller, Bernd Nagel, Frank Petzke, Anke Preissler, Julia Pritzke-Michael, Leonie Schouten, Katja Schwenk, Catharina Schumacher, Anja Waidner, Ulrike Kaiser","doi":"10.1007/s40122-025-00729-3","DOIUrl":"10.1007/s40122-025-00729-3","url":null,"abstract":"<p><strong>Introduction: </strong>Patients at risk of developing chronic pain are often significantly impaired in their daily, social and work activities. An early interdisciplinary multimodal assessment (IMA) includes a systematically integrated view of medical, psychosocial and functional factors to direct patients to need-based treatment services. This multicentre, randomised, controlled trial examined the effects of an IMA on preventing chronic pain and improving care for adult patients.</p><p><strong>Methods: </strong>The intervention group (IG) received an IMA in accordance with standardised guidelines. The control group (CG) was offered a unimodal medical pain assessment (MPA). Data from the Characteristic Pain Intensity (PI) and Disability Score (DS), as primary outcomes, were collected at assessment and 3 and 6 months later together with secondary outcomes (e.g. depression, anxiety, stress, catastrophizing, health-related quality of life).</p><p><strong>Results: </strong>A total of 620 (68.4%) valid questionnaires were available at the 6-month follow-up. The mean reduction (numerical rating scale, 0-10) in terms of improvement within both groups (IG/CG) was 1.6/1.7 points for PI and 1.9/1.8 points for DS. Most secondary outcomes improved as well. However, the differences between the two groups did not reach statistical significance, although there was a tendency for the IG to have a greater effect on some psychological outcomes. Regarding the recommended treatment approaches, the focus in the IG was more on physical activity and psychological and psychosomatic interventions, whereas in the CG there was also a preference for adjusting the medication.</p><p><strong>Conclusions: </strong>Both early MPA and IMA seem to have a positive effect on outcomes such as pain intensity, functional limitations and psychological factors for patients at risk of developing chronic pain. We critically reflect on the results of the primary research question by discussing the limitations in detail and conclude that further research should ensure that the control conditions reflect standard care and that the follow-up period is long enough.</p><p><strong>Trial registration: </strong>German Clinical Trials Register (DRKS-ID: DRKS00015443).</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1081-1102"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024365","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 Role of Biomarkers in Acute Pain: A Narrative Review.","authors":"Thalis Asimakopoulos, Athanasia Tsaroucha, Maria Kouri, Alberto Pasqualucci, Giustino Varrassi, Matteo Luigi Giuseppe Leoni, Martina Rekatsina","doi":"10.1007/s40122-025-00718-6","DOIUrl":"10.1007/s40122-025-00718-6","url":null,"abstract":"<p><p>Acute pain, a critical aspect of patient care, presents a challenge due to its subjective nature and complex biological underpinnings. Biomarkers for acute pain promise a paradigm shift in how pain is perceived, diagnosed, and managed. The study of genetic, inflammatory, and neurotransmission markers associated with pain experience may hold the key for the development of personalized and effective pain management strategies. This narrative review explores the neurobiological pathways of acute pain, encompassing inflammatory responses and neurotransmission mechanisms. It synthesizes current research on the identification and clinical application of biomarkers, emphasizing their potential to enhance diagnostic precision, treatment effectiveness, and risk prediction. We underscore the promising role of acute pain biomarkers in identifying patients at risk for developing acute and potentially chronic pain, predicting patients' response to pharmacological interventions, and aiding in the development of novel therapeutic and pain preventive strategies. The evolving landscape of biomarker research not only deepens our understanding of pain mechanisms but also lays the foundation for more tailored and patient-specific healthcare interventions.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"775-789"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634399","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 Relationship Between Treatment Satisfaction and Medication Understanding Among Patients Taking a Novel Oral Pain Reliever: A Questionnaire-Based Cross-Sectional Study.","authors":"Makio Takahashi, Sho Kodama, Maiko Akahane, Shuhei Yamamoto, Takashi Yonemoto, Haruhiko Seki","doi":"10.1007/s40122-025-00709-7","DOIUrl":"10.1007/s40122-025-00709-7","url":null,"abstract":"<p><strong>Introduction: </strong>Patient satisfaction is important in pain management. Satisfaction with prescribed pain relievers and continued use of these drugs may be affected by a patient's understanding of their efficacy and safety. We investigated the association between patients' satisfaction and understanding of their prescribed medication for three oral pain relievers (lasmiditan, mirogabalin, and tramadol) that recently became available in Japan.</p><p><strong>Methods: </strong>This questionnaire-based, cross-sectional study included adult patients taking these oral pain relievers after April 2023. The primary endpoint was overall satisfaction (five-point rating) and the secondary endpoint was overall understanding (five-point rating) of the oral pain relievers.</p><p><strong>Results: </strong>In total, 328 patients (lasmiditan, 36.9%; mirogabalin, 55.5%, tramadol, 8.8%; four patients had been prescribed more than one medication) were included, and 71.6% of patients reported high satisfaction (score 4, 5) with their oral pain relievers (lasmiditan, 62.0%; mirogabalin, 76.1%; tramadol, 85.2%). The proportion of patients in the total population who reported a high understanding (score 4, 5) of their oral pain relievers was 68.0% (lasmiditan, 77.7%; mirogabalin, 63.3%; tramadol, 55.6%). In the total population and the lasmiditan and mirogabalin subgroups, the patient satisfaction level was significantly associated with scores on medication understanding (Cochran-Armitage test, p < 0.0001 for all). Discontinuation rates were higher in patients who were unsatisfied with their treatment than those who were satisfied (38.7% and 9.8%, respectively).</p><p><strong>Conclusion: </strong>This study showed that a higher level of understanding of oral pain relievers is associated with higher satisfaction, which may be associated with lower discontinuation rates.</p><p><strong>Clinical trial registration: </strong>UMIN000052629.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"931-945"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374239","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":"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":"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":"985-998"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085465/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Benefits of Ibuprofen Arginine: A Narrative Review.","authors":"Piercarlo Sarzi-Puttini, Serge Perrot, Juan Perez-Cajaraville, Diego Maria Michele Fornasari, Franco Radaelli, Giustino Varrassi","doi":"10.1007/s40122-025-00735-5","DOIUrl":"10.1007/s40122-025-00735-5","url":null,"abstract":"<p><p>Ibuprofen arginine (IBA) combines well-established analgesic and anti-inflammatory properties with enhanced pharmacokinetics. The addition of arginine significantly improves solubility and absorption, leading to a faster onset of action compared to conventional ibuprofen. Clinical studies consistently demonstrate that IBA achieves meaningful pain relief within a shorter timeframe while maintaining a favorable safety profile. IBA's rapid action is particularly valuable in managing acute exacerbations of chronic pain and preventing central sensitization, thus improving patient comfort, adherence, and overall quality of life. By addressing both the inflammatory and nociceptive components of pain, IBA offers an effective and well-tolerated alternative in multimodal pain management strategies. This review explores the clinical benefits of IBA in pain management among various clinical settings.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"891-912"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008994","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":"Predicting the Risk of Lumbar Prolapsed Disc: A Gene Signature-Based Machine Learning Analysis.","authors":"Fengfeng Wang, Fei Meng, Stanley Sau Ching Wong","doi":"10.1007/s40122-025-00744-4","DOIUrl":"10.1007/s40122-025-00744-4","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar prolapsed disc (LPD) is a leading cause of low back pain, contributing significantly to global disability and healthcare burden. This study aimed to develop machine learning models to predict the risk of LPD by analysing gene expression profiles for early detection.</p><p><strong>Methods: </strong>Transcriptomic data from peripheral blood samples were obtained from the Gene Expression Omnibus (GEO) database, with dataset GSE150408 used for training and GSE124272 for testing. The training dataset included 17 patients with sciatica resulting from LPD, all of whom had magnetic resonance imaging confirmation of single-level LPD at either the L4/5 or L5/S1 levels. Data from 17 healthy volunteers were used as controls. Recursive feature elimination (RFE) was employed to identify the most relevant gene signatures among 23 pain-related genes. Machine learning models, including support vector machine (SVM), random forest, k-nearest neighbours (KNN), logistic regression, and Extreme Gradient Boosting (XGBoost), were trained and evaluated. Model performance was assessed using accuracy, area under the curve (AUC), F1 score, and Matthews correlation coefficient (MCC).</p><p><strong>Results: </strong>Eight key gene signatures were identified as significant predictors of LPD, with MMP9 exhibiting the highest importance score. Most of these genes were differentially expressed between patients with LPD and healthy controls (p < 0.05). Among the models, random forest demonstrated the highest accuracy (0.80, 95% CI 0.73-0.85) and MCC (0.64, 95% CI 0.53-0.76), followed by KNN, XGBoost, and SVM. Overall, the random forest model exhibited the most robust performance in predicting the risk of LPD.</p><p><strong>Conclusion: </strong>The results of our study suggest that machine learning models based on pain-related gene signatures may identify patients at high risk of developing LPD with reasonably high accuracy. These prediction models could perhaps be integrated into clinical diagnostic tools to enhance early diagnosis and prevention.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1117-1129"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038390","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":"Pain Management in Minimally Invasive Cardiac Surgery: A Review of Current Clinical Evidence.","authors":"Burhan Dost, Esra Turunc, Muhammed Enes Aydin, Cengiz Kaya, Aslihan Aykut, Zeliha Asli Demir, Madan Narayanan, Alessandro De Cassai","doi":"10.1007/s40122-025-00739-1","DOIUrl":"10.1007/s40122-025-00739-1","url":null,"abstract":"<p><p>Compared with conventional sternotomy, minimally invasive cardiac surgery (MICS) is associated with significant advantages such as reduced tissue trauma, faster recovery, and shorter hospital stay. However, the management of postoperative pain caused by intercostal nerve injury, pleural irritation, and tissue retraction remains a major challenge. Despite the less invasive nature of MICS, patients often report experiencing pain similar to that experienced following conventional cardiac surgery, particularly during the acute postoperative period. Effective pain management is essential for optimizing recovery, reducing the consumption of opioids, and preventing the transition to chronic postsurgical pain. Regional anesthesia techniques play a key role in multimodal analgesia for MICS. Thoracic epidural analgesia exhibits strong analgesic efficacy; nevertheless, it remains underutilized owing to concerns regarding anticoagulation-related complications and hemodynamic instability. The thoracic paravertebral block is a safer alternative that provides comparable pain relief with fewer side effects. Similarly, ultrasound-guided fascial plane blocks, such as serratus anterior, parasternal intercostal, interpectoral + pectoserratus, and erector spinae plane blocks, have gained popularity owing to their safety and feasibility; however, the effectiveness of these blocks varies according to the surgical approach and type of incision. Systemic analgesia is an integral component of multimodal pain management in MICS. Despite the efficacy of opioids, a shift toward opioid-sparing strategies has been observed given the significant adverse effects associated with the use of opioids. Intravenous adjuncts such as dexmedetomidine, ketamine, and non-steroidal anti-inflammatory drugs can reduce opioid consumption and improve postoperative pain control. Despite advances in pain management, a single approach that can provide comprehensive analgesia for MICS remains to be established. A multimodal strategy that combines systemic and regional techniques must be developed to optimize pain management and long-term outcomes.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"913-930"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039790","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":"Advances in Musculoskeletal Ultrasound for Assistive Diagnosis in Pain Clinics.","authors":"Mingrui Zhang, Keyue Xie","doi":"10.1007/s40122-025-00721-x","DOIUrl":"10.1007/s40122-025-00721-x","url":null,"abstract":"<p><p>Musculoskeletal ultrasound has gained increasing attention as a noninvasive imaging modality in pain clinics. Its advantages include the lack of radiation exposure, cost-effectiveness, and efficiency, allowing for rapid provision of dynamic examination results. Notably, it has demonstrated significant effectiveness in diagnosing common joint injuries. This review synthesizes the advancements in the application of musculoskeletal ultrasound across various domains, including muscles, joints, bones, tendons, ligaments, and bursae. It explores the critical role of ultrasound in pain management, highlighting both its importance and limitations. Moreover, the review analyzes the latest research findings and the potential for clinical applications, underscoring the evolving landscape of musculoskeletal ultrasound in enhancing diagnostic accuracy in pain management.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"791-801"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634396","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}