Pain and Therapy最新文献

{"title":"Immuno-Inflammatory Mechanisms in the Chronification of Pain.","authors":"Marcelo A A Moncada, Marco A Narvaez Tamayo, Miguel A Narvaez Encinas, Matteo Luigi Giuseppe Leoni, Giustino Varrassi","doi":"10.1007/s40122-026-00818-x","DOIUrl":"10.1007/s40122-026-00818-x","url":null,"abstract":"<p><p>Chronic pain affects 20% of the global population, with current treatments achieving meaningful relief in less than 30% of patients. Growing evidence indicates that immuno-inflammatory mechanisms critically mediate the transition from acute to chronic pain, extending beyond sustained nociceptive input. This narrative review synthesizes current understanding of cellular and molecular immuno-inflammatory processes underlying pain chronification, emphasizing therapeutic implications of immune-neural interactions. Peripheral tissue injury triggers coordinated immune responses involving pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, tumor necrosis factor alpha (TNF-α), and algesic mediators that sensitize nociceptors. Infiltrating macrophages, T lymphocytes, and mast cells perpetuate pro-nociceptive environments. Centrally, microglial and astrocytic activation induces persistent neuroinflammation, synaptic remodeling, and enhanced excitatory neurotransmission while impairing descending inhibition. The balance between pro-inflammatory T helper 1 and T helper 17 (Th1/Th17) and anti-inflammatory T helper 2 and regulatory T cell (Th2/Treg) responses determines pain outcomes. Critically, premature suppression of acute inflammation with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may paradoxically promote chronification by disrupting endogenous resolution pathways mediated by specialized pro-resolving mediators and regulatory immune cells. Local inflammation proves more relevant than systemic inflammation for pain persistence. The gut-brain-immune axis emerges as a novel therapeutic target, with microbiota composition influencing pain susceptibility through immunomodulation. Finally, chronic pain represents a failure of natural resolution mechanisms rather than prolonged nociceptive activation. Understanding temporal dynamics of immune responses, individual variability, and sex-specific mechanisms opens avenues for precision medicine approaches. Future strategies should restore homeostatic mechanisms rather than simply suppress symptoms, incorporating biomarker-guided treatment selection and multimodal interventions targeting the complex immuno-inflammatory cascade.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"443-464"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372986","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":"Next-Generation SCS Programming Platform: Enhancing ECAP Fidelity and Objectivity to Improve Patient Experience.","authors":"Daniel J Parker, Ajay B Antony, Gregory L Smith, Johnathan H Goree, Marc A Russo, Erika A Petersen, Chau M Vu, Paul Verrills, Christopher Gilmore, Leonardo Kapural, Darayus Nanavati, Dean M Karantonis, Jason E Pope","doi":"10.1007/s40122-025-00808-5","DOIUrl":"10.1007/s40122-025-00808-5","url":null,"abstract":"<p><strong>Introduction: </strong>Evoked compound action potentials (ECAPs) are neurophysiological biomarkers of neural activation during spinal cord stimulation (SCS). Clear distinction between ECAPs and nonphysiological signals is critical to the application of contemporary, ECAP-based closed-loop (CL) SCS therapies. Herein, we evaluated the performance and user acceptability of a novel programming software that automates generation of ECAP-based CL-SCS programs-the Assisted Programming Module (APM).</p><p><strong>Methods: </strong>We report results from two prospective, multicenter, single-arm, feasibility studies: Freshwater (NCT04662905) and Rosella (NCT06057480). APM performance was compared with the previous generation programming software and other published methods. Performance was assessed by comparing signal-to-noise ratios, artifact rejection, and other objective parameters. User acceptability was assessed using questionnaires administered to SCS users.</p><p><strong>Results: </strong>The APM successfully generated a CL program in 96% of initial programming sessions (n = 81/84; Freshwater, 31/34; Rosella, 50/50). In the Rosella study, median time to generate an automated CL program (n = 68) was 11.9 min [interquartile range (IQR) 9.9-14.0]. Median dose ratio was 1.31 (IQR 1.20-1.46) at end of trial (n = 24), 1.34 (IQR 1.13-1.51) at 1 month post implant (n = 16), and 1.32 (IQR 1.21-1.48) at 3 months post implant (n = 15). At least 90% of patients [trial, 90% (27/30); implant, 94% (17/18)] were satisfied with their programming experience, and ≥ 90% of patients [trial, 90% (26/29); implant, 94% (16/17)] felt in control of their therapy. The APM achieved a mean signal-to-noise ratio of 4.6 ± 1.2, a 35% improvement over the previous generation ECAP dose-controlled CL-SCS system. Detectable artifact leakage rates decreased by 75% when compared with other published methods without compromise to signal-to-noise performance.</p><p><strong>Conclusions: </strong>Next-generation ECAP dose-controlled CL technology demonstrated strong feasibility, high patient satisfaction and therapy control, and superior ECAP signal fidelity compared with existing methods. By standardizing CL-SCS programming and enhancing signal fidelity, the APM may improve workflow efficiency and long-term therapy outcomes in chronic pain management.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifiers: NCT04662905, NCT06057480.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"465-480"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934686","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":"Objective, Same-Day SCS Trials with ECAP-Controlled Closed-Loop Therapy: Depth of Response is Maintained from Trial to 12 months.","authors":"Jason E Pope, Chau M Vu, Johnathan H Goree, Eric G Cornidez, Drew Trainor, Abeer Khurram, Ian Gould, Dean M Karantonis","doi":"10.1007/s40122-026-00821-2","DOIUrl":"10.1007/s40122-026-00821-2","url":null,"abstract":"<p><strong>Introduction: </strong>Traditional spinal cord stimulation (SCS) trials often span several days, increasing the risks of infection, equipment failure, lead migration, and complications for patients on anticoagulant/antiplatelet therapy. Optimal SCS trial durations have not been established, although shorter durations are recommended for patients at high risk. Evoked compound action potential (ECAP)-controlled closed-loop (CL) SCS provides objective, real-time confirmation of neural activation at therapeutic dose levels, enabling immediate assessment of SCS treatment response. We evaluated the long-term response up to 12 months for patients undergoing ECAP-controlled CL-SCS trial evaluations where leads were removed on the same day of the trial procedure (day 0).</p><p><strong>Methods: </strong>Fifteen patients who met predefined day 0 responder criteria underwent a day 0 trial using ECAP-controlled CL-SCS at a single center in the ECAP Study. Outcomes and ECAP-based neural metrics were assessed at day 0, 3 months, and 12 months.</p><p><strong>Results: </strong>All 15 (100.0%) day 0 trial evaluations were successful, with 13 patients continuing to permanent implantation; 11 had complete follow-up through 12 months. Average pain reduction was 85.5% at day 0 and 79.6% at 12 months. Responder rates (≥ 50% improvement) remained high (81.8-92.3%), with consistently strong patient satisfaction. Most patients (57.1-72.7%) showed improvement in ≥ 4 domains associated with overall health quality. ECAP-derived neural metrics remained within ranges associated with maximal analgesic effect, confirming stable, therapeutic neural activation over time.</p><p><strong>Conclusions: </strong>Durable and holistic clinical benefits were observed through 12 months. The combination of strong patient-reported outcomes and objective confirmation of therapy delivery at patient-specific therapeutic dose levels suggests that same-day trials with ECAP-controlled CL-SCS may safely streamline SCS screening trial workflows in suitable patients without compromising clinical outcomes. This approach has the potential to reduce the risks and patient burden associated with prolonged trial durations, especially in vulnerable patient populations.</p><p><strong>Trial registration: </strong>The ECAP Study is registered with ClinicalTrials.gov (NCT04319887).</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"569-583"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344809","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":"Outcomes of Low Back Placement of Intrathecal Pumps for Patients with Chronic Pain.","authors":"Alaa Abd-Elsayed, Madelyn J Reilly, Nina Hashimoto, Kylie K Ruprecht","doi":"10.1007/s40122-026-00832-z","DOIUrl":"https://doi.org/10.1007/s40122-026-00832-z","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain poses a significant challenge to quality of life throughout the USA. It is estimated that as much as 21% of the US population experiences chronic pain, and the incidence of new chronic pain cases is shockingly high, at 52.4 cases per 1000 persons per year. An intrathecal pump (ITP) consists of a small pump surgically implanted under the skin, along with a catheter inserted into the intrathecal space in the spine. Medication, usually in the form of opioids, local anesthetics, or muscle relaxants, is then delivered through the catheter into the spinal fluid, where it can act directly on nerves to provide pain relief or reduce spasticity. The use of intrathecal drug delivery has been established for decades and is used for various conditions, including chronic noncancer pain and cancer-related pain. ITPs are also employed for managing severe spasticity in conditions such as multiple sclerosis or spinal cord injury. Over the years, there has been a gradual increase in the use of ITPs, particularly as awareness of their benefits and technological advancements has increased. ITPs have been historically placed in the abdomen. However, more recently, some ITPs have begun to be placed in the lower back. Placing ITPs in the lower back has the potential to lower operative time and complication rates, but more research in this area is warranted. This study analyzes the outcomes of posterior ITP placement to evaluate their suitability and potential benefits.</p><p><strong>Methods: </strong>This study consisted of a retrospective review including data from 115 procedures completed between 2015 and 2025. Data collection included patient demographics, preoperative and postoperative pain scores, surgical time, needle and catheter locations, and adverse events. Pain scores were collected using the visual analog scale (VAS), and data were analyzed using SPSS 29. Two-tailed paired t-tests were used to determine the significance of the difference between preoperative and postoperative pain scores.</p><p><strong>Results: </strong>A total of 115 procedures from 103 patients were included in the statistical analysis. The average preoperative pain was 6.54 (6.54 ± 2.00, n = 114), and the average postoperative pain score in the first year following the procedure was 4.45 (4.45 ± 2.30, n = 114), with a p value of < 0.001. The average surgical time for the procedure was 49.00 ± 19.53 min (n = 113).</p><p><strong>Conclusions: </strong>In this study, ITPs implanted in the lower back were associated with greater pain relief, shorter surgical times, and fewer complications than those placed in the abdomen. These findings, while indirect, provide evidence for promoting ITP placement in the lower back as a safe and effective option for patients experiencing chronic pain.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147531838","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":"A Real-World Evidence Study on US Patients Demonstrating Safety of High-Frequency Use of the Remote Electrical Neuromodulation (REN) Wearable Device for Migraine Treatment.","authors":"Reena G Rastogi, Jason A Santiago, Alicia Chang, Eden Mama, Alit Stark-Inbar, Alon Ironi, Alan R Towne, Klaus Werner","doi":"10.1007/s40122-026-00828-9","DOIUrl":"https://doi.org/10.1007/s40122-026-00828-9","url":null,"abstract":"<p><strong>Introduction: </strong>Remote electrical neuromodulation (REN) is an FDA-cleared, nonsignificant-risk, drug-free, prescribed wearable device (Nerivio^®) for the acute treatment of migraine and/or every other day for prophylactic treatment in patients aged 8 years and older. Despite established efficacy within labeled use parameters, some patients adopt more frequent treatment regimens, including multiple treatments within a single day, daily use, or both. This study assessed the safety and tolerability of REN when used at frequencies exceeding the labeled indication.</p><p><strong>Methods: </strong>Real-world observational data from patients with migraine using REN with frequent treatment patterns were collected. Safety assessments evaluated all adverse events (AE) reports, with emphasis on device-related AEs (dAEs), categorized by severity and seriousness per regulatory standards.</p><p><strong>Results: </strong>A total of 1863 patients with migraine (82.1% female, mean age of 38.8 ± 20.1 years) were eligible: (1) 1654 treated multiple times a day, at least once, (2) 310 treated daily; 101 patients met both patterns. Safety profile was favorable, with a total of 17 patients reporting dAEs (0.91% of patients, 0.02% of treatments). Of them, 16 dAEs reported in multiple treatments per day group (0.97% of patients, 0.05% of treatments), and 6 dAEs in daily treatment group (1.94% of patients, 0.01% of treatments) with 5 dAEs overlapping between the groups (reported by patients who met both criteria). dAEs were infrequent, negligible to moderate in severity, and resolved without medical intervention. No serious dAEs were observed, and the majority of patients continued to use REN after reporting the dAE.</p><p><strong>Conclusion: </strong>REN is a safe and well-tolerated treatment for migraine, even when used more frequently than the labeled indication. These findings support its use in real-world clinical practice, including for patients with severe or highly frequent attacks who may need additional treatments.</p><p><strong>Trial registration: </strong>ClinicalTrial.gov NCT07336056.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521641","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":"The Association Between Body Mass Index and Acute Postoperative Pain in Bariatric Surgery Patients: A Prospective Cohort Study.","authors":"Chong Wang, Pin Zhang, Mengmeng Zhao, Shanshan Zuo, Xing Dong, Yangxi Hu, Qinjun Chu, Yan Wang","doi":"10.1007/s40122-026-00829-8","DOIUrl":"https://doi.org/10.1007/s40122-026-00829-8","url":null,"abstract":"<p><strong>Introduction: </strong>The rising global prevalence of obesity has established bariatric surgery as a key therapeutic option; however, postoperative pain management remains a challenge. This study investigated the influence of body mass index (BMI) stratification on acute postoperative pain in patients undergoing bariatric surgery.</p><p><strong>Methods: </strong>Fifty-five patients aged 18-65 years with BMI ≥ 30 kg/m² scheduled for laparoscopic sleeve gastrectomy were categorized into the obesity group (O group; 30 kg/m² ≤ BMI < 40 kg/m²) and the severe obesity group (SO group; BMI ≥ 40 kg/m²). Preoperative pain threshold and pain tolerance threshold, perioperative inflammatory cytokines, Brief Pain Inventory (BPI) scores, Quality of Recovery-15 (QoR-15) scores, postoperative resting and movement numeric rating scale (NRS) scores, patient-controlled analgesia (PCA) pump usage, cumulative analgesic consumption, and analgesic satisfaction were assessed.</p><p><strong>Results: </strong>Compared with the O group, the SO group demonstrated a significantly higher pain tolerance threshold (4.1 ± 0.8 vs. 3.5 ± 1.0, P < 0.01), along with lower demand for PCA and reduced consumption of cumulative morphine milligram equivalents and flurbiprofen (P < 0.05). Notably, the primary outcome, the 24-h BPI score, showed no significant difference between the two groups. On postoperative days 1 and 3, tumor necrosis factor-α (TNF-α) levels were significantly lower in the O group, whereas no significant intergroup differences were observed in other inflammatory cytokines. No significant differences were observed in NRS or QoR-15 scores between the two groups.</p><p><strong>Conclusion: </strong>BMI may be considered as a factor for stratifying postoperative analgesia, favoring multimodal, opioid-sparing strategies in patients with severe obesity who demonstrate higher pain tolerance and lower analgesic requirements.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2400095080.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513785","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":"Real-World Safety and Effectiveness of Mirogabalin in Chinese Adults with Diabetic Peripheral Neuropathic Pain: a Protocol of ReMIssion Study.","authors":"Lin Zhao, Botao Liu, Hong Chen, Bin Lu, Weimin Wang, Yiqian Shi, Min Li, Na Guo, Bifa Fan, Xiaoying Li","doi":"10.1007/s40122-026-00827-w","DOIUrl":"https://doi.org/10.1007/s40122-026-00827-w","url":null,"abstract":"<p><strong>Introduction: </strong>Mirogabalin is an oral Ca²⁺ channel α₂δ ligand used for treating diabetic peripheral neuropathic pain (DPNP) in China. However, there is limited real-world evidence on its safety and effectiveness in treating adult patients with DPNP in China. This study aims to evaluate the safety and effectiveness of mirogabalin in patients with DPNP treated in a routine clinical practice in China.</p><p><strong>Methods: </strong>The ReMIssion study is a multicenter, prospective, observational study that aims to enroll 720 patients from around 36 centers. The study population will consist of patients aged ≥ 18 years, who are treatment-naïve, and have a visual analog scale (VAS) score of ≥ 40 mm. Patients will be observed for 15 weeks, including 14 weeks of mirogabalin treatment and a 1-week follow-up.</p><p><strong>Planned outcomes: </strong>The primary endpoint is to evaluate the real-world safety of mirogabalin, whereas the secondary endpoint is to evaluate the real-world effectiveness of mirogabalin in Chinese patients with DPNP. Exploratory endpoints will investigate the real-world usage pattern and patient-reported outcomes (PRO) associated with mirogabalin treatment in Chinese adult patients with DPNP. In China, this is the first observational study focusing on the safety and effectiveness of mirogabalin in real-world clinical practice. Mirogabalin may offer clinical benefits for DPNP management, including improved real-world effectiveness, tolerable safety, and favorable usage patterns, potentially enhancing patient-reported outcomes.</p><p><strong>Trial registration: </strong>Clinicaltrial.gov/NCT06812117.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481302","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":"Acetyl-L-Carnitine in the Treatment of Peripheral Neuropathies: A Narrative Review.","authors":"Diego Maria Michele Fornasari","doi":"10.1007/s40122-026-00826-x","DOIUrl":"https://doi.org/10.1007/s40122-026-00826-x","url":null,"abstract":"<p><p>Acetyl-L-carnitine is an ester of L-carnitine, both endogenous molecules, with a vital role in lipid metabolism. Exogenously delivered acetyl-L-carnitine is endowed with neuroprotective and neurotrophic actions due to its antioxidant and metabolic properties. Moreover, acetyl-L-carnitine is an epigenetic regulator of genes involved in analgesia such as the metabotropic glutamate 2 receptor in the presynaptic neurons and of neurotrophic factors including nerve growth factor. Accordingly, its long-term neurotrophic and analgesic activity has been confirmed in animal models of chronic inflammatory and neuropathic pain and in clinical studies in patients with peripheral neuropathies. The aim of this narrative review was to summarise the available evidence on the usefulness of acetyl-L-carnitine in the treatment of peripheral neuropathies.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147459202","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":"Association Between Triglyceride Glucose Index and Postherpetic Neuralgia in Patients with Acute Herpes Zoster: A Retrospective Study.","authors":"Ziwei Lu, Chengcheng Zhao, Tong Zhi, Huadong Ni, Ming Yao","doi":"10.1007/s40122-026-00824-z","DOIUrl":"https://doi.org/10.1007/s40122-026-00824-z","url":null,"abstract":"<p><strong>Introduction: </strong>Insulin resistance (IR) is an important factor in the development of chronic pain. The triglyceride-glucose (TyG) index is a convenient measure of insulin resistance. However, as a common subtype of chronic pain, the relationship between postherpetic neuralgia (PHN) and the TyG index remains unclear. Through a retrospective analysis of the relationship between the TyG index and the incidence of PHN, we aim to determine whether the TyG index possesses predictive capability for PHN occurrence, thereby enabling the development of strategies to reduce the incidence of PHN.</p><p><strong>Methods: </strong>This retrospective study analyzed the medical records of patients diagnosed with acute herpes zoster (with a disease course of ≤ 1 month) in the Pain Department of Jiaxing University Affiliated Hospital from November 2024 to May 2025. Eligible patients were those who had available data on triglycerides and glucose, and no history of diabetes. Relevant clinical data were extracted from existing records and subjected to retrospective analysis. The numerical rating scale (NRS) score was utilized as the primary outcome measure to assess whether patients developed PHN. Those who still had pain (NRS ≥ 4) were classified as the PHN group, while those without pain symptoms (NRS < 4) were classified as the non-PHN group. The association between the TyG index and PHN was evaluated using multi-model logistic regression. In addition, the nonlinear relationship between these indicators and the results was studied using a restricted cubic spline plot. Subsequently, subgroup analyses were conducted on the sensitive population. The predictive value of the TyG index for PHN was evaluated using the receiver operating characteristic curve.</p><p><strong>Results: </strong>The retrospective study comprised 157 patients with acute herpes zoster, of whom 55 were male and 102 female, with a mean age of 64.87 ± 11.67 years. The TyG index in patients with acute herpes zoster exhibited a nonlinear relationship with PHN, with an odds ratio (OR) and 95% confidence interval (CI) of 4.32 (1.56-11.97). A linear correlation was found between the triglyceride-glucose-body mass index (TyG-BMI) and PHN, with OR and 95% CI of 1.07 (1.02-1.11). The TyG index and the TyG-BMI showed similar performance on the receiver operating characteristic (ROC) curve for evaluating PHN and have certain predictive value.</p><p><strong>Conclusion: </strong>Higher TyG index and TyG-BMI are associated with an increased risk of PHN.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, ChiCTR2500113190 (retrospectively registered). Registration Date: November 26, 2025.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147459189","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":"Efficacy of Transcutaneous Auricular Vagus Nerve Stimulation for Postoperative Pain Relief in Patients Undergoing Elective Laparoscopic Gastrointestinal Tumor Surgery.","authors":"Yu Yi, Yongjie Li, Ge Luo, Yiqi Fang, Lin He, Hongjin Ni, Hongming Wu, Meihui Li, Suyun Xia, Weidong Wu, Longfei Ma, Lina Yu","doi":"10.1007/s40122-026-00825-y","DOIUrl":"https://doi.org/10.1007/s40122-026-00825-y","url":null,"abstract":"<p><strong>Introduction: </strong>Acute postoperative pain remains prevalent among patients undergoing gastrointestinal tumor surgery. The study was conducted to evaluate the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) in alleviating postoperative pain in this population.</p><p><strong>Methods: </strong>This patient- and assessor-blinded randomized controlled trial was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine. Eligible participants who underwent elective laparoscopic gastrointestinal tumor surgery were randomly assigned to the taVNS or control stimulation group. Both groups received the stimulation on the day before surgery and the day after surgery. The primary outcome was the change in visual analogue scale (VAS) scores at 24 h postoperatively.</p><p><strong>Results: </strong>The median reduction in VAS scores was 12.0 in the taVNS group, compared with 5.0 in the control stimulation group (median [interquartile range, IQR] 12.0 [10.0-13.3] mm vs 5.0 [2.0-8.0] mm; P < 0.001). Additionally, the taVNS group showed lower cumulative morphine milligram equivalents (MME) at 48 h (median [IQR] 0 [0-5] mg vs 5 [0-10] mg; P = 0.004) and 72 h (median [IQR] 0 [0-5] mg vs 5 [0-10] mg; P = 0.002), and shorter time to first flatus (median [IQR] 45 [40-60] h vs 75 [60-85] h; P < 0.001). The incidence of complications, length of hospital stay, and quality of recovery-15 (QoR-15) scores are similar between groups.</p><p><strong>Conclusion: </strong>TaVNS statistically alleviated postoperative pain in patients undergoing gastrointestinal tumor surgery, decreased analgesic requirements, and promoted gastrointestinal function recovery.</p><p><strong>Trial registration: </strong>NCT06763913.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147459216","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}