Pain and Therapy最新文献

{"title":"Efficacy and Safety of Oral Zavegepant in Migraine Prevention: A Phase 2/3 Randomized, Double-Blind, Placebo-Controlled Study in Patients with Chronic Migraine.","authors":"Robert J Fountaine, Sergey Dubrovin, Linda Mosher, Jing Liu, Mohamed H Shahin, Terence Fullerton","doi":"10.1007/s40122-026-00861-8","DOIUrl":"10.1007/s40122-026-00861-8","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess the efficacy and safety of once daily oral zavegepant as a preventive treatment for chronic migraine.</p><p><strong>Methods: </strong>This multicenter, randomized, double-blind, placebo-controlled phase 2/3 study consisted of a 12-week double-blind treatment (DBT) phase and a 52-week open-label extension (OLE). Adults with ≥ 1-year history of chronic migraine (with or without aura), ≥ 15 headache days/month, ≥ 8 migraine days/month, and ≥ 1 headache-free day/month during the 3 months prior to screening were randomly assigned 2:2:1:1 to zavegepant 100 mg, 200 mg, placebo for zavegepant 100 mg, or placebo for zavegepant 200 mg. Following a 28-day observation phase (OP), participants took the study treatment every calendar day. The primary endpoint was mean change from the OP in number of migraine days/month in the DBT phase. This study was stopped prematurely due to recruitment challenges.</p><p><strong>Results: </strong>Of 1753 screened participants, 522 were treated and 411 completed the DBT phase. Participants were predominantly female (n = 391, 79.5%) and mean (SD) age of chronic migraine onset was 26.5 (11.7) years. The mean (97.5% CI) changes from the OP in number of migraine days/month in the DBT phase were - 7.0 (- 8.10, - 5.92), - 6.3 (- 7.45, - 5.10), and - 5.6 (- 6.80, - 4.37) for zavegepant 100 mg, 200 mg, and placebo groups, respectively. The corresponding least squares (LS) mean change differences (zavegepant-placebo pooled; 97.5% CI) were - 1.4 (- 2.72, - 0.12) and - 0.7 (- 2.07, 0.69) for zavegepant 100 mg and zavegepant 200 mg groups, respectively. During DBT, 21 (12.1%) and 14 (8.0%) participants had at least one adverse event considered zavegepant-related in the zavegepant 100 mg and 200 mg groups, respectively, with corresponding rates of nine (5.8%) and nine (6.3%) participants during the OLE.</p><p><strong>Conclusions: </strong>Oral zavegepant had a favorable safety and tolerability profile for up to 200 mg daily. Additional research is needed to determine the effectiveness of oral zavegepant as a preventive migraine treatment.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov number: NCT04804033.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1653-1672"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831518","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":"Persistence and Reasons for Treatment Discontinuation of Anti-CGRP Therapies in Migraine Prophylaxis: A Systematic Review and Meta-analysis of Real-World Studies.","authors":"Lanfranco Pellesi, Aidin Yangjeh, Ibrahim Hajjaj, Dilara Onan, Marta Waliszewska-Prosół, Paolo Martelletti","doi":"10.1007/s40122-026-00895-y","DOIUrl":"https://doi.org/10.1007/s40122-026-00895-y","url":null,"abstract":"<p><strong>Introduction: </strong>Anti-calcitonin gene-related peptide (anti-CGRP) therapies have become a mainstay of migraine prophylaxis. In routine care, treatment persistence and the reasons patients discontinue are indicators of long-term effectiveness, tolerability, and acceptability, but the available real-world evidence is fragmented across settings. We aimed to synthesize treatment persistence at 3, 6, and 12 months and to summarize the documented reasons for discontinuation.</p><p><strong>Methods: </strong>This systematic review and meta-analysis (PROSPERO CRD420261298053) searched Embase (via Ovid) and PubMed for real-world studies with a clinical follow-up of adults receiving an anti-CGRP therapy for migraine prophylaxis with longitudinal follow-up. Persistence, defined as the proportion of patients remaining on treatment from initiation, was pooled using random-effects meta-analysis of proportions. Reasons for discontinuation were pooled descriptively. Exploratory subgroup analyses examined migraine type, drug class, and individual monoclonal antibody.</p><p><strong>Results: </strong>Fifty-three studies were included. Pooled persistence was 93.3% (95% CI 90.2-95.9) at 3 months, 84.2% (80.4-87.6) at 6 months and 76.2% (69.7-82.2) at 12 months, with substantial heterogeneity throughout (I² 82-93%). Among 1242 documented discontinuation events, lack of efficacy was the leading reason (63.7%), followed by adverse events or poor tolerability (15.1%). Persistence did not differ significantly by migraine type or between individual monoclonal antibodies. Atogepant showed lower 3-month persistence than monoclonal antibodies (83.5% vs. 94.2%; p = 0.013), although data were limited to early follow-up.</p><p><strong>Conclusions: </strong>Approximately three-quarters of patients remain on anti-CGRP therapy at 1 year, with most discontinuation occurring within the first six months and driven mainly by perceived lack of efficacy rather than tolerability. Marked between-study heterogeneity warrants cautious interpretation and more standardized reporting of persistence in future real-world studies.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113067","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 Migraine Care Gap: A Qualitative Analysis of Patients' Perspectives on Medical Progress and Persistent Unmet Needs.","authors":"Carl H Göbel, Maximilian Zimmermann, Axel Heinze, Katja Heinze-Kuhn, Anna Cirkel, Hartmut Göbel","doi":"10.1007/s40122-026-00894-z","DOIUrl":"https://doi.org/10.1007/s40122-026-00894-z","url":null,"abstract":"<p><strong>Introduction: </strong>Despite remarkable advances in migraine diagnosis and treatment, it remains unclear to what extent these developments have translated into meaningful improvements in the everyday lives of people living with migraine. This qualitative study explored how patients perceive the evolution of migraine care over the past decade and identified persistent unmet needs from their perspective.</p><p><strong>Methods: </strong>A qualitative exploratory study was conducted using reflexive thematic analysis. The dataset comprised 446 publicly available patient narratives posted in response to an Instagram Reel and a corresponding Facebook post inviting individuals with migraine to reflect on changes in migraine care over the previous 12 years. Comments describing personal experiences with diagnosis, treatment, healthcare delivery, social participation and future expectations were analysed inductively following the methodological framework proposed by Braun and Clarke.</p><p><strong>Results: </strong>Analysis identified four overarching conceptual domains. Participants consistently acknowledged substantial progress in migraine medicine, particularly through migraine-specific acute therapies, calcitonin gene-related peptide (CGRP)-targeted preventive treatments, specialised headache services and improved access to disease-related information. However, these advances were perceived as only partially reflected in clinical practice and everyday life. Persistent barriers included delayed diagnosis, unequal access to specialised care, reimbursement restrictions, workplace challenges, stigma and limited societal recognition of migraine as a disabling neurological disorder. Patients defined treatment success far more broadly than reductions in monthly migraine days, emphasising restored participation, autonomy, predictability, self-efficacy and quality of life. Across all themes, a recurring discrepancy emerged between rapid biomedical innovation and the slower evolution of healthcare delivery and social recognition, conceptualised as the Migraine Care Gap.</p><p><strong>Conclusion: </strong>Patients perceive migraine care as having undergone substantial scientific progress while continuing to experience important medical, structural and societal shortcomings. These findings suggest that future advances should extend beyond therapeutic innovation and include earlier diagnosis, equitable access to specialist care, structured patient education, multidisciplinary management and broader implementation of patient-centred outcome measures. Closing the Migraine Care Gap may represent a key challenge for the next stage of migraine care.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113015","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":"Post Hoc Analysis of Time to First and Sustained Improvement in Weekly Migraine Days Among Patients Receiving Preventive Treatment With Rimegepant 75 mg.","authors":"Stewart J Tepper, Lucy Abraham, Andrew G Bushmakin, Joseph C Cappelleri, Terence Fullerton, Jiyue Yang, Richard B Lipton","doi":"10.1007/s40122-026-00887-y","DOIUrl":"https://doi.org/10.1007/s40122-026-00887-y","url":null,"abstract":"<p><strong>Introduction: </strong>For preventive migraine treatment, understanding an intervention's onset, extent of action, and duration can help set realistic treatment expectations and may help prevent both premature discontinuation and reduce unnecessary prolonged exposure. Rimegepant is an oral calcitonin gene-related peptide receptor (CGRP) antagonist with demonstrated efficacy in the acute and preventive treatment of migraine. This post hoc analysis aimed to assess the onset of benefits of rimegepant 75 mg for the preventive treatment of migraine.</p><p><strong>Methods: </strong>Median (25th, 75th percentiles) time to first and sustained reductions in weekly migraine days (WMDs) were estimated. Improvements from baseline were evaluated in 10% increments. Time to first improvement was based on the first week that a reduction of a particular magnitude was achieved, and time to sustained improvement was defined as the week that a reduction at a particular level was achieved and that persisted, on average, until study end.</p><p><strong>Results: </strong>Among 370 participants, the median (25th, 75th percentiles) time to first reduction in WMDs of ≥ 50% was 2 (1, 4) weeks. Thus, 50% of patients are expected to experience ≥ 1 week with a ≥ 50% reduction in WMDs within the first 2 weeks. The median (25th, 75th percentiles) time to a sustained reduction in WMDs of ≥ 50% was 3 (1, 14) weeks. Accordingly, 50% of patients are expected to experience a ≥ 50% reduction in WMDs by week 3 and to maintain this improvement, on average, up to week 64.</p><p><strong>Conclusion: </strong>Following rimegepant 75-mg treatment initiation, it is expected that 50% of patients will experience first ≥ 50% reduction in WMDs by week 2 and sustained reduction by week 3. Graphical abstract available for this article.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov number: NCT03732638. https://www.</p><p><strong>Clinicaltrials: </strong>gov/study/NCT03732638 .</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113098","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":"Beyond Nerve Hyperexcitability: Potential Implications of Cerebrospinal Fluid CASPR2 Antibodies for Central Pain Processing in Isaacs Syndrome: A Case-Based Systematic Review.","authors":"Rafaella Theologou, Panagiotis Zis","doi":"10.1007/s40122-026-00893-0","DOIUrl":"https://doi.org/10.1007/s40122-026-00893-0","url":null,"abstract":"<p><strong>Introduction: </strong>Isaacs syndrome (IS), or acquired neuromyotonia, is a rare immune-mediated neuromuscular disorder characterized by increased peripheral nerve excitability. Clinically, it manifests with fasciculations, cramps, excessive sweating, and the presence of CASPR2 autoantibodies in the serum. IS can occur as a paraneoplastic condition or may remain idiopathic.</p><p><strong>Methods: </strong>We report an adult case of IS that prompted a case-based literature review investigating the association between cerebrospinal fluid (CSF) CASPR2 antibodies and IS. A systematic literature search of PubMed and Scopus was conducted on 7 July 2026, with reference-list screening of eligible articles for additional relevant studies. Eligible studies reported original data on adults with IS and CSF CASPR2 antibody testing; reviews, editorials, abstracts, letters, pediatric studies, and studies without relevant CSF testing were excluded.</p><p><strong>Discussion: </strong>A 65-year-old man with a history of prostate cancer, treated with radiotherapy 4 years earlier, presented with a 3-year history of neuropathic pain and painful lower-limb cramps. Examination revealed fasciculations in all limbs and brisk tendon reflexes, with no Babinski sign. Neurophysiological studies demonstrated spontaneous doublet, triplet, and multiplet discharges. IS was supported by weakly positive serum VGKC-complex antibodies, low-positive LGI1 antibodies, and strongly positive CASPR2 antibodies, with strong CASPR2 positivity in cerebrospinal fluid, despite the absence of clinical features of Morvan syndrome. Our literature review identified six additional cases of IS in which CSF CASPR2 antibodies were tested. Of these, three had positive CSF CASPR2 antibody results. In two cases, IS remained idiopathic, whereas, in the third, it was associated with recurrent malignant thymoma. Including our patient, all reported cases of IS with CSF CASPR2 positivity presented with neuropathic pain.</p><p><strong>Conclusion: </strong>IS should be considered in patients presenting with painful muscle cramps and electromyographic evidence of peripheral nerve hyperexcitability. The presence of CASPR2 antibodies in the CSF may be associated with neuropathic pain and could suggest involvement of pain pathway sensitization, potentially including central sensitization mechanisms.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081715","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":"Glymphatic-Hippocampal Axis Alterations Across the Migraine-Medication Exposure Continuum: A Multi-modal Neuroimaging Study.","authors":"Ange Li, Qiongfeng Guan, Weinv Fan, Guoping Chen, Bin Chen, Li Li, Zhenyi Fan, Yunqin Wu","doi":"10.1007/s40122-026-00883-2","DOIUrl":"https://doi.org/10.1007/s40122-026-00883-2","url":null,"abstract":"<p><strong>Introduction: </strong>Medication-overuse headache (MOH) is a debilitating consequence of analgesic use, yet its pathophysiology remains incompletely characterised. Impaired glymphatic clearance may contribute to headache chronification. We investigated whether glymphatic-structural alterations progress across the migraine-medication exposure continuum and their biomarker potential.</p><p><strong>Methods: </strong>This cross-sectional study enrolled 149 right-handed participants: 29 MOH patients, 34 patients with migraine and moderate medication use (MM), 46 medication-naive migraine patients (MN), and 40 healthy controls (HCs). The diffusion tensor imaging along the perivascular space (DTI-ALPS), perivascular space volume fraction (PVSVF), free water, and regional brain volumes were quantified. Group differences, imaging-clinical correlations, and diagnostic utility were assessed.</p><p><strong>Results: </strong>Right-hemispheric centrum semiovale (CSO) PVSVF increased progressively across the continuum (HC < MN < MM < MOH; linear trend p = 0.003), with elevation in MOH versus controls (Cohen's d = 0.59, p = 0.014). Hippocampal volume was reduced in all migraine groups, most in MOH (d =  - 0.61, p = 0.001). DTI-ALPS and free water showed no group differences. Lower DTI-ALPS was associated with higher hippocampal free water in MOH (r =  - 0.539, p_FDR = 0.043). Hippocampal decline accelerated beyond approximately 11 years disease duration (exploratory). A combined right PVSVF-CSO and hippocampal volume model distinguished MOH from controls, with an area under the curve (AUC) of 0.75.</p><p><strong>Conclusion: </strong>A graded, cross-sectional increase in perivascular space burden and reduced hippocampal volume, with right-hemispheric predominance, were observed across the migraine-medication exposure continuum. These markers may serve as adjunctive tools for MOH evaluation, meriting independent cohorts.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075415","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":"Effect of Bilateral Ultrasound-Guided Deep Parasternal Intercostal Plane Block Before Extubation on Early Recovery After Cardiac Surgery via Median Sternotomy: A Randomized Controlled Trial.","authors":"Zhousheng Jin, Jiaying Sun, Yujun Zha, Shijie Ji, Shikang Deng, Youmei Qiang, Hongfei Chen","doi":"10.1007/s40122-026-00892-1","DOIUrl":"https://doi.org/10.1007/s40122-026-00892-1","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative pain remains a major concern after cardiac surgery via median sternotomy and may impair early recovery. Deep parasternal intercostal plane (DPIP) block is a regional analgesic technique targeting the parasternal intercostal nerves, but the effect of DPIP block performed before extubation on postoperative recovery has not been well defined. We therefore evaluated whether bilateral ultrasound-guided DPIP block administered before extubation could improve early recovery after median sternotomy cardiac surgery.</p><p><strong>Methods: </strong>In this single-center, prospective, randomized, single-blind, controlled trial, 64 adults undergoing elective cardiac surgery via median sternotomy were randomly assigned in a 1:1 ratio to receive either a bilateral ultrasound-guided DPIP block with 0.375% ropivacaine or a saline placebo nerve block (control group) before extubation. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h after extubation. Secondary outcomes included the QoR-15 score at 48 h after extubation, cumulative sufentanil consumption during the first 24 h after extubation, rescue analgesia requirement, time to first ambulation, and postoperative adverse events.</p><p><strong>Results: </strong>Of the 64 randomized patients, 61 were included in the final analysis (30 in the DPIP group and 31 in the control group). Total QoR-15 scores were higher in the DPIP group than in the control group at both 24 h (112.83 ± 13.13 vs. 101.83 ± 13.50; P = 0.002) and 48 h (127.93 ± 9.65 vs. 121.53 ± 8.83; P = 0.01) after extubation. Cumulative sufentanil consumption during the first 24 h after extubation was lower in the DPIP group (50.00 [21.26-57.60] μg vs. 60.10 [48.00-63.40] μg; P = 0.016), and postoperative nausea and vomiting occurred less frequently (13.3% vs. 38.7%; P = 0.024). No significant between-group differences were observed in rescue analgesia requirement or time to first ambulation.</p><p><strong>Conclusion: </strong>Bilateral ultrasound-guided DPIP block performed before extubation was associated with improved early recovery after median sternotomy cardiac surgery, reflected by higher QoR-15 score, lower postoperative sufentanil consumption, and less postoperative nausea and vomiting. These findings suggest that the timing of DPIP block administration may be important in optimizing recovery after cardiac surgery. Future multicenter studies or studies with extended follow-up may be conducted to validate the generalizability of these findings.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2400092616.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040341","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":"Anterior Infraspinatus Tendon Lesions and Selective Superior Muscle Belly Atrophy: A Case Series Introducing a Novel Ultrasound-Based Approach for Precise Rotator Cuff Tear Localization.","authors":"Salvatore Massimo Stella, Roberta Gualtierotti, Fabio Vita, Gianni Nucci, Luca Puce, Stefano Galletti, Filippo Cotellessa","doi":"10.1007/s40122-026-00890-3","DOIUrl":"https://doi.org/10.1007/s40122-026-00890-3","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate ultrasound (US) localization of full-thickness rotator cuff tears remains challenging when lesions extend from the supraspinatus to the anterior infraspinatus tendon, due to anatomical overlap at the greater tuberosity. We hypothesized that selective hypotrophy of the superior infraspinatus muscle belly represents an early imaging marker of combined tendon involvement.</p><p><strong>Methods: </strong>Five adult patients (mean age 53.6 ± 19.1 years) with recent traumatic shoulder pain and full-thickness tears (Snyder C 1-2; Patte I-II) underwent US evaluation, combining axial and longitudinal tendon scans with comparison of infraspinatus muscle trophism with the contralateral side. Hypotrophy was graded by contour, echogenicity, and cross-sectional area; strain elastography was used to calculate strain ratios. Paired comparisons used both a paired Student's t-test and an exact two-sided Wilcoxon signed-rank test.</p><p><strong>Results: </strong>US showed involvement of both the supraspinatus and anterior infraspinatus tendons in all cases, indicating that standard imaging may underestimate tendon involvement and misclassify these as isolated supraspinatus tears. Selective superior infraspinatus hypotrophy was consistently observed, with mean scores of 1.6 ± 0.55 (profile), 1.0 ± 0.71 (echogenicity), and 1.8 ± 0.45 (area). Strain ratios were lower in the hypotrophic than in the contralateral muscle in all five patients (t-test p = 0.00055; Wilcoxon p = 0.0625). Interobserver agreement was excellent (κ = 1.00; intraclass correlation coefficient = 0.90). Magnetic resonance imaging, available in three cases, confirmed our findings.</p><p><strong>Conclusions: </strong>Superior infraspinatus hypotrophy is a reproducible US marker of anterior infraspinatus tendon involvement and may improve precise rotator cuff tear localization.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025724","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":"Age-Related Transitions in Low Back Pain Pathology: A Life-Course Narrative Review.","authors":"Tatsunori Ikemoto, Atsuhiko Hirasawa, Norimitsu Wakao","doi":"10.1007/s40122-026-00891-2","DOIUrl":"https://doi.org/10.1007/s40122-026-00891-2","url":null,"abstract":"<p><strong>Introduction: </strong>Low back pain (LBP) represents the primary global cause of years lived with disability, significantly compromising health-related quality of life and imposing a substantial economic burden on healthcare systems. This narrative review conceptualizes LBP as a dynamic life-course process rather than a static diagnostic entity.</p><p><strong>Method: </strong>A comprehensive search of PubMed, Scopus, and Web of Science was conducted using MeSH and free-text terms (e.g., \"Low Back Pain,\" \"Aging,\" spine diseases) for clinical trials, cohorts, and reviews published from inception through to January 2026.</p><p><strong>Results: </strong>In adolescence, the focus is primarily on mechanical stress-induced spondylolysis among young athletes. As individuals transition into young adulthood, the pathological emphasis shifts toward intervertebral disc health, marked by symptomatic herniation and the emergence of Modic changes, alongside the increasing relevance of psychosocial \"Yellow Flags\" in predicting chronicity. By middle and older adulthood (60+), cumulative degenerative changes involve both the intervertebral discs and facet joints, frequently manifesting as lumbar spinal stenosis and sagittal malalignment. During this phase, global spinal balance replaces localized pathology as the primary determinant of disability. For late-old adults (80+), the clinical landscape is dominated by the synergistic impacts of sarcopenia and osteoporosis, shifting the assessment focus from flexibility to functional standing and walking capacity. The high prevalence of fragility fractures and the potential for serious \"red flag\" conditions necessitate a high index of clinical suspicion in this demographic.</p><p><strong>Conclusions: </strong>LBP is not a static diagnostic entity but a dynamic, evolving process that shifts across the human lifespan.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990908","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":"Improving Clinical Trial Design in Low Back Pain: Insights from Studies of Gabapentinoids.","authors":"Ralf Baron, Rainer Freynhagen, Bart Morlion, Andrea Truini, Chris Walker, Sebnem Er, Gavin J Lyndon","doi":"10.1007/s40122-026-00886-z","DOIUrl":"https://doi.org/10.1007/s40122-026-00886-z","url":null,"abstract":"<p><p>Low back pain (LBP) is one of the leading causes of disability worldwide, affecting hundreds of millions of people globally. Scientific literature continues to highlight key issues in managing these patients, including accuracy of diagnostic terminology, identification of the specific pain mechanisms, and lack of effective licensed treatment options. Using published clinical trials of gabapentinoids to provide insights, we discuss key methodological and clinical factors, such as the accurate use of terminology, appropriate patient selection, effective application of screening tools, and mechanism-based selection of medicines at therapeutic doses. It is important to select a patient population appropriately for the specific pain mechanism treated by the medicine under assessment. Current evidence suggests that identification of a neuropathic component in clinical trials is often inadequate, with many studies either failing to use available validated screening tools or applying them without sufficient methodological rigor. Alongside this, spontaneous resolution of acute pain in low back patients remains an important confounder that is often not thoroughly accounted for. Patients with LBP represent a highly heterogeneous group, and the potential disconnect between diagnosis and mechanism is not helped by older nonspecific terminology. The clinical community continues to improve the terminology, such as the recent International Association for the Study of Pain (IASP) definition of \"spine-related leg pain\" updating the older diagnosis of \"sciatica.\" Defining or further stratifying a patient population (for example, using neuropathic screening tool scores) and then evaluating multiple treatments effective for nociceptive or neuropathic pain may improve a study's discriminatory power while reducing the number of patients required. Once initial drug efficacy has been established in randomized, placebo-controlled trials, additional study designs targeting specific patient populations can still provide valuable insight into key clinical questions, often requiring substantially fewer resources.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956314","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}