Pain and Therapy最新文献

{"title":"Selective EP4 Receptor Antagonism for Osteoarthritis Pain: Emerging Evidence and Future Directions for KF-0210.","authors":"Ahmed I Anwar, Tucker L Apgar, Abdul-Rahman A Hegazi, John L Dolan, Lucas M Corona, Alan D Kaye","doi":"10.1007/s40122-026-00888-x","DOIUrl":"https://doi.org/10.1007/s40122-026-00888-x","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a leading cause of chronic pain and disability. Its increasing global prevalence and substantial socioeconomic burden highlights need for safer and more effective therapeutic strategies. Current pharmacological treatments provide symptomatic relief; however, are limited by gastrointestinal, cardiovascular, renal, and other adverse effects. Prostaglandin E2 (PGE2)-mediated EP4 receptor signaling plays a central role in OA pain, peripheral sensitization, subchondral bone remodeling, and cartilage degeneration, which makes EP4 an attractive therapeutic target. Current evidence suggests that KF-0210 is a potential therapy for OA pain and the present investigation summarizes pathophysiology of OA pain, the biological role of PGE2-EP4 signaling pathway, and the rationale for selective EP4 antagonism as a targeted alternative to conventional cyclooxygenase inhibition. Preclinical and clinical evidence for the oral EP4 antagonist KF-0210 is reviewed, including pharmacological properties, analgesic efficacy, safety profile, and potential disease-modifying mechanisms compared with existing OA therapies. Although the available evidence remains preliminary, selective EP4 antagonism represents a novel therapeutic strategy that requires further investigation.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920846","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":"Surgeon Perceptions and Experiences with Postoperative Acute Pain Management: A Mixed-Methods Study.","authors":"Vinod Dasa, Scott J Keating, Sushanth Jeyakumar, K D Jacobs, Lauren A Crowder, Sloan Rucker, Alexandra J Feld, Moeen Panni, Ann M Menzie","doi":"10.1007/s40122-026-00842-x","DOIUrl":"10.1007/s40122-026-00842-x","url":null,"abstract":"<p><strong>Introduction: </strong>Although prior studies have examined healthcare providers' perspectives on opioid prescribing for postoperative pain, limited research exists on surgeons' experiences managing acute postoperative pain in adults. This study evaluated surgeons' perceptions and experiences to better understand challenges in managing acute pain and assess perceived impacts of inadequately managed pain on patients.</p><p><strong>Methods: </strong>A sequential mixed methods study was conducted using concept elicitation interviews and a descriptive quantitative survey, with a convenience sample of United States (US)-based general, orthopedic, and plastic surgeons. Interview findings identified key themes related to surgeons' perceptions of challenges and barriers associated with managing postoperative acute pain. These themes informed the development of a survey to quantify surgeons' unmet needs, challenges, and experiences regarding postoperative pain management.</p><p><strong>Results: </strong>Key themes from the interviews (N = 30) included challenges with effective pain management, advantages and disadvantages of commonly used pain medications, and difficulties managing pain in special populations. Among surveyed surgeons (N = 80), the most frequently reported challenges were managing patient pain management expectations (72.5%) and balancing adequate analgesic effect with risk of adverse events (71.3%). Approximately half (53.8%) were \"moderately satisfied\" with pain medications available during the study period, identifying the most important medication characteristics as the degree and duration of analgesic effect and time to onset. Most surgeons (80.0%) reported that concerns about opioid addiction or dependency \"moderately\" to \"extremely impacted\" their prescribing patterns. Additionally, 65% of surgeons indicated that inadequately managed postoperative pain has a moderate to extreme impact on patient recovery.</p><p><strong>Conclusions: </strong>Surgeon experiences with postoperative pain management emphasize challenges and unmet needs surrounding acute pain medications and highlight surgeons' perceptions of the negative impacts of inadequately managed acute pain on patients.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1109-1129"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948951","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":"Transcutaneous Pulsed Radiofrequency in Chronic Pain: A Systematic Review of Randomized Controlled Trials.","authors":"Thalis Asimakopoulos, Athanasia Tsaroucha, Martina Rekatsina","doi":"10.1007/s40122-026-00849-4","DOIUrl":"10.1007/s40122-026-00849-4","url":null,"abstract":"<p><strong>Introduction: </strong>Transcutaneous pulsed radiofrequency (TcPRF) is a non-invasive neuromodulation technique increasingly investigated for the management of chronic pain. However, its clinical efficacy and safety across different chronic pain conditions remains uncertain.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, and Google Scholar was performed from database inception to March 2026. Randomized controlled trials (RCTs) evaluating TcPRF in chronic pain conditions were included. Pain intensity, functional outcomes, and safety data were extracted. Risk of bias was assessed using the Cochrane RoB 2 tool.</p><p><strong>Results: </strong>Eight RCTs were included, encompassing both musculoskeletal and neuropathic pain conditions. TcPRF was associated with reductions in pain intensity in most studies, with more consistent effects observed in sham-controlled trials and at later follow-up time points. Functional outcomes generally improved in parallel with pain, although results varied depending on the outcome measures used. TcPRF was well tolerated, with no serious adverse events reported. However, substantial heterogeneity was noted in patient populations, comparator interventions, treatment protocols, and outcome measures.</p><p><strong>Conclusion: </strong>TcPRF appears to be a promising non-invasive treatment option for selected chronic pain conditions, particularly when a minimally invasive approach is preferred. Nevertheless, current evidence remains limited by heterogeneity and methodological variability. Further large-scale, well-designed RCTs with standardized treatment protocols and longer follow-up are required to clarify its clinical role.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1049-1064"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265421","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 Characteristics and Treatment Patterns of Calcitonin Gene-Related Peptide Monoclonal Antibody Users: a Japanese Claims Database-Based Study.","authors":"Tsubasa Takizawa, Ryo Takemura, Kaname Ueda, Yasuhiro Miki, Chie Hashimoto","doi":"10.1007/s40122-026-00843-w","DOIUrl":"10.1007/s40122-026-00843-w","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding real-world calcitonin gene-related peptide monoclonal antibodies' (CGRP mAbs) use in patients with migraine is necessary to potentially guide treatment strategies.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed administrative claims data from the IQVIA claims data for Japan. It included CGRP mAb-naïve individuals with confirmed migraine diagnosis and ≥ 1 CGRP mAb prescription (January 2021-June 2023). Index date was the first CGRP mAb prescription. Patient characteristics, treatment patterns, adherence (proportion of days covered ≥ 0.80), persistence, and migraine-related direct costs were assessed. Persistence was measured as the proportion of patients continuing treatment for ≥ 3 or ≥ 6 months (≤ 90-day gap between fills). Factors predicting adherence to CGRP mAb treatment were assessed using multivariate logistic regression. Subgroup analyses were conducted for galcanezumab users.</p><p><strong>Results: </strong>Of the 1781 patients included (mean age 41.8 years [standard deviation, SD 10.3]; 79.3% female patients), 55.0% received galcanezumab, followed by fremanezumab (29.7%), and erenumab (15.3%). The prescription rates of concomitant acute and oral preventive medications were 86.1% and 51.3%, respectively, in the first 3 months after initiating CGRP mAb treatment but numerically decreased to 49.8% and 22.5%, respectively, in the fourth to sixth month. The index CGRP mAb persistence rates were 91.9% for ≥ 3 months and 76.9% for ≥ 6 months, and adherence rate was 51.7%. Multiple positive and negative predictors of adherence to CGRP mAbs were observed. Index to 3 months after initiating index CGRP mAbs, the median average monthly migraine-related costs were JPY 75,320 (Q1, Q3 61,593, 89,843) (USD 592), and non-CGRP mAb migraine-related costs were JPY 15,702 (Q1, Q3 8845, 27,848) (USD 123). These costs tended to reduce or plateau for up to 12 months thereafter. The galcanezumab subgroup showed a similar trend.</p><p><strong>Conclusions: </strong>CGRP mAb adherence and ≥ 6 months persistence rates were 51.7% and 76.9%, respectively, in CGRP mAb-initiating adults with migraine in Japan. During CGRP mAb treatment, acute and oral preventive medication prescription rates appeared to reduce, while direct costs initially increased but appeared to reduce from the post-initiation peak and plateau over time, although the underlying reasons could not be determined from claims data.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1065-1083"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841468","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":"French National Guidelines for the Appropriate Use of Opioids: Analgesia, Opioid Use Disorder, and Overdose Prevention-Part 2: Prevention and Management of Opioid Use Disorder and Overdose.","authors":"Célian Bertin, Julie Dupouy, Nicolas Authier, Nathalie Michenot, Sidonie Verdier, Mathieu Chappuy, Anne-Priscille Trouvin","doi":"10.1007/s40122-026-00852-9","DOIUrl":"10.1007/s40122-026-00852-9","url":null,"abstract":"<p><p>Opioid use disorder (OUD) and overdoses represent critical challenges linked to the widespread availability of opioid medications. To address these risks, the French National Authority for Health convened a multidisciplinary working group to develop comprehensive guidelines on the prevention and management of OUD and overdoses. These recommendations expand on the second part of the guidelines, which specifically addressed the prevention and management of OUD and overdoses. Grounded in the highest level of international evidence and developed through a rigorous formal consensus process, the guidelines emphasize appropriate opioid prescribing as the cornerstone of prevention. They provide practical recommendations for identifying patients at risk, detecting problematic use early, and initiating opioid agonist treatment when indicated. The role of naloxone as an essential tool to prevent fatal overdoses is highlighted, along with strategies for coordinated and multidisciplinary care across diverse healthcare settings. By integrating prevention, treatment, and harm reduction measures, these guidelines seek to balance legitimate access to opioid analgesics with robust safeguards against opioid use disorder and overdose. Although developed within the French healthcare system, their strong evidence base and underlying clinical principles make them applicable to international practice. Together with the first part on pain management, they constitute one of the most comprehensive and up-to-date sets of recommendations on the safe and effective use of opioid medications.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"957-981"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345987","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":"Anterior Quadratus Lumborum Block: A Scoping Review of Anatomical Rationale, Techniques, and Clinical Applications.","authors":"Burhan Dost, Cengiz Kaya, Esra Turunc, Yunus Emre Karapinar, Madan Narayanan, Kiran Koneti, Dario Bugada, Alessandro De Cassai, Bayram Ufuk Sakul, Edward R Mariano, Hesham Elsharkawy","doi":"10.1007/s40122-026-00846-7","DOIUrl":"10.1007/s40122-026-00846-7","url":null,"abstract":"<p><strong>Introduction: </strong>The anterior quadratus lumborum block (aQLB) is a fascial plane block targeting the interfascial plane between the quadratus lumborum and psoas major muscles, aiming to achieve both somatic and visceral analgesia through potential spread of local anesthetic toward the thoracolumbar nerve roots. Despite years of clinical use and a growing body of randomized trials across different surgical settings, uncertainty remains regarding its mechanisms of action, patterns of local anesthetic spread, and overall clinical effectiveness. This scoping review aimed to systematically map and synthesize the available evidence on aQLB and identify key knowledge gaps relevant to clinical practice and future research.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from database inception to February 14, 2026. The search terms included variations of aQLB and related terminology. Only randomized controlled trials were included in this review.</p><p><strong>Results: </strong>A total of 1174 records were identified, of which 360 underwent full-text assessment, and 119 randomized controlled trials were included. Most studies were conducted in Asia (63%) and involved adults (92%). Abdominal and urological procedures were the most commonly studied surgical indications (56%), followed by orthopedic surgeries (26%) and obstetric-gynecological procedures (17%). Multiple aQLB variants have been reported, including transmuscular, subcostal anterior, supra-arcuate ligament, and lateral arcuate ligament approaches. Comparators included sham or no block, wound infiltration, transversus abdominis plane block, erector spinae plane block, paravertebral block, neuraxial techniques, and other regional techniques. Across studies, the aQLB generally reduced postoperative pain scores, opioid consumption, and postoperative nausea and vomiting. However, the findings were heterogeneous and varied by surgical procedure and study design.</p><p><strong>Conclusions: </strong>The available literature suggests that aQLB may provide effective postoperative analgesia and opioid-sparing benefits across different surgical procedures. However, inconsistent findings among studies, the limited number of well-designed randomized controlled trials, and substantial heterogeneity across surgical populations restrict the strength of the current conclusions. Moreover, the deep anatomical location of the block, technical complexity, and potential risks should be considered when evaluating its role in routine clinical practice.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"983-999"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864341","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":"A Novel Machine Learning Signature Incorporating Lipid and Inflammatory Biomarkers to Predict Pulsed Radiofrequency Efficacy in Zoster-Associated Pain.","authors":"Lei Zhang, Hongfei Chen, Haoying Chen, Wenjing Hu, Junkai Zhang, Zhibing Pi, Yuan Jin, Yu Peng, Linchao Li, Hai Lin, Wujun Geng","doi":"10.1007/s40122-026-00854-7","DOIUrl":"10.1007/s40122-026-00854-7","url":null,"abstract":"<p><strong>Introduction: </strong>Pulsed radiofrequency (PRF) is a pivotal neuromodulation strategy for zoster-associated pain (ZAP); however, clinical outcomes exhibit significant interindividual heterogeneity. This study aimed to identify robust predictors and develop a transparent machine learning (ML) framework to forecast treatment response, thereby facilitating individualized pain management.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of a large-scale cohort comprising 1773 patients with ZAP treated with PRF. Patients were stratified into \"responders\" and \"nonresponders\" on the basis of clinical outcomes at a 3-month follow-up. To handle an initial pool of 47 multidimensional clinical and laboratory variables, a tripartite feature selection pipeline-incorporating least absolute shrinkage and selection operator (LASSO), Boruta, and multivariable logistic regression-was implemented. We benchmarked eight ML architectures. The optimal model was interpreted using Shapley additive explanations (SHAP) to ensure biological transparency and subsequently deployed as an interactive point-of-care tool.</p><p><strong>Results: </strong>The favorable clinical response rate for PRF was 68.0%. A parsimonious set of five core predictors was identified: age, baseline Numerical Rating Scale (NRS) score, preoperative opioid use, apolipoprotein B (ApoB), and neutrophil-to-monocyte ratio (NMR). Among the candidate algorithms, the CatBoost architecture was selected for its robust performance, achieving the highest F₁ score (0.853) and an area under the receiver operating characteristic curve (AUROC) of 0.834. SHAP analysis revealed that preoperative opioid use was the most potent determinant of suboptimal response, followed by advanced age and high baseline pain intensity. Notably, elevated ApoB levels emerged as a novel metabolic indicator of favorable prognosis, whereas an increased NMR suggested a systemic pro-inflammatory state associated with diminished PRF efficacy.</p><p><strong>Conclusions: </strong>We developed and internally validated a high-performance CatBoost-based model for predicting PRF outcomes in ZAP. By integrating novel metabolic (ApoB) and immunoinflammatory (NMR) biomarkers with established clinical metrics, this model provides a granular approach to risk stratification. The deployment of a Streamlit-based calculator translates complex algorithmic insights into an accessible clinical decision-support system.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1147-1165"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259151","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":"Comparative Cost-Utility and Clinical Efficacy of 5-HT3 Receptor Antagonists in Sufentanil-Based PCIA: A Propensity Score-Matched Analysis.","authors":"Youmei Wu, Yingchao Ye, Han Gong, Fangfang Xia","doi":"10.1007/s40122-026-00847-6","DOIUrl":"10.1007/s40122-026-00847-6","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative pain management using sufentanil-based patient-controlled intravenous analgesia (PCIA) is often compromised by opioid-induced nausea and vomiting. Although 5-HT3 receptor antagonists are commonly added to PCIA regimens, the effectiveness of continuous of low-concentration infusion strategies remains uncertain from a pharmacokinetic perspective. Furthermore, China's national volume-based procurement (VBP) policy has drastically altered the cost landscape, necessitating a re-evaluation of premium agents such as palonosetron. This study aimed to assess the incremental clinical outcomes and cost-effectiveness of palonosetron versus ondansetron in this specific post-VBP setting.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study with propensity score matching (PSM). Patients receiving sufentanil-based PCIA were grouped as sufentanil alone, sufentanil plus ondansetron, or sufentanil plus palonosetron. The primary outcomes were the incidence of postoperative nausea and vomiting (PONV). A cost-effectiveness analysis (CEA) was performed using bootstrapping and cost-effectiveness acceptability curves (CEAC).</p><p><strong>Results: </strong>After matching, neither palonosetron nor ondansetron significantly reduced overall PONV incidence compared with sufentanil alone. However, subgroup analyses revealed that palonosetron significantly reduced severe nausea in elderly patients (P < 0.05). From an economic perspective, palonosetron demonstrated a high probability (87.0%) of being cost-saving in a probabilistic sensitivity analysis, whereas ondansetron was likely to be \"dominated.\"</p><p><strong>Conclusions: </strong>Under low-concentration background infusion regimens, 5-HT3 antagonists may provide limited benefit in the general patient population, especially high-risk female patients. However, in the context of VBP-driven price reductions, palonosetron may represent a cost-saving option, with potential benefits in elderly patients, and may confer additional prophylactic advantages in male patients.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1131-1145"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948954","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":"Research Progress on Low-Temperature Plasma Nucleoplasty and Targeted Radiofrequency for Cervical Spondylotic Radiculopathy: A Retrospective Review.","authors":"Jiajia Deng, Chenxuan Xiao, Keyue Xie","doi":"10.1007/s40122-026-00851-w","DOIUrl":"10.1007/s40122-026-00851-w","url":null,"abstract":"<p><p>Cervical spondylotic radiculopathy (CSR) is a common neurological condition caused by compression or inflammation of cervical nerve roots, often resulting in significant pain and functional impairment. While many patients improve with conservative management, a substantial subset remains refractory and requires further intervention. Over the past 2 decades, minimally invasive percutaneous techniques have emerged as effective alternatives to conventional open surgery. This review synthesizes contemporary evidence on two key modalities: percutaneous cervical nucleoplasty (PCN), a decompressive procedure utilizing low-temperature plasma (coblation) technology to reduce intradiscal pressure, and pulsed radiofrequency (PRF) applied to the dorsal root ganglion, a neuromodulatory approach that modulates pain signaling without tissue destruction. Drawing on observational studies, randomized controlled trials, and systematic reviews, the article evaluates the clinical efficacy, safety, and durability of each technique, compares their outcomes with anterior cervical discectomy and fusion, and explores emerging combination strategies. Evidence indicates that both PCN and PRF provide significant and sustained pain relief with favorable safety profiles. PCN achieves long-term outcomes comparable to surgery in carefully selected patients with contained disc herniations, while PRF offers superior duration of relief compared with steroid injections alone. Emerging data support the synergistic use of PCN and PRF, as well as augmentation with intradiscal collagenase or ozone. Patient selection-guided by symptom duration, imaging characteristics, and predictive factors-remains critical for optimizing outcomes. Despite encouraging results, the evidence base is limited by study heterogeneity and moderate-to-low certainty. Future large-scale, multicenter randomized trials are needed to refine patient selection, optimize technical parameters, and establish comparative effectiveness. Overall, PCN and PRF represent valuable, minimally invasive options within a stepped-care approach to CSR, bridging conservative management and open surgery.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1001-1022"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148227107","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":"French National Guidelines for the Appropriate Use of Opioids: Analgesia, Opioid Use Disorder, and Overdose Prevention-Part 1: Methodology and Pain Management.","authors":"Célian Bertin, Julie Dupouy, Nicolas Authier, Nathalie Michenot, Sidonie Verdier, Mathieu Chappuy, Anne-Priscille Trouvin","doi":"10.1007/s40122-026-00853-8","DOIUrl":"10.1007/s40122-026-00853-8","url":null,"abstract":"<p><p>Opioid medications play a central role in pain management but are associated with significant risks, including dependence, opioid use disorder (OUD), and overdose. In response to rising concerns, the French National Authority for Health convened a multidisciplinary working group to develop updated guidelines on the appropriate use of opioids. These recommendations, grounded in the high-level international evidence and developed through a rigorous formal consensus method, represent the most comprehensive and recent guidelines addressing the entire opioid pharmacological class, regardless of indication. The first part focuses on the clinical use of opioid analgesics in acute and chronic pain, both cancer-related and non-cancer-related. The guidelines emphasize prudent prescribing, prioritization of non-opioid therapies, and the integration of multimodal analgesia. Specific clinical situations are addressed, including management in primary care, emergency settings, postoperative care, inpatient treatment, and the perioperative management of patients already receiving opioids or opioid agonist treatment. Practical tools such as equianalgesic conversion principles, criteria for opioid rotation, and strategies to minimize adverse effects are provided to support prescribers. By considering opioids as a single pharmacological class, these guidelines enable consistent principles to be applied across diverse clinical contexts, from the initiation of short-term opioid therapy to the safe management of patients with complex dependence profiles. Although developed in France, the recommendations are intended to have international relevance, given their reliance on global evidence and their focus on balancing effective pain relief with risk reduction. A second part, addressing the prevention and management of OUD and overdoses, complements the present manuscript.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"923-955"},"PeriodicalIF":4.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345945","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}