Pain and Therapy最新文献

{"title":"Genicular Nerve Ultrasound-Guided Cryoanalgesia for the Treatment of Chronic Knee Joint Pain: An Observational Retrospective Study.","authors":"Giuliano Lo Bianco, Francesco Paolo D'angelo, Guillherme Ferreira Dos Santos, Agnes Stogicza, Matteo Luigi Giuseppe Leoni, Andrea M Trescot, Robert Jason Yong, Christopher L Robinson","doi":"10.1007/s40122-025-00727-5","DOIUrl":"10.1007/s40122-025-00727-5","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic knee pain caused by osteoarthritis (OA) is a prevalent source of disability in the adult population. Total knee arthroplasty (TKA) is an effective surgical treatment for advanced disease, but many patients continue to suffer from chronic post-surgical pain (CPSP). In recent years, minimally invasive techniques targeting peripheral nerves have been explored. Cryoanalgesia of the genicular nerves (GNCryo) is one such intervention that disrupts sensory input by applying extremely low temperatures to the target nerves, potentially leading to sustained pain relief without the need for neurodestructive heat lesions. This study aims to evaluate the effectiveness of ultrasound-guided GNCryo in patients with chronic knee pain due to primary OA or CPSP after TKA.</p><p><strong>Methods: </strong>This retrospective, single-center study included 90 patients who underwent GNCryo between September 2021 and February 2023. Inclusion criteria were patients over 18 years of age, symptomatic knee OA or CPSP after TKA, and a positive response (≥ 50% pain relief) to diagnostic genicular nerve blocks. Ultrasound guidance was used to optimize needle placement and reduce complications. Clinical outcomes were assessed at baseline and at 1, 3, 6, and 9 months post-procedure. Outcome measures included the Visual Analog Scale (VAS, 0-10) for pain intensity, the Western Ontario and McMaster Universities Arthritis Index (WOMAC, 0-100) for assessing pain, stiffness, and physical function related to OA, the Douleur Neuropathique en 4 Questions (DN4, 0-10) for neuropathic pain, and the EuroQol 5-Dimension (EQ-5D, 0-100) for quality of life.</p><p><strong>Results: </strong>Ninety patients completed the 9 months follow-up. The median VAS score decreased from 7.0 (6.0, 8.0) at baseline to 4.0 (3.0, 5.0) at 1 month, remained at 4.0 (3.0, 5.0) at 3 months, and increased slightly to 5.0 (4.0, 5.0) at 6 months and 5.0 (4.0, 6.0) at 9 months, yet pain relief remained lower than baseline. WOMAC scores decreased from 65 (55, 71) at baseline to 35 (30, 40) at 1 month and 35 (30, 40) at 3 months, increased to 40 (35, 50) at 6 months and 55 (45, 65) at 9 months. DN4 scores decreased from 7 (5, 8) at baseline to 4 (3, 4) at 1 month and 3 (2, 4) at 3 months, increased to 3.5 (3, 5) at 6 months and 5 (4, 6) at 9 months, yet remained lower than baseline. EQ-5D scores increased from 64.5 (47, 84) at baseline to 42 (32, 58) at 1 month, 43.5 (31, 59) at 3 months, 45.5 (35, 60) at 6 months, and 52 (41, 72) at 9 months.</p><p><strong>Conclusions: </strong>Ultrasound-guided GNCryo is a promising minimally invasive treatment for chronic knee pain, providing pain relief and improved quality of life for up to 9 months. Although some outcomes showed a trend toward baseline over time, pain relief remained lower than baseline, consistent with potential nerve regeneration or recovery. Larger prospective, controlled trials are necessary to confirm these findings and to","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"985-998"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Benefits of Ibuprofen Arginine: A Narrative Review.","authors":"Piercarlo Sarzi-Puttini, Serge Perrot, Juan Perez-Cajaraville, Diego Maria Michele Fornasari, Franco Radaelli, Giustino Varrassi","doi":"10.1007/s40122-025-00735-5","DOIUrl":"10.1007/s40122-025-00735-5","url":null,"abstract":"<p><p>Ibuprofen arginine (IBA) combines well-established analgesic and anti-inflammatory properties with enhanced pharmacokinetics. The addition of arginine significantly improves solubility and absorption, leading to a faster onset of action compared to conventional ibuprofen. Clinical studies consistently demonstrate that IBA achieves meaningful pain relief within a shorter timeframe while maintaining a favorable safety profile. IBA's rapid action is particularly valuable in managing acute exacerbations of chronic pain and preventing central sensitization, thus improving patient comfort, adherence, and overall quality of life. By addressing both the inflammatory and nociceptive components of pain, IBA offers an effective and well-tolerated alternative in multimodal pain management strategies. This review explores the clinical benefits of IBA in pain management among various clinical settings.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"891-912"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the Risk of Lumbar Prolapsed Disc: A Gene Signature-Based Machine Learning Analysis.","authors":"Fengfeng Wang, Fei Meng, Stanley Sau Ching Wong","doi":"10.1007/s40122-025-00744-4","DOIUrl":"10.1007/s40122-025-00744-4","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar prolapsed disc (LPD) is a leading cause of low back pain, contributing significantly to global disability and healthcare burden. This study aimed to develop machine learning models to predict the risk of LPD by analysing gene expression profiles for early detection.</p><p><strong>Methods: </strong>Transcriptomic data from peripheral blood samples were obtained from the Gene Expression Omnibus (GEO) database, with dataset GSE150408 used for training and GSE124272 for testing. The training dataset included 17 patients with sciatica resulting from LPD, all of whom had magnetic resonance imaging confirmation of single-level LPD at either the L4/5 or L5/S1 levels. Data from 17 healthy volunteers were used as controls. Recursive feature elimination (RFE) was employed to identify the most relevant gene signatures among 23 pain-related genes. Machine learning models, including support vector machine (SVM), random forest, k-nearest neighbours (KNN), logistic regression, and Extreme Gradient Boosting (XGBoost), were trained and evaluated. Model performance was assessed using accuracy, area under the curve (AUC), F1 score, and Matthews correlation coefficient (MCC).</p><p><strong>Results: </strong>Eight key gene signatures were identified as significant predictors of LPD, with MMP9 exhibiting the highest importance score. Most of these genes were differentially expressed between patients with LPD and healthy controls (p < 0.05). Among the models, random forest demonstrated the highest accuracy (0.80, 95% CI 0.73-0.85) and MCC (0.64, 95% CI 0.53-0.76), followed by KNN, XGBoost, and SVM. Overall, the random forest model exhibited the most robust performance in predicting the risk of LPD.</p><p><strong>Conclusion: </strong>The results of our study suggest that machine learning models based on pain-related gene signatures may identify patients at high risk of developing LPD with reasonably high accuracy. These prediction models could perhaps be integrated into clinical diagnostic tools to enhance early diagnosis and prevention.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1117-1129"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Management in Minimally Invasive Cardiac Surgery: A Review of Current Clinical Evidence.","authors":"Burhan Dost, Esra Turunc, Muhammed Enes Aydin, Cengiz Kaya, Aslihan Aykut, Zeliha Asli Demir, Madan Narayanan, Alessandro De Cassai","doi":"10.1007/s40122-025-00739-1","DOIUrl":"10.1007/s40122-025-00739-1","url":null,"abstract":"<p><p>Compared with conventional sternotomy, minimally invasive cardiac surgery (MICS) is associated with significant advantages such as reduced tissue trauma, faster recovery, and shorter hospital stay. However, the management of postoperative pain caused by intercostal nerve injury, pleural irritation, and tissue retraction remains a major challenge. Despite the less invasive nature of MICS, patients often report experiencing pain similar to that experienced following conventional cardiac surgery, particularly during the acute postoperative period. Effective pain management is essential for optimizing recovery, reducing the consumption of opioids, and preventing the transition to chronic postsurgical pain. Regional anesthesia techniques play a key role in multimodal analgesia for MICS. Thoracic epidural analgesia exhibits strong analgesic efficacy; nevertheless, it remains underutilized owing to concerns regarding anticoagulation-related complications and hemodynamic instability. The thoracic paravertebral block is a safer alternative that provides comparable pain relief with fewer side effects. Similarly, ultrasound-guided fascial plane blocks, such as serratus anterior, parasternal intercostal, interpectoral + pectoserratus, and erector spinae plane blocks, have gained popularity owing to their safety and feasibility; however, the effectiveness of these blocks varies according to the surgical approach and type of incision. Systemic analgesia is an integral component of multimodal pain management in MICS. Despite the efficacy of opioids, a shift toward opioid-sparing strategies has been observed given the significant adverse effects associated with the use of opioids. Intravenous adjuncts such as dexmedetomidine, ketamine, and non-steroidal anti-inflammatory drugs can reduce opioid consumption and improve postoperative pain control. Despite advances in pain management, a single approach that can provide comprehensive analgesia for MICS remains to be established. A multimodal strategy that combines systemic and regional techniques must be developed to optimize pain management and long-term outcomes.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"913-930"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Musculoskeletal Ultrasound for Assistive Diagnosis in Pain Clinics.","authors":"Mingrui Zhang, Keyue Xie","doi":"10.1007/s40122-025-00721-x","DOIUrl":"10.1007/s40122-025-00721-x","url":null,"abstract":"<p><p>Musculoskeletal ultrasound has gained increasing attention as a noninvasive imaging modality in pain clinics. Its advantages include the lack of radiation exposure, cost-effectiveness, and efficiency, allowing for rapid provision of dynamic examination results. Notably, it has demonstrated significant effectiveness in diagnosing common joint injuries. This review synthesizes the advancements in the application of musculoskeletal ultrasound across various domains, including muscles, joints, bones, tendons, ligaments, and bursae. It explores the critical role of ultrasound in pain management, highlighting both its importance and limitations. Moreover, the review analyzes the latest research findings and the potential for clinical applications, underscoring the evolving landscape of musculoskeletal ultrasound in enhancing diagnostic accuracy in pain management.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"791-801"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological Deficits Following Regional Anesthesia and Pain Interventions: Reviewing Current Standards of Care.","authors":"Salah N El-Tallawy, Rania S Ahmed, Gehan I Salem, Tariq A Alzahrani, Mamdouh M Haddara, Radwa H Ahmed, Mohamed S Nagiub, Abdullah T Alsubaie, Mohamed M Ali, Mahmoud M Elbasha, Ahmed A Ahmed","doi":"10.1007/s40122-025-00726-6","DOIUrl":"10.1007/s40122-025-00726-6","url":null,"abstract":"<p><p>Regional anesthesia (RA) has become an integral part of modern anesthesia practice and acute pain management strategies. It provides effective pain relief, reduces opioid consumption, and facilitates enhanced recovery after surgery. However, like any medical intervention, RA is not without risks. RA is associated with potential complications, including neurological deficits which can range from mild and transient to severe and permanent. These neurological deficits may result from non-adherence to established standards of care and deviations from the clinical practice guidelines. An online database search was conducted across multiple websites to identify the relevant articles. The inclusion criteria were articles in English, published between January 2010 and July 2024. The search included various study types, such as case series, observational studies, cross-sectional analyses, cohort studies, longitudinal studies, systematic reviews, and practice guidelines. A total of 38 articles met the inclusion criteria and were included in this comprehensive review which examines the neurological complications associated with regional anesthesia and pain interventions, with a particular focus on how deviations from the standards of care contribute to adverse neurological outcomes. Furthermore, it highlights preventive strategies aimed at minimizing the risks of these complications and improving patient safety.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"817-839"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721026","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":"Trends in Opioid and Non-opioid Prescriptions in Austria (2016-2021): A Nationwide Study on Utilization and Concomitant Benzodiazepine Use.","authors":"Aylin Bilir, Lorenz Kapral, Andrea Michalek-Sauberer, Razvan Bologheanu, Felix Gruber, Oliver Kimberger","doi":"10.1007/s40122-025-00736-4","DOIUrl":"10.1007/s40122-025-00736-4","url":null,"abstract":"<p><strong>Introduction: </strong>Although global opioid consumption is decreasing, high-income populations are experiencing an increase. Data on specific opioid-prescribed and at-risk patient groups in Austria are lacking.</p><p><strong>Methods: </strong>We performed a retrospective observational population-based study analysing health insurance data between January 2016 and December 2021. The dataset included demographic information; hospital data, including coded primary and secondary discharge diagnoses; and prescription data for all legally available opioids and nonopioid analgesics. The primary objective was to describe trends in opioid and nonopioid analgesic prescriptions. Logistic regression analysis was conducted to identify potential risk factors for receiving an opioid prescription.</p><p><strong>Results: </strong>The study cohort included 7,274,651 individuals. During the observation period, the percentage of individuals receiving an opioid prescription decreased by 14.69% (4.22-3.60%). The number of individuals receiving an opioid prescription was consistently greatest for tramadol. A particularly strong positive correlation was observed between opioid prescriptions and the concurrent use of benzodiazepines (odds ratio [OR], 1.45 [95% confidence interval {CI}, 1.43-1.47]). Furthermore, a history of persistent somatoform pain disorder (OR, 1.28 [95% CI, 1.21-1.36]) and a diagnosis of pain disorder (OR, 1.26 [95% CI, 1.25-1.28]) were identified as significant risk factors. In 2021, general practitioners were the predominant initial opioid prescribers, issuing 82.17% of the prescriptions, followed by hospital staff and orthopaedic specialists.</p><p><strong>Conclusion: </strong>Prescription opioid use decreased from 2016 to 2021, with tramadol representing the most prevalent opioid. The study revealed a strong link between opioid and benzodiazepine prescriptions and an association with persistent somatoform pain disorder, where opioid use is typically not recommended. Interactive map available for this article.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1131-1145"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993886","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":"Efficacy and Safety of Mirogabalin in Patients with Neuropathic Pain Due to Cervical Spondylotic Radiculopathy: Miro-Cens, A Randomized, Controlled, Interventional Study.","authors":"Takashi Hirai, Atsushi Okawa, Hiroshi Takahashi, Kazuhito Shiosakai, Toshitaka Yoshii","doi":"10.1007/s40122-025-00722-w","DOIUrl":"10.1007/s40122-025-00722-w","url":null,"abstract":"<p><strong>Introduction: </strong>There are few studies of pharmacotherapy of neuropathic pain in cervical spondylotic radiculopathy (CSR). Miro-Cens aimed to examine the efficacy and safety of mirogabalin for treating pain in patients with CSR on non-steroidal anti-inflammatory drugs (NSAIDs), compared with NSAIDs alone.</p><p><strong>Methods: </strong>Miro-Cens was a 12-week, multicenter, randomized, controlled, open-label, interventional study in Japan. Eligible patients with CSR having upper limb pain (visual analog scale score ≥ 40 mm) were randomly assigned in a 1:1 ratio to the mirogabalin add-on to NSAIDs group and the NSAIDs alone group. The primary endpoint was the change in the weekly average numerical rating scale (NRS) score for upper limb pain from baseline at Week 12.</p><p><strong>Results: </strong>The mirogabalin add-on group and NSAIDs alone group included 72 and 70 patients, respectively. The mirogabalin add-on group had a significantly greater reduction in the NRS score for upper limb pain than the NSAIDs alone group: estimated changes from baseline at Week 12, - 2.63 [95% confidence interval (CI) - 3.14, - 2.11] in the mirogabalin add-on group; - 1.07 (- 1.62, - 0.53) in the NSAIDs alone group; intergroup difference, - 1.55 (- 2.31, - 0.80; p < 0.001). The responder rate on the NRS score at Week 12 was significantly higher in the mirogabalin add-on group than in the NSAIDs alone group: ≥ 30% improvement, 71.7% vs. 39.6%; ≥ 50% improvement, 58.3% vs. 22.6% (both p < 0.001). The frequent treatment-emergent adverse drug reactions in the mirogabalin add-on group were the known ones (somnolence and dizziness), with most being mild or moderate in severity.</p><p><strong>Conclusion: </strong>In patients with CSR, combination therapy with mirogabalin and NSAIDs significantly improved neuropathic pain compared with NSAID monotherapy. No new safety concerns were identified, although caution should be exercised regarding somnolence and dizziness. These findings suggest that concomitant use of mirogabalin with NSAIDs could be tolerable and a novel treatment option for CSR patients with insufficient analgesic effects on NSAIDs.</p><p><strong>Trial registration number: </strong>jRCTs031210629.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1063-1079"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025838","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 Cooled Radiofrequency Ablation of Lumbar Nerves as Treatment for Chronic Low Back Pain.","authors":"Alaa Abd-Elsayed, Trevor N Johnson, Kylie K Ruprecht, Tristan R Argall, Lukas J Henjum, Kenneth J Fiala","doi":"10.1007/s40122-025-00717-7","DOIUrl":"10.1007/s40122-025-00717-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Worldwide, 23% of adults suffer from chronic lower back pain, which is defined as pain persisting for more than 3-6 months [Merskey in Can J Psychiatry 34:329-336, 1989]. The lifetime prevalence of back pain is as high as 84% in adults [Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2023 Dec 11]. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/ ]. Conservative treatment options for chronic low back pain include as needed or scheduled analgesics, physical therapy, anticonvulsants, exercise, weight loss, muscle relaxants, and much more. With chronic pain that is refractory to the aforementioned treatments, more invasive procedures may be indicated. Cooled radiofrequency ablation (CRFA), a minimally invasive therapy, utilizes internally cooled radiofrequency probes to deliver targeted thermal energy that causes neurolysis, disrupting the transmission of pain stimuli along nociceptive pathways, thus resulting in pain relief [Walker in J Spinal Disord 13:205-217, 2000 June]. This study investigates whether patients receiving CRFA for relief of chronic low back pain caused by lumbar facet arthropathy experience a reduction in pain scores, the length of this reduction in pain scores, and the magnitude of this reduction in pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was a retrospective analysis of data extracted from UW-Health Electronic Medical Health records (EMR), encompassing lumbar CRFA procedures performed from 2015 through April of 2024. Patient data was obtained, including diagnosis, preoperative pain score, postoperative pain score, duration of relief, patient age, sex, and BMI. A two-tailed paired t test was used to statistically analyze the preoperative and postoperative pain scores, in which a p value ≤ 0.05 was considered significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1450 lumbar CRFA procedures were reviewed, and 206 were excluded due to absent pre- or post-op pain scores. An additional eight procedures were excluded due to weekly lidocaine infusions in between their procedure and reporting of their post-op score. 1026 CRFA patients were included in the analysis, comprising 584 females and 442 males with an average age of 59.81 ± 13.40 and a BMI of 31.67 ± 7.13. The average pre-procedure visual analog scale (VAS) pain score was 6.44 (6.44 ± 1.67, n = 1236), and the average post-procedure VAS pain score was 3.21 (3.21 ± 2.45, n = 1236) this achieved statistical significance (p &lt; 0.0001). Improvement of pain symptoms was reported in 85.92% (n = 1062), 14.08% (n = 174) reported complete pain remission, 7.61% (n = 94) reported no change, and 6.47% (n = 80) reported worsening symptoms. For effective procedures (those with any amount of pain relief, n = 1062) with an available postoperative pain score, the mean percentage improvement was 60.56 ± 27.21%. The average duration of improvement wa","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"949-956"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions.","authors":"Sebastiano Mercadante, Giorgio Sapienza, Alessio Lo Cascio, Alessandra Casuccio","doi":"10.1007/s40122-025-00728-4","DOIUrl":"10.1007/s40122-025-00728-4","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit.</p><p><strong>Methods: </strong>Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information regarding opioids, and route of administration, prescribed prior to admission, during admission, and at time of discharge was recorded. Opioids, doses, and routes were changed according to the clinical need to obtain the maximum benefit, individualizing the treatment. The opioid escalation index was calculated in milligrams (OEImg) and as a percentage (OEI%).</p><p><strong>Results: </strong>A total of 113 patients were assessed. The mean pain intensity at admission and at time of discharge was 6.4 (SD 1.8) and 2.3 (SD 1.4), respectively (P < 0.0005). The mean opioid dose expressed as oral morphine equivalent (OME) by patients who were receiving opioids before admission was 128 mg/day (SD 120). There was no statistical difference in OME between admission and discharge time. Sixty-one and 20 patients were prescribed a second and a third opioid/route, respectively. Mean OEI% and OEImg were 9.3% (SD = 22.5) and 4.0 mg/day (SD = 24.1), respectively. Only a minority of patients had a breakthrough pain prescription at admission. Intravenous morphine was more frequently prescribed at beginning, then replaced by oral morphine and fentanyl preparations at discharge.</p><p><strong>Conclusions: </strong>An intensive and careful use of opioids in the APCU allows for the achievement of adequate analgesia in all examined patients within a short time, without increasing OME. These findings should encourage further studies in APCUs as well as in other palliative care settings.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"999-1006"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743565","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}