Pain and Therapy最新文献

{"title":"A European Delphi Consensus to Support the Diagnosis, Management, and Appropriate Positioning of Topical Treatments for Postherpetic Neuralgia (PHN).","authors":"Andrea Truini, Arun Bhaskar, Diego Fornasari, Didier Bouhassira, Michael Collins, Ralf Baron, Gisele Pickering","doi":"10.1007/s40122-026-00834-x","DOIUrl":"10.1007/s40122-026-00834-x","url":null,"abstract":"<p><strong>Introduction: </strong>Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ), characterized by persistent neuropathic pain that significantly impairs quality of life. Despite the availability of multiple treatment options, PHN remains under-recognized and undertreated, with wide variation in management practices across Europe. This Delphi consensus aimed to: (1) identify key challenges and unmet needs in PHN diagnosis and management; (2) determine the optimal use and positioning of topical treatments, such as lidocaine-medicated plasters; and (3) develop best-practice recommendations to support clinical decision-making and improve patient outcomes.</p><p><strong>Methods: </strong>A modified Delphi methodology was followed. An international steering group (SG) comprising seven healthcare professionals (HCPs) experienced in PHN management met online and developed 42 consensus statements for inclusion in an HCP survey; 16 statements were adapted for inclusion in a patient survey. Each statement was presented with a four-point Likert scale to assess agreement, and the surveys were distributed online by a third party to 640 HCPs and 205 patients located in France, Germany, Ireland, Italy, and the UK. Consensus was defined a priori as ≥ 75% agreement. The SG reviewed the results at a second meeting, identified key findings, and formulated best-practice recommendations.</p><p><strong>Results: </strong>A total of 205 HCPs experienced in managing PHN and 26 patients with PHN completed the surveys. Consensus was achieved on 41 of 42 statements in the HCP survey and on all 16 statements in the patient survey. The SG reviewed and discussed the consensus results and formulated eight key recommendations addressing HZ prevention, PHN diagnosis, and optimization of management, including the appropriate positioning of topical therapies and multidisciplinary care.</p><p><strong>Conclusions: </strong>The results of this consensus highlight the unmet needs in PHN care. Implementation of the recommendations into clinical practice is hoped to support more consistent, patient-centered management and improved outcomes for individuals with PHN across Europe.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"765-784"},"PeriodicalIF":4.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717805","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":"Analgesic Efficacy and Adverse Effects of Epidural Ropivacaine Combined with Equipotent Alfentanil or Sufentanil for Labor Analgesia: A Multicenter Randomized Controlled Single-Blind Trial.","authors":"Xiao Jiang, Yufang Xiu, Chang Jia, Bo Han, Jianyu Zu, Shanni Zhang, Nana Han, Lingling Pan, Huixuan Sun, Jing Li, Yingjian Wang, Kean Wang, Yufei Man, Wenchao Liu, Zhenzhou Guan, Fang Yao, Ning Jin, Zhiqiang Xue, Wenhua Yuan, Peng Li, Yuyue Gong, Qi Wang, Sijin Lu, Huijun Wang, Yingjie Sun, Yugang Diao, Huijuan Cao","doi":"10.1007/s40122-025-00812-9","DOIUrl":"10.1007/s40122-025-00812-9","url":null,"abstract":"<p><strong>Introduction: </strong>Epidural analgesia has shown high maternal-fetal safety and satisfactory analgesia. Sufentanil is associated with a high risk of pruritus, nausea, and vomiting for epidural labor analgesia. Alfentanil is characterized by a rapid onset and is also used for labor analgesia. The study aimed to compare the analgesic efficacy and adverse effects of epidural ropivacaine combined with equipotent doses of alfentanil or sufentanil for labor analgesia, and to provide evidence for optimizing obstetric analgesic regimens.</p><p><strong>Methods: </strong>In this multicenter, randomized, controlled, single-blind trial conducted at four tertiary hospitals in China between June 2023 and June 2024, 442 nulliparous women with singleton, term pregnancies were enrolled. Participants were randomly assigned (1:1) to receive epidural 0.075% ropivacaine combined with either 4 μg/ml alfentanil (group A) or 0.2 μg/ml sufentanil (group S). Analgesia was delivered via a programmed intermittent epidural bolus (PIEB) plus patient-controlled epidural analgesia (PCEA) regimen (10 ml bolus, 50-min interval, 3 ml/h background infusion, 8-ml patient-controlled bolus, 20-min lockout). The onset of analgesia, defined as the median time from drug administration to the first recording of a visual analogue scale (VAS) score ≤ 3 within 30 min was the primary outcome. Hemodynamic parameters, labor characteristics, analgesic consumption, maternal satisfaction, neonatal outcomes, and adverse events were recorded as secondary outcomes.</p><p><strong>Results: </strong>The median onset time of analgesia was significantly shorter in the alfentanil group compared with the sufentanil group (8.0 min vs. 10.0 min, P < 0.001). No significant differences were observed between groups in blood pressure, heart rate, SpO₂, fetal heart rate, Bromage scores, VAS scores at subsequent time points, uterine pressure, sensory block level, body temperature, duration of analgesia, labor duration, mode of delivery, oxytocin use, total drug consumption, maternal satisfaction, or neonatal Apgar scores (all P > 0.05). Adverse events such as pruritus, nausea, vomiting, urinary retention, and lower limb numbness were infrequent and comparable between groups.</p><p><strong>Conclusions: </strong>Both alfentanil and sufentanil, when combined with 0.075% ropivacaine, provide effective and safe epidural labor analgesia. However, alfentanil offers the advantage of a faster onset of analgesia, making it a valuable alternative to sufentanil in clinical practice.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2300072104, Date of registration: June 2, 2023.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"481-494"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086616","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":"Economic and Treatment Burden of Chronic Low-Back Pain Patients Transitioning from Short-Acting to Long-Acting Opioids or Buprenorphine Buccal Film: US Claims Analysis.","authors":"Filip Stanicic, Dimitrije Grbic, Vladimir Zah","doi":"10.1007/s40122-026-00815-0","DOIUrl":"10.1007/s40122-026-00815-0","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess economic burden and treatment characteristics of patients with chronic low-back pain (cLBP) transitioning from oral Schedule II (CII) short-acting opioids (SAO) to oral CII long-acting opioids (LAO) or Belbuca^® (buprenorphine buccal film, BBF).</p><p><strong>Methods: </strong>Merative MarketScan^® commercial US claims (2019-2023) were retrospectively analyzed. Index date was the first BBF or LAO prescription date. The observation covered 6-month pre-index and 12-month follow-up periods. Patients were adults with ≥ 2 low-back pain and ≥ 1 SAO prescription pre-index claims. Cases with BBF-LAO switching, coverage gap, or cancer/HIV were excluded. Economic burden and treatment characteristics were explored during follow-up. Rescue medication utilization trends were also analyzed (6-month pre-index vs. 6-month follow-up). Propensity-score matching minimized the impact of patient characteristics.</p><p><strong>Results: </strong>Study sample had 964 patients per cohort. Despite higher prescription costs in BBF ($10,417 vs. $8238, p = 0.007), total and cLBP-related costs were similar. BBF had fewer outpatient visits (33.1 vs. 35.4, p = 0.038), hospitalizations (0.2 vs. 0.3, p = 0.041), cLBP-related hospitalizations (0.04 vs. 0.08, p = 0.013), and shorter cLBP-related hospital stay (0.14 vs. 0.33 days, p = 0.023). BBF also had fewer patients with ED visits (36.9% vs. 41.6%, p = 0.036) and cLBP-related hospitalizations (3.5% vs. 6.1%, p = 0.008). Adherence and treatment duration between cohorts were similar, with fewer prescriptions in BBF (5.8 vs. 6.5, p = 0.003). Trends showed BBF had greater decreases in SAO treatment duration (- 15.4 vs. - 2.2 days, p < 0.001), prescription counts (- 0.9 vs. - 0.3, p < 0.001), and daily morphine milligram equivalents (- 9.7 vs. - 6.1, p = 0.015). However, more BBF-treated patients had buprenorphine patches (8.2% vs. 3.3%, p < 0.001) with more patch prescriptions (0.3 vs. 0.1, p < 0.001) and longer treatment duration (8.9 vs. 2.6 days, p < 0.001).</p><p><strong>Conclusion: </strong>Study findings demonstrated similar healthcare expenditures between patients with cLBP transitioning from SAO to BBF and to LAO. Yet, initiating BBF may have lowered healthcare resource utilization and decreased further SAO utilization.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"513-534"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143237","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":"Screening and Management of Sleep Disorders in Patients with Fibromyalgia Syndrome: A French Multicenter, Prospective, Observational Study.","authors":"Gilbert André, Marlène Bonnefoi, Inès Ramos, Christèle Perez, Eric Luneau, Emilie Gadéa","doi":"10.1007/s40122-025-00813-8","DOIUrl":"10.1007/s40122-025-00813-8","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigates the prevalence of sleep disorders among patients with fibromyalgia syndrome (FMS) in French pain clinics, addressing a gap between international and national data. It also aims to describe associated factors such as quality of life (QoL), pain, daily functioning, and psychological symptoms.</p><p><strong>Methods: </strong>The study included 508 patients with an average age of 46 ± 10 years. Patients attending a specialized chronic pain center, either at their initial consultation or within the first year of follow-up, completed online self-administered questionnaires. Questionnaire were related to sleep disorders, pain, anxiety and QoL.</p><p><strong>Results: </strong>In this sample, sleep disorders were highly prevalent among French patients with FMS (95.3% with Pittsburgh Sleep Quality Index (PSQI) > 5; 69.9% with PSQI > 10). More than 13% were identified as being at high risk for sleep apnea, and 60% reported symptoms suggestive of restless leg syndrome (RLS). The median scores on the Brief Pain Inventory were 6.0 (Q1: 5.3-Q3: 7.0) for pain severity and 5.9 (Q1: 4.7-Q3: 7.1) for pain interference. The Hospital Anxiety and Depression Scale revealed a median anxiety score of 11.0 (Q1: 9.0-Q3: 15.0). Regarding the impact of FMS on daily life, the median score on the Fibromyalgia Impact Questionnaire was 59.0 (Q1: 44.0-Q3: 71.0).</p><p><strong>Conclusions: </strong>In contrast to French estimates, this study revealed a high prevalence of sleep disorders among patients with FMS, underscoring a gap in care. A substantial proportion of patients were at high risk for RLS and a clinically relevant risk for sleep apnea. Anxiety, depression, and reduced QoL were also highly prevalent, reflecting the complex and multifactorial burden of FMS. These findings highlight the need for a comprehensive, patient-centered approach that includes targeted management of sleep disturbances as a core component of fibromyalgia care.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"495-511"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100479","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":"Analgesic Effect of Laparoscopic Versus Ultrasound-Guided Quadratus Lumborum Block in Patients Undergoing Laparoscopic Nephrectomy: A Randomized Controlled Clinical Trial.","authors":"Manhua Zhu, Lingzhi Wang, Pingping Chen, Wenfei Xu","doi":"10.1007/s40122-026-00822-1","DOIUrl":"10.1007/s40122-026-00822-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Quadratus lumborum block (QLB), as a trunk regional block technique, can effectively alleviate postoperative pain in renal surgery. Ultrasound-guided QLB (U-QLB) administered by anesthesiologists is one of the most commonly used techniques. Recently, QLB can be administered by surgeons with the help of laparoscopy during renal surgery. Laparoscopic-assisted QLB (L-QLB) is a new technique. However, there is still a lack of comparison between U-QLB and L-QLB. The aim of this study was to compare the analgesic effects of laparoscopic and ultrasound-guided QLB in patients undergoing laparoscopic nephrectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Sixty patients undergoing laparoscopic nephrectomy were enrolled and randomized to receive L-QLB (group L) or U-QLB (group U) in a 1:1 ratio. A patient-controlled intravenous analgesia (PCIA) pump with sufentanil was administered after surgery. The primary outcome was cumulative sufentanil consumption within the first 24 h after surgery. Secondary outcomes consisted of the procedural time of QLB; the dermatomes of sensory block 2 h after surgery; resting and coughing visual analog scale (VAS) scores at 6, 12, 24, and 48 h postoperatively; rescue analgesia rate during the 0-48 h period after surgery; patient satisfaction with pain relief at 24 h post-surgery; and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The cumulative sufentanil consumption within the first 24 h after surgery was significantly lower in the L group (median [IQR], 50.00 [48.00-52.00] μg) than in the U group (54.00 [48.75-59.25] μg) (Mann-Whitney U = 276.0, z = -2.234, P = 0.026). The procedural time of QLB was significantly shorter in group L than in group U (2.8 ± 0.8 min versus. 5.6 ± 1.1 min, mean difference (MD): 2.8 min, 95% CI 2.29 to 3.31, P &lt; 0.001). Compared with the L group, the dermatomes of sensory block 2 h after surgery were significantly lower in the U group (6.9 ± 1.0 versus 6.2 ± 1.1, MD: -0.7, 95% CI -1.25 to -0.15, P = 0.014). The VAS scores during rest and coughing at 6, 12, and 24 h postoperatively were significantly lower in the L group than in the U group (P &lt; 0.05). However, no significant difference in VAS scores between the two groups 48 h postoperatively was noted (P &gt; 0.05). Compared with the L group, the rescue analgesia rate during the 0-48 h period after surgery was significantly higher in the U group (17.2% versus 44.8%, relative risk: 0.39, 95% CI 0.16-0.94, P = 0.023). Patients in group L had significantly higher satisfaction with pain relief 24 h postoperatively than those in group U (P = 0.037). No significant difference in adverse events was observed between the two groups (P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Compared with ultrasound-guided QLB, laparoscopic QLB demonstrates favorable analgesic trends within the first 24 h after laparoscopic nephrectomy, including reduced sufentanil consumption. Furthermore, L-QLB shows a shorter procedural time, broader sensory b","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"555-568"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220740","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":"Ultrasound-Guided Radiofrequency Ablation of the Ilioinguinal Nerves to Treat Ilioinguinal Neuralgia: A Description of a Novel Approach.","authors":"Alaa A Abd-Elsayed, Madelyn J Reilly, Rishika Joshi","doi":"10.1007/s40122-026-00819-w","DOIUrl":"10.1007/s40122-026-00819-w","url":null,"abstract":"<p><strong>Introduction: </strong>Ilioinguinal neuralgia is a commonly underdiagnosed and often refractory cause of chronic groin and lower abdominal pain. This technical report outlines an ultrasound-guided radiofrequency ablation (RFA) technique for ilioinguinal nerve (IIN) pain, summarizing key anatomical considerations to enhance procedural accuracy.</p><p><strong>Technique: </strong>Anatomical studies show that the IIN most commonly arises from L1 and traverses between the internal oblique and transversus abdominis muscles within 1-2 cm of the anterior superior iliac spine (ASIS). Under ultrasound guidance, an 18-22-gauge radiofrequency cannula is advanced into the interfascial plane to target the IIN. Sensory stimulation is used to elicit the patient's typical symptoms, while motor testing confirms the absence of distal muscle activation. A diagnostic block is performed before lesioning. Continuous RFA is then applied at 80 °C for 60-90 s with additional lesions placed as needed based on anatomical variation.</p><p><strong>Discussion: </strong>Previous published data demonstrate significant pain reduction and sustained benefits following ilioinguinal RFA, with improved function and minimal complications. Ultrasound-guided probe placement and stimulation testing enhance the reproducibility, accuracy, and safety of the procedure.</p><p><strong>Conclusions: </strong>Ultrasound-guided RFA of the IIN offers a minimally invasive treatment option for patients with refractory ilioinguinal neuralgia. Recognizing anatomical variability and utilizing stimulation testing, along with real-time imaging, can help clinicians improve the consistency of outcomes and reduce complications.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"585-595"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776502","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":"Letter to the Editor Regarding \"Impact of Posterior Quadratus Lumborum Block on Acute Pain Relief and Chronic Pain Prevention in Breast Cancer Surgery\".","authors":"Yong-Bao Lin, Dan-Feng Wang, Fu-Shan Xue","doi":"10.1007/s40122-026-00817-y","DOIUrl":"10.1007/s40122-026-00817-y","url":null,"abstract":"","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"597-599"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258824","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 Retrospective Safety Analysis of OnabotulinumtoxinA for the Treatment of Patients with Chronic Migraine and Concomitant Therapeutic Indications.","authors":"Andrew M Blumenfeld, Christopher Rhyne, Kenneth Martinez, Atul Patel, Kim Becker Ifantides, Ritu Singh, Irina Yushmanova, Simona Battucci, Marc Schwartz, Grace Forde","doi":"10.1007/s40122-026-00816-z","DOIUrl":"10.1007/s40122-026-00816-z","url":null,"abstract":"<p><strong>Introduction: </strong>Patients receiving onabotulinumtoxinA treatment for chronic migraine (CM) may have coexisting diseases warranting multi-indication use of onabotulinumtoxinA. However, data on safety and treatment patterns for concomitant treatment of CM and other diseases are limited.</p><p><strong>Methods: </strong>SYNCHRONIZE was a phase 4, multicenter, retrospective study that explored the safety of onabotulinumtoxinA treatment for ≥ 2 therapeutic (non-aesthetic) indications within 3 months. The observation period of interest was approximately 6 months before and 24 months after receiving treatment for the second indication. The primary outcome was treatment-emergent adverse events (TEAEs) occurring within 6 months. Results are reported descriptively and stratified by treatment indications. This analysis focuses on patients treated for CM and ≥ 1 other onabotulinumtoxinA indication.</p><p><strong>Results: </strong>A total of 183 patients had CM and ≥ 1 other onabotulinumtoxinA indication (CM + cervical dystonia [CD], n = 121; CM + oromandibular dystonia [OD] ± blepharospasm [BS], n = 17; CM + BS or hemifacial spasm [HS], n = 13; CM + CD + other movement disorders [MD], n = 11; CM + spasticity [SP] or focal dystonia [FD], n = 10; CM + hyperhidrosis [HH] ± other MD, n = 5; CM + overactive bladder [OAB] or neurogenic detrusor overactivity [NDO], n = 4; CM + other MD, n = 2). The 3-month mean cumulative onabotulinumtoxinA dose ranged from 163.4 U (CM + OD ± BS) to 396.2 U (CM + SP or FD), and most patients received treatment for their first and subsequent indications within 24 h. The proportion of patients with ≥ 1 TEAE in the 6 months post-index was 23.5% overall, with the most common being neck pain (6.6%), headache (4.9%), migraine (4.9%), and brow ptosis (2.2%). There were no TEAEs consistent with distant spread of toxin and no discontinuations due to adverse events.</p><p><strong>Conclusion: </strong>TEAEs associated with onabotulinumtoxinA treatment in adults with CM and ≥ 1 coexisting disease within 3 months were generally consistent with the known safety profiles for the individual onabotulinumtoxinA indications. There were no new safety signals observed for up to 6 months after multi-indication treatment.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"535-553"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146181566","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":"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":4.4,"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":"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":4.4,"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}