Pain and Therapy最新文献

{"title":"Next-Generation SCS Programming Platform: Enhancing ECAP Fidelity and Objectivity to Improve Patient Experience.","authors":"Daniel J Parker, Ajay B Antony, Gregory L Smith, Johnathan H Goree, Marc A Russo, Erika A Petersen, Chau M Vu, Paul Verrills, Christopher Gilmore, Leonardo Kapural, Darayus Nanavati, Dean M Karantonis, Jason E Pope","doi":"10.1007/s40122-025-00808-5","DOIUrl":"10.1007/s40122-025-00808-5","url":null,"abstract":"<p><strong>Introduction: </strong>Evoked compound action potentials (ECAPs) are neurophysiological biomarkers of neural activation during spinal cord stimulation (SCS). Clear distinction between ECAPs and nonphysiological signals is critical to the application of contemporary, ECAP-based closed-loop (CL) SCS therapies. Herein, we evaluated the performance and user acceptability of a novel programming software that automates generation of ECAP-based CL-SCS programs-the Assisted Programming Module (APM).</p><p><strong>Methods: </strong>We report results from two prospective, multicenter, single-arm, feasibility studies: Freshwater (NCT04662905) and Rosella (NCT06057480). APM performance was compared with the previous generation programming software and other published methods. Performance was assessed by comparing signal-to-noise ratios, artifact rejection, and other objective parameters. User acceptability was assessed using questionnaires administered to SCS users.</p><p><strong>Results: </strong>The APM successfully generated a CL program in 96% of initial programming sessions (n = 81/84; Freshwater, 31/34; Rosella, 50/50). In the Rosella study, median time to generate an automated CL program (n = 68) was 11.9 min [interquartile range (IQR) 9.9-14.0]. Median dose ratio was 1.31 (IQR 1.20-1.46) at end of trial (n = 24), 1.34 (IQR 1.13-1.51) at 1 month post implant (n = 16), and 1.32 (IQR 1.21-1.48) at 3 months post implant (n = 15). At least 90% of patients [trial, 90% (27/30); implant, 94% (17/18)] were satisfied with their programming experience, and ≥ 90% of patients [trial, 90% (26/29); implant, 94% (16/17)] felt in control of their therapy. The APM achieved a mean signal-to-noise ratio of 4.6 ± 1.2, a 35% improvement over the previous generation ECAP dose-controlled CL-SCS system. Detectable artifact leakage rates decreased by 75% when compared with other published methods without compromise to signal-to-noise performance.</p><p><strong>Conclusions: </strong>Next-generation ECAP dose-controlled CL technology demonstrated strong feasibility, high patient satisfaction and therapy control, and superior ECAP signal fidelity compared with existing methods. By standardizing CL-SCS programming and enhancing signal fidelity, the APM may improve workflow efficiency and long-term therapy outcomes in chronic pain management.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifiers: NCT04662905, NCT06057480.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"465-480"},"PeriodicalIF":4.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Efficacy and Safety between Anterior Cisterna and High Cervical Intrathecal Drug Delivery for Craniofacial Cancer Pain: A Multicenter Retrospective Cohort Study.","authors":"Qin Li, Deshan Li, Qiju Li, Zheng Zou, Huaiming Wang, Xin Min, Yu Wang, Jiang Zou, Pengjiu Feng, Aimin Zhang","doi":"10.1007/s40122-025-00799-3","DOIUrl":"10.1007/s40122-025-00799-3","url":null,"abstract":"<p><strong>Introduction: </strong>Intrathecal drug delivery systems (IDDS) represent an advanced option for refractory craniofacial cancer pain, though optimal catheter tip positioning remains debated between anterior cisterna (AC) and high cervical (HC) approaches.</p><p><strong>Methods: </strong>This multicenter retrospective cohort analyzed 108 patients with severe craniofacial cancer pain undergoing IDDS catheterization (33 AC; 75 HC) between January 2018 and December 2024. Propensity score matching (1:2 ratio) created balanced cohorts (33 AC versus 66 HC). Primary outcome was pain reduction (numerical rating scale), with minimum clinically important difference defined as ≥ 1.5-point reduction. Secondary outcomes included opioid requirements, intrathecal morphine dosing, conversion ratios, and safety.</p><p><strong>Results: </strong>After matching, both approaches demonstrated comparable pain reduction, with 90.9% of AC and 92.4% of HC patients achieving minimum clinically important difference at 3 months (risk difference: 1.5%, 95% confidence interval [CI] -9.8 to 12.8%). HC patients required higher intrathecal morphine doses during the first 2 weeks (week 1: 285 versus 220 mcg/day; ratio: 0.77, 95% CI 0.65-0.91), with significantly different oral-to-intrathecal conversion ratios (week 1: 886 versus 667; ratio: 1.33, 95% CI 1.12-1.58); these differences resolved by 1 month. Complete systemic opioid discontinuation at 3 months was comparable between groups (63.6% AC versus 59.1% HC). Safety profiles differed, with AC patients experiencing more procedure-related complications (postdural puncture headache: 18.2% versus 4.5%), while HC patients showed trends toward more opioid-related adverse events.</p><p><strong>Conclusions: </strong>Both AC and HC catheterization provide comparable pain control for refractory craniofacial cancer pain. The AC approach offers superior initial delivery efficiency but requires advanced technical skill, while the HC approach provides comparable long-term outcomes with a more familiar technique. Selection should be guided by institutional expertise and patient-specific risk profiles.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"251-267"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145605475","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 Therapeutic Potential of Dual NMR (NOP/MOP) Agonism in Pain Management.","authors":"Roberto Ciccocioppo, Jeffrey Gudin, Charles E Argoff, Emanuela Offidani, James Hackworth, David S Fam, Jim Potenziano","doi":"10.1007/s40122-025-00794-8","DOIUrl":"10.1007/s40122-025-00794-8","url":null,"abstract":"<p><p>Addressing pain effectively remains a major global challenge for healthcare systems and public health initiatives. While this issue is pervasive worldwide, it is particularly pressing in the United States, where pain management using opioid analgesics has led to significant concerns due to widespread misuse, drug dependence, and overdose fatalities. A central dilemma for clinicians in pain management lies in balancing the delivery of sufficient pain relief while minimizing potential risks. Although preferential μ-opioid receptor (MOP) agonists, such as morphine and oxycodone, often remain a necessary therapeutic choice, particularly for individuals experiencing moderate to severe pain, their safety profiles present a clinical dilemma, as there are limited other options available to clinicians. A promising area of research focus is on the development of dual NOP/MOP receptor (NMR) agonists , compounds that co-activate the nociceptin/orphanin FQ (NOP) receptor and the MOP receptor. Despite sharing some structural homology with opioid receptors, the NOP receptor exhibits a distinct pharmacological profile. Activating the NOP receptor induces pain relief and, more importantly, counteracts important adverse effects associated with MOP activation including reduction in euphoria by inhibiting opioid-induced activation of dopaminergic neuron activity in the ventral tegmental area (VTA), which in turn reduces the likelihood of misuse. Preclinical data have shown a potential role of NOP activation in reducing the occurrence of opioid withdrawal symptoms and, perhaps most importantly, respiratory depression. Investigations in nonhuman primates support the NOP receptor's modulatory role, demonstrating that NOP agonism not only produced analgesia across various pain models (nociceptive, neuropathic, and inflammatory) but also lessened MOP-related negative outcomes, such as opioid reward-seeking behavior, the development of tolerance, and withdrawal symptoms. Preclinical studies using dual NMR agonists showed that administration of a NOP antagonist increased the side effects similar to those caused by a preferential MOP agonist, underscoring the role of NOP receptor activation in counteracting these adverse events. Altogether these findings suggest that dual NMR (NOP/MOP receptor) agonists represent a promising novel class of medications with the potential to achieve strong analgesia while lessening the side effects of opioid agonists.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"71-95"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678343","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":"Chronic Pelvic Pain Syndrome in Women: Clinical Covariates and Comorbidity Patterns.","authors":"Stefan Weinschenk, Nura Fitnat Topbas Selcuki, Thomas Strowitzki, Axel Gerhardt, Oliver Zivanovic, Manuel Feisst","doi":"10.1007/s40122-025-00787-7","DOIUrl":"10.1007/s40122-025-00787-7","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pelvic pain syndrome (CPPS) in women is a debilitating condition with a high prevalence (5-25%), yet its etiology remains unclear. This prospective observational study aimed to identify clinical and medical history covariates associated with CPPS to elucidate potential pathophysiological mechanisms.</p><p><strong>Methods: </strong>A total of 225 women were evaluated in a gynecological pain clinic in Germany, including 41 patients with CPPS (≥ 6 months of lower abdominal pain) and 184 control patients undergoing routine gynecological screening. Exclusion criteria included pregnancy, pelvic malignancy, acute pelvic inflammation, and abnormal uterine bleeding. Covariates were assessed through structured clinical history and physical examination.</p><p><strong>Results: </strong>Significant associations with CPPS were observed for prior pelvic surgery (72% vs. 45%, p = 0.003), bowel constipation (37% vs. 11%, p = 0.002), history of endometriosis (33% vs. 10%, p = 0.043), and prior trauma (27% vs. 11%, p = 0.013). In contrast, there were no significant differences in rates of depression (p = 0.376), use of psychopharmaceuticals (p = 0.757), pelvic floor abnormalities (p = 0.503), uterine retroversion (p = 0.330), or pelvic congestion (p = 0.455). Dysmenorrhea (59% vs. 42%) and vulvar pain (31% vs. 8%) were more frequent in the CPPS group, though not statistically significant. No differences were found in delivery mode, use of intrauterine devices, analgesics, hormonal replacement therapy, and other medications, or comorbidities such as diabetes, thyroid disease, hypertension, other pain diseases, or musculoskeletal disorders.</p><p><strong>Conclusions: </strong>CPPS was not associated with several commonly suspected cofactors, including psychosomatic factors, pelvic congestion, or pelvic floor dysfunction. The findings suggest the existence of two subgroups of CPPS, the endometriosis-associated type and the neurovegetative type, associated with prior pelvic surgery, constipation, and trauma. This concept allows for the development of new targeted therapeutic strategies to successfully treat CPPS.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"201-218"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426915","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":"Gut Microbiota in the Treatment of Migraine with Acupuncture: A Review.","authors":"Jifa Zhong, Xiaoying Liu, Hong Zhu, Chenghua Zhang, Ruiqian Guan","doi":"10.1007/s40122-025-00793-9","DOIUrl":"10.1007/s40122-025-00793-9","url":null,"abstract":"<p><p>Migraine is one of the most common nervous system diseases in the world, which is characterized by recurrent severe headache, accompanied by gut microbiota imbalance and gut-brain axis dysfunction, seriously affecting the quality of life of patients. The existing treatment methods have some limitations, such as low diagnostic rate and drug dependence, so we should pay attention to the potential value of acupuncture, a traditional Chinese medicine therapy. This paper systematically reviews the mechanisms underlying the association between gut microbiota and migraine, and the pathways by which acupuncture intervention in migraine regulates gut microbiota. Studies have shown that patients with migraine generally have the phenomenon that the diversity of gut microbiota decreases, the abundance of beneficial bacteria decreases, and the proportion of harmful bacteria increases. The imbalance of gut microbiota promotes the disorder of intestinal metabolites, the destruction of the intestinal barrier and blood-brain barrier, the activation of trigeminal neurovascular system and central inflammation, and induces or aggravates migraine. Studies have found that acupuncture can regulate the diversity of gut microbiota and the abundance of beneficial bacteria through multiple targets, reduce the production of harmful metabolites, and protect the integrity of the intestinal barrier and blood-brain barrier. Acupuncture can relieve stress and negative emotion, and reduce the inducement of migraine. This review provides a theoretical basis for clarifying the mechanism of \"microbiota-gut-brain axis (MGBA)\" in acupuncture treatment of migraine, and also provides a new idea for the clinical standardized treatment of migraine.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"1-18"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145489977","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 Safety and Efficacy of Unilateral Biportal Endoscopic Decompression for the Treatment of Thoracic Ossification of Ligamentum Flavum with Occupancy Ratio > 60%: A Retrospective Cohort Study.","authors":"Lei Qi, Biteng Xu, Xiangji Guo, Gaoya Yu, Yuxuan Yang, Haozhi Yu, Liang Wang","doi":"10.1007/s40122-025-00806-7","DOIUrl":"10.1007/s40122-025-00806-7","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic decompression is a favorable option for the treatment of spinal diseases. However, there have been few reports of unilateral biportal endoscopy-assisted unilateral laminotomy for bilateral decompression (UBE-ULBD) for the treatment of severe thoracic spinal stenosis (TSS) and ossification of ligamentum flavum (OLF) with a high ossification occupancy ratio. The purpose was to evaluate the safety and efficacy of UBE-ULBD for the treatment of severe TSS-OLF with an occupancy ratio > 60%.</p><p><strong>Methods: </strong>The retrospective cohort study enrolled 40 patients with TSS-OLF from January 2021 to August 2023. All the patients presented with typical neurological symptoms with radiological one- or two-level thoracic OLF, receiving UBE-ULBD surgery with at least 2 years of follow-up. Preoperative and postoperative clinical and radiological data were reviewed and analyzed. In addition, operative time, postoperative drainage, postoperative length of stay, and complications were also recorded.</p><p><strong>Results: </strong>There were 33 cases of TSS-OLF with a single level and 7 two-level cases included in the study. The UBE-ULBD surgery was successfully performed for all the patients with an average operative time of 111.6 min/level. The mean follow-up time was 33.5 ± 6.4 months. The modified Japanese Orthopaedic Association (mJOA) score (9.1 ± 0.8 vs. 5.3 ± 1.0) and Oswestry Disability Index (ODI) (31.8 ± 5.2 vs. 46.4 ± 3.3) were significantly improved at last follow-up compared to the preoperative score. The mean recovery rate (RR) was 65.0%, with an effective rate of 100%. The mean preoperative ossification occupancy ratio was 76.7% and the ossification was removed for all cases with adequate decompression and radiological outcomes. The mean dural sac cross-sectional area (DSCA) expansion rate in magnetic resonance imaging (MRI) was 228.4 ± 115.8%.</p><p><strong>Conclusions: </strong>UBE-ULBD is a technically demanding and feasible, efficient, and minimally invasive option for the treatment of severe one- or two-level OLF-TSS with a high ossification occupancy ratio > 60% with excellent clinical and radiological outcomes.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"379-390"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794137","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 Radiofrequency Treatment of Primary Trigeminal Neuralgia in the V2 Maxillary Nerve.","authors":"Huan Zhang, Chenxuan Xiao, Hanqi Wang","doi":"10.1007/s40122-025-00810-x","DOIUrl":"10.1007/s40122-025-00810-x","url":null,"abstract":"<p><p>Primary trigeminal neuralgia (TN) involving the V2 maxillary nerve presents unique therapeutic challenges. Traditional radiofrequency techniques at the semilunar ganglion often lack selectivity and carry risks of injuring adjacent nerves. The recently refined CT-guided foramen ovale puncture radiofrequency thermocoagulation technique has significantly improved outcomes for V2 TN. This narrative review systematically explores the evolution of radiofrequency treatment for V2 TN, with a particular focus on comparing the efficacy and safety of different puncture pathways. We emphasize the superior clinical utility of the infrazygomatic approach, which offers greater precision and fewer complications than the obsolete orbital and mandibular routes. Furthermore, we discuss the impact of technical innovations, such as personalized needle modification, on treatment precision. This review aims to consolidate current evidence and provide practical, evidence-based guidance for clinicians managing this complex pain condition.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"149-159"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892808","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":"Pulsed Radiofrequency Analgesia Alters EEG Spatiotemporal Dynamics: A Microstate-Based Exploratory Study.","authors":"Ying Yang, Lanxing Wu, Yan Pan, Xuelian Li, Dong Huang, Raoxiang Zhang, Kuankuan Li, Yuzhao Huang","doi":"10.1007/s40122-025-00791-x","DOIUrl":"10.1007/s40122-025-00791-x","url":null,"abstract":"<p><strong>Introduction: </strong>Pulsed radiofrequency (PRF) is a well-established neuromodulation technique widely used for managing neuropathic pain. Lumbosacral radicular pain, a common neuropathic condition, is often refractory to conventional treatments. Although dorsal root ganglion (DRG) PRF has emerged as a promising intervention, its therapeutic efficacy is often limited and variable, likely due to an incomplete understanding of its mechanisms. To elucidate the neural mechanisms underlying DRG PRF analgesia, this study characterized treatment-induced alterations in microstate spatiotemporal dynamics and examined their correlation with pain intensity, thereby assessing their potential as neurophysiological markers.</p><p><strong>Methods: </strong>We recorded high-density electroencephalograms (EEG) in healthy controls and patients before and after DRG PRF treatment. Topographic differences were assessed using topographic analysis of variance (TANOVA). Microstate temporal parameters (duration, occurrence, coverage) and transition probabilities were analyzed. Pearson correlation analysis was performed between transition probabilities and visual analogue scale (VAS) scores.</p><p><strong>Results: </strong>TANOVA revealed significant differences in microstate topographies among the three groups (p = 0.033), primarily attributed to microstates C and E. Although we found no significant differences in global temporal parameters or transition probabilities, our exploratory analysis revealed a reduction in the transition probability from microstate D to E (Delta TM D to E) in patients before DRG PRF treatment compared to healthy controls (p = 0.016, uncorrected). Notably, this reduction showed a trend toward normalization after treatment. Furthermore, we observed a significant negative correlation between Delta TM D to E and VAS scores (r = -0.459, p = 0.008).</p><p><strong>Conclusion: </strong>DRG PRF alleviates neuropathic pain by normalizing interactions between large-scale brain networks, as evidenced by topographic reorganizations and trends toward normalized transition dynamics. The sensitivity of microstate metrics to these changes supports their potential as neurophysiological markers for assessing both pain-related brain dysfunction and treatment response.</p><p><strong>Trial registration: </strong>The trial was registered on ClinicalTrials.gov with the following number: ChiCTR2500104921.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"219-234"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145438725","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 Role of Dexketoprofen/Tramadol in Multimodal Therapy to Prevent Acute Postsurgical and Acute Low Back Pain from Developing into Chronic Pain: A Delphi Consensus Study.","authors":"Giustino Varrassi, Maria Dolma Gudez-Santos, Magdi Hanna, Magdalena Kocot-Kępska, Antonio Montero Matamala, Marco Antonio Narvaez Tamayo, Serge Perrot","doi":"10.1007/s40122-025-00786-8","DOIUrl":"10.1007/s40122-025-00786-8","url":null,"abstract":"<p><strong>Introduction: </strong>Dexketoprofen/tramadol is a fixed-dose multimodal combination analgesic that significantly controls multiple acute pain states, and may have an important clinical application in providing pain control adequate to prevent the transition from acute to chronic postsurgical and low back pain. A consensus is needed to quantify and define the actual burden of postsurgical pain (PSP) and low back pain (LBP), which can support efforts toward effective approaches to manage potential pain chronification.</p><p><strong>Methods: </strong>This study utilized a modified Delphi approach. A Scientific Committee set forth 28 statements on six themes about the burden of acute PSP and LBP, their potential transition to chronic pain, their pathophysiology, therapeutic approaches to stop this transition, and the role of multimodal analgesia in this context, specifically a fixed-dose combination oral product of dexketoprofen/tramadol. An international panel of healthcare professionals from various regions and relevant medical specialties participated in a Delphi study and were surveyed for consensus on a 5-point Likert scale with consensus defined as > 70% concordance. A round of online voting lasting 3 months and using an online survey platform was permitted for each participant.</p><p><strong>Results: </strong>A total of 100 experts completed the Delphi survey. All the 28 proposed statements reached consensus > 70% in the first round of voting. A fixed-dose combination product, specifically dexketoprofen/tramadol was recognized as a multimodal analgesic which could effectively relieve acute pain and act to prevent its transition to chronic pain. The high global burden of chronic PSP (CPSP) and chronic LBP (CLBP) was identified as well.</p><p><strong>Conclusions: </strong>Healthcare professionals who deal with pain recognize the burden of acute pain, the risks of acute pain transitioning to chronic pain, and inspire to avert the transition by providing effective multimodal control of acute pain. The role of fixed-dose combination analgesics, in particular dexketoprofen/tramadol, was recognized by consensus as an efficacious and safe therapy option for these acute pain syndromes. A Video Abstract is available for this article. To view, please see the online version of the manuscript or follow the 'Digital Features' link. A Video Abstract for The Role of Dexketoprofen/Tramadol in Multimodal Therapy to Prevent Acute Postsurgical and Acute Low Back Pain from Developing into Chronic Pain: A Delphi Consensus Study (MP4 112565 KB).</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"175-199"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426920","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":"Prediction of Postherpetic Neuralgia in Patients with Acute and Subacute Herpetic Neuralgia Using Structural Magnetic Resonance Imaging: A Retrospective Study.","authors":"Dan Wu, Bo Peng, Yingjie Hua, Wujun Geng, Bing Huang, Siyu Lu, Junlin Chen, Keyi He, Yuxi Wang, Qiaoyin Rao, Zubo Jiang, Chuanguang Wang, Yakang Dai, Jiansong Ji, Zhongwei Zhao","doi":"10.1007/s40122-025-00796-6","DOIUrl":"10.1007/s40122-025-00796-6","url":null,"abstract":"<p><strong>Introduction: </strong>This study integrated structural magnetic resonance imaging (sMRI) of the brain with clinical characteristics to identify the \"vulnerable brain regions\" and risk factors associated with the development of postherpetic neuralgia (PHN) in patients with acute and subacute herpetic neuralgia. Furthermore, the study explored the combined predictive performance of these neuroimaging and clinical indicators.</p><p><strong>Methods: </strong>From February 2023 to January 2025, a total of 214 hospitalized patients with acute and subacute herpetic neuralgia were enrolled. Follow-up was conducted via telephone or outpatient visits, revealing that 116 patients (54.98%) developed PHN, while 95 did not. Clinical data and magnetic resonance imaging (MRI) data were collected for all participants. T1-weighted structural MRI images underwent preprocessing procedures including N4 bias field correction, skull stripping, brain tissue segmentation, and parcellation. Gray matter volume (GMV) values were extracted from 90 predefined regions of interest (ROIs) for further analysis. Group differences were assessed using two-tailed Student's t-tests or the non-parametric Kruskal-Wallis H test, as appropriate. Features showing significant intergroup differences in GMV were integrated with clinical variables to train machine learning models, and receiver-operating characteristic (ROC) curve analysis was employed to evaluate their predictive performance for PHN.</p><p><strong>Results: </strong>Significant differences were observed between the PHN and Non-PHN groups in several clinical variables, including age, body mass index (BMI), age ≥ 50 years, disease duration, admission Numeric Rating Scale (NRS) score, hospitalization during the acute phase (< 1 month), involved dermatome, and total Charlson Comorbidity Index (CCI) score (all P < 0.05). In terms of neuroimaging findings, GMV differed significantly between the two groups in the following brain regions: the left inferior frontal gyrus (triangular part), fusiform gyrus, Heschl's gyrus, and superior temporal gyrus; the right orbital part of the inferior frontal gyrus, lentiform nucleus (globus pallidus); and the bilateral cingulate gyrus, hippocampus, and caudate nucleus (P < 0.05, corrected for multiple comparisons using the false discovery rate [FDR] method). The combined model integrating T1-weighted MRI features and clinical characteristics achieved an area under the ROC curve (AUC) of 0.748 (95% CI 0.677-0.816) for predicting the occurrence of PHN.</p><p><strong>Conclusion: </strong>This study is the first to innovatively integrate sMRI to identify \"vulnerable brain regions\" associated with the transition from acute and subacute herpetic neuralgia to PHN. By combining GMV metrics with clinical features, the study provides a novel approach for predicting the development of PHN.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":"269-289"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701358","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}