{"title":"Acupressure as part of comprehensive postpartum pain care: a systematic review of clinical evidence from low- and middle-income countries.","authors":"Prety Zinta Aprila, Fauzan Syarif Nursyafi, Gestina Aliska","doi":"10.1080/17581869.2026.2708173","DOIUrl":"https://doi.org/10.1080/17581869.2026.2708173","url":null,"abstract":"<p><p>Postpartum pain remains a significant yet under-addressed issue in low- and middle-income countries (LMICs), where pharmacological analgesia may be limited by availability, side effects, and breastfeeding safety concerns. This systematic review aimed to synthesize and critically appraise the clinical trial evidence on the effectiveness of acupressure for managing postpartum pain in LMIC settings. Following PRISMA 2020 guidelines, searches were conducted in PubMed, Cochrane Library, ScienceDirect, Taylor & Francis, ProQuest, and Google Scholar for studies published between 2015 and 2025. Nine eligible studies from Turkey, Iran, Taiwan, Thailand, and Indonesia were included and appraised using the CASP tool. Most studies focused on the immediate/acute postpartum phase, while a few extended into the early postpartum period. Across various postpartum pain conditions, most included studies reported reductions in pain intensity following body or auricular acupressure compared with usual care, sham, or comparator interventions. Several studies also reported additional benefits, such as decreased analgesic consumption after cesarean delivery and improvements in functional limitations and depressive symptoms. Overall, acupressure may serve as a low-cost adjunct for postpartum pain management in resource-limited maternity services. Nevertheless, protocol variability and short follow-up periods highlight the need for larger multicentre trials with standardized dosing and broader maternal outcomes.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"1-12"},"PeriodicalIF":1.7,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2026-07-01Epub Date: 2026-04-20DOI: 10.1080/17581869.2026.2660895
M van Liefland, P J van Tilborg, M Szmukala, Z Zhang, C Kramers, G J Lammers, R Khatami, R Fronczek
{"title":"Efficacy, safety, and tolerability of low sodium oxybate for nocturnal cluster headache attacks in chronic cluster headache: protocol for a phase II randomized, double-blind, placebo-controlled, trial (SUNCET).","authors":"M van Liefland, P J van Tilborg, M Szmukala, Z Zhang, C Kramers, G J Lammers, R Khatami, R Fronczek","doi":"10.1080/17581869.2026.2660895","DOIUrl":"10.1080/17581869.2026.2660895","url":null,"abstract":"<p><strong>Background: </strong>Cluster headache presents with severe headache attacks that typically occur during sleep. This study aims to evaluate the efficacy, tolerability, and safety of low sodium oxybate (LXB), a sleep-deepening drug, for nocturnal attacks in chronic cluster headache.</p><p><strong>Method: </strong>In this randomized, double-blind, placebo-controlled, bi-center trial, we will include 52 participants (18-75 years) with chronic cluster headache and ≥4 nocturnal attacks per week. Participants with a contraindication for LXB will be excluded. After a 4-week baseline phase, participants will be randomized to receive either LXB or placebo as a twice nightly regimen during the treatment phase. All participants will undergo a 6-week titration phase followed by a 4-week stable dose treatment phase. The primary outcome is the change from baseline in the average weekly frequency of nocturnal cluster headache attacks during the 4-week stable dose treatment phase, comparing the LXB group to the placebo group. Secondary and exploratory outcomes include change in daytime attack frequency, the improvement of sleep quality and sleep continuity parameters.</p><p><strong>Discussion: </strong>The results of this trial could have a substantial impact on the treatment for chronic cluster headache, particularly for patients suffering from frequent nocturnal attacks.</p><p><strong>Clinical trial registration: </strong>The www.clinicaltrials.gov identifier is NCT06950281.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"703-711"},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2026-07-01Epub Date: 2026-04-08DOI: 10.1080/17581869.2026.2656279
Giovanni Leoni, Andrea Demeco, Claudia Correia, Afonso Braz, João Tocha, Xavier Melo, Tomás Caroço, Cosimo Costantino, Jorge Barbosa
{"title":"Ultrasound-guided radiofrequency ablation of genicular nerves: a novel 5-nerve protocol - pilot study.","authors":"Giovanni Leoni, Andrea Demeco, Claudia Correia, Afonso Braz, João Tocha, Xavier Melo, Tomás Caroço, Cosimo Costantino, Jorge Barbosa","doi":"10.1080/17581869.2026.2656279","DOIUrl":"10.1080/17581869.2026.2656279","url":null,"abstract":"<p><strong>Objectives: </strong>Genicular nerve radiofrequency ablation (RFA) efficacy for knee osteoarthritis (OA) remains debated. This prospective pilot study evaluated the feasibility and outcomes of a novel 5-nerve ultrasound-guided protocol targeting: Superior-Medial (SMGN), Superior-Lateral (SLGN), Inferior-Medial (IMGN), Inferior-Lateral (ILGN) Genicular Nerves and Recurrent Fibular Nerve (RFN).</p><p><strong>Methods: </strong>Nineteen patients were enrolled. Feasibility was assessed through protocol adherence and safety (adverse events rate). Primary outcomes were pain (Numerical Rating Scale - NRS) and function (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC) defining responders as ≥50% improvement. Secondary assessments included Environmental Quality of Life Scale (EQoL-5), 6-Minute Walk Test (6MWT), Timed-Up-and-Go (TUG), and Medical Research Council (MRC) scale at 1 and 3 months.</p><p><strong>Results: </strong>Significant improvements occurred in NRS (<i>p</i> < 0.001), WOMAC (<i>p</i> < 0.001), and EQoL-Index (<i>p</i> = 0.003); responder rate was 63.2% (<i>n</i> = 12/19). One patient withdrew after T1 due to dissatisfaction; no study attrition or adverse events (notably motor deficits) occurred. Baseline 6MWT >200 m associated with treatment response (<i>p</i> = 0.048), though small sample size limits generalizability.</p><p><strong>Conclusions: </strong>This 5-nerve protocol demonstrated clinical plausibility and safety. Lack of a control group precludes definitive attribution of improvements to RFA over placebo. Robust RCTs comparing 3-nerve vs. 5-nerve protocols are mandatory before clinical implementation.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"747-753"},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2026-07-01Epub Date: 2026-06-04DOI: 10.1080/17581869.2026.2674158
Timothy Deer, Anuj Shah, David Reece, Chau M Vu, Siddardth Umapathy, Harman Chopra, Colin Mark Buday, Rosa A Garcia, Johnson S Ho, Robin Mata, Christopher M Lam, Christopher L Robinson, Lucas Bracero, Mateusz Graca, Casey Grillo, Ashley G Comer, Kasra Amirdelfan, Dawood Sayed
{"title":"Best practices for the LinQ sacroiliac joint stabilization procedure for the treatment of sacroiliac joint disorders.","authors":"Timothy Deer, Anuj Shah, David Reece, Chau M Vu, Siddardth Umapathy, Harman Chopra, Colin Mark Buday, Rosa A Garcia, Johnson S Ho, Robin Mata, Christopher M Lam, Christopher L Robinson, Lucas Bracero, Mateusz Graca, Casey Grillo, Ashley G Comer, Kasra Amirdelfan, Dawood Sayed","doi":"10.1080/17581869.2026.2674158","DOIUrl":"10.1080/17581869.2026.2674158","url":null,"abstract":"<p><strong>Introduction: </strong>Sacroiliac joint (SIJ) disease is a common source of low back and buttock pain and is often linked to prior lumbar fusion, pregnancy, trauma, or repetitive loading. Because conservative measures such as injections and radiofrequency can be short-lived, interest has shifted toward minimally invasive SIJ fusion.</p><p><strong>Areas covered: </strong>This review summarizes SIJ diagnosis, workup, and patient selection for fusion, and focuses on posterior allograft fixation, including procedural steps, postoperative care, outcomes, complications, and limitations.</p><p><strong>Expert opinion/commentary: </strong>Modern SIJ fusion first gained momentum with lateral transfixing implants. Additional developments included the method of lateral oblique placement, with a theory of being higher in the sacrum to avoid the neural structures and arterial supply to the gluteal muscles. Posterior intra-articular allograft fixation (LinQ; PainTEQ) may reduce exposure to major vessels and nerves, can be performed in office or outpatient settings, and may be easier to adopt because access and imaging resemble SIJ injection. Available studies suggest meaningful pain and functional improvement. We view posterior intra-articular allograft fixation as appealing for osteoporosis, where transfixing implants are less desirable, and we recommend registry data plus randomized trials to refine selection and comparative effectiveness.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"809-830"},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2026-07-01Epub Date: 2026-04-30DOI: 10.1080/17581869.2026.2653162
Leonardo Kapural, Jeff Pullen, Nicholas J Hargus
{"title":"High-frequency nerve block treatment for chronic post-amputation pain over 12 months: plain language summary of the QUEST trial.","authors":"Leonardo Kapural, Jeff Pullen, Nicholas J Hargus","doi":"10.1080/17581869.2026.2653162","DOIUrl":"10.1080/17581869.2026.2653162","url":null,"abstract":"","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"685-702"},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2026-07-01Epub Date: 2026-04-15DOI: 10.1080/17581869.2026.2660325
Juan Antonio Valera-Calero, Sandra Sánchez-Jorge, Davinia Vicente-Campos, Dariusz Kosson, Marcin Kołacz, Magdalena Kocot-Kępska, Piotr Mieszczański, José López-Chicharro, Umut Varol, Grzegorz Górniewski, Mónica López-Redondo, Mateusz D Kobylarz
{"title":"Percutaneous electrical nerve stimulation as alternative to nerve blocks for the diagnosis of facet joint syndrome in patients with non-specific chronic low back pain: a clinical trial protocol.","authors":"Juan Antonio Valera-Calero, Sandra Sánchez-Jorge, Davinia Vicente-Campos, Dariusz Kosson, Marcin Kołacz, Magdalena Kocot-Kępska, Piotr Mieszczański, José López-Chicharro, Umut Varol, Grzegorz Górniewski, Mónica López-Redondo, Mateusz D Kobylarz","doi":"10.1080/17581869.2026.2660325","DOIUrl":"10.1080/17581869.2026.2660325","url":null,"abstract":"<p><p>The diagnosis of chronic low back pain is frequently complicated by the absence of identifiable pathoanatomical causes on imaging. Consequently, clinical guidelines often advocate for interventional diagnostic procedures, such as medial branch nerve blocks, for suspected facet joint syndrome. Despite their utility, these interventions involve significant resource costs and potential risks associated with needle gauges and pharmacological agents. This study describes a protocol to evaluate percutaneous electrical nerve stimulation (PENS) as a safer, drug-free, and more cost-effective alternative. A parallel and multicenter study with an experimental design through a randomized clinical trial will be conducted. Adults with chronic low back pain and facet-mediated pain confirmed by two positive comparative medial branch diagnostic blocks will be randomized into four parallel groups: PENS, diagnostic medial branch nerve block (with local anesthetic), PENS + nerve block, and PENS + placebo block (full block ritual without active perineural anesthetic). The primary outcomes will be analgesic response. Secondary outcomes include pressure pain threshold, disability, health-related quality of life, rescue analgesic consumption, and the incidence/severity of local and systemic adverse events.Clinical Trial Registration: The www.clinicaltrials.gov identifier is NCT07273006.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"713-719"},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2026-07-01Epub Date: 2026-04-23DOI: 10.1080/17581869.2026.2660326
Julie R Brewer, Pearl Lee, Nadine Levey, Joseph W Ditre, Neal Chen, Chaitanya Mudgal, Abhiram R Bhashyam, Rohit Garg, David Ring, Ana-Maria Vranceanu, Jafar Bakhshaie
{"title":"Patient perspectives on non‑traumatic painful upper‑extremity conditions, co-occurring risky substance use, and an integrated web-based mind-body intervention addressing both conditions.","authors":"Julie R Brewer, Pearl Lee, Nadine Levey, Joseph W Ditre, Neal Chen, Chaitanya Mudgal, Abhiram R Bhashyam, Rohit Garg, David Ring, Ana-Maria Vranceanu, Jafar Bakhshaie","doi":"10.1080/17581869.2026.2660326","DOIUrl":"10.1080/17581869.2026.2660326","url":null,"abstract":"<p><strong>Objective: </strong>This study explored patient experiences with non-traumatic painful upper-extremity conditions (NPUCs) and co-occurring risky substance use and assessed perspectives on the acceptability and usability of Web-TIRELESS, an integrated web-based mind-body intervention addressing both conditions concurrently.</p><p><strong>Methods: </strong>Nineteen adults with NPUCs and risky substance use completed individual semi-structured interviews. Data were analyzed using a hybrid deductive-inductive thematic analysis approach.</p><p><strong>Results: </strong>Four themes emerged: (1) Challenges managing pain: Patients reported functional deterioration, emotional distress, and frustration with limited symptom relief, often associated with maladaptive coping strategies, including substance use. (2) Motivations for substance use and change: Alcohol, cannabis, and tobacco were commonly used to manage pain, stress, or sleep difficulties. Participants had limited awareness of the reciprocal relationship between pain and substance use and expressed low motivation to change. (3) Intervention preferences: Web-TIRELESS was viewed positively for its flexibility, privacy, and accessibility. Participants preferred credible, evidence-based, and practical pain-coping content. (4) Barriers and facilitators: Barriers included skepticism about efficacy, low motivation, and technological accessibility. Facilitators included live-human support, streamlined content, and accountability reminders.</p><p><strong>Conclusion: </strong>Patients prefer flexible, accessible, and evidence-based psychosocial interventions addressing pain and substance use simultaneously. Upon integrating patient suggestions, Web-TIRELESS may effectively bridge gaps in integrated orthopedic care.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"765-777"},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2026-07-01Epub Date: 2026-04-30DOI: 10.1080/17581869.2026.2663948
Steven Falowski, Dirk DeRidder
{"title":"BurstDR and multi-area Burst DR spinal cord stimulation for the treatment of chronic pain: \"less is more\".","authors":"Steven Falowski, Dirk DeRidder","doi":"10.1080/17581869.2026.2663948","DOIUrl":"10.1080/17581869.2026.2663948","url":null,"abstract":"<p><strong>Introduction: </strong>Neuromodulation treatments are a well-established therapy for chronic pain patients. BurstDR is a novel spinal cord stimulation platform rooted in clinical and scientific data.</p><p><strong>Body: </strong>It not only activates the lateral and descending pathways which are observed with traditional tonic stimulation but is able to activate the medial pathways and therefore effect the emotional and cognitive components of pain. It has been shown to be different than other \"burst\" platforms on the market which are intermittent tonic stimulation. It is a highly energy-efficient stimulation paradigm that operates on a \"less is more\" paradigm.</p><p><strong>Evidence: </strong>BurstDR<sup>TM</sup> SCS has level 1A evidence supporting its use, multiple systematic reviews, and numerous placebo-controlled trials. Multi- area Burst DR/Flexburst360<sup>TM</sup> has 6-month prospective data, 4-year real-world data, and trial data in addition to established scientific evidence with human electrophysiological recordings.</p><p><strong>Conclusion: </strong>The distinct characteristics of the BurstDR and multi-area Burst DR platforms not only deliver consistent pain relief but also lend itself to improving painfulness, suffering, disability, quality of life, pain intensity, and pain interference. The high levels of patient global impression of change demonstrate the considerable impact on the patients' lives.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"721-735"},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2026-07-01Epub Date: 2026-04-14DOI: 10.1080/17581869.2026.2658063
Chad E Cook, Bryan O'Halloran, Derek Clewley, Frank Keefe, Cindy Green, Amy McDevitt
{"title":"Specific and shared mechanisms mediating pain intensity and functional outcomes in chronic neck pain.","authors":"Chad E Cook, Bryan O'Halloran, Derek Clewley, Frank Keefe, Cindy Green, Amy McDevitt","doi":"10.1080/17581869.2026.2658063","DOIUrl":"10.1080/17581869.2026.2658063","url":null,"abstract":"<p><strong>Background: </strong>To date, very few studies have used mediation analysis to explore the reasons why people with chronic neck pain improve after physical therapy intervention involving manual therapy or exercise.</p><p><strong>Objectives: </strong>To evaluate which specific mechanisms (mobility, pain modulation and endurance) and shared mechanisms (self-efficacy, working alliance, engagement, fear, and positive coping) mediated the effects of treatment on clinical outcomes at 4-weeks and 6-months in individuals with chronic neck pain.</p><p><strong>Methods: </strong>The study incorporated planned indirect‑only mediation analyses to evaluate both specific and shared mechanisms as mediator using data from a mechanistic clinical trial comparing manual therapy and exercise interventions, which demonstrated no between‑group differences. Baseline pain intensity was modeled as the independent variable, and pain interference and physical function at four-weeks and six-months were specified as outcomes. Direct, indirect, and total effects were estimated across four mediation models.</p><p><strong>Results: </strong>None of the mediation analyses found specific or shared mechanisms that mediated the relationship of baseline pain intensity to long-term pain interference and physical function. Discussion/Conclusion: Our findings suggest that the absence of significant mediation implies that commonly targeted mechanisms may not be the primary drivers of the relationship of pain intensity to longer-term pain interference or physical function.</p><p><strong>Clinical trial registration: </strong>www.clinicaltrials.gov identifier is NCT05940012.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"799-808"},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}