Scandinavian Journal of Pain最新文献

{"title":"Analgesic, anti-inflammatory and joint protective effects of ACD137, a selective negative allosteric modulator of TrkA, in models of chemotherapy-induced peripheral neuropathy and osteoarthritis.","authors":"Pontus Forsell, Maria Backlund, Veronica Lidell, Azita Rasti, Cristina Parrado Fernandez, Märta Segerdahl, Johan Sandin, Gunnar Nordvall","doi":"10.1515/sjpain-2026-0007","DOIUrl":"10.1515/sjpain-2026-0007","url":null,"abstract":"<p><strong>Objectives: </strong>The neurotrophin receptor TrkA is a clinically and genetically validated target in pain signaling. Anti-nerve growth factor (NGF) monoclonal antibodies have shown clinical efficacy but with side effects such as rapidly progressing osteoarthritis limiting their use, potentially mediated via inhibition of NGF/p75NTR signaling. Therefore, we sought to identify novel and selective small molecule negative allosteric modulators of tropomyosin receptor kinase A (TrkA) and to verify their analgesic effect <i>in vivo</i>.</p><p><strong>Methods: </strong>We have identified ACD137 as a potent and selective negative allosteric modulator (NAM) of TrkA during a lead optimization program. The potency of ACD137 on TrkA and selectivity over TrkB was determined in cell-based assays. ACD137 was tested for its analgesic and anti-inflammatory effects in a model of chemotherapy induced peripheral neuropathy (CIPN) using paclitaxel and in the mono-iodo acetate (MIA)-induced osteoarthritis model in rats.</p><p><strong>Results: </strong>ACD137 demonstrated an IC₅₀-value on TrkA of 1.2 nM and showed approximately 17,300- and 17,600-fold selectivivity for TrkA over TrkB and TrkC, respectively. After oral administration in rats, ACD137 reduced mechanical allodynia in the CIPN model in a dose-dependent manner with maximal analgesic efficacy similar to the effect of gabapentin. In a comparative arthritis study using the anti-NGF antibody tanezumab as comparator, ACD137 reduced both evoked and non-evoked pain behavior as well as inflammation with similar efficacy as tanezumab. Surprisingly, ACD137 demonstrated a significant protective effect against knee joint deterioration, something that was not observed with tanezumab.</p><p><strong>Conclusions: </strong>The data demonstrates that ACD137 is a potent, selective and <i>in vivo</i> active negative allosteric modulator of TrkA exhibiting analgesic effects in models of neuropathic and nociceptive pain. The molecule possesses promising properties for further pre-clinical development.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785075","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}

{"title":"Boredom lowers, but humor elevates pressure pain thresholds in pain-free humans: a randomized controlled trial.","authors":"Helena Gunnarsson, Jens Agerström","doi":"10.1515/sjpain-2026-0006","DOIUrl":"10.1515/sjpain-2026-0006","url":null,"abstract":"<p><strong>Objectives: </strong>Emotional states could affect sensitivity to pain through the descending nociceptive modulatory system. Drawing on the theory of unconscious nociceptive processing and the idea that ascending sensory signals could be unconscious due to the distraction of external events, this study examined whether boredom would increase sensitivity to pain by lowering pressure pain thresholds (PPTs) in four body locations (right m.trapezius; left m. trapezius; right m.tibialis anterior; left m.tibialis anterior) in pain-free individuals.</p><p><strong>Methods: </strong>Pain-free individuals (n=114) were randomly assigned to three different mental state inductions (boring; humorous; control). Baseline PPTs were measured after an emotionally neutral video and induction PPTs were measured after each of the mental state inductions. Pre-validated videos were used for emotion induction, and a manipulation check was conducted at each test session.</p><p><strong>Results: </strong>The results showed that boredom significantly lowered PPTs in all four body locations, with large effect sizes. Induced humor significantly elevated PPTs in the right and left m. trapezius, with moderate effect sizes.</p><p><strong>Conclusions: </strong>It was concluded that boredom increases sensitivity to pain in healthy individuals. Whether this effect extends to clinical pain populations should be examined in future research due to its potential implications for the treatment of pain.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718361","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}

{"title":"Effect of ambient cold exposure on pain modulation: exploring individually reported thermal comfort as moderating factor in a crossover study of young adults.","authors":"Fred Haugen, Therese Velle, Dagfinn Matre","doi":"10.1515/sjpain-2025-0062","DOIUrl":"10.1515/sjpain-2025-0062","url":null,"abstract":"<p><strong>Objectives: </strong>Pain is a hallmark of musculoskeletal conditions. Some studies suggest that pain is exacerbated by working in cold environments, potentially due to poorly understood mechanisms within the somatosensory system. The aim of this study was to assess whether ambient cold exposure influences the efficiency of endogenous pain inhibition and the potential role of subjective thermal comfort.</p><p><strong>Methods: </strong>In a crossover study with 1 week interval and in randomized order, 20 healthy men were exposed to cold (COLD; 10 °C) and thermoneutral (TN; 22 °C) conditions in a controlled environment room (CER) for 2 h. Conditioned pain modulation (CPM), defined as the difference in mean rated pain of a test stimuli (TS) with and without a conditioning stimulus (CS), was calculated before and after CER. Test stimuli (TS) was a 30 s tonic noxious heat stimulation to the dominant volar forearm, and conditioning stimuli (CS) was immersion of the contralateral hand in water holding 4 °C. Subjective TS pain was rated on a 0-10 cm computerized Visual Analogue Scale (VAS). Thermal comfort, encompassing subjective thermal perception, evaluation, and preference, was assessed using standardized subjective judgment scales.</p><p><strong>Results: </strong>The CPM-effect was significantly reduced by COLD exposure, but not by TN exposure. As expected, participants' ratings of thermal comfort changed across exposure conditions; however, this had no significant influence on the CPM-effect.</p><p><strong>Conclusions: </strong>Exposure to cold ambient conditions impaired endogenous pain-inhibitory pathways, an outcome not observed under thermoneutral conditions. Furthermore, the results suggest that thermal comfort does not influence endogenous pain-inhibitory pathways. Further research is required to identify moderators affecting pain processing in cold working environments. Regional Ethics Committee, Norway (REK sør-øst C; application # 2017/1859).</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724442","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}

{"title":"The influence of polymorphisms in cytokine genes on pain and response to palliative radiotherapy in multiple myeloma patients: prospective observational study.","authors":"Milda Rudzianskiene, Arturas Inciura, Rolandas Gerbutavicius, Viktoras Rudzianskas, Rasa Ugenskiene, Renata Paukstaitiene, Ruta Dambrauskiene, Domas Vaitiekus, Migle Kulboke, Elona Juozaityte","doi":"10.1515/sjpain-2025-0013","DOIUrl":"10.1515/sjpain-2025-0013","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to assess the impact of polymorphisms in cytokine genes on pain severity and pain treatment with palliative radiotherapy.</p><p><strong>Methods: </strong>81 patients were enrolled. Pain severity and dose of analgesics were evaluated prior to radiotherapy and at 4, 12 and 24 weeks following treatment. The study analysed 12 gene polymorphisms of 6 cytokines (IL-6, IL-10, TNFα, IL-1α, IL-1β, IL-1RA) involved in the pathogenesis of pain syndrome.</p><p><strong>Results: </strong>Association between severe pain and patients' variables and genotype groups of each cytokine gene studied were analysed. Karnofsky index ≥ 60 % and IL1RN rs2234677 polymorphism GG genotype were found to have significant impact on severe pain prior to radiation. Patients with IL-1α encoding gene IL1A rs1800587 CC genotype and patients with IL-1β encoding gene IL1B rs1143634 CC genotype had significantly better response to radiotherapy. Patients with IL-1RA encoding gene IL1RN rs315952 CC genotype had a faster response to radiation.</p><p><strong>Conclusions: </strong>Findings of this study emphasize the importance of gene polymorphisms which encode inflammatory interleukins in the severity of pain and response to palliative radiotherapy. Regional research ethical committee number BE-2-39 ClinicalTrials.gov registration number NCT02024815.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460579","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}

{"title":"Motor-evoked pain on a background of widespread muscle strain: a novel model simulating everyday activities.","authors":"Vivien Schreiber, Stefan Lautenbacher, Claus-Christian Carbon, Isabelle Lindner, Miriam Kunz","doi":"10.1515/sjpain-2025-0057","DOIUrl":"10.1515/sjpain-2025-0057","url":null,"abstract":"<p><strong>Objectives: </strong>Musculoskeletal pain is among the most prevalent types of pain. However, experimental models that induce acute musculoskeletal pain by everyday activities - on top of sustained daily muscular strain - in a controlled and moderate manner are still lacking. Such models are essential for investigating underlying mechanisms of musculoskeletal pain and evaluating treatment approaches. The present study proposes a novel experimental model to address this gap.</p><p><strong>Methods: </strong>A total of 43 pain-free participants completed two motor (lifting objects) and two sensory (hot water immersion, noxious pressure) pain challenges. Participants were randomly assigned to either an experimental group, who wore a suit that induced widespread muscle strain through limb weights and joint restrictions, or a control group without the suit. Both groups performed the additional pain challenges. Numerical pain ratings, pain-related facial expressions (Facial Action Coding System, FACS), heart rate (HR) and its variability (HRV), as well as electrodermal activity (EDA), were recorded.</p><p><strong>Results: </strong>Wearing the experimental suit to induce muscle strain led to increased pain ratings during motor challenges when further muscle power was required (weightlifting). Additionally, pain-specific facial responses and autonomic markers (heart rate and tonic EDA) were significantly elevated in the experimental group during motor tasks. No significant group differences were observed during the sensory pain challenges.</p><p><strong>Conclusion: </strong>This study introduces a novel and effective experimental model for inducing acute musculoskeletal pain by applying light weightlifting on top of sustained muscular strain, with both stressors designed to reflect everyday motor activities. This approach offers a promising tool for future research into pain-relieving interventions and the mechanisms of musculoskeletal pain, including studies involving affected patient populations.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436667","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}

{"title":"Association between early post-stroke pain and quality of life in working-age patients: results from the FRAILTY study.","authors":"Daniel Šaňák, Lenka Štureková, Elena Gurková, Daniela Bartoníčková, David Franc, Šárka Šaňáková, Jana Zapletalová","doi":"10.1515/sjpain-2025-0049","DOIUrl":"10.1515/sjpain-2025-0049","url":null,"abstract":"<p><strong>Objectives: </strong>To assess early PSP in IS patients of working age and evaluate the possible impact of PSP on HRQoL at three months after IS.</p><p><strong>Methods: </strong>Consecutive IS patients of working age (18-65 years) enrolled in the prospective FRAILTY (ClinicalTrials.gov: NCT04839887) were analysed. PSP was assessed using the Brief Pain Inventory (BPI) at three months after IS. QoL was assessed using the Stroke Impact Scale (SIS) version 3.0 and Quality of Life in Neurological Disorders (NeuroQoL). Linear regression analysis was used to test PSP and other variables as possible predictors for perceived overall recovery after IS.</p><p><strong>Results: </strong>In total, 138 (52.9 % males, mean age: 51.9 ± 8.4 years) were analysed. PSP was present in 34 (24.6 %) patients. Presence of PSP was associated with lower scores in all SIS domains except \"communication\" and \"participation\", and with lower scores in all NeuroQoL domains except \"social roles\" and \"emotions\". Linear regression analysis showed BPI interference as the only negative predictor of perceived overall HRQoL and recovery after IS (β=-0.824, p=0.000).</p><p><strong>Conclusions: </strong>PSP was present in 24.6 % of patients of working age at three months after IS. The presence of PSP significantly affected HRQoL and had a negative impact on perceived overall recovery after IS. Early assessment of PSP and its management may contribute to better HRQoL and recovery after IS.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436718","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}

{"title":"Insomnia symptom severity predicts long-term pain intensity and bothersomeness across ICD-11 chronic pain categories: a registry-based cohort study.","authors":"Live Landmark, Martijn Smits, Egil A Fors, Øyvin Nydal Dahm, Leif Edward Ottesen Kennair, Henrik Børsting Jacobsen","doi":"10.1515/sjpain-2025-0050","DOIUrl":"10.1515/sjpain-2025-0050","url":null,"abstract":"<p><strong>Objectives: </strong>Sleep and pain are reciprocally linked, each exacerbating functional impairments. In this observational cohort study, we examined differences in insomnia symptom severity among patients whose pain diagnoses, originally classified according to the International Classification of Diseases, 10th edition (ICD-10), were transformed into ICD-11 chronic pain categories. We further investigated whether the severity of insomnia symptoms at intake at a specialized pain clinic could predict pain outcomes 12 months later.</p><p><strong>Methods: </strong>Data were drawn from 4,283 patients registered in the Oslo University Hospital Pain Registry. Baseline data from 3,705 patients were analyzed for differences in insomnia severity (measured using the Insomnia Severity Index, ISI) across ICD-11 chronic pain categories. At follow-up, 1,163 patients were included to test whether baseline insomnia severity predicted pain intensity and bothersomeness at 12-month follow-up using hierarchical linear regression models.</p><p><strong>Results: </strong>The severity of insomnia symptoms (0-28, ISI) was slightly lower in chronic primary pain (Mean 15.3, SD=6.77) compared to chronic neuropathic pain (Mean 16.3, SD=6.65), adjusted p=0.017. No differences were observed between other chronic pain categories. After adjusting for age, gender, baseline pain scores, and psychological characteristics, a higher baseline severity of insomnia symptoms predicted greater pain intensity and bothersomeness at follow-up.</p><p><strong>Conclusions: </strong>While the severity of insomnia symptoms appears to be equally distributed across ICD-11 chronic pain categories and has a substantial impact on the long-term intensity and bothersomeness of pain, it is largely ignored in clinical guidelines. Findings suggest that early, targeted interventions for insomnia symptoms may benefit patients.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436664","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}

{"title":"Success rates of a surgical neurectomy for lateral cutaneous nerve entrapment syndrome (LACNES).","authors":"Monica L Y E Jacobs, Willem A R Zwaans, Marc R M Scheltinga, Rudi M H Roumen","doi":"10.1515/sjpain-2025-0030","DOIUrl":"10.1515/sjpain-2025-0030","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic flank pain is occasionally due to entrapped lateral end branches of intercostal nerves (lateral cutaneous nerve entrapment syndrome, LACNES). If local injection therapy fails, a neurectomy may be considered. The literature on LACNES is limited to case reports and a small case series. Aim of the present study is to determine short- and long-term success rates of a neurectomy in a large group of patients with LACNES.</p><p><strong>Methods: </strong>All adult patients who underwent a neurectomy for LACNES between January 2012 and December 2022 in a single centre of expertise were asked to complete a questionnaire regarding their current pain levels. Primary objectives were short-term (6-12 weeks postoperatively) and long-term (>6 months postoperatively) treatment outcome. A successful outcome was defined as a minimal 50 % pain reduction.</p><p><strong>Results: </strong>Data from 54 of 69 operated patients (81 % female, mean age 47 years) were analysed (78 % response rate). Baseline characteristics of responders and non-responders were not different. A 67 % short-term success rate was observed (n=36). Long-term outcome remained successful in 23 patients (43 %, mean follow-up 23 months). Ten patients had minor complications (delayed wound healing n=6, hematoma n=3, deep vein thrombosis n=1; all recovered after conservative treatment).</p><p><strong>Conclusions: </strong>If local injection therapy fails in LACNES, a lateral neurectomy should be discussed. Approximately half of patients report success on the long-term.</p><p><strong>Trial registration: </strong>The Local Medical Ethics Committee of Máxima Medical Centre number N20.125.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436699","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}

{"title":"Plasma vitamin D and cytokines in relation to exercise in patients with fibromyalgia- A 15-week strength training intervention trial.","authors":"Maria Samefors, Karin Rådholm, Carl Johan Östgren, Malin Ernberg, Kaisa Mannerkorpi, Eva Kosek, Bijar Ghafouri","doi":"10.1515/sjpain-2025-0043","DOIUrl":"10.1515/sjpain-2025-0043","url":null,"abstract":"<p><strong>Objectives: </strong>The underlying causes of fibromyalgia are not fully understood and a link to chronic inflammation and vitamin D deficiency has been suggested. The mechanisms involved in the associations of fibromyalgia to vitamin D, biomarkers of inflammation and their relation to exercise have not been reported previously. This study aimed to investigate the effects of exercise on plasma 25-hydroxyvitamin D3 levels in patients with fibromyalgia, and further to examine the associations between biomarkers of chronic inflammation and vitamin D status.</p><p><strong>Methods: </strong>This is a sub-study of a larger randomised controlled multi-center trial. Women with fibromyalgia (n=84) aged 20-65 years and 36 age-matched healthy controls were included. The fibromyalgia patients were randomised to resistance exercise or relaxation therapy and were examined based on physical capacity, symptoms and biomarkers including plasma 25-hydroxyvitamin D3 and cytokines.</p><p><strong>Results: </strong>At baseline, participants with fibromyalgia had lower plasma 25-hydroxyvitamin D3 compared to controls, 78.0 vs. 90.6 n mol/l (p=0.041). The 25-hydroxyvitamin D3 in participants with fibromyalgia increased after the intervention (p<0.001), but not in the controls. Multivariate data analyses showed an association between several cytokines and 25-hydroxyvitamin D3 in fibromyalgia at baseline, but not after the intervention. There were subgroups of patients who responded differently to exercise.</p><p><strong>Conclusions: </strong>In women with fibromyalgia, several cytokines and 25-hydroxyvitamin D3 were associated. The vitamin D levels increased after resistance exercise and relaxation therapy. Different subgroups responded differently to strength training also from the point of objective data such as vitamin D and cytokines, which emphasise individual therapy strategies for patients with fibromyalgia.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436701","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}

{"title":"Linking intraoperative nociception to postoperative pain: a secondary comparative analysis of opioid-free and opioid-based anesthesia.","authors":"Daniel Widarsson Norbeck, Henrik Öhrström, Sophie Lindgren, Axel Wolf, Pether Jildenstål","doi":"10.1515/sjpain-2025-0063","DOIUrl":"10.1515/sjpain-2025-0063","url":null,"abstract":"<p><strong>Objectives: </strong>Nociception monitoring during general anesthesia is evolving to improve intraoperative management and postoperative outcomes. While opioid-based anesthesia (OBA) remains widely used for its strong antinociceptive effects, concerns about opioid-induced adverse effects have fueled interest in opioid-free anesthesia (OFA) approaches. This study aimed to compare perioperative and postoperative hemodynamic parameters, nociceptive dynamics, and depth of consciousness between OFA and OBA.</p><p><strong>Methods: </strong>This secondary analysis used data from the multicenter cohort study Opioid-Sparing Person- Centered Care study, a prospective, multicenter randomized controlled trial (ClinicalTrials.gov number: NCT03756961), including 79 patients undergoing bariatric surgery with OFA or OBA. Hemodynamic parameters, depth of consciousness, and nociception level (NOL) index was collected during anesthesia induction, surgery and in post-anesthesia care unit (PACU), while postoperative pain scores, measured with the Numbers Rating Scale (NRS), were recorded only in the PACU. NOL index values were blinded to clinicians throughout the procedure.</p><p><strong>Results: </strong>During anesthesia induction, the OFA group exhibited significantly higher hemodynamic and nociceptive responses compared to the OBA group. NOL index values were elevated in the OFA group, indicating increased nociceptive activity. In contrast, the OBA group showed slightly higher NOL index values in the PACU. Bispectral index monitoring demonstrated a lighter depth of anesthesia in the OFA group compared with the OBA group, although both groups remained within an adequate anesthesia range. OFA regime was identified as a strong predictor of lower postoperative NOL index values. However, the OBA group also included a higher proportion of patients that scored postoperative pain with NRS ≥4 compared with the OFA group.</p><p><strong>Conclusions: </strong>Intraoperative monitoring revealed distinct patterns in nociceptive dynamics and their coupling with anesthetic depth between OFA and OBA techniques. OBA showed a tighter coupling between nociception and anesthetic depth, whereas both approaches appeared suboptimal for postoperative pain control. Despite these intraoperative variations, the overall impact on early postoperative recovery was limited. Larger, prospective studies are warranted to assess how nociception-guided anesthesia strategies and time within specific NOL intervals influence postoperative pain and long-term outcomes.</p>","PeriodicalId":47407,"journal":{"name":"Scandinavian Journal of Pain","volume":"26 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436642","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}