Frontiers in pain research (Lausanne, Switzerland)最新文献

{"title":"Study protocol for microneurographic investigation of nociceptor sensitisation in fibromyalgia syndrome (MICRO-FMS).","authors":"Elise A Ajay, Faris Khan, Atanu Bhattacharjee, Anthony E Pickering, James P Dunham","doi":"10.3389/fpain.2026.1911020","DOIUrl":"10.3389/fpain.2026.1911020","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain in fibromyalgia may be driven by abnormal ongoing activity in a subclass of C-fibre nociceptors known as Type1B or CMi nociceptors. As is common in C-nociceptor microneurography studies, the modest patient numbers in these prior studies generate large confidence intervals around the point estimate of the prevalence of this abnormal activity. This complicates the interpretation of the relative importance of this ongoing nociceptor activity as a pain generating mechanism in fibromyalgia. The study aims to improve precision via an adaptive Bayesian protocol that maximises the yield and quality of data collection whilst minimising patient burden. This study will clarify whether the prevalence of ongoing nociceptor activity is higher in the fibromyalgia patient population, and if this is correlated with their sensory phenotype and/or pain experience, providing much needed insight into the mechanisms of the condition.</p><p><strong>Methods: </strong>The study employs an optimised microneurography protocol with an adaptive study design. The microneurography protocol incorporates early identification of CMi nociceptors via an abbreviated activity dependent slowing protocol to increase yields enabling efficient collection of the primary outcome data. The adaptive study design will use Bayesian principles to iteratively assess the predictive probability of futility, and terminate early if there is high confidence that the hypothesis is false. Furthermore, the study will employ questionnaires to explore links with pain in the area under study to the electrophysiology data. Finally, quantitative sensory testing will be used to investigate whether the irritable nociceptor phenotype is associated with abnormalities in CMi nociceptor physiology.</p><p><strong>Ethics & dissemination: </strong>This study has received HRA REC approval in the UK. Participants will provide written informed consent, and may withdraw at any time without consequence. At the end of the study, the results will be disseminated through peer-reviewed publication, and the data made available via a data repository<i>.</i></p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1911020"},"PeriodicalIF":2.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225459","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}

{"title":"Persistent postoperative pediatric pain: a secondary analysis of the 4P prospective observational multicenter study.","authors":"Anna K M Persson, Johanna Broman","doi":"10.3389/fpain.2026.1930534","DOIUrl":"10.3389/fpain.2026.1930534","url":null,"abstract":"<p><strong>Introduction: </strong>Few large studies have examined the prevalence and risk factors for persistent postoperative pain (PPOP) in children. Chronic pain in childhood can lead to significant personal suffering, including non-attendance at school and social isolation.</p><p><strong>Methods: </strong>In a prospective observational multicenter study, we followed 601 children undergoing common pediatric surgeries. This secondary analysis aimed to describe the prevalence, characteristics, and exploratory risk factor associations of PPOP. The primary outcome was defined as recurrent pain (4 on an age-specific scale lasting for over three months after surgery. Persistent pain was further characterized regarding its impact on various activities and whether it was anatomically localized at the site of surgery.</p><p><strong>Results: </strong>Of the 601 children, 380 were available for follow-up at 3 and 6 months after surgery. The median age was 5 years, and 34% were female. Preoperative pain was reported by 41 children (11%), and 126 (33%) reported anxiety or sleep problems before surgery. Thirteen (3%) patients experienced PPOP (≥ 4) after either 3 (<i>n</i> = 9) or 6 months (<i>n</i> = 4). Ten attributed the pain to the surgical area, and in six children, the pain affected activity-levels. Five children used analgesics for their symptoms. Only one child experienced pain daily, and three children reported weekly pain. Applying a stricter definition from ICD-11 to our cohort resulted in an even lower PPOP prevalence: only three (0.8%) children experienced pain lasting more than 3 months, in whom the pain began or increased after surgery, was at a level ≥4, influenced activity-levels, and was located in the surgical area.</p><p><strong>Conclusion: </strong>The prevalence of persistent postoperative pain after common pediatric surgeries was very low. As one of the few prospective multicenter studies in this field, these findings are noteworthy.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1930534"},"PeriodicalIF":2.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229472","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}

{"title":"Comparative evaluation of the antipyretic and analgesic efficacy and safety of a fast-release paracetamol 650 mg formulation vs. conventional paracetamol formulations in adults with acute febrile or febrile-pain conditions: a multicenter randomized controlled trial.","authors":"Susobhan Mondal, S K Ashik Ikbal, Sumit Agrawal, Amar Raykantiwar, Avirath Acchammachary, Suhas Kalashetti, K R Shivaprasad, Ashok V B, Mukulesh Gupta, Vikas Verma, Monjori Mitra, Amitrajit Pal, Dattatray Pawar, Akhilesh Sharma","doi":"10.3389/fpain.2026.1965374","DOIUrl":"10.3389/fpain.2026.1965374","url":null,"abstract":"<p><strong>Aim: </strong>Paracetamol is widely used for management of fever/pain. With increasing emphasis on rapid symptom relief, this study compared the response following a single 650 mg oral dose of four commercially available tablets in acute febrile and febrile-pain conditions.</p><p><strong>Methods: </strong>This multicenter, open-label trial (CTRI/2025/12/098995) included adults (18-60 years) with oral temperature ≥38 °C (with/without pain) and symptom onset within ≤72 h. Consenting participants were randomized (1:1:1:1) to receive a single dose of the test fast release test paracetamol (A) and conventional paracetamol (B, C, D) drug. Oral body temperature(digital thermometer) and pain (numerical rating scale (NRS) were assessed at predefined intervals till 90 ± 2 min. Outcomes included magnitude and onset of antipyretic and analgesic effects, adverse events (AEs), and patient satisfaction.</p><p><strong>Results: </strong>Among 220 febrile participants (55% women; mean temperature 38.51 °C), 169 reported pain (mean NRS score 7.31). At 90 ± 2 min, fast release paracetamol demonstrated significantly greater reduction in temperature (1.54 °C), along with the fastest rate of decline (1.03 °C/hr), and the shortest restricted mean time to defervescence (84.27 min), resulting in majority of participants (60.0%) experiencing defervescence (temperature ≤37 °C). Pain reduction was also significantly greater with fast release test paracetamol (5.2 units; 3.4 units/hr), with onset of analgesia (≥30% reduction in NRS score) after a comparatively shorter median time (30 min; conventional, 60-90 min). By 90 ± 2 min, pain resolved (NRS score = 0) in 23.2% (A), 22.5% (B), 11.9% (C), and 6.8% (D) participants, with restricted mean times to resolution being 90.00, 89.25, 89.29, and 90.00 min, respectively. Overall, 82.2% participants reported treatment satisfaction, with likelihood highest for fast-release test paracetamol (A). Four participants reported unrelated, mild/moderate AEs.</p><p><strong>Conclusion: </strong>All evaluated paracetamol 650 mg formulations demonstrated antipyretic and analgesic activity within 90 min, while the fast-release formulation showed earlier and, for several assessed outcomes, greater reductions in temperature and pain. These findings may support consideration of formulation choice when rapid early symptomatic relief is desired.</p><p><strong>Clinical trial registration: </strong>CTRI/2025/12/098995.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1965374"},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186417","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}

{"title":"Yaobitong plus celecoxib for low back pain: a Chinese multicenter cohort and network pharmacology study.","authors":"Huahui Gong, Chenxing Lu, Zhanghao Guo, Min Wu, Di Wu, Xu Zheng, Lei Liu, Fenghua Chen, Changyou Li","doi":"10.3389/fpain.2026.1915365","DOIUrl":"10.3389/fpain.2026.1915365","url":null,"abstract":"<p><strong>Background: </strong>Yaobitong capsule is frequently co-administered with celecoxib for low back pain in China, but its incremental effectiveness and safety in routine clinical practice remain uncertain. We compared Yaobitong plus celecoxib with celecoxib alone and explored potential biological mechanisms.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included Chinese outpatients with low back pain treated at 3 hospitals. After 1:1 propensity score matching, 150 patients receiving Yaobitong plus celecoxib were compared with 150 receiving celecoxib alone. The primary outcome was the change in the Oswestry Disability Index (ODI) at 1 month. Secondary outcomes included pain, lumbar function, clinically meaningful response, rescue analgesic use, treatment escalation, and adverse events. Network pharmacology was conducted as an exploratory analysis.</p><p><strong>Results: </strong>After matching, measured baseline characteristics were balanced. At 1 month, the mean ODI reduction was 20.8 points with combination therapy and 14.6 points with celecoxib alone (between-group difference, -6.2 points; 95% CI, -8.36 to -4.04). Combination therapy was also associated with greater reductions in low back and leg pain and greater improvement in JOA score. Clinically meaningful ODI improvement occurred in 80.7% versus 64.0% of patients. Rescue analgesic use and treatment escalation were less frequent with combination therapy. Adverse events occurred in 19.3% and 16.0% of patients, respectively; no serious adverse events were documented. Exploratory network analyses highlighted cytokine- and inflammation-related targets and pathways.</p><p><strong>Conclusions: </strong>Adding Yaobitong to celecoxib may be associated with greater short-term improvement in disability, pain, and lumbar function, with no clear between-group difference in adverse events. Randomized trials with longer follow-up are warranted.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1915365"},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186329","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}

{"title":"MuscleSCS: a standardized programming framework combining neural neuromodulation and spinally mediated paraspinal muscle modulation.","authors":"Matthias Hubert Morgalla","doi":"10.3389/fpain.2026.1954865","DOIUrl":"https://doi.org/10.3389/fpain.2026.1954865","url":null,"abstract":"<p><strong>Background: </strong>Conventional spinal cord stimulation (SCS) primarily modulates neural pain-processing pathways but may not address persistent paraspinal muscle dysfunction associated with chronic back pain. MuscleSCS extends the therapeutic scope of implanted SCS systems by applying low-frequency stimulation through the existing epidural electrode to generate objectively verifiable paraspinal muscle activity. This activity is consistent with spinal motor pathway recruitment, although the specific neural pathways involved remain undetermined.</p><p><strong>Objective: </strong>To describe the conceptual basis, technical implementation, programming workflow, validation, anticipated results, and biological rationale of MuscleSCS as a method for combined neural and muscular neuromodulation.</p><p><strong>Methods: </strong>Low-frequency stimulation (typically 2-8 Hz, most commonly 4-8 Hz) is delivered through selected electrode contacts. Programs are optimized using contact screening, amplitude titration, patient feedback, visual and haptic assessment, surface electromyography, and muscle ultrasound. Programming is technically similar to conventional SCS and typically requires 15-20 min.</p><p><strong>Anticipated results: </strong>Previous clinical studies demonstrated technical feasibility, electrophysiologically verifiable muscle activation, ultrasound-confirmed activation of deep paraspinal muscles, and additional pain relief when MuscleSCS was combined with BurstDR SCS. The goal is comfortable muscle modulation rather than muscle strengthening.</p><p><strong>Conclusion: </strong>MuscleSCS provides a reproducible framework for spinally mediated muscle modulation that may complement conventional neural neuromodulation and improve pain relief. The underlying downstream mechanotransductive and immunomodulatory tissue responses provide a biologically plausible mechanistic framework derived from established skeletal-muscle mechanobiology but remain to be specifically validated for MuscleSCS.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1954865"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186327","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}

{"title":"Efficacy of auriculotherapy in reducing pain: a comprehensive literature review.","authors":"Miguel Faria, Paulo Sargento, Mónica Dias-Teixeira, Emidio Maia, Jorge Maia, José P Pereira","doi":"10.3389/fpain.2026.1909832","DOIUrl":"10.3389/fpain.2026.1909832","url":null,"abstract":"<p><strong>Introduction: </strong>This review examines the efficacy of auriculotherapy in reducing pain across acute and chronic contexts, focusing on pain intensity scores, analgesic requirements, and safety profiles.</p><p><strong>Methods: </strong>A comprehensive, English-language literature search was conducted across PubMed, b-On, Web of Science, Scopus, and SciELO using Boolean combinations of terms related to auriculotherapy, chronic and acute pain, and randomized trials (searches first run March 2026, re-run June 2026). Eligibility was defined <i>a priori</i> using a PICOS framework. From 280 initially identified records, 13 studies were included after duplicate removal and eligibility screening, and findings were synthesized narratively by pain type given substantial heterogeneity across designs. Methodological quality was assessed using the Cochrane risk-of-bias tool for the seven included primary RCTs and AMSTAR-2 for the five included systematic reviews/meta-analyses.</p><p><strong>Results: </strong>Auriculotherapy significantly reduced acute postoperative pain, with meta-analyzed Visual Analog Scale (VAS) reductions of -0.44 (95% CI: -0.72 to -0.17) at 24 h and an analgesic-requirement standardized mean difference of -0.88 (95% CI: -1.29 to -0.46). For chronic back pain, standardized mean differences ranged from -0.65 to -0.85. In migraine, VAS decreased by -0.65 (95% CI: -0.86 to -0.43) with attack frequency reduced by an MD of -0.49 (95% CI: -0.59 to -0.40). Cancer pain studies reported 36% VAS reductions at 2 months. Adverse events were minimal, limited to mild local reactions in less than 5%-8% of cases, with no serious events reported.</p><p><strong>Discussion: </strong>Auriculotherapy demonstrates moderate, consistent efficacy across pain types, likely mediated through autonomic modulation and endorphin release via somatotopic ear projections. A dose-response pattern emerged, with multiple sessions (2-3 weekly over 4-8 weeks) yielding sustained effects. Stronger benefits were observed in orthopedic perioperative settings and with needle-retention protocols. It concludes that auriculotherapy is a safe, viable non-pharmacological adjunct for pain management, while calling for large, diverse, standardized RCTs with longer follow-up and objective biomarker measures to strengthen the evidence base. Because these findings derive from a narrative synthesis of a heterogeneous mix of primary trials, they should be interpreted as indicative rather than definitive, particularly given the diversity of study designs and predominantly Asian/perioperative populations represented.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1909832"},"PeriodicalIF":2.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167639","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}

{"title":"Targeted modulation of thalamocortical and descending control networks in chronic shoulder pain: a longitudinal connectomics study.","authors":"Li He, Wenjing Li, Lihang Gao, Xuan Du, Hongwei Ren, Qian Zhang, Yingchao Wu, Nicholas B Dadario, Hongkai Chen, Michael E Sughrue, Duanwei Wang, Hong Jin","doi":"10.3389/fpain.2026.1794217","DOIUrl":"10.3389/fpain.2026.1794217","url":null,"abstract":"<p><strong>Background: </strong>Central sensitization involves maladaptive plasticity in ascending nociceptive and descending modulatory pathways. This pilot study was designed with three integrated aims: (1) to characterize baseline thalamocortical and descending control network abnormalities in chronic shoulder pain (CSP) relative to healthy controls; (2) to examine whether these network features change following a standardized course of peripheral myofascial stimulation (PMS); and (3) to explore potential mechanistic pathways linking peripheral intervention to central network reconfiguration. While PMS has been reported anecdotally as effective for musculoskeletal pain, preliminary empirical evidence from randomized controlled trials remains limited, and its central neural mechanisms remain unclear.</p><p><strong>Methods: </strong>Twelve patients with CSP underwent longitudinal resting-state fMRI before and after a 10-session PMS intervention. A matched healthy control cohort (<i>n</i> = 18) provided cross-sectional baseline normative data for disease characterization only; no longitudinal data were collected from controls. High-resolution parcellation (HCP-MMP1.0) was used to quantify connectivity in <i>a priori</i> hypothesized networks. Statistical analysis employed a tiered approach combining whole-brain Network-Based Statistics (<i>N</i>BS) and hypothesis-driven Region of Interest (ROI) analyses, rigorously controlled for site effects using ComBat harmonization.</p><p><strong>Results: </strong>At baseline, patients exhibited trend-level reduced thalamo-somatosensory coupling (Cohen's d = 0.72, <i>p</i> = 0.054) compared to controls, which correlated with disease burden. Following treatment, we observed: (1) a downregulation of ACC-brainstem connectivity at the ROI level (Pre 0.017 ± 0.209, Post -0.149 ± 0.211, <i>Δ</i> = -0.166; Wilcoxon <i>p</i> = 0.012, d = -0.82), which did not survive Bonferroni correction across the eight <i>a priori</i> edges (corrected <i>p</i> = 0.098); and (2) patient-specific change in thalamo-somatosensory connectivity, which was associated with change in present pain intensity (<i>Δ</i>PPI, <i>ρ</i> = -0.73). Control analyses in visual and limbic networks were null; this is compatible with, but does not confirm, anatomical restriction.</p><p><strong>Conclusions: </strong>PMS is associated with the reconfiguration of specific bottom-up gating and top-down control circuits in CSP. While the absence of a sham control and the small sample size (<i>n</i> = 12) limit causal inference and generalizability, the large effect sizes and high anatomical specificity suggest these are preliminary biological signals worthy of further investigation. These preliminary findings provide mechanistic targets for future adequately powered randomized controlled trials.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1794217"},"PeriodicalIF":2.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139743","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}

{"title":"Comparative effectiveness and safety of topiramate versus amitriptyline for the prophylactic management of chronic migraine: a prospective comparative study.","authors":"Mohammed Matoog Karami, Amber Hassan, Amal Alkhotani, Mazen Basheikh, Adnan Badahdah, Raed Gasemaltayeb, Ahmed Bamaga, Taghreed Alsinani, Rakan Bokhari, Abdulrahman Almazrooa, Siti Sarah Maidin, Humaira Waseem, Muhammad Anjum, Maher Kurdi","doi":"10.3389/fpain.2026.1923623","DOIUrl":"10.3389/fpain.2026.1923623","url":null,"abstract":"<p><strong>Background: </strong>Chronic migraine is a chronic disabling neurological disease and has a significant impact on quality of life. Topiramate and amitriptyline are commonly used for migraine prevention, but treatment decisions should consider their effectiveness and safety profiles. This study aimed to compare the effectiveness and safety of topiramate and amitriptyline in chronic migraine.</p><p><strong>Methods: </strong>We conducted a quasi-experimental study at a specialised healthcare facility in Lahore, Pakistan, over a one-year period from March 2023 to March 2024. A total of 330 patients meeting the ICHD-3 criteria for chronic migraine were enrolled, including group (a) 165 patients treated with topiramate and group (b) 165 treated with amitriptyline. We used monthly headache frequency and the Headache Impact Test-6 (HIT-6) score to measure headache frequency and headache-related disability at baseline and at Weeks 4, 8, and 12. Adverse events were noted during the study period. We analysed the data using independent-samples t-tests, paired-samples t-tests, and the Chi-Square test, respectively.</p><p><strong>Results: </strong>The mean age of both groups (a) and (b) was 32.37 ± 8.48 years and 34.49 ± 9.02 years, respectively. Both treatments effectively decreased headache frequency and HIT-6 scores during the 12-week follow-up. Mean headache frequency was significantly reduced in group (a) vs. group (b) at week 12 (0.85 ± 0.63 vs. 1.22 ± 0.81 headache days per month, respectively, <i>p</i> < 0.001). Similarly, at Week 12, the mean HIT-6 score was significantly lower in the topiramate group than in the amitriptyline group (49.58 ± 6.16 vs. 51.64 ± 5.94, respectively; <i>p</i> = 0.002). Overall headache frequency decreased from 20.39 ± 4.23 episodes/month at baseline to 1.03 ± 0.75 episodes/month at week 12 (<i>p</i> < 0.001), while HIT-6 scores decreased from 68.14 ± 4.44 to 50.61 ± 6.13 (<i>p</i> < 0.001). Adverse events were reported in 25.5% of the patients taking topiramate and 35.8% of the patients taking amitriptyline (<i>p</i> = 0.042).</p><p><strong>Conclusion: </strong>Topiramate and amitriptyline both were effective in decreasing headache frequency and headache-related disability among chronic migraine patients. Topiramate was slightly more effective and better tolerated than amitriptyline.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1923623"},"PeriodicalIF":2.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139709","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}

{"title":"Metabolic and neuropathic outcomes following combined sodium-glucose cotransporter-2 inhibitor therapy and adjunctive acupuncture in obese patients with diabetic neuropathy: a case series.","authors":"Yun Jin Kim","doi":"10.3389/fpain.2026.1886313","DOIUrl":"10.3389/fpain.2026.1886313","url":null,"abstract":"<p><strong>Background: </strong>Obesity and type 2 diabetes mellitus (T2DM) are associated with chronic metabolic dysregulation and microvascular complications, including diabetic peripheral neuropathy (DPN). This case series describes metabolic and patient reported outcomes during ongoing empagliflozin therapy with adjunctive acupuncture treatment.</p><p><strong>Methods: </strong>The prospective observational case series included three adult participants with obesity, T2DM, and symptom defined DPN. All participants received empagliflozin 10 mg daily for at least 4 weeks before enrollment and continued treatment while receiving standardized acupuncture twice weekly for 10 weeks. Primary outcomes included body weight, body mass index (BMI), and waist circumference. Secondary outcomes included neuropathic pain intensity assessed using the visual analogue scale (VAS), sleep quality measured by a single-item sleep quality score, and fatigue assessed using the fatigue severity scale were recorded at baseline and week 10.</p><p><strong>Results: </strong>All participants completed the intervention without adverse events. The body weight decreased by 4-9 kg, BMI by 1.2-3.5 kg/m², and waist circumference by 5-10 cm. VAS reduction range from 2 to 4 points, sleep quality and fatigue scores also improved consistently in all cases. Exploratory outcomes indicated enhanced mobility, reduced nocturnal neuropathic symptoms, and high treatment tolerability.</p><p><strong>Conclusion: </strong>Combined therapy with SGLT2 inhibitors and acupuncture was associated with improvements in metabolic, neuropathic, and functional outcomes in obese patients with T2DM, and DPN. These findings suggest that a potential multidimensional therapeutic approach, however, larger controlled studies are required to confirm efficacy.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1886313"},"PeriodicalIF":2.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139745","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}

{"title":"Phase-dependent oscillatory dynamics during needle retention and withdrawal: a comparison of penetrating and non-penetrating acupuncture.","authors":"Qian Wu, Dehui Lin, Shanze Wang, Xuesong Liang, Bingxin Wu, Qing Yang, Fangyuan Zhang, Xiuyun Wen, Wenbin Fu","doi":"10.3389/fpain.2026.1842608","DOIUrl":"10.3389/fpain.2026.1842608","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical and neuroimaging studies have shown that non-penetrating sham acupuncture can elicit effects comparable to those of verum acupuncture. However, the electrophysiological signatures on the scalp remain unclear.</p><p><strong>Method: </strong>In a 2 × 2 crossover study involving 20 acupuncture-naive college students, we recorded electroencephalography (EEG) during verum and sham acupuncture at Hegu (LI4) to determine whether sham acupuncture evokes scalp electrophysiological activities comparable to verum acupuncture during the needle retention and post-withdrawal phases.</p><p><strong>Results: </strong>Despite eliciting a stronger deqi sensation, verum acupuncture produced scalp electrophysiological responses that closely resembled those evoked by sham acupuncture. Both interventions were associated with a significant increase in theta power in the central region during the needle retention and post-withdrawal phases, a significant increase in beta power in the central region during the needle retention phase, and a widespread reduction in alpha power from the needle retention to the post-withdrawal phase. Nevertheless, sham acupuncture may exert a relatively weaker influence, and the most consistent difference between verum and sham acupuncture concerned the alpha power reduction from the needle retention phase to the post-withdrawal phase. Exploratory correlation analyses indicated that the associations between deqi sensations and scalp EEG power may differ between verum and sham acupuncture.</p><p><strong>Conclusion: </strong>These results indicate that non-penetrating skin touch stimulation at acupoints and the associated sensory attention can trigger electrophysiological activities similar to, though partially weaker than, those of verum acupuncture.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1842608"},"PeriodicalIF":2.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129360","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}