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

{"title":"Effectiveness of epidural steroid injections in the treatment of lumbar radiculopathy: a systematic review and meta-analysis.","authors":"Sebastian E Moran, Samuel B Kankam, Andrew O Schindler, Sophia Dinh, Ryan Dinh, Neha Kulkarni, Sarah Voon, Audrey Demand, Paul J Holman, Meng Huang, Sean Barber","doi":"10.3389/fpain.2026.1904875","DOIUrl":"https://doi.org/10.3389/fpain.2026.1904875","url":null,"abstract":"<p><strong>Introduction: </strong>Epidural steroid injection (ESI) techniques have demonstrated effectiveness in improving short- and intermediate-term pain and disability outcomes; however, their efficacy may vary depending on the specific approach used. This meta-analysis aims to compare disability and pain outcomes among different ESI techniques - transforaminal (TFESI), interlaminar (ILESI), caudal (CESI), and combined approaches - in patients with lumbar radiculopathy.</p><p><strong>Methods: </strong>The authors searched PubMed/MEDLINE, Scopus, and Cochrane from inception to December 16, 2025, in accordance with PRISMA guidelines. Studies comparing disability and pain outcomes between different ESIs were assessed. Random-effects meta-analyses were performed to estimate the pooled mean difference between treatment groups at different follow-up timepoints. Sensitivity analyses and publication bias assessments were conducted.</p><p><strong>Results: </strong>In total, 31 studies comprising 2,452 patients were included. Compared with ILESI, TFESI demonstrated significantly greater pain reduction at 2 weeks and 1 month of follow-up, as well as superior improvements in both disability and pain at 3 and 6 months. Compared with CESI, TFESI showed superior disability improvements at 2 weeks and 1 month, with pain outcomes remaining superior at 1 and 3 months; however, both disability and pain outcomes plateaued by 6 months. At 12-month follow-up, TFESI demonstrated improved disability scores compared with CESI, with no significant difference in pain outcomes. Across all follow-up timepoints, the combined TFESI + CESI approach was associated with significantly greater improvements in both disability and pain relief compared with TFESI alone.</p><p><strong>Conclusions: </strong>TFESI demonstrated superior short- and intermediate-term improvements in disability and pain compared with ILESI, but its advantages over CESI remained inconsistent. Limited evidence suggests that the combined TFESI + CESI approach may offer additional benefits over TFESI alone. Further prospective randomized trials are warranted to better define the efficacy and long-term outcomes of the combined approach.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261320804.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1904875"},"PeriodicalIF":2.5,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898532","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":"The intrinsic reason why the term \"central sensitization\" should be refined, by introducing the terms \"spinal sensitization\", \"pain-related brain network sensitization\", and \"psychosocial-related sensitization\".","authors":"Jean-Pascal Lefaucheur","doi":"10.3389/fpain.2026.1825371","DOIUrl":"https://doi.org/10.3389/fpain.2026.1825371","url":null,"abstract":"","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1825371"},"PeriodicalIF":2.5,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898460","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":"Opioid receptor agonist-antagonists in pain management: receptor specific mechanisms, dose response relationships, and clinical combination strategies.","authors":"Sining Zhao, Zhiqiang Xue, Shu Wang","doi":"10.3389/fpain.2026.1903184","DOIUrl":"https://doi.org/10.3389/fpain.2026.1903184","url":null,"abstract":"<p><p>Opioid receptor agonist-antagonists occupy a distinctive position between high-efficacy agonists and pure antagonists and have been widely used in clinical pain management. Nevertheless, their pharmacological complexity and dose-dependent receptor interactions have led to persistent controversy regarding their analgesic efficacy, ceiling effects, and clinical performance when combined with full <i>μ</i>-opioid receptor agonists. Most existing reviews focus on individual agents or isolated mechanisms and do not adequately address the dynamic relationship between receptor selectivity, intrinsic efficacy, and dose-effect behavior that underlies their clinical outcomes. This narrative review integrates recent preclinical and clinical evidence to examine the pharmacological properties and clinical application strategies of opioid receptor agonist-antagonists, with particular emphasis on <i>κ</i>-opioid receptor agonism, μ-opioid receptor partial agonism or antagonism, and their interactions across different dose ranges. We discuss the mechanistic basis of the analgesic ceiling effect observed with μ-partial agonists, highlighting that this phenomenon reflects limited intrinsic efficacy rather than a dose-dependent transition to pure antagonism. Furthermore, the review analyzes how agonist-antagonists may exert synergistic or functional antagonistic effects when co-administered with full μ-opioid agonists, depending on dose, receptor affinity, and binding kinetics. At low to moderate doses, complementary <i>κ</i>-μ receptor modulation may enhance analgesia while attenuating opioid-related adverse effects such as respiratory depression, pruritus, and nausea, whereas excessive dosing may compromise analgesic efficacy or increase sedation. By synthesizing receptor-specific mechanisms with clinical dosing considerations, this review proposes a receptor-selective, dose-dependent framework to support safer and more effective use of opioid receptor agonist-antagonists in contemporary multimodal pain management.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1903184"},"PeriodicalIF":2.5,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898537","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":"Open and closed loop differential target multiplexed spinal cord stimulation in patients with persistent spinal pain syndrome type II: protocol for a one year European multicenter cohort study (ENDLESS).","authors":"Lisa Goudman, Kliment Gatzinsky, Vivek Mehta, Kavita Poply, Ashish Gulve, Iris Smet, Paul Murphy, Dirk Rasche, Georgios Matis, Jan Willem Kallewaard, José Manuel Trinidad, Pasquale De Negri, Philippe Rigoard, Maarten Moens","doi":"10.3389/fpain.2026.1922595","DOIUrl":"10.3389/fpain.2026.1922595","url":null,"abstract":"<p><p>Differential target multiplexed spinal cord stimulation (DTM SCS) is a stimulation paradigm for chronic pain management that aims to modulate neuron-glial interactions. In parallel, closed-loop SCS systems using evoked compound action potential (ECAP) sensing have been introduced to adjust stimulation output in response to measured neural activation. Although clinical evidence for DTM SCS has expanded, data remain limited for patients with Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), particularly regarding ECAP-controlled closed-loop DTM SCS and its implementation in routine European practice. ENDLESS aims to investigate the feasibility, safety, and longitudinal clinical outcomes associated with open-loop and closed-loop DTM SCS in patients with PSPS-T2 through a longitudinal European multicentre cohort study. ENDLESS is a prospective multicentre cohort study including at least 200 patients, with follow-up until 12 months after implantable pulse generator activation. Outcomes will be assessed at baseline and at 1, 6 and 12 months after DTM SCS initiation. The primary effectiveness endpoint is pain intensity, measured using the Visual Analogue Scale through ecological momentary assessment. Secondary effectiveness outcomes include pain intensity with and without medication use, negative affect, disability, health-related quality of life, pain medication use, clinical holistic responder status, patient impression of change, work status, pain catastrophising, symptoms of anxiety and depression, patient unwanted stimulation awareness and patient expectations. In a subset of patients, sleep, activity patterns and RR-intervals will be assessed using actigraphy. Device-derived outcomes will include time spent in different body postures, technical implantable pulse generator details, battery consumption, stimulation parameters, programming information and ECAP-related data when closed-loop DTM SCS is used. Technical issues, adverse events, serious adverse events and the proportion of successful DTM SCS trial periods will also be documented. Longitudinal mixed models will be used to evaluate changes in effectiveness outcomes over time.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov identifier NCT07211308.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1922595"},"PeriodicalIF":2.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882610","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":"Management of pain for people with dementia living in nursing homes: stakeholders' perspectives on a prototype of a complex intervention.","authors":"Caroline Kreppen Overen, Adelheid Hummelvoll Hillestad, Maria Larsson, Cecilia Olsson, Siren Eriksen","doi":"10.3389/fpain.2026.1868719","DOIUrl":"10.3389/fpain.2026.1868719","url":null,"abstract":"<p><strong>Background: </strong>Healthcare personnel often report uncertainty about how to identify and alleviate pain in people with dementia. Up to 80% of nursing home residents with dementia are estimated to experience chronic pain. There is a lack of structured pain management interventions that focus on integrating and building upon the individual resources of people with dementia in the nursing home context. Although a prototype of such an intervention has been developed, further knowledge is needed regarding its functioning in clinical practice, relevance, and capacity to meet clinical needs. Stakeholders possess substantial field-specific knowledge. In this study, the prototype of the intervention is presented to stakeholders to increase the likelihood of a clinically relevant intervention and successful implementation.</p><p><strong>Objectives: </strong>To describe stakeholders' perspectives of the prototype regarding intervention content and relevance, and implementation strategy.</p><p><strong>Methods: </strong>Seven dyadic interviews were conducted with practice development nurses and first-line managers in nursing homes between May to June 2025 to describe their perspectives on the prototype. The transcripts were analyzed with a deductive framework analysis.</p><p><strong>Results: </strong>The intervention was regarded as relevant and as having the potential to enhance healthcare personnel competence, structure pain management, and integrate residents' resources. However, successful implementation requires integration into existing practice models, and potential moderators were identified at both the organizational and individual levels.</p><p><strong>Conclusions: </strong>This study presents an applied approach to collaborating with stakeholders in intervention development. The participants' perspectives on activities, moderators and potential outcomes of the intervention provides essential knowledge for further refinement of the intervention and future evaluation.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1868719"},"PeriodicalIF":2.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882629","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":"Occipital nerve stimulation for refractory facial pain following occipital pain onset: a case report supporting cervicotrigeminal convergence.","authors":"Marina Raguž, Marko Tarle, Koraljka Hat, Petar Marčinković, Sven Krušić, Tonko Marinović, Darko Chudy","doi":"10.3389/fpain.2026.1917660","DOIUrl":"10.3389/fpain.2026.1917660","url":null,"abstract":"<p><strong>Introduction: </strong>Cervicotrigeminal convergence within the trigeminocervical complex (TCC) provides a neuroanatomical basis for referral of nociceptive input from upper cervical structures to trigeminal territories. However, clinical evidence linking occipital pain onset, trigeminal symptom propagation, and successful treatment with occipital nerve stimulation (ONS) remains limited.</p><p><strong>Case presentation: </strong>A 35-year-old woman developed persistent right-sided occipital, retroauricular, and upper cervical pain approximately eight years before presentation, which progressively spread into trigeminal territories. Multiple pharmacological therapies, greater occipital nerve neurolysis, microvascular decompression, and treatments targeting temporomandibular dysfunction failed to provide sustained relief. Following multidisciplinary evaluation, diagnostic greater occipital nerve (GON) blockade resulted in complete temporary resolution of pain. The patient subsequently underwent bilateral ONS, resulting in marked pain reduction (VAS 8-10/10 to 2/10), contraction of the pain distribution, discontinuation of opioid-containing analgesics, and sustained clinical improvement during follow-up.</p><p><strong>Conclusion: </strong>This case supports cervicotrigeminal convergence as a plausible mechanism underlying refractory facial pain following occipital pain onset. Complete temporary pain relief after diagnostic GON blockade and sustained improvement following ONS suggest that occipital neuromodulation may represent a therapeutic option in carefully selected patients.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1917660"},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876710","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":"Mechanisms and clinical application of photobiomodulation in pain therapy: a mini review.","authors":"Yuxuan Ren, Weiwei Li, He Miao, Yushan Chen, Xiaowei Chen","doi":"10.3389/fpain.2026.1920821","DOIUrl":"10.3389/fpain.2026.1920821","url":null,"abstract":"<p><p>Chronic pain remains a major clinical challenge, creating a need for safe, non-pharmacological interventions. This narrative mini-review examines two light-based approaches that differ in their sites of action and treatment parameters: visual-light exposure and local red or near-infrared light-emitting diode photobiomodulation. Visual-light exposure acts through retinal and central neural circuits, including pathways involving the ventrolateral geniculate nucleus, dorsal raphe nucleus, periaqueductal gray, medial secondary visual cortex, and anterior cingulate cortex. Its effects are wavelength- and context-dependent. Green light has generally produced antinociceptive effects in preclinical studies and preliminary clinical benefits in migraine, whereas visual exposure to red light has predominantly been associated with increased pain. White light can either facilitate or suppress pain depending on irradiance, exposure duration, circadian timing, and clinical context. By contrast, locally applied red or near-infrared LEDs have reduced pain in several preclinical models and limited clinical studies through peripheral opioid signaling, modulation of nitric oxide and nociceptor sensitization, and anti-inflammatory and antioxidant effects. The opposing effects of visual and local red light indicate that wavelength alone does not determine the pain response; exposure route, target tissue, dose, timing, and baseline pain state are also critical. Although visual-light interventions and local LED PBM appear promising as adjuncts to conventional treatment, the evidence remains limited by heterogeneous protocols, small clinical samples, and incomplete dosimetric reporting. Future studies should use standardized parameters, rigorous controls, and condition-specific protocols to establish efficacy and identify patients most likely to benefit.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1920821"},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876759","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":"Bilateral nervus intermedius neuralgia with neurovascular contact: a case report highlighting hypertension and eczema as potential precipitating factors.","authors":"Shusheng Jiao, Yi Zhou, Yanxia Zhu, Zhekai Zhang, Haoyuan Ma","doi":"10.3389/fpain.2026.1862625","DOIUrl":"10.3389/fpain.2026.1862625","url":null,"abstract":"<p><strong>Background: </strong>Nervus intermedius neuralgia (NIN) is a rare craniofacial pain syndrome. Bilateral involvement is extremely uncommon, and the pathophysiology and precipitating factors of NIN remain poorly understood.</p><p><strong>Case presentation: </strong>A 57-year-old female presented with a 3-month history of bilateral paroxysmal stabbing deep ear pain triggered by cold wind and auricular pressure, superimposed on a persistent dull ache. She had a 5-year history of hypertension, with poor blood pressure control (140-160/90-105 mmHg) for four months preceding symptom onset. Otoscopic examination revealed bilateral external auditory canal eczema. Dedicated cranial MRI demonstrated bilateral anterior inferior cerebellar artery (AICA) loops in contact with the facial-vestibulocochlear nerve complexes, with no vascular contact at the trigeminal or glossopharyngeal nerves. A clinical diagnosis of bilateral NIN was established according to ICHD-3 criteria. The patient responded favorably to pregabalin combined with strict blood pressure control. At three-month follow-up, her stabbing pain had essentially resolved (VAS: 0-1/10).</p><p><strong>Conclusion: </strong>This first case of bilateral NIN with radiologically confirmed bilateral neurovascular contact supports neurovascular conflict as a pathophysiological mechanism even in bilateral presentations. Uncontrolled hypertension and local inflammation may serve as potential precipitating factors. A conservative approach combining pharmacotherapy with cardiovascular risk factor management may achieve favorable outcomes, potentially avoiding surgery in selected patients.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1862625"},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876654","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":"Editorial: A lifespan approach towards paediatric pain management: from neonates to young adults.","authors":"L Caes, J McParland, H Durand","doi":"10.3389/fpain.2026.1933896","DOIUrl":"10.3389/fpain.2026.1933896","url":null,"abstract":"","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1933896"},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876629","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":"Electromagnetic neuromodulation for chronic pain: historical context, contemporary modalities, and evidence gaps.","authors":"Laura Dipietro, Ciro Ramos-Estebanez, Paola Gonzalez-Mego, Anna Carolyna Gianlorenco, Arisara Wongtanawat, Christopher Robinson, Salim M Hayek, Felipe Fregni, Timothy Wagner","doi":"10.3389/fpain.2026.1901466","DOIUrl":"10.3389/fpain.2026.1901466","url":null,"abstract":"<p><p>Electromagnetic neuromodulation is increasingly used as an adjunct or alternative to pharmacologic therapy for pain, with several approaches cleared for select indications and many others under active investigation. We review implanted neuromodulation approaches (intracranial and spinal), vagal neuromodulation, noninvasive central/cranial neuromodulation, peripheral neuromodulation, and hybrid/multimodal approaches, with a primary focus on chronic pain management and brief coverage of selected acute-use indications (e.g., primary headache disorders) where relevant. Beyond summarizing individual modalities, we highlight the recurring patterns that have shaped the evolution of pain neuromodulation. For each modality, we summarize putative mechanism of action, typical stimulation paradigms, and key strengths and limitations of the clinical evidence, emphasizing sources of heterogeneity that complicate cross-study comparison and translation. We conclude by outlining priorities for the field, including more rigorous trial design, standardized reporting of stimulation parameters and outcomes, and clearer indication-specific evidence to support clinical translation.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1901466"},"PeriodicalIF":2.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876641","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}