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

{"title":"Low dose naltrexone for fibromyalgia: case series demonstrating pain relief and other health benefits.","authors":"Adrienne Junek, Mya Anderson","doi":"10.3389/fpain.2026.1731455","DOIUrl":"10.3389/fpain.2026.1731455","url":null,"abstract":"<p><p>Fibromyalgia is a chronic pain disorder with multiple proposed etiologies. Pharmacological treatments approved for fibromyalgia are few and not always effective; therefore, some practitioners use off-label medications such as low dose naltrexone (LDN). This case series presents a retrospective chart review of patients who were prescribed LDN for fibromyalgia at an integrative medicine clinic over a 2-year period. Outcomes assessed included pain relief, other health benefits, side effects and prescription habits. Of 10 patients identified, LDN provided substantial pain relief for 8 patients (-4.7/10 points, average -3.75/10 for all 10 patients, <i>p</i> < 0.001). These same patients also reported other important health benefits such better quality of life in 6 patients, reductions in pain flares in 5 patients, improved sleep in 4 patients, improved cognitive functioning in 2 patients, and cessation of other pain medications in 4 patients. Two patients discontinued LDN due to side effects, which in both cases was increased pain. LDN was well tolerated overall, although reported side effects included increased pain, vivid dreams, insomnia and irritability. LDN's proposed mechanism involving hormesis at opioid receptors and its implications for customized dosing in clinical care and research trials are discussed. While not all patients respond to LDN, this medication shows promise as an effective and safe intervention and deserves to be considered as a treatment recommendation for fibromyalgia.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1731455"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474612","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":"Adapting to life with chronic migraine: a qualitative study of lived experiences among multi-ethnic Asian patients.","authors":"Yasmin Idu Jion, Jun Ying Hor, Jun Zhi Teh, Yi Jing Zhao, Chai Ching Ng, Jiao Jiao Dang, Nijanth Manohararaj, Chew Seah Tan, Sungwon Yoon","doi":"10.3389/fpain.2026.1825004","DOIUrl":"10.3389/fpain.2026.1825004","url":null,"abstract":"<p><strong>Background: </strong>Chronic migraine is associated with greater disability, productivity losses and reduced quality of life compared to episodic migraine. Limited research has explored the multi-faceted burden of chronic migraine from patients' perspectives and experiences, particularly in the Asian context. This study aims to explore the burden of chronic migraine through the lived experience of multi-ethnic Asian patients and to identify gaps in migraine awareness, service provision and clinical management.</p><p><strong>Methods: </strong>This was a qualitative study design involving semi-structured interviews with patients with chronic migraine recruited from a Neurology outpatient clinic in a large tertiary hospital in Singapore. Data was collected through face-to-face interviews and transcribed verbatim. Inductive thematic analysis was performed to identify key themes.</p><p><strong>Results: </strong>17 participants with chronic migraine took part in the study. 4 main themes were identified which illustrate the substantial burden of chronic migraine: 1) Living with migraine long-term; 2) Dealing with stigma; 3) Navigating the healthcare journey; and 4) Regaining agency and validation. Participants described physical, psychosocial and financial consequences that disrupted their daily roles and sense of self. Stigma and the invisibility of chronic migraine compounded this burden. Participants demonstrated strong efforts to regain agency through lifestyle modifications, complementary therapies and peer support, despite limited treatment options and persistent uncertainty.</p><p><strong>Conclusion: </strong>This study provided insights into the lived experience of chronic migraine among multi-ethnic Asian patients. Our findings highlight the importance of culturally sensitive and patient-centred approaches that validate patients' experiences, address stigma, and integrate psychosocial as well as medical needs.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1825004"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474580","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":"Cellular and molecular changes in the skin driving increased nociception and pain during burn injury and repair.","authors":"Chiara Nappi, Francisco J Taberner","doi":"10.3389/fpain.2026.1797161","DOIUrl":"10.3389/fpain.2026.1797161","url":null,"abstract":"<p><p>Burn injuries are among the most frequent traumas associated with human activity and primarily affect the skin. Unlike other forms of tissue injury, burns produce a unique combination of extensive tissue destruction, rapid release of damage-associated signals, and profound alterations in cutaneous architecture. These injury-specific features generate a robust inflammatory environment and early neuroimmune activation that can transition into neuropathic pain. Together, they drive marked peripheral sensitization and, in some cases, evolve into pain chronification, substantially affecting long-term quality of life in burn survivors. This review synthesizes current evidence on how thermal injury reshapes the function of key cutaneous cell populations, including keratinocytes, epidermal stem cells, melanocytes, fibroblasts, and immune cells, and how these changes modulate nociceptor activity through inflammatory, neurotrophic, and neuroimmune pathways. Furthermore, we describe how burn-induced cellular dysregulation contributes to peripheral sensitization across the continuum of wound healing, from acute inflammation to tissue repair. By integrating emerging mechanistic insights, this review highlights therapeutic targets aimed at minimizing subacute pain and preventing or mitigating chronic pain after burn injury.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1797161"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474538","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":"Effects of Tai Chi on pain, functional dysfunction, and sleep in patients with chronic nonspecific low back pain: a systematic review and meta-analysis.","authors":"Cenhui Xu, Huaimeng Cui, Tongtong Hao","doi":"10.3389/fpain.2026.1852975","DOIUrl":"10.3389/fpain.2026.1852975","url":null,"abstract":"<p><strong>Objective: </strong>This study systematically evaluated the effects of Tai Chi on pain, functional disability, and sleep quality in patients with chronic non-specific low back pain (CNLBP).</p><p><strong>Methods: </strong>We searched CNKI, WanFang, VIP, China Biology Medicine Database, PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of Tai Chi for CNLBP. Study quality was assessed using the Cochrane RoB 2 tool and the PEDro scale. Meta-analysis was used to pool the data.</p><p><strong>Results: </strong>Eight RCTs involving 526 patients with CNLBP were included. Meta-analysis showed that Tai Chi significantly reduced pain, improving VAS scores (MD = -1.40, 95% CI: -2.41 to -0.40) and NRS scores. Tai Chi also significantly improved RMDQ scores (MD = -1.67, 95% CI: -2.75 to -0.59) and overall functional disability (SMD = -0.51, 95% CI: -0.90 to -0.12), but did not significantly affect ODI scores (MD = -0.62, 95% CI: -2.53 to 1.29). Moreover, improvements in PSQI scores were not statistically significant (MD = -0.18, 95% CI: -1.82 to 1.45).</p><p><strong>Conclusion: </strong>Tai Chi can effectively relieve pain and improve functional disability in patients with CNLBP. It is a safe and feasible non-pharmacological rehabilitation approach. However, current evidence is insufficient to confirm its effect on sleep quality. Further high-quality RCTs are needed.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420261361228.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1852975"},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474591","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":"Diffusion tensor imaging in chronic tension-type headache.","authors":"M Teepker, L Vacik, A M Hermsen, K Menzler, V Mylius, L Timmermann, S Knake, M Belke","doi":"10.3389/fpain.2026.1850836","DOIUrl":"10.3389/fpain.2026.1850836","url":null,"abstract":"<p><strong>Background: </strong>Tension-type headache (TTH) is the most common primary headache disorder and chronic tension-type headache (CTTH) is difficult to treat. Despite this clinical importance, the pathophysiology especially of CTTH remains unclear. Therefore, the aim of this study was to search for microstructural changes in CTTH to further evaluate the pathogenesis of CTTH.</p><p><strong>Methods: </strong>Nine female patients suffering from CTTH and ten healthy controls matched by age and gender were included. All participants underwent a magnetic resonance imaging (MRI) scan with a diffusion tensor imaging (DTI) sequence. From the diffusion tensor the Fractional Anisotropy (FA), the Axial Diffusivity (AD), the Radial Diffusivity (RD), the NODDI parameters, the Orientation Dispersion Index (ODI), and the Neurite Density Index (NDI) were calculated.</p><p><strong>Results: </strong>Microstructural changes were found in the right cerebellum, tectum, right occipital fusiform gyrus, left inferior temporal gyrus, left cingulate gyrus (anterior and posterior devision), right thalamic radiation, right lateral occipital cortex (inferior division), left cerebellum, left insular cortex, left precuneous, left central opercular cortex, left inferior frontal gyrus, left middle temporal gyrus, right middle temporal gyrus, left middle frontal gyrus, right postcentral gyrus, left superior longitudinal fasciculus, and the right paracingulate gyrus.</p><p><strong>Conclusions: </strong>Patients suffering from CTTH had microstructural changes in multiple brain areas. Those were related to brain regions that belong to or interact with the pain matrix, trigeminal system or association fibers.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1850836"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457698","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":"Combined bidirectional spinal cord stimulation for refractory neuropathic pelvic pain: a case report.","authors":"Yakov Perper, Alana Taub, Jenifer Perper","doi":"10.3389/fpain.2026.1864829","DOIUrl":"10.3389/fpain.2026.1864829","url":null,"abstract":"<p><strong>Introduction: </strong>Refractory neuropathic pelvic pain significantly impairs quality of life and is notoriously difficult to treat. We present the case of a 63-year-old woman who developed severe pelvic pain following emergency open thoracic aortic aneurysm repair. Despite extensive pharmacologic, non-pharmacologic, and interventional treatments, she experienced minimal relief.</p><p><strong>Methods: </strong>To address her pain, we attempted a novel approach termed \"Combined Bidirectional\": anterograde (thoracic) and retrograde (sacral) spinal cord stimulator (SCS) placement, accompanied by combination therapy-high-frequency stimulation (HFX) at the thoracic spine and tonic stimulation at the sacral spine.</p><p><strong>Case description: </strong>Technical difficulties complicated retrograde sacral placement, and we discussed our approach to managing these challenges. Additionally, the patient developed unexpected hip pain with tonic sacral stimulation, prompting discontinuation of this modality and continuation of HFX thoracic stimulation alone.</p><p><strong>Conclusion: </strong>This case underscores both the potential advantages and challenges of combined bidirectional SCS for pelvic pain. Further research is warranted to clarify the efficacy and optimal application of this novel approach for refractory neuropathic pelvic pain.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1864829"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457981","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":"Treatment characteristics and safety profiles of Belbuca®, buprenorphine patch, and oral schedule II opioids among chronic low back pain patients without a positive history of opioid-use disorder: a retrospective US commercial claims analysis.","authors":"Vladimir Zah, Dimitrije Grbic, Filip Stanicic","doi":"10.3389/fpain.2026.1764842","DOIUrl":"10.3389/fpain.2026.1764842","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this retrospective study was to evaluate and compare the safety characteristics of patients with chronic low back pain (cLBP) without a recent positive history of opioid use disorder (OUD).</p><p><strong>Methods: </strong>This study was conducted using the Merative MarketScan® database (January 2019-December 2023). The first date of Belbuca®, buprenorphine patch, or oral schedule II (CII) opioid prescription was designated as the index date. The observational period covered a 6-month preindex period and a follow-up period that lasted until the end of index treatment or continuous healthcare coverage. Patients were required to have two low back pain diagnoses and no OUD in the preindex period and continuous healthcare coverage during the observational period. The primary outcomes were serious treatment-emergent adverse event (TEAE) rates reported as incidence rate ratios (IRR) or absolute incidence rate difference (IRD) per 1,000 person-years for TEAEs occurring in one cohort. Propensity-score matching was employed to balance differences in patient characteristics and minimize their impact on study outcomes.</p><p><strong>Results: </strong>There were no serious TEAEs associated with higher occurrence in the Belbuca® cohort compared with oral CII opioids. Belbuca® treatment was associated with a significantly lower rate of serious opioid abuse/dependence (IRD -33.76 per 1,000 person-years, <i>p</i> = 0.032), osteoarthritis (IRD -78.77 per 1,000 person-years, <i>p</i> = 0.001), urinary discomfort (IRD -146.28 per 1,000 person-years, <i>p</i> < 0.001), seizures (IRR 0.11, <i>p</i> = 0.019), dehydration (IRR 0.13, <i>p</i> = 0.003), abdominal pain (IRR 0.25, <i>p</i> < 0.001), and nausea/vomiting (IRR 0.30, <i>p</i> = 0.001). The subanalysis compared incidence rates of serious TEAEs between Belbuca® and buprenorphine patch cohorts. Belbuca® demonstrated higher rates of serious coronary artery disease (IRD 39.01 per 1,000 person-years, <i>p</i> = 0.035), cholecystitis (IRD 39.01 per 1,000 person-years, <i>p</i> = 0.035), and headache (IRD 39.01 per 1,000 person-years, <i>p</i> = 0.035). However, the buprenorphine patch cohort had higher incidence rates of serious QT prolongation (IRD -52.78 per 1,000 person-years, <i>p</i> = 0.009), opioid abuse/dependence (IRD -184.75 per 1,000 person-years, <i>p</i> < 0.001), confusion (IRR 0.10, <i>p</i> = 0.007), hypertension (IRR 0.22, <i>p</i> = 0.043), and cellulitis (IRR 0.41, <i>p</i> = 0.011).</p><p><strong>Conclusion: </strong>The study findings suggest that Belbuca® may have a favorable safety profile relative to oral CII opioids and buprenorphine patch treatments in cLBP patients without a positive history of OUD.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1764842"},"PeriodicalIF":2.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450842","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":"Sex-related associations between psychoemotional factors and health-related quality of life in patients with chronic low back pain.","authors":"Mariia Ovdii, Mykola Kondratiuk, Lilia Yaremenko, Maria Prokopiv, Kateryna Potapova, Andrii Borysenko, Olena Lazarieva, Iurii Kuchyn","doi":"10.3389/fpain.2026.1872295","DOIUrl":"10.3389/fpain.2026.1872295","url":null,"abstract":"<p><strong>Introduction: </strong>Psychoemotional Factors Are Closely Associated With Health-Related Quality Of Life (Hrqol) In Individuals With Chronic Low Back Pain (Clbp). However, It Remains Unclear Whether These Associations Differ Between Women And Men.</p><p><strong>Aim: </strong>To Evaluate Sex-Stratified Associations Between Psychoemotional Factors And Hrqol Domains In Adults With Chronic Nonspecific Clbp.</p><p><strong>Material and methods: </strong>This Cross-Sectional Study Included 223 Adults With Chronic Nonspecific Clbp (138 Women And 85 Men) Assessed Before Initiation Of Outpatient Rehabilitation. Pain Intensity, Anxiety, Depression, Perceived Stress, Kinesiophobia, And Hrqol Were Evaluated Using Standardized Questionnaires. Primary Analyses Examined Associations Between Psychoemotional Thresholds And Eight Sf-36 Domains Separately In Women And Men. Secondary Analyses Assessed Severe Pain (Vas ≥7). Exploratory Logistic Regression Models With Sex-By-Variableinteraction Terms Were Additionally Performed. Multiple Testing Was Controlled Using The Benjamini-Hochberg False Discovery Rate Procedure.</p><p><strong>Results: </strong>The Prevalence Of Clinically Significant Anxiety, Depression, High Perceived Stress, And Kinesiophobia Did Not Differ Significantly Between Women And Men. In Sex-Stratified Analyses, Elevated Psychoemotional Burden In Women Was Primarily Associated With Lower Scores In Vitality, Mental Health, Social Functioning, And General Health. In Men, Associations Involved A Broader Range Of Hrqol Domains, Including Physical Functioning, Role Limitations, Bodily Pain, And General Health. In Secondary Analyses, High Kinesiophobia Was Associated With Severe Pain In Women (Or 9.00, 95% Ci 2.01-40.32; <i>Q</i> = 0.033), Whereas No Psychoemotional Indicator Remained Significantly Associated With Severe Pain In Men After Correction For Multiple Testing. However, Exploratory Sex-By-Variableinteraction Analyses Did Not Demonstrate Statistically Robust Interaction Effects After Adjustment For Potential Confounders And Correction For Multiple Testing.</p><p><strong>Conclusions: </strong>Psychoemotional Factors Were Closely Associated With Hrqol In Adults With Chronic Nonspecific Clbp. Although Sex-Stratified Analyses Revealed Different Patterns Of Associations In Women And Men, Formal Interaction Analyses Did Not Provide Statistically Robust Evidence That These Associations Differed By Sex. The Findings Support The Importance Of Considering Psychoemotional Factors During Assessment And Rehabilitation Planning In Patients With Chronic Nonspecific Clbp And May Help Inform Future Individualized Rehabilitation Approaches.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1872295"},"PeriodicalIF":2.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450872","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":"Linking central sensitization to multisystemic manifestations in hypermobile Ehlers-Danlos syndrome.","authors":"Ana Paula Montemayor Zarazúa, César Vidal Elizondo Solis, Camila Ayala García, Diego Jesús Pacheco Estrella, Octavio Ilizaliturri Guerra, Ana Cecilia Arana Guajardo, Emma Purón Gonzalez, Karina Silva Luna, Luis Iván Lozano Plata, Mario Ramon García Pompermayer, Mario Alberto Garza Elizondo","doi":"10.3389/fpain.2026.1799439","DOIUrl":"10.3389/fpain.2026.1799439","url":null,"abstract":"<p><p>Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are complex multisystemic conditions frequently associated with chronic pain. Central Sensitization (CS)-a state of neural amplification and hyperexcitability-is hypothesized to be a unifying mechanism underlying the heterogeneous symptoms in chronic pain patients. Our aim was to investigate the association between central sensitization and multisystemic symptom burden in patients with hEDS/HSD while identifying independent clinical predictors of CS. We prospectively enrolled 150 adults diagnosed with hEDS/HSD at a specialized joint hypermobility clinic. Participants were evaluated using the Central Sensitization Inventory (CSI) and the SPIDER questionnaire. Clinical CS was defined as a CSI score > 40. Statistical analyses included univariate correlations and multivariable logistic regression. Centrally sensitized patients (<i>n</i> = 76) were significantly younger and predominantly female compared to the non-CS group. While CSI scores correlated strongly with all eight SPIDER domains (<i>p</i> < 0.001), a multivariable logistic regression model (AUC 0.98) identified only three independent predictors of CS: fatigue (OR 1.089), pain (OR 1.067), and cardiac dysautonomia (OR 1.057). Central sensitization in hEDS/HSD is independently associated with a triad of fatigue, pain, and cardiac dysautonomia. Clinical management should shift toward multidisciplinary strategies to effectively address the sensitized state in this population.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1799439"},"PeriodicalIF":2.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450860","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":"Short-term efficacy of physical interventions for lateral epicondylitis: a network meta-analysis based on multidimensional evaluation of pain and function.","authors":"Yu-Hong Song, Jin-Yan Lan, He-Hui Fu, Li-Xu Tang","doi":"10.3389/fpain.2026.1855508","DOIUrl":"10.3389/fpain.2026.1855508","url":null,"abstract":"<p><strong>Background: </strong>Lateral epicondylitis (LE) is a prevalent chronic tendinopathy that significantly impairs upper limb function and quality of life. This network meta-analysis (<i>N</i>MA) aims to evaluate and compare the short-term (≤3 months) efficacy of various micro-invasive and physical interventions for pain relief and functional restoration, providing an evidence-based framework for tailored clinical decision-making.</p><p><strong>Methods: </strong>A comprehensive search was performed in PubMed, Embase, the Cochrane Library, Web of Science, and CNKI for randomized controlled trials (RCTs) investigating physical interventions for LE. Primary outcomes included the Visual Analogue Scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Patient-Rated Tennis Elbow Evaluation (PRTEE). Data synthesis, consistency testing, and Surface Under the Cumulative Ranking curve (SUCRA) calculations were performed using Stata 18.0. Two-dimensional cluster analysis was employed to concurrently assess the analgesic and functional benefits of the interventions.</p><p><strong>Results: </strong>Analysis of 38 RCTs revealed that percutaneous electrolysis (PE) was the most effective intervention for pain reduction (SUCRA = 98.5%), yielding a clinically pronounced effect size against baseline care (MD = -6.00, 95% CI: -9.75 to -2.25) and outperforming most other physical therapies. Dry needling (DN) demonstrated the highest ranking probability in functional improvement (DASH SUCRA = 79.7%; PRTEE SUCRA = 85.2%), and was the sole active treatment significantly superior to conservative care on the PRTEE scale (MD = -25.04, 95% CI: -48.29 to -1.79). In the cluster analysis, PE was localized to the \"strong analgesia\" quadrant, while DN was situated in the \"strong functional recovery\" quadrant. Other interventions, such as platelet-rich plasma and corticosteroid injections, exhibited only moderate effectiveness.</p><p><strong>Conclusion: </strong>The investigated interventions yield distinct therapeutic profiles for LE within an early temporal window. Percutaneous electrolysis shows the highest probability for rapid pain mitigation, whereas dry needling presents a favorable probability profile for restoring localized elbow function. However, given the high underlying network heterogeneity, the lack of statistical significance in DASH-related pairwise comparisons, and overlapping prediction intervals, these SUCRA-based rankings should be interpreted cautiously. We do not recommend formulating definitive long-term clinical recommendations based on these early temporal profiles; instead, clinical decisions should be tailored to the patient's predominant short-term symptoms-balancing immediate pain relief with early targeted functional recovery.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero, PROSPERO CRD420251234552.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1855508"},"PeriodicalIF":2.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427059","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}