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

{"title":"Conditioned pain modulation, cortical imbalance, and arthrogenic muscle inhibition: an integrative model with implications for exercise in chronic pain.","authors":"Juan Vicente-Mampel, Montserrat Mampel-Ariño, Ciara Vicente-Mampel, Mariola Belda-Antolí, Marta Martinez-Soler, Mónica Alonso-Martín","doi":"10.3389/fpain.2026.1928053","DOIUrl":"10.3389/fpain.2026.1928053","url":null,"abstract":"<p><strong>Objective: </strong>Conditioned Pain Modulation (CPM), cortical excitability, psychosocial factors, and arthrogenic muscle inhibition (AMI, defined as reflex inhibition of musculature surrounding a damaged joint), proposing a framework linking these domains in chronic pain.</p><p><strong>Methods: </strong>A narrative literature search was conducted in databases, focusing on studies addressing endogenous pain modulation, cortical mechanisms, psychosocial influences, and motor dysfunction in chronic musculoskeletal conditions.</p><p><strong>Results: </strong>Evidence suggests that impaired CPM is associated with altered cortical function, including compromised prefrontal top-down control and maladaptive motor cortex excitability. In this context, AMI reflects peripheral joint-driven adaptations and centrally mediated alterations in motor output. We propose that CPM and AMI interact through a shared cortical-motor axis, where the dorsolateral prefrontal cortex acts as an executive top-down regulator of brainstem nociceptive pathways, while the primary motor cortex serves as a crucial neurophysiological intersection actively engaged during CPM paradigm, collectively contributing to persistent AMI.</p><p><strong>Discussion: </strong>Chronic pain involves complex interactions among pain modulation, cortical mechanisms, and motor control. Consequently, baseline CPM efficiency may help predict AMI severity, offering a novel perspective for early patient identification and stratified, timely multimodal rehabilitation; however, further empirical research is required.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1928053"},"PeriodicalIF":2.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835288","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 Informational Blackout chronic pain and fatigue as rational outputs of a brain operating on degraded biological signals.","authors":"Carla Pandolfi-Cuadrado","doi":"10.3389/fpain.2026.1896306","DOIUrl":"10.3389/fpain.2026.1896306","url":null,"abstract":"<p><p>Chronic pain and fatigue have resisted pharmacological resolution for two decades despite detailed mechanistic characterisation of nociceptive circuits. This perspective argues that the problem is not insufficient data but a mismatch between the level at which the dominant model operates and the level at which chronification is decided. Central sensitisation describes how nociceptive circuits amplify their gain. It does not, on its own, explain why that amplification becomes permanent, why it co-emerges systematically with fatigue and autonomic dysregulation, or why its epidemiology is stratified by sex in ways that differ qualitatively rather than quantitatively. The Informational Blackout framework proposes that chronic pain and fatigue are not malfunctions but appropriate responses from a self-maintaining system that has lost the biological infrastructure on which it was built to depend. The upstream driver is structural degradation of the signal architecture by the modern environment, mediated through SOCS3-driven multichannel transduction collapse and a convergent five-arm ionic setpoint failure that inscribes pain as a stable engram. The framework is offered as an upstream extension of central sensitisation; it grades its own evidence explicitly and generates falsifiable predictions that reorient therapeutic logic from nociceptive suppression toward signal architecture restoration.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1896306"},"PeriodicalIF":2.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835348","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":"Low-dose esketamine for postoperative pain, sleep, and hemodynamic stability in functional endoscopic sinus surgery: a retrospective cohort study.","authors":"Yan-Ping Zhao, Xun-Si Fu, Yan Jia, Feng Zhu, Li-Juan Shi","doi":"10.3389/fpain.2026.1858148","DOIUrl":"10.3389/fpain.2026.1858148","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of low-dose esketamine (0.2 mg/kg or 0.3 mg/kg) in improving postoperative pain, sleep quality, hemodynamic stability, and emotional status in functional endoscopic sinus surgery (FESS) patients.</p><p><strong>Methods: </strong>This retrospective cohort study analysed 135 chronic rhinosinusitis patients (January 2021-December 2023) divided into control (normal saline, <i>n</i> = 45), 0.2 mg/kg esketamine (<i>n</i> = 45), and 0.3 mg/kg esketamine (<i>n</i> = 45) groups. Propensity score matching (PSM)-balanced baselines. Primary outcome: 24-hour post-operative VAS pain score. Secondary outcomes included sleep/emotion/hemodynamic indices and adverse events. Python-based statistical analyses were performed.</p><p><strong>Results: </strong>After PSM, 40 patients/group were analysed. The 0.3 mg/kg (5.82 ± 1.89) and 0.2 mg/kg (6.53 ± 1.59) groups had significantly lower 24-hour VAS scores than the control group did (7.16 ± 0.93, <i>P</i> < 0.001), with the 0.3 mg/kg group being superior (<i>P</i> = 0.032). The eyesketamine group had better sleep quality (PSQI: 3.53 ± 0.69-6.31 ± 0.51 vs. 9.07 ± 1.12; <i>P</i> < 0.001), reduced anxiety/depression (HAM-A/HAM-D), improved resilience (CD-RISC), and less vasoactive drug use (<i>P</i> < 0.001). Adverse events were lower, with no increased neuropsychiatric reactions.</p><p><strong>Conclusion: </strong>The use of low-dose esketamine (particularly 0.3 mg/kg) in FESS patients is associated with clinically meaningful improvements in pain control, sleep quality, emotional well-being, and hemodynamic parameters, alongside a favorable safety profile with no increase in neuropsychiatric adverse events. These findings support its consideration as a viable non-opioid analgesic adjunct in this surgical setting.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1858148"},"PeriodicalIF":2.5,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820533","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":"Force-based manipulation via wearable focal vibration for pain relief and changes in gait biomechanics in diabetic peripheral neuropathy: a secondary analysis of a pilot trial.","authors":"Hongwu Wang, Raghuveer Chandrashekhar, Kyle W Ruffing, Roger B Fillingim","doi":"10.3389/fpain.2026.1925489","DOIUrl":"10.3389/fpain.2026.1925489","url":null,"abstract":"<p><strong>Background: </strong>Diabetic peripheral neuropathy (DPN) disrupts somatosensory feedback, causing chronic pain, altered gait mechanics, and elevated fall risk. While force-based manipulations are known to modulate nociception and proprioception, their biomechanical effects and clinical efficacy in DPN remain underexplored. This secondary analysis investigated the effects of a wearable, force-based focal vibration therapy (FVT) on pain relief, estimated fall risk category, and gait performance in adults with DPN.</p><p><strong>Methods: </strong>We analyzed data from our single-blinded, parallel-group pilot trial of 28 participants (Experimental Group [EG], <i>n</i> = 25; Sham Control Group [CG], <i>n</i> = 3). Participants completed a 4-week home-based intervention. Clinical outcomes included the Timed Up-and-Go (TUG), Berg Balance Scale, and Brief Pain Inventory (BPI-DPN). Spatiotemporal, kinematic, and kinetic gait parameters were captured via 3D motion analysis. Given the small control sample, analyses prioritized within-group standardized effect sizes (Cohen's <math><msub><mi>d</mi> <mi>z</mi></msub> </math> ) and clinical Minimal Clinically Important Difference (MCID) responder thresholds.</p><p><strong>Results: </strong>The force-based intervention yielded exceptional compliance. In the EG, FVT significantly reduced pain interference with walking (<i>p</i> = 0.015, <math><msub><mi>d</mi> <mi>z</mi></msub> </math> =-0.54), and 44.4% of highly symptomatic participants achieved a clinically meaningful (≥3-point) reduction in worst pain. Functionally, continuous TUG times significantly improved (<i>p</i> = 0.033, <math><msub><mi>d</mi> <mi>z</mi></msub> </math> =-0.93), resulting in 33.3% of high-risk patients successfully transitioning to a low fall-risk category (compared to a descriptive 0% in the CG). Biomechanically, these functional gains were accompanied by changes in gait biomechanics that may reflect improved gait performance, specifically, increased gait speed, reduced total double-support time (<i>p</i> = 0.014, <math><msub><mi>d</mi> <mi>z</mi></msub> </math> =-0.53), and increased initial ground reaction forces, achieved without requiring compensatory proximal joint moments.</p><p><strong>Conclusion: </strong>Targeted force-based manipulation via wearable FVT offers a highly feasible mechanism for pain relief and changes in gait biomechanics in DPN. By uncoupling neuropathic pain from functional ambulation, this intervention provides preliminary, hypothesis-generating evidence that supports the need for further investigation in fully powered trials.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1925489"},"PeriodicalIF":2.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13500243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815186","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 cold therapy on ecchymosis and pain after subcutaneous heparin injection: a meta-analysis and systematic review.","authors":"Xiao Min Cao, Xi Xi Feng, Yin Qi Tan, Dan Dan Chen, Xue Sen Zhang","doi":"10.3389/fpain.2026.1853710","DOIUrl":"10.3389/fpain.2026.1853710","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to compare the efficacy of three local physical cooling techniques (ice pack compression, vapor cooling spray, and pre-cooled needles) on pain and ecchymosis after subcutaneous anticoagulant injection, re-examine prior controversies with the latest evidence, and provide evidence-based references for clinical nursing.</p><p><strong>Methods: </strong>Five electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL) were systematically searched for randomized controlled trials (RCTs) comparing local cold therapy with routine care. Primary outcomes included post-injection pain intensity, ecchymosis incidence, and ecchymosis size.</p><p><strong>Results: </strong>Ten randomized trials, including seven parallel-group and three randomized within-participant trials, enrolled 807 unique participants. Local cold therapy reduced immediate pain intensity after heparin injection (SMD = -0.64, 95% CI: -0.81 to -0.47, <i>P</i> < 0.00001). The analgesic effects did not differ significantly among cooling modalities (<i>P</i> = 0.65). Cold therapy increased the odds of being ecchymosis-free at 48 h (OR = 2.77, 95% CI: 1.57-4.88, <i>P</i> = 0.0004) and reduced ecchymosis size at 48 h (SMD = -3.03, 95% CI: -4.95 to -1.10, <i>P</i> = 0.002). At 72 h, cold therapy increased the odds of being ecchymosis-free (OR = 4.17, 95% CI: 1.31-13.29, <i>P</i> = 0.02), but did not significantly reduce ecchymosis size (SMD = -0.76, 95% CI: -1.89 to 0.37, <i>P</i> = 0.19). Heterogeneity was substantial for ecchymosis size at 48 h (I2 = 98%); therefore, the magnitude of this pooled effect should be interpreted cautiously.</p><p><strong>Conclusion: </strong>Local cold therapy may reduce immediate injection pain and early ecchymosis after subcutaneous heparin injection. Evidence at 72 h was outcome-dependent: ecchymosis-free status favored cold therapy, whereas ecchymosis size did not differ significantly. The findings should be interpreted cautiously because of high heterogeneity, outcome-specific risk of bias, and inconsistent reporting of intervention and measurement procedures.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278725, identifier CRD420261278725.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1853710"},"PeriodicalIF":2.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815136","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 stress-fascia-pain axis in myofascial pain syndrome: a mechanistic integrative review and conceptual synthesis.","authors":"Ali Gür","doi":"10.3389/fpain.2026.1834354","DOIUrl":"https://doi.org/10.3389/fpain.2026.1834354","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Myofascial pain syndrome (MPS) is common in musculoskeletal practice, but its persistence, recurrence, and clinical heterogeneity are not fully explained by a muscle-only model. The integrated hypothesis remains central to understanding the active trigger point itself, yet patients with longstanding symptoms often show a broader picture, including stress-related fluctuation, disturbed sleep, regional spread, autonomic imbalance, and only partial benefit from strictly local treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine whether trigger-point biochemistry, fascial dysfunction, stress-related neuroendocrine change, autonomic imbalance, and altered pain processing can be brought together within a single account of persistence and recurrence in MPS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a mechanistic integrative review using PRISMA 2020 reporting principles. MEDLINE/PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library were searched from inception to 28 February 2026. The review question was framed using a modified PICOS structure. Because the literature comprised heterogeneous human, translational, and animal studies and was not suitable for pooled quantitative analysis, findings were synthesized narratively, with reporting informed by SWiM principles. Study screening, data extraction, and methodological appraisal were performed by a single reviewer; the review protocol was prespecified but was not prospectively registered. The included studies were grouped into four mechanistic domains: trigger-point microenvironment, fascial biomechanics and tissue gliding, stress-related endocrine-immune and autonomic dysregulation, and central amplification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search identified 1,246 records; 318 duplicates were removed, 928 titles and abstracts were screened, and 121 full texts were assessed for eligibility. Fifty-seven studies were included in the qualitative synthesis. Across domains, the literature supports a multilevel account in which the active trigger point constitutes the peripheral nociceptive core; fascial innervation, myofibroblast activity, and impaired hyaluronan-mediated gliding may contribute to local stiffness and persistence; stress-related autonomic and hypothalamic-pituitary-adrenal dysregulation may hinder recovery; and persistent nociceptive input may facilitate central amplification in susceptible phenotypes. Evidence is strongest for local biochemical sensitization and more indirect, though broadly convergent, for sympathetic-fascial and neuroendocrine mechanisms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Taken together, the available evidence supports a conceptual Stress-Fascia-Pain axis that may help explain recurrence, heterogeneity, and variable treatment response in MPS. This heuristic framework does not displace established trigger-point models; rather, it situates them within a broader integrative account that links local nociception with t","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1834354"},"PeriodicalIF":2.5,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802467","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":"Touch-based interventions, biofield therapies, and hypnosis for pain management: a scoping review of complementary approaches in physiotherapy.","authors":"Francesco Bonanno, Clemente Cedro, Angelo Alito, Demetrio Milardi, Vincenzo Rizzo, Carmela Mento, Clara Lombardo","doi":"10.3389/fpain.2026.1869699","DOIUrl":"https://doi.org/10.3389/fpain.2026.1869699","url":null,"abstract":"<p><strong>Background: </strong>Pain is a complex and multidimensional experience shaped by biological, psychological, and contextual factors. Complementary approaches, including hypnosis-based interventions, touch-based interventions, and biofield therapies, are increasingly explored in physiotherapy and rehabilitation as non-pharmacological strategies for pain management.</p><p><strong>Objective: </strong>This scoping review aimed to synthesize current evidence on the clinical applications, reported outcomes, and proposed mechanisms of hypnosis-based interventions, touch-based interventions, and biofield therapies in the management of pain and related outcomes.</p><p><strong>Methods: </strong>The review followed PRISMA-ScR guidelines and included randomized controlled trials (RCTs) and non-RCTs published in English between 2004 and December 2025. Databases searched were PubMed, Scopus, and Cochrane Library. Fourteen studies met the inclusion criteria, involving 1,001 patients with conditions such as fibromyalgia, chronic widespread pain, temporomandibular disorders, knee osteoarthritis, and chronic back pain.</p><p><strong>Results: </strong>Overall, hypnotherapy was associated with consistent reductions in pain intensity and improvements in psychological outcomes, including anxiety, depression, catastrophizing, and sleep quality. Several studies reported that these improvements were maintained at medium- and long-term follow-ups. Touch-based interventions and biofield therapies were associated with potential improvements in pain-related outcomes and, in some studies, physical function. Some combined approaches integrating hypnosis-based interventions, touch-based interventions, or biofield therapies with conventional treatments were associated with greater improvements than standard care alone.</p><p><strong>Conclusions: </strong>Despite encouraging findings, methodological heterogeneity and variable study quality limit definitive conclusions. Hypnosis-based interventions, touch-based interventions, and biofield therapies may represent complementary approaches to pain management and rehabilitation; however, the available safety and effectiveness evidence remains preliminary.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1869699"},"PeriodicalIF":2.5,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802489","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 Gür fibromyalgia model: a clinically operational framework for phenotype-informed, sequence-sensitive multimodal care.","authors":"Ali Gür","doi":"10.3389/fpain.2026.1891033","DOIUrl":"https://doi.org/10.3389/fpain.2026.1891033","url":null,"abstract":"<p><p>Fibromyalgia affects approximately 2%-4% of adults and many patients obtain less than clinically meaningful benefit from any single pharmacological treatment, underscoring the need for a practical method of prioritizing multimodal care. This purposive narrative, hypothesis-generating review introduces the Gür Fibromyalgia Model (GFM), an expert-derived and currently unvalidated framework that organizes fibromyalgia around five interacting domains: central pain amplification, sleep dysregulation, load imbalance, peripheral drivers, and regulation deficit. Its therapeutic value lies not in introducing novel interventions but in sequencing familiar interventions with greater clinical deliberation. The model uses domain-weighted bedside assessment, phenotype-informed entry-point selection, and iterative reassessment to move from generic multimodal care toward deliberate, sequence-sensitive multimodal care. Tables 5, 6 provide an operationalization map and a provisional 0-3 research checklist with a defined recall window and decision rules. The GFM is not a replacement for diagnostic, nociplastic, biopsychosocial, clustering, or guideline frameworks; it is a testable sequencing hypothesis intended to determine whether closer alignment between dominant burden and the initial therapeutic lever improves adherence, tolerance, function, and early clinical trajectory. To our knowledge, the GFM is the first framework to operationalize domain-weighted, sequence-sensitive treatment entry-point selection as an explicitly testable clinical hypothesis within the constraints of standard fibromyalgia consultation.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1891033"},"PeriodicalIF":2.5,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802477","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":"Is the location of the needling point in sham acupuncture for tension-type headache associated with outcomes? A systematic review and network meta-analysis.","authors":"Qiu-Yue Tu, Zi-Yi He, Jing-Sheng Huang, Ying-Shan Deng, Xin-Yu Peng, Yu-Feng Xie","doi":"10.3389/fpain.2026.1874475","DOIUrl":"https://doi.org/10.3389/fpain.2026.1874475","url":null,"abstract":"<p><strong>Objective: </strong>In trials of acupuncture for tension-type headache (TTH), sham acupuncture may not be physiologically inert, and its design may influence the estimated specific effect of acupuncture. Sham acupuncture was classified into the following 2 types: (1) sham acupuncture needling at the same acupuncture points as those in the acupuncture group, referred to as sham acupuncture therapy (verum) (SATV) and (2) sham acupuncture needling at points different from those in the acupuncture group, referred to as sham acupuncture therapy (sham) (SATS). Therefore, we aimed to evaluate whether the needling point location in sham acupuncture is associated with treatment outcomes for TTH.</p><p><strong>Methods: </strong>Eight electronic databases were searched from inception to September 4, 2025. Randomized controlled trials (RCTs) comparing manual acupuncture with sham acupuncture or waiting-list control in adults with TTH diagnosed within the contemporaneous IHS/ICHD framework were eligible. Sham acupuncture was classified by needling location as SATV or SATS. The primary outcome was pain intensity; secondary outcomes were headache days and responder rate, defined as at least a 50% reduction in headache days. Random-effects frequentist network meta-analysis was performed after evaluating clinical similarity, transitivity, and statistical consistency. Certainty of evidence was assessed using the GRADE framework for network meta-analysis.</p><p><strong>Results: </strong>Six RCTs involving 1,055 participants were included. Compared with waiting-list control, acupuncture, SATV, and SATS were each associated with improvements in pain intensity, headache days, and responder rate. No statistically significant difference was detected between SATV and SATS for any outcome. Acupuncture did not differ significantly from either sham approach for pain intensity or headache days; however, acupuncture was associated with a higher responder rate than both SATV and SATS. The certainty of network evidence ranged from moderate to low for continuous outcomes and from high to low for responder rate, mainly because of risk of bias and imprecision.</p><p><strong>Conclusion: </strong>Within the available sparse network, the anatomical location of sham acupuncture alone did not explain differences in TTH outcomes. Sham acupuncture procedures used in previous TTH trials may carry physiological and contextual activity, regardless of whether they are delivered at the same acupoints or at different points. Future trials should move beyond simply debating \"where to needle\" and should quantify and report the full sham-acupuncture dose, including insertion depth, stimulation intensity, retention time, frequency, patient information, and blinding assessment.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251135928, identifier CRD420251135928.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1874475"},"PeriodicalIF":2.5,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802449","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":"A pilot protocol for conditioning music-cued relaxation responses in patients undergoing total shoulder arthroplasties.","authors":"Janice W Stouffer, Christina A Myers, Susan E Hassenbein, April D Armstrong, Heather L Stuckey","doi":"10.3389/fpain.2026.1872237","DOIUrl":"https://doi.org/10.3389/fpain.2026.1872237","url":null,"abstract":"<p><strong>Background: </strong>Orthopedic patients undergoing shoulder arthroplasties-to treat chronic joint pain-frequently experience significant pain. Music therapy (MT) has demonstrated non-pharmaceutical benefits for reducing postoperative pain and associated perioperative anxiety. However, a study of approaches and timing is needed to enhance patient care.</p><p><strong>Objective: </strong>This qualitative study examined the effects of a conditioned MT intervention on pre/postoperative pain and anxiety among patients undergoing shoulder surgery. As part of a larger quantitative randomized controlled trial, this paper specifically evaluated qualitative participant journal comments from two music groups.</p><p><strong>Methods: </strong>Eligible adult surgery patients were consented and randomized to Live MT, Recorded MT, or Control (standard of care). Those in the two music groups received an original intervention comprising an induction song, autogenic muscle relaxation, and directed cognitive visualization over prescribed sedative guitar playing. In addition to practice recordings, a music therapist treated the Live group. Participants experienced multiple contacts with the study process, allowing for preparation, education, practice, and pre/postsurgery treatment. Journals were provided to the participants to record responses to the intervention. Comments were analyzed by the researchers and recurring themes identified.</p><p><strong>Results: </strong>From 69 MT participants, 319 comments were collected as data points. Four themes identified areas of impact: (1) The MT intervention contained qualities and components that were perceived as beneficial for relaxation and calming. (2) Participants personalized their visualization experience with the music, which cued memories and associations of soothing or reflection. (3) Music therapists were a supportive presence, in addition to the healthcare team. (4) Through practice, aspects of the music intervention became internalized as a self-help tool. Theme 1, referencing general relaxation, was further divided into three subthemes-(1a) pain management, (1b) anxiety management, and (1c) sleep hygiene-which were found to be interrelated. Pre/postsurgery comparisons were made between the Live and Recorded groups.</p><p><strong>Conclusions: </strong>Given opportunities for repeated practice, the MT intervention was effective in supporting relaxation. The effects included improved pain and anxiety management, as well as increased sleep and personalized patient experience.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, identifier NCT02692768.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1872237"},"PeriodicalIF":2.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13486239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802439","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}