Traditional spinal cord stimulation (SCS) trials often span several days, increasing the risks of infection, equipment failure, lead migration, and complications for patients on anticoagulant/antiplatelet therapy. Optimal SCS trial durations have not been established, although shorter durations are recommended for patients at high risk. Evoked compound action potential (ECAP)-controlled closed-loop (CL) SCS provides objective, real-time confirmation of neural activation at therapeutic dose levels, enabling immediate assessment of SCS treatment response. We evaluated the long-term response up to 12months for patients undergoing ECAP-controlled CL-SCS trial evaluations where leads were removed on the same day of the trial procedure (day 0). Fifteen patients who met predefined day 0 responder criteria underwent a day 0 trial using ECAP-controlled CL-SCS at a single center in the ECAP Study. Outcomes and ECAP-based neural metrics were assessed at day0, 3months, and 12months. All 15 (100.0%) day 0 trial evaluations were successful, with 13 patients continuing to permanent implantation; 11 had complete follow-up through 12months. Average pain reduction was 85.5% at day0 and 79.6% at 12months. Responder rates (≥ 50% improvement) remained high (81.8-92.3%), with consistently strong patient satisfaction. Most patients (57.1-72.7%) showed improvement in ≥ 4 domains associated with overall health quality. ECAP-derived neural metrics remained within ranges associated with maximal analgesic effect, confirming stable, therapeutic neural activation over time. Durable and holistic clinical benefits were observed through 12months. The combination of strong patient-reported outcomes and objective confirmation of therapy delivery at patient-specific therapeutic dose levels suggests that same-day trials with ECAP-controlled CL-SCS may safely streamline SCS screening trial workflows in suitable patients without compromising clinical outcomes. This approach has the potential to reduce the risks and patient burden associated with prolonged trial durations, especially in vulnerable patient populations. The ECAP Study is registered with ClinicalTrials.gov (NCT04319887).

Ilioinguinal neuralgia is a commonly underdiagnosed and often refractory cause of chronic groin and lower abdominal pain. This technical report outlines an ultrasound-guided radiofrequency ablation (RFA) technique for ilioinguinal nerve (IIN) pain, summarizing key anatomical considerations to enhance procedural accuracy. Anatomical studies show that the IIN most commonly arises from L1 and traverses between the internal oblique and transversus abdominis muscles within 1-2cm of the anterior superior iliac spine (ASIS). Under ultrasound guidance, an 18-22-gauge radiofrequency cannula is advanced into the interfascial plane to target the IIN. Sensory stimulation is used to elicit the patient's typical symptoms, while motor testing confirms the absence of distal muscle activation. A diagnostic block is performed before lesioning. Continuous RFA is then applied at 80°C for 60-90s with additional lesions placed as needed based on anatomical variation. Previous published data demonstrate significant pain reduction and sustained benefits following ilioinguinal RFA, with improved function and minimal complications. Ultrasound-guided probe placement and stimulation testing enhance the reproducibility, accuracy, and safety of the procedure. Ultrasound-guided RFA of the IIN offers a minimally invasive treatment option for patients with refractory ilioinguinal neuralgia. Recognizing anatomical variability and utilizing stimulation testing, along with real-time imaging, can help clinicians improve the consistency of outcomes and reduce complications.

Quadratus lumborum block (QLB), as a trunk regional block technique, can effectively alleviate postoperative pain in renal surgery. Ultrasound-guided QLB (U-QLB) administered by anesthesiologists is one of the most commonly used techniques. Recently, QLB can be administered by surgeons with the help of laparoscopy during renal surgery. Laparoscopic-assisted QLB (L-QLB) is a new technique. However, there is still a lack of comparison between U-QLB and L-QLB. The aim of this study was to compare the analgesic effects of laparoscopic and ultrasound-guided QLB in patients undergoing laparoscopic nephrectomy. Sixty patients undergoing laparoscopic nephrectomy were enrolled and randomized to receive L-QLB (group L) or U-QLB (group U) in a 1:1 ratio. A patient-controlled intravenous analgesia (PCIA) pump with sufentanil was administered after surgery. The primary outcome was cumulative sufentanil consumption within the first 24h after surgery. Secondary outcomes consisted of the procedural time of QLB; the dermatomes of sensory block 2h after surgery; resting and coughing visual analog scale (VAS) scores at 6, 12, 24, and 48h postoperatively; rescue analgesia rate during the 0-48h period after surgery; patient satisfaction with pain relief at 24h post-surgery; and adverse events. The cumulative sufentanil consumption within the first 24h after surgery was significantly lower in the L group (median [IQR], 50.00 [48.00-52.00] μg) than in the U group (54.00 [48.75-59.25] μg) (Mann-Whitney U = 276.0, z = -2.234, P = 0.026). The procedural time of QLB was significantly shorter in group L than in group U (2.8 ± 0.8 min versus. 5.6 ± 1.1min, mean difference (MD): 2.8min, 95% CI 2.29 to 3.31, P < 0.001). Compared with the L group, the dermatomes of sensory block 2h after surgery were significantly lower in the U group (6.9 ± 1.0 versus 6.2 ± 1.1, MD: -0.7, 95% CI -1.25 to -0.15, P = 0.014). The VAS scores during rest and coughing at 6, 12, and 24h postoperatively were significantly lower in the L group than in the U group (P < 0.05). However, no significant difference in VAS scores between the two groups 48h postoperatively was noted (P > 0.05). Compared with the L group, the rescue analgesia rate during the 0-48h period after surgery was significantly higher in the U group (17.2% versus 44.8%, relative risk: 0.39, 95% CI 0.16-0.94, P = 0.023). Patients in group L had significantly higher satisfaction with pain relief 24h postoperatively than those in group U (P = 0.037). No significant difference in adverse events was observed between the two groups (P > 0.05). Compared with ultrasound-guided QLB, laparoscopic QLB demonstrates favorable analgesic trends within the first 24h after laparoscopic nephrectomy, including reduced sufentanil consumption. Furthermore, L-QLB shows a shorter procedural time, broader sensory blockade coverage, and higher patient satisfaction. Chictr.org.cn identifier, ChiCTR2400080942.

Patients receiving onabotulinumtoxinA treatment for chronic migraine (CM) may have coexisting diseases warranting multi-indication use of onabotulinumtoxinA. However, data on safety and treatment patterns for concomitant treatment of CM and other diseases are limited. SYNCHRONIZE was a phase4, multicenter, retrospective study that explored the safety of onabotulinumtoxinA treatment for ≥ 2 therapeutic (non-aesthetic) indications within 3months. The observation period of interest was approximately 6months before and 24months after receiving treatment for the second indication. The primary outcome was treatment-emergent adverse events (TEAEs) occurring within 6months. Results are reported descriptively and stratified by treatment indications. This analysis focuses on patients treated for CM and ≥ 1 other onabotulinumtoxinA indication. A total of 183 patients had CM and ≥ 1 other onabotulinumtoxinA indication (CM + cervical dystonia [CD], n = 121; CM + oromandibular dystonia [OD] ± blepharospasm [BS], n = 17; CM + BS or hemifacial spasm [HS], n = 13; CM + CD + other movement disorders [MD], n = 11; CM + spasticity [SP] or focal dystonia [FD], n = 10; CM + hyperhidrosis [HH] ± other MD, n = 5; CM + overactive bladder [OAB] or neurogenic detrusor overactivity [NDO], n = 4; CM + other MD, n = 2). The 3-month mean cumulative onabotulinumtoxinA dose ranged from 163.4U (CM + OD ± BS) to 396.2U (CM + SP or FD), and most patients received treatment for their first and subsequent indications within 24h. The proportion of patients with ≥ 1 TEAE in the 6months post-index was 23.5% overall, with the most common being neck pain (6.6%), headache (4.9%), migraine (4.9%), and brow ptosis (2.2%). There were no TEAEs consistent with distant spread of toxin and no discontinuations due to adverse events. TEAEs associated with onabotulinumtoxinA treatment in adults with CM and ≥ 1 coexisting disease within 3months were generally consistent with the known safety profiles for the individual onabotulinumtoxinA indications. There were no new safety signals observed for up to 6months after multi-indication treatment.

This study aimed to assess economic burden and treatment characteristics of patients with chronic low-back pain (cLBP) transitioning from oral ScheduleII (CII) short-acting opioids (SAO) to oral CII long-acting opioids (LAO) or Belbuca® (buprenorphine buccal film, BBF). Merative MarketScan® commercial US claims (2019-2023) were retrospectively analyzed. Index date was the first BBF or LAO prescription date. The observation covered 6-month pre-index and 12-month follow-up periods. Patients were adults with ≥ 2 low-back pain and ≥ 1 SAO prescription pre-index claims. Cases with BBF-LAO switching, coverage gap, or cancer/HIV were excluded. Economic burden and treatment characteristics were explored during follow-up. Rescue medication utilization trends were also analyzed (6-month pre-index vs. 6-month follow-up). Propensity-score matching minimized the impact of patient characteristics. Study sample had 964 patients per cohort. Despite higher prescription costs in BBF ($10,417 vs. $8238, p = 0.007), total and cLBP-related costs were similar. BBF had fewer outpatient visits (33.1 vs. 35.4, p = 0.038), hospitalizations (0.2 vs. 0.3, p = 0.041), cLBP-related hospitalizations (0.04 vs. 0.08, p = 0.013), and shorter cLBP-related hospital stay (0.14 vs. 0.33days, p = 0.023). BBF also had fewer patients with ED visits (36.9% vs. 41.6%, p = 0.036) and cLBP-related hospitalizations (3.5% vs. 6.1%, p = 0.008). Adherence and treatment duration between cohorts were similar, with fewer prescriptions in BBF (5.8 vs. 6.5, p = 0.003). Trends showed BBF had greater decreases in SAO treatment duration (-15.4 vs. -2.2days, p < 0.001), prescription counts (-0.9 vs. -0.3, p < 0.001), and daily morphine milligram equivalents (-9.7 vs. -6.1, p = 0.015). However, more BBF-treated patients had buprenorphine patches (8.2% vs. 3.3%, p < 0.001) with more patch prescriptions (0.3 vs. 0.1, p < 0.001) and longer treatment duration (8.9 vs. 2.6days, p < 0.001). Study findings demonstrated similar healthcare expenditures between patients with cLBP transitioning from SAO to BBF and to LAO. Yet, initiating BBF may have lowered healthcare resource utilization and decreased further SAO utilization.

This study investigates the prevalence of sleep disorders among patients with fibromyalgia syndrome (FMS) in French pain clinics, addressing a gap between international and national data. It also aims to describe associated factors such as quality of life (QoL), pain, daily functioning, and psychological symptoms. The study included 508 patients with an average age of 46 ± 10years. Patients attending a specialized chronic pain center, either at their initial consultation or within the first year of follow-up, completed online self-administered questionnaires. Questionnaire were related to sleep disorders, pain, anxiety and QoL. In this sample, sleep disorders were highly prevalent among French patients with FMS (95.3% with Pittsburgh Sleep Quality Index (PSQI) > 5; 69.9% with PSQI > 10). More than 13% were identified as being at high risk for sleep apnea, and 60% reported symptoms suggestive of restless leg syndrome (RLS). The median scores on the Brief Pain Inventory were 6.0 (Q1: 5.3-Q3: 7.0) for pain severity and 5.9 (Q1: 4.7-Q3: 7.1) for pain interference. The Hospital Anxiety and Depression Scale revealed a median anxiety score of 11.0 (Q1: 9.0-Q3: 15.0). Regarding the impact of FMS on daily life, the median score on the Fibromyalgia Impact Questionnaire was 59.0 (Q1: 44.0-Q3: 71.0). In contrast to French estimates, this study revealed a high prevalence of sleep disorders among patients with FMS, underscoring a gap in care. A substantial proportion of patients were at high risk for RLS and a clinically relevant risk for sleep apnea. Anxiety, depression, and reduced QoL were also highly prevalent, reflecting the complex and multifactorial burden of FMS. These findings highlight the need for a comprehensive, patient-centered approach that includes targeted management of sleep disturbances as a core component of fibromyalgia care.

Epidural analgesia has shown high maternal-fetal safety and satisfactory analgesia. Sufentanil is associated with a high risk of pruritus, nausea, and vomiting for epidural labor analgesia. Alfentanil is characterized by a rapid onset and is also used for labor analgesia. The study aimed to compare the analgesic efficacy and adverse effects of epidural ropivacaine combined with equipotent doses of alfentanil or sufentanil for labor analgesia, and to provide evidence for optimizing obstetric analgesic regimens. In this multicenter, randomized, controlled, single-blind trial conducted at four tertiary hospitals in China between June 2023 and June 2024, 442 nulliparous women with singleton, term pregnancies were enrolled. Participants were randomly assigned (1:1) to receive epidural 0.075% ropivacaine combined with either 4μg/ml alfentanil (group A) or 0.2μg/ml sufentanil (group S). Analgesia was delivered via a programmed intermittent epidural bolus (PIEB) plus patient-controlled epidural analgesia (PCEA) regimen (10ml bolus, 50-min interval, 3ml/h background infusion, 8-ml patient-controlled bolus, 20-min lockout). The onset of analgesia, defined as the median time from drug administration to the first recording of a visual analogue scale (VAS) score ≤ 3 within 30min was the primary outcome. Hemodynamic parameters, labor characteristics, analgesic consumption, maternal satisfaction, neonatal outcomes, and adverse events were recorded as secondary outcomes. The median onset time of analgesia was significantly shorter in the alfentanil group compared with the sufentanil group (8.0min vs. 10.0min, P < 0.001). No significant differences were observed between groups in blood pressure, heart rate, SpO₂, fetal heart rate, Bromage scores, VAS scores at subsequent time points, uterine pressure, sensory block level, body temperature, duration of analgesia, labor duration, mode of delivery, oxytocin use, total drug consumption, maternal satisfaction, or neonatal Apgar scores (all P > 0.05). Adverse events such as pruritus, nausea, vomiting, urinary retention, and lower limb numbness were infrequent and comparable between groups. Both alfentanil and sufentanil, when combined with 0.075% ropivacaine, provide effective and safe epidural labor analgesia. However, alfentanil offers the advantage of a faster onset of analgesia, making it a valuable alternative to sufentanil in clinical practice. Chinese Clinical Trial Registry, ChiCTR2300072104, Date of registration: June 2, 2023.

Evoked compound action potentials (ECAPs) are neurophysiological biomarkers of neural activation during spinal cord stimulation (SCS). Clear distinction between ECAPs and nonphysiological signals is critical to the application of contemporary, ECAP-based closed-loop (CL) SCS therapies. Herein, we evaluated the performance and user acceptability of a novel programming software that automates generation of ECAP-based CL-SCS programs-the Assisted Programming Module (APM). We report results from two prospective, multicenter, single-arm, feasibility studies: Freshwater (NCT04662905) and Rosella (NCT06057480). APM performance was compared with the previous generation programming software and other published methods. Performance was assessed by comparing signal-to-noise ratios, artifact rejection, and other objective parameters. User acceptability was assessed using questionnaires administered to SCS users. The APM successfully generated a CL program in 96% of initial programming sessions (n = 81/84; Freshwater, 31/34; Rosella, 50/50). In the Rosella study, median time to generate an automated CL program (n = 68) was 11.9min [interquartile range (IQR) 9.9-14.0]. Median dose ratio was 1.31 (IQR 1.20-1.46) at end of trial (n = 24), 1.34 (IQR 1.13-1.51) at 1month post implant (n = 16), and 1.32 (IQR 1.21-1.48) at 3months post implant (n = 15). At least 90% of patients [trial, 90% (27/30); implant, 94% (17/18)] were satisfied with their programming experience, and ≥ 90% of patients [trial, 90% (26/29); implant, 94% (16/17)] felt in control of their therapy. The APM achieved a mean signal-to-noise ratio of 4.6 ± 1.2, a 35% improvement over the previous generation ECAP dose-controlled CL-SCS system. Detectable artifact leakage rates decreased by 75% when compared with other published methods without compromise to signal-to-noise performance. Next-generation ECAP dose-controlled CL technology demonstrated strong feasibility, high patient satisfaction and therapy control, and superior ECAP signal fidelity compared with existing methods. By standardizing CL-SCS programming and enhancing signal fidelity, the APM may improve workflow efficiency and long-term therapy outcomes in chronic pain management. ClinicalTrials.gov identifiers: NCT04662905, NCT06057480.