Treatment Of Pain Research Articles

The Diagnosis and Treatment of Neuropathic Pain.

The reported prevalence of neuropathic pain in the general population in Germany is from 6.9% to 10%. There are both medical and surgical treatment options. This review is based on pertinent publications retrieved by a selective search in PubMed, with consideration of clinical trials, meta-analyses, and guidelines. Neuropathic pain is diagnosed when pain of the appropriate character is accompanied by further features such as hypesthesia/anesthesia, allodynia, or hyperalgesia. It is generally treated initially with drugs (antidepressant drugs, anticonvulsant drugs, opioids, topical agents, and others); the number needed to treat (NNT) is between 7 and 8 for gabapentin and 3.6 for amitryptiline, as estimated in meta-analyses. For nerve compression and entrapment syndromes, surgical decompression is a treatment directed against the cause of the problem, which can therefore be curative. Microvascular decompression (MVD) is often used to treat supposed compression syndromes of cranial nerves, above all classic trigeminal neuralgia; according to a meta-analysis, MVD brings about a pain-free state in 92.9% [89.1; 96.8] of patients after 5 months to 5 years of follow-up. Ablative surgical procedures are used for symptom control in patients with refractory and/or cancer-related pain. Further symptom-directed treatment options for medically intractable neuropathic pain include neuromodulatory techniques, which involve minimally invasive electrical stimulation of neural structures, and the chronic intrathecal application of drugs such as opioids and ziconotide. The treatment of neuropathic pain can be either cause-directed or symptom-directed, depending on its origin. Multidisciplinary collaboration can facilitate both the diagnostic evaluation and the selection of the optional modality and timing of treatment.

Postpanniculectomy Improvement in Low Back Pain: A Case Report

While panniculectomy is traditionally considered a cosmetic surgery, there is growing interest in the potential role of panniculectomy for the treatment of low back pain. We present a case of a 69-year-old man with a history of over 10 years of significant low back pain with radiculopathy rated as 7 out of 10 and resistant to conservative measures as well as multiple spinal decompression surgeries. He had undergone bariatric surgery 14 years prior and maintained a stable body mass index. He presented with a large pannus desiring panniculectomy for aesthetic purposes. He underwent an uncomplicated panniculectomy. As an unintended benefit of his procedure on his 1-month post-op visit, he reported near resolution of his low back pain and radiculopathy. His reported pain had been reduced to 1–2 out of 10. More research needs to be done to assess the potential of panniculectomy as a treatment for low back pain in patients with massive weight loss.

Hederagenin is a Highly Selective Antagonist of the Neuropeptide FF Receptor 1 that Reveals Mechanisms for Subtype Selectivity

AbstractRF‐amide peptide receptors including the neuropeptide FF receptor 1 (NPFFR1) are G protein‐coupled receptors (GPCRs) that modulate diverse physiological functions. High conservation of endogenous ligands and receptors makes the identification of selective ligands challenging. Previously identified antagonists mimic the C‐terminus of peptide ligands and lack selectivity towards the closely related neuropeptide FF receptor 2 (NPFFR2) or the neuropeptide Y1 receptor (Y1R). In a high‐throughput screening, we identified the pentacyclic triterpenoid hederagenin (1) as a novel selective antagonist for the NPFFR1. Hederagenin (1) is a natural product isolated from Hedera helix (ivy). We characterized its mode of activity using in vitro and in silico methods, revealing an overlapping binding site of the small molecule with the orthosteric peptide agonists. Despite the high similarity of the orthosteric binding pockets of NPFFR1 and NPFFR2, hederagenin (1) shows strong subtype selectivity, particularly caused by slight differences in the shape of the binding pockets and the rigidity of the small molecule. Several residues inhibiting the activity of hederagenin (1) at the NPFFR2 were identified. As NPFFR1 antagonists are discussed as potential candidates for the treatment of chronic pain, these insights into the structural determinants governing subtype specificity will facilitate the development of next‐generation analgesics with improved safety and efficacy.

Hederagenin is a Highly Selective Antagonist of the Neuropeptide FF Receptor 1 that Reveals Mechanisms for Subtype Selectivity.

RF-amide peptide receptors including the neuropeptide FF receptor 1 (NPFFR1) are G protein-coupled receptors (GPCRs) that modulate diverse physiological functions. High conservation of endogenous ligands and receptors makes the identification of selective ligands challenging. Previously identified antagonists mimic the C-terminus of peptide ligands and lack selectivity towards the closely related neuropeptide FF receptor 2 (NPFFR2) or the neuropeptide Y1 receptor (Y1R). In a high-throughput screening, we identified the pentacyclic triterpenoid hederagenin (1) as a novel selective antagonist for the NPFFR1. Hederagenin (1) is a natural product isolated from Hedera helix (ivy). We characterized its mode of activity using in vitro and in silico methods, revealing an overlapping binding site of the small molecule with the orthosteric peptide agonists. Despite the high similarity of the orthosteric binding pockets of NPFFR1 and NPFFR2, hederagenin (1) shows strong subtype selectivity, particularly caused by slight differences in the shape of the binding pockets and the rigidity of the small molecule. Several residues inhibiting the activity of hederagenin (1) at the NPFFR2 were identified. As NPFFR1 antagonists are discussed as potential candidates for the treatment of chronic pain, these insights into the structural determinants governing subtype specificity will facilitate the development of next-generation analgesics with improved safety and efficacy.

Chronic Pain Management by Analgesic Effects of Shoolprashman Mahakashaya Herbal Drugs: A Conceptual Review

Chronic pain can lead to physical limitations, emotional suffering, and social isolation, all of which can seriously impair a person's quality of life. In addition, poor chronic pain diagnosis and management can worsen opioid use disorders and increase the risk of morbidity and mortality among people who suffer from it. Consequently, healthcare professionals must understand chronic pain and implement appropriate treatment strategies. Due to the discovery of analgesic nephropathy and other systemic illnesses brought on by excessive and prolonged use of analgesics, Shoolprashman Mahakashya, an alternate method of managing chronic pain of unknown cause, is referenced in Ayurveda. This article focuses on Shoolprashman Mahakashaya's herbal drug phytoconstituent, which acts as an analgesic, and its mode of action on the pain and inflammatory markers.

Research hotspots and trends in the treatment of postoperative pain with ropivacaine: A bibliometric analysis from 2003 to 2022.

The aim of this study is to explore the current study status and progression of the effects of ropivacaine in local analgesia by using bibliometric methods. Published articles related to the treatment of postoperative pain with ropivacaine from 2003 to 2022 were retrieved from the Web of Science database. Detailed information such as authors, keywords, journals, countries, institutions and references were analyzed by bibliometric methods and visualized by VOSviewer. A total of 1150 articles published in the treatment of postoperative pain with ropivacaine were included in the bibliometric analysis. From 2003 to 2022, the number of articles was on the rise and increased rapidly after 2018. The United States published the highest number of articles and Ilfeld ranked first in the number of papers (35) and citation frequency (1670). Journal of Anesthesiology had the highest average number of citations per article (89.43). There is a close cooperation among countries especially centering China and the United States at their core, universities are the main institutions in publishing articles. The most cited literature was published by Knudsen whose study major in finding out the effects of ropivacaine and bupivacaine to the central nervous system. Among the top 10 high frequency keywords, ropirvacaine and postoperative anesthesia appeared most frequently. The application of ropivacaine to postoperative anesthesia attracts growing interest from the scholars all over the world and was the future research hotspot in treating postoperative pain.

Research Progress of Lidocaine in the Treatment of Chronic Pain

Chronic pain is a subjective experience that involves not only nociception but also emotional, cognitive, and social factors. Chronic pain affects almost every aspect of daily life. However, the mechanism of chronic pain is extremely complicated. Clinically, there is still a lack of safe and effective treatment methods for chronic pain, and its treatment has always been an important topic in the medical field. In recent years, more and more studies have shown that lidocaine may be an excellent analgesic. It can be used alone as a patch for external use, as a supplement to systemic medication methods, and also for optimizing the treatment of chronic pain and multimodal analgesia. This article reviews the latest research progress of lidocaine in the treatment of chronic pain.

Exploring Mycolactone—The Unique Causative Toxin of Buruli Ulcer: Biosynthetic, Synthetic Pathways, Biomarker for Diagnosis, and Therapeutic Potential

Mycolactone is a complex macrolide toxin produced by Mycobacterium ulcerans, the causative agent of Buruli ulcer. The aim of this paper is to review the chemistry, biosynthetic, and synthetic pathways of mycolactone A/B to help develop an understanding of the mode of action of these polyketides as well as their therapeutic potential. The synthetic work has largely been driven by the desire to afford researchers enough (≥100 mg) of the pure toxins for systematic biological studies toward understanding their very high biological activities. The review focuses on pioneering studies of Kishi which elaborate first-, second-, and third-generation approaches to the synthesis of mycolactones A/B. The three generations focused on the construction of the key intermediates required for the mycolactone synthesis. Synthesis of the first generation involves assignment of the relative and absolute stereochemistry of the mycolactones A and B. This was accomplished by employing a linear series of 17 chemical steps (1.3% overall yield) using the mycolactone core. The second generation significantly improved the first generation in three ways: (1) by optimizing the selection of protecting groups; (2) by removing needless protecting group adjustments; and (3) by enhancing the stereoselectivity and overall synthetic efficiency. Though the synthetic route to the mycolactone core was longer than the first generation, the overall yield was significantly higher (8.8%). The third-generation total synthesis was specifically aimed at an efficient, scalable, stereoselective, and shorter synthesis of mycolactone. The synthesis of the mycolactone core was achieved in 14 linear chemical steps with 19% overall yield. Furthermore, a modular synthetic approach where diverse analogues of mycolactone A/B were synthesized via a cascade of catalytic and/or asymmetric reactions as well as several Pd-catalyzed key steps coupled with hydroboration reactions were reviewed. In addition, the review discusses how mycolactone is employed in the diagnosis of Buruli ulcer with emphasis on detection methods of mass spectrometry, immunological assays, RNA aptamer techniques, and fluorescent-thin layer chromatography (f-TLC) methods as diagnostic tools. We examined studies of the structure–activity relationship (SAR) of various analogues of mycolactone. The paper highlights the multiple biological consequences associated with mycolactone such as skin ulceration, host immunomodulation, and analgesia. These effects are attributed to various proposed mechanisms of actions including Wiskott–Aldrich Syndrome protein (WASP)/neural Wiskott–Aldrich Syndrome protein (N-WASP) inhibition, Sec61 translocon inhibition, angiotensin II type 2 receptor (AT2R) inhibition, and inhibition of mTOR. The possible application of novel mycolactone analogues produced based on SAR investigations as therapeutic agents for the treatment of inflammatory disorders and inflammatory pain are discussed. Additionally, their therapeutic potential as anti-viral and anti-cancer agents have also been addressed.

Esketamine infusion as treatment for chronic endometriosis-associated pain? Study protocol for a randomized controlled trial (EASYlight-study)

Current treatment options for chronic endometriosis-associated pain are often inadequate, resulting in a rise in opioid consumption in this population. Given its analgesic, anti-inflammatory, and anti-depressive properties, esketamine may be a promising alternative treatment option. While esketamine is globally used in the treatment of chronic pain conditions, no clinical trials have been conducted to investigate the efficacy of esketamine infusion to alleviate chronic endometriosis-associated (pelvic) pain. Therefore, the objective of this double-blinded randomized controlled trial (RCT) is to assess the efficacy of 8-h infusion with esketamine versus placebo (saline) to reduce chronic endometriosis-associated pain symptoms. Secondary study objectives include pain scores, quality of life, depressive symptoms, health care utilization, productivity loss, cost-effectiveness, side effects, treatment experience, and pain coping and cognition. Premenopausal women (aged ⩾18 years) diagnosed with endometriosis (peritoneal, ovarian, deep, or adenomyosis), with an indication for laparoscopic endometriosis resection surgery and who suffer from chronic pelvic pain (NRS score ⩾6) will be eligible for inclusion. In total, we aim to include 56 participants, with a follow-up of 12 weeks. Digital questionnaires will be sent at baseline and 4, 8, and 12 weeks after the day of infusion. Trial registration number The EASYlight study is registered as “EASYlight-NEK” in the Clinical Trials Register (NCT06161805)

Considerations for the implementation of a non-pharmacological, patient-centered approach to chronic non-oncological pain treatment in the UK and Chile

Non-oncological chronic pain imposes a significant global burden, and its prevalence is increasing. The World Health Organisation and UK National Institute for Health and Care Excellence promote patient-centered care as an effective approach to treating chronic non-oncological pain. This approach improves long term health outcomes by identifying root causes which impact these conditions, within the framework of the biopsychosocial care model. Within Chile and the United Kingdom, patients advocate for pharmacological interventions, however Centres for Disease Control and Prevention emphasise a preference for non-pharmacological management strategies. As the UK healthcare system actively seeks to reduce reliance on pharmacological treatment modalities, using alternative interventions, Chilean healthcare has also begun to regenerate its approaches to treatment. The objective of this paper is to reflect upon the implementation of these strategies to gain insights into their potential for driving change.

Opioid prescriptions for insured individuals without cancer in Germany: data from the BARMER

The importance of opioids in the treatment of non-cancer pain is under debate. No current data are available from Germany on the prevalence of opioid treatment for non-cancer pain. Data on the prevalence of short- and long-term opioid prescriptions for patients without cancer, prescribed agents, co-medication, specialty of prescribing physicians, demographic and clinical characteristics of patients. Retrospective analysis of billing data of adult BARMER-insured persons without evidence of cancer (N = 6,771,075) in 2021 and for patients initiating opioid therapy in 2019 (n = 142,598). In total, 5.7% of the insured persons without acancer diagnosis received at least one prescription for an opioid in 2021, while 1.9% received long-term therapy. Tilidine and tramadol were the most frequently prescribed opioids in short- and long-term therapy. Women received opioids more frequently than men. The frequency of prescriptions significantly increased with age. In 2021, 22.5% of insured persons with long-term opioid therapy received aco-medication with pregabalin and/or gabapentin, 37.5% with an antidepressant and 58.1% with metamizole and/or NSAIDs. Atotal of 59.5% of first prescriptions were issued by general practitioners. In the first year of therapy, an average of 2.1 practices were involved in prescribing analgetics for people on long-term opioid therapy and 13different chronic diseases were documented. Opioid therapy for non-cancer-related pain is predominantly carried out by general practitioners in older and multi-morbid patients. The indication for or against opioid therapy requires shared decision-making with patients and, if necessary, their relatives, as well as areview of possible drug interactions.

Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autistic Spectrum Disorder.

Acetaminophen is a common over-the-counter medication that recently gained substantial media attention regarding its use by pregnant individuals. In this clinical perspective, we discuss the strengths and limitations of the published literature on the effect of maternal acetaminophen use in pregnancy on the child's risk of developing attention-deficit and hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). Studies included were specifically selected on the basis of the quality and validity of ADHD or ASD outcome definitions. From a total of 56 identified studies, commentaries, and editorials of relevance, we critically reviewed nine studies with original data that satisfied our inclusion criteria and three meta-analyses. Most studies that have reported positive findings are difficult to interpret because they have important biases, notably a high degree of selection bias, variability in selection and adjustment for various potential confounders, and unmeasured familial confounding. When unobserved familial confounding through sibling analysis was controlled for, associations weakened substantially. This suggests that residual confounding from shared genetic and environmental factors may have caused an upward bias in the original observations. According to the current scientific evidence, in utero exposure to acetaminophen is unlikely to confer a clinically important increased risk of childhood ADHD or ASD. The current level of evidence does not warrant changes to clinical guidelines on the treatment of fever or pain in pregnancy. Prospective research designed to account for familial and psychosocial environmental factors related to both maternal use of acetaminophen and children's neurodevelopment should be undertaken.

Promoting a foundation of resilience in older adults: pilot trial of a strengths-based positive psychology intervention for chronic low back pain

ABSTRACT Introduction Chronic low back pain (cLBP) is a global public health problem and a leading cause of disability among older adults. Recent years have seen a burgeoning interest in promoting resilience in individuals with chronic pain; however, therapeutic strategies that focus on positive psychological resources and individual strengths are understudied among older adult populations. The aim of this study was to examine the feasibility and acceptability of a resilience-promoting intervention among older adults with cLBP, and to assess preliminary treatment effects on pain severity, pain interference, and quality of life. Methods Participants included 50 adults, ages ≥50 years, with back pain rated (at minimum) of moderate intensity and having a significant impact on daily activities. This single-arm trial included seven weekly group sessions targeting positive psychology concepts and techniques that have established benefits in pain management. Results Results suggest high credibility and engagement in the intervention program. Participants found the weekly session content to be beneficial and global treatment satisfaction was high. Pain intensity (−4.3 [−6.14, −2.54]), pain interference (−3.3 [−4.83, −1.80]), depression (−1.6 [−3.16, −0.04]) and QoL-health satisfaction (0.3 [0.01, 0.55]) improved from pre- to post-intervention. At the 3-month follow-up, improvements were also observed for pain intensity (−2.1 [−9.29, −5.04]), pain interference (−5.3 [−6.54, −2.86]), and QoL-physical health (0.9 [0.11, 1.74]). Discussion Results support the feasibility, acceptability, and potential efficacy of a resilience intervention for older adults with cLBP. These findings may be a step toward the advancement of therapeutic pain modalities and provide a foundation for future research on resilience-promoting interventions for aging populations with chronic pain.

Patient perspectives on low back pain treatment in primary care: a qualitative study of hopes, expectations, and experiences

BackgroundPatients’ hopes and expectations for low back pain treatment influence their consultation experiences and treatment outcomes. These hopes and expectations may evolve over time, potentially leading to a shift in what patients consider important before and after a consultation. Understanding the distinction between hopes and expectations, and how they evolve is important for improving patient care. This study explored patients’ hopes and expectations prior to LBP consultations and examined how these were reflected in their post-consultation experiences.MethodsWe employed a qualitative design consisting of individual semi-structured pre- and post-consultation interviews with patients seeking care for low back pain from general practitioners, physiotherapists, and chiropractors in Denmark. A convenience sample of 18 patients (10 females and 8 males) aged between 28 and 79 years were interviewed about their hopes and expectations before a consultation and their experiences immediately following the consultation. Data were analysed employing Braun and Clarke’s thematic analysis.ResultsTwo themes with five subthemes were developed: (1) “Something needs to be done,” which included subthemes related to life disruption, expectations of clinical assessment, and the clinicians as experts; and (2) “Experiences and emotional responses to the interaction with the clinician”, highlighting the importance of trust and the personal attributes of clinicians. Patients initially sought urgent help and clarity regarding their condition but shifted their focus post-consultation to the relational dynamics and emotional engagement experienced during interactions with clinicians.ConclusionsThis study contributes to the understanding of how patients’ hopes and expectations regarding low back pain consultations evolve, shifting from a focus on clinical actions and outcomes to valuing interpersonal relationships and emotional support from clinicians. Recognising these shifts can enhance clinician-patient interactions and improve overall patient satisfaction and treatment outcomes.Clinical trial numberNot applicable.

Paradigm Shift in the Treatment of Temporomandibular Joint Pain with Injectable Platelet-Rich Fibrin—A Single-Arm Trial

Paradigm Shift in the Treatment of Temporomandibular Joint Pain with Injectable Platelet-Rich Fibrin—A Single-Arm Trial

Comparative evaluation of ultrasound and fluoroscope guided intra-articular sacroiliac joint injection in patients with sacroiliac joint pain

Background: Tissues which transmit pain in the lower back include disc, nerve root, dura, muscles, ligaments, facet joints, and sacroiliac joint (SIJ). The SIJ contributes around 13–30% in patients with chronic low back pain. The SIJ is difficult to enter with a needle because of its complex configuration. Ultrasound and fluoroscopy are the two tools which guide in performing SIJ injections. Aims and Objectives: The SIJ is susceptible to arthritis, trauma, and degeneration which lead to pain and dysfunction. Intra-articular SIJ injections (IASIJIs) have diagnostic and therapeutic value and have been administered for the treatment of SIJ pain. Materials and Methods: Sixty patients (aged 20–60 years) with pain patterns consistent with SIJ pain who did not respond to conservative treatment were included in the study. The patients were randomly divided into two groups of 30 each: Group U (n=30): Ultrasound-guided IASIJI and Group F (n=30): Fluoroscope-guided IASIJI. A total of 3 mL drug solution comprising 1 mL of 0.25% bupivacaine plus 2 mL of methylprednisolone (80 mg) was injected in both groups. Results: There was a statistically significant improvement in pain scores after IASIJI in both groups. The change in pain score was significantly more in Group F as compared to Group U at 3 and 6 months after IASIJI. Two weeks after IASIJI, the mean pain score in both groups remained < 2 at all time intervals throughout the study period. The variation in the Oswestry Disability Index (ODI) at different time intervals when compared to ODI before injection in both the groups was clinically and statistically significant (P<0.001). The change in ODI was more in Group F as compared to Group U at all time intervals. Excellent patient satisfaction was reported by the majority of the patients at different time intervals in both groups. Conclusion: Both techniques were effective and provided good pain relief to the patients with SIJ pain. Fluoroscope-guided SIJ injection is better than ultrasound-guided SIJ injection in terms of improvement in pain score and functional disability.

Consensus statement on chronic pain treatment in cancer survivors.

In September 2023, the Japanese Society for Palliative Medicine (JSPM) issued this consensus statement on chronic pain treatment in cancer survivors. With recent advances in the early diagnosis and treatment of cancer, its prognosis has improved, so prolonged pain in cancer survivors is considered to represent chronic pain and should be addressed. In this statement, we emphasize that not all cancer survivor pain is cancer pain. Pain that is not cancer pain should be managed with analgesics other than opioids and nerve blocks, and pain that persists despite this approach should be treated as non-cancer chronic pain so as to prevent opioid overuse. In addition, cancer survivors at any stage of disease have a potentially life-threatening condition and constantly carry the fear of cancer recurrence. Therefore, even non-cancer pain should not be treated in the same way as general chronic pain, but should be managed with consideration of emotional distress. In the future, we plan to create educational tools for healthcare professionals and to conduct online seminars, both with the goal of providing cancer survivors with appropriate assessment and treatment of chronic pain.

Editorial: Insight in non-pharmacological treatment of pain—2023

Editorial: Insight in non-pharmacological treatment of pain—2023

Parental Assessment of Postsurgical Pain in Infants at Home Using Artificial Intelligence-Enabled and Observer-Based Tools: Construct Validity and Clinical Utility Evaluation Study.

Pain assessment in the infant population is challenging owing to their inability to verbalize and hence self-report pain. Currently, there is a paucity of data on how parents identify and manage this pain at home using standardized pain assessment tools. This study aimed to explore parents' assessment and intervention of pain in their infants at home following same-day surgery, using standardized pain assessment tools. This prospective study initially recruited 109 infant boys undergoing circumcision (same-day surgery). To assess pain at home over 3 days after surgery, parents using iOS devices were assigned to use the PainChek Infant tool, which is a point-of-care artificial intelligence-enabled tool, while parents using Android devices were assigned to use the Observer-Administered Visual Analog Scale (ObsVAS) tool. Chi-square analysis compared the intervention undertaken and pain presence. Generalized estimating equations were used to evaluate outcomes related to construct validity and clinical utility. Receiver operating characteristic analysis assessed pain score cutoffs in relation to the intervention used. A total of 69 parents completed postsurgery pain assessments at home and returned their pain diaries. Of these 69 parents, 24 used ObsVAS and 45 used PainChek Infant. Feeding alone and feeding with medication were the most common pain interventions. Pain presence over time reduced. In the presence of pain, an intervention was likely to be administered (χ22=21.4; P<.001), with a medicinal intervention being 12.6 (95% CI 4.3-37.0; P<.001) times more likely and a nonmedicinal intervention being 5.2 (95% CI 1.8-14.6; P=.002) times more likely than no intervention. In the presence of intervention, score cutoff values were ≥2 for PainChek Infant and ≥20 for ObsVAS. A significant effect between the use of the pain instrument (χ21=7.2, P=.007) and intervention (χ22=43.4, P<.001) was found, supporting the construct validity of both instruments. Standardized pain scores were the highest when a medicinal intervention was undertaken (estimated marginal mean [EMM]=34.2%), followed by a nonmedicinal intervention (EMM=23.5%) and no intervention (EMM=11.2%). Similar trends were seen for both pain instruments. Pain was reduced in 94.5% (224/237) of assessments where parents undertook an intervention. In 75.1% (178/237) of assessments indicative of pain, the score changed from pain to no pain, with PainChek Infant assessments more likely to report this change (odds ratio 4.1, 95% CI 1.4-12.3) compared with ObsVAS assessments. The use of standardized pain assessment instruments by parents at home to assess pain in their infants can inform their decision-making regarding pain identification and management, including determining the effectiveness of the chosen intervention. In addition to the construct validity and clinical utility of PainChek Infant and ObsVAS in this setting, feeding alone and a combination of feeding with medication use were the key pain intervention strategies used by parents.

A meta-analysis of the efficacy and safety of genicular artery embolization for the treatment of pain secondary to knee osteoarthritis

Objective: To assess the efficacy and safety of genicular artery embolization (GAE) in the management of pain secondary to knee osteoarthritis (KOA). Methods: Literature search was conducted on PubMed, Web of Science, Cochrane Library, Embase, and Wanfang databases to collect literatures related to KOA, GAE and therapeutic effects. The search period was from the inception of the databases to July 2024. Literature screening and data extraction were carried out independently by two researchers according to the inclusion and exclusion criteria, and the quality of the included literature was assessed using the methodological index for non-randomized studies. Data extracted included visual analog scale (VAS) scores, total western ontario and mcmaster universities osteoarthritis index (WOMAC) scores, and the incidence of adverse events, followed by a meta-analysis using STATA 15.1 software. Results: A total of 11 papers involving 332 patients (419 knees) from 11 studies were included according to the Na-row criteria. The technical success rate was 100%. The standardized mean differences of VAS scores at 1, 3, 6, and 12 months postoperatively were -2.42(95%CI:-2.89--1.95), -2.44(95%CI:-2.94--1.93), -2.57(95%CI:-3.13--2.01), and -2.60(95%CI:-3.37--1.84), respectively, all showing decreases (all P<0.001); the weighted mean difference of WOMAC total score at 1, 3, 6, and 12 months after surgery were -24.44(95%CI:-29.13--19.75), -28.30(95%CI:-31.47--25.12), -30.66(95%CI:-32.94--28.37), and -34.23(95%CI:-44.39--24.07), all showing decreases (all P<0.001). The incidence of adverse events mainly included skin color changes of 16.4%(95%CI: 5.5%-31.0%, P<0.001) and hematoma at the puncture site 3.8%(95%CI: 1.1%-7.6%, P<0.001), with the majority being mild and self-resolving. Conclusions: GAE treatment for KOA secondary pain has good efficacy and safety, providing a new treatment option for KOA patients as a minimally invasive procedure.