Long-term Pain Research Articles

Safety and efficacy of purely endoscopic microvascular decompression for trigeminal neuralgia: systematic review and single arm meta-analysis.

Microscopic microvascular decompression(M-MVD) is considered the gold standard treatment for primary trigeminal neuralgia and presents excellent long-term pain control rates. Despite the effectiveness of M-MVD, the use of endoscopy in these procedures has proven to be a promising approach. To evaluate the safety and efficacy of purely endoscopic microvascular decompression (E-MVD). A systematic review of the literature was performed using the PubMed, Scopus, Embase, and Cochrane databases. The primary outcome was satisfactory pain relief in short-term (0-30 days), mid-term (mean follow-up >/= 12 months) and long-term (mean follow-up >/= 24 months). Secondary outcomes were CSF leak, facial weakness, hearing loss, facial numbness, the rate of intraoperative identification of the offending vessel(s), mortality, length of stay and operative time. Inclusion criteria were studies including only patient submitted to E-MVD. Exclusion were secondary trigeminal neuralgia and mean follow-up < 12 months. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed using I² statistics. Sensitivity analysis was performed with leave-one-out test. Thirteen articles met the inclusion criteria, comprising a total of 1336 patients. Patients submitted to E-MVD had mean satisfactory pain relief rates of 92.93% (95% CI: 89.52-96.34% I2 = 86%), 88.54% (95% CI: 83.73-93.54% I2 = 87%) and 83.38% (95% CI: 76.58-90.17% I2 = 83%) in the short-term, mid-term and long-term follow-ups, respectively. Furthermore, the incidence of postoperative complications was low, including CSF leak (1.29% (95% CI: 0.32-2.26% I2 = 20%)), facial weakness (0.50% (95% CI: 0.00-1.79% I2 = 60%)), hearing loss (0.81% (95% CI: 0.05-1.57% I2 = 7%)) and facial numbness (3.84% (95% CI: 1.95-6.20% I2 = 54%)). There was no mortality related to the procedure (0% (95% CI: 0-0%; I2 = 0%)). The offending vessel(s) were identified in 99.57% of the cases (95% CI: 98.17-100.00% I2 = 67%)). Our meta-analysis revealed that E-MVD is a safe and effective procedure for the treatment of primary trigeminal neuralgia. Further studies are necessary to compare its usefulness to the traditional M-MVD approach.

Abuse-deterrent wearable device with potential for extended delivery of opioid drugs

Abstract Purpose Unethical attempts to misuse and overdose opioids have led to strict prescription limits, necessitating frequent hospital visits and prescriptions for long-term severe pain management. Therefore, this study aimed to develop a prototype wearable device that facilitates the extended delivery of opioid drugs while incorporating abuse-deterrent functionality, referred to as the abuse deterrent device (ADD). Methods The ADD was designed and fabricated using 3D-printed components, including reservoirs for the drug and contaminant, as well as an actuator. In vitro tests were conducted using a skin-mimicking layer and phosphate-buffered saline (PBS) to evaluate the drug release profile and the effectiveness of the ADD abuse-deterrent mechanism. Results Under simulated skin attachment, ADD demonstrated sustained drug release with the potential to persist for up to 200 days. Upon detachment from the skin mimic, the mechanical components of the ADD facilitated immediate exposure of the contaminant to the drug and effectively halted further drug exposure throughout-diffusion. Conclusion Wearable ADD provides a secure and practical solution for the long-term treatment of high-risk medications such as opioids, enhances patient convenience, and addresses important public health concerns.

Patient-reported outcomes after immediate and delayed DIEP-flap breast reconstruction in the setting of post-mastectomy radiation therapy-results of the multicenter UMBRELLA breast cancer cohort.

Timing of Deep Inferior Epigastric artery Perforator (DIEP)-flap breast reconstruction in the context of post-mastectomy radiotherapy for breast cancer patients is topic of debate. We compared the impact of immediate (before radiotherapy) versus delayed (after radiotherapy) DIEP-flap breast reconstruction (IBR versus DBR) on short- and long-term patient-reported outcomes (PROs). Within the prospective, multicenter breast cancer cohort (UMBRELLA), we identified 88 women who underwent immediate or delayed DIEP-flap breast reconstruction and received PMRT. At 6 and 12months post-mastectomy, as well as on long-term (≥ 12months post-reconstruction) body image, breast symptoms, physical functioning, and pain were measured by EORTC-QLQ-30/BR23. Additionally, long-term evaluation included satisfaction with breast(s), physical well-being and self-reported adverse effects of radiation as measured by BREAST-Q, and late treatment toxicity. PROs were compared between groups using independent sample T-test. IBR was performed in 56 patients (64%) and DBR in 32 patients (36%), with 15 months of median time to reconstruction. At 6 and 12months post-mastectomy, better body image and physical functioning were observed after IBR. No statistically nor clinically relevant differences were observed in long-term EORTC and BREAST-Q outcomes (median follow-up 37-41months for IBR vs. 42-46months for DBR). Patients with IBR reported more fibrosis and movement restriction (median follow-up 29 vs. 61months, resp.). Long-term PROs were comparable for patients with IBR and DBR, despite more patient-reported fibrosis and movement restriction after IBR. Therefore, both treatment pathways can be considered when opting for autologous breast reconstruction in the setting of PMRT.

Long-term Outcomes After Minimally Invasive Ventral Rectopexy for Rectal Prolapse Using Biologic Graft Prosthesis: A 15-Year Retrospective Cohort Study.

Minimally invasive ventral rectopexy has widely become the preferred prolapse procedure. However there have been recent concerns regarding the safety of permanent synthetic mesh in the pelvis. Biologic grafts have also been commonly used as an alternative prosthesis, but data on their safety and the longevity of the prolapse repair have been lacking. To assess the short and long-term safety and efficacy of biologic grafts in minimally invasive ventral rectopexy. Retrospective cohort study using data from a prospectively collected database. Single surgeon at a single tertiary hospital in Australia. There were 366 patients with minimum 6 months follow-up undergoing minimally invasive ventral rectopexy using a biologic graft between January 1, 2008, and October 5, 2023. Overall recurrence, complications and functional outcomes. A total of 57 patients (15.6%, n = 57) experienced a recurrence during the study period, with a median follow up time of 35.5 months (range, 6-183 months). Of these, 17 (4.6%) were full thickness recurrence. The Kaplan-Meier estimates of the overall 1-, 3-, and 5-year recurrence rates were 2.0%, 6.0% and 16.0% respectively. There was no statistically significant difference in recurrence for patients who presented with a full thickness prolapse compared to those with other indications (16.8% vs 14.2%, p=0.29). Overall, there were a total of 34 complications which occurred in 29 (7.9%) patients. 19 patients (5.2%) required a return to theatre. There were no graft related complications or long-term pelvic pain. 98% of patients had symptomatic improvement and were satisfied with their outcome. Retrospective study and generalizability of the results from single surgeon experience. Late recurrences may have been missed. Minimally invasive ventral rectopexy using a biological graft is both safe and effective, offering acceptable short- and long-term recurrence rates and overall complications with no graft related morbidity. See Video.

Peripheral blood immunoinflammatory biomarkers: prospective predictors of postoperative long-term survival and chronic postsurgical pain in breast cancer

BackgroundTumor progression and chronic postsurgical pain (CPSP) in patients with breast cancer are both significantly influenced by inflammation. The associations between immunoinflammatory biomarkers and long-term survival, as well as CPSP, remain ambiguous. This study examined the predictive value of immunoinflammatory biomarkers for both long-term survival and CPSP.MethodsData on the clinicopathological characteristics and perioperative peripheral blood immunoinflammatory biomarkers of 80 patients who underwent breast cancer surgery were retrospectively collected. Optimal cut-off values for preoperative immunoinflammatory biomarkers, including the preoperative systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and pan-immune-inflammation value (PIV), were established via receiver operating characteristic (ROC) curves. Kaplan−Meier curves and Cox regression analysis were used to evaluate the relationships between preoperative immunoinflammatory biomarkers and long-term survival. The relationships among the perioperative neutrophil count (NEU), monocyte count (MONO), lymphocyte count (LYM), platelet count (PLT), SII, SIRI, NLR, PIV, dynamic changes in peripheral blood cell counts, and CPSP were further assessed using logistic regression analysis.ResultsKaplan−Meier curves revealed a considerable prolongation of disease-free survival (DFS) and overall survival (OS) in the low preoperative SII, SIRI, NLR, and PIV groups. Multivariate Cox regression analysis revealed that only an elevated preoperative SIRI was an independent risk factor for postoperative DFS (HR=8.890, P=0.038). The incidence of CPSP was 28.75%. Univariate logistic regression analysis revealed that body mass index (BMI), postoperative NEU, MONO, SIRI, and PIV were negatively correlated with the occurrence of CPSP, whereas subsequent multivariate logistic regression analysis revealed that only BMI was independently associated with CPSP (OR=0.262, P=0.023).ConclusionElevated preoperative SIRI was an independent risk factor for poor DFS in breast cancer patients after surgery. In contrast, perioperative immunoinflammatory biomarkers had limited potential for predicting CPSP in patients who underwent breast cancer surgery.

Regional Anesthesia and Pain Outcomes After Anterior Cruciate Ligament Reconstruction Surgery in Pediatric Patients: Society of Pediatric Anesthesia Improvement Network.

Optimal perioperative pain management is unknown for adolescent patients undergoing anterior cruciate ligament reconstruction (ACLR). The study aimed to determine the association of nerve blocks with short- and long-term pain outcomes and factors influencing self-reported neurological symptoms. We performed a multisite, prospective observational study of adolescent patients undergoing ACLR. Perioperative data included demographics, block details, anesthetic, and surgical techniques. Self-reported surveys documented pain scores, medication use, and neurological symptoms at various time points after the surgery (postoperative day [POD] 1, POD 3, week 6, and month 6). Associations between different groups of peripheral nerve blocks (PNBs) and the absence of a block were analyzed for their effects on acute postoperative pain outcomes. In addition, factors influencing self-reported neurological outcomes were determined using both univariate and multivariate regression. Data from 519 subjects (aged 15 years, 55.7% female) showed that 23.9% of patients with anterior plus posterior nerve blocks (A+P PNB) reported severe postanesthesia care unit (PACU) pain scores, compared to 40% with no PNB and 38.3% with anterior PNB (A-PNB). Patients receiving A-PNB or A+P PNB had significantly lower intraoperative morphine equivalents (MEs) (0.49 mg/kg and 0.46 mg/kg, respectively) vs no block patients (0.61 mg/kg). Total PACU MEs were lower for any patient who received a PNB. Multivariable logistic regression analysis showed that patients who received A+P PNB or a hamstring autograft had lower POD 1 severe pain scores (odds ratio [OR] = 0.35; 95% confidence interval [CI], 0.15-0.84 and OR = 0.35; 95% CI, 0.15-0.83, respectively). Patients with PNBs with local anesthesia concentration (LAC) greater than 0.25% reported higher POD1 pain scores (OR = 2.14; 95% CI, 1.1-4.16) compared to those with lower LAC. Patients with PNB catheters had reduced POD 1 pain. Multivariable logistic regression analysis for numbness at week 6 revealed a greater odds of numbness for A-PNB with LAC >0.25% (OR = 5.13; 95% CI, 1.27-20.8). At month 6, patients receiving PNB with perineural steroid adjuvant were more likely to report numbness (dexamethasone OR = 5.93; 95% CI, 1.61-21.9, methylprednisolone OR = 11.3; 95% CI, 2.16-58.6). Patients who received A+P PNB had lower postoperative pain scores than those who received no block. Additional studies are necessary to discern how PNB type, graft harvest site, LAC, and adjuvants influence pain control, persistent numbness, and weakness.

Efficacy and Safety of Boswellia serrata and Apium graveolens L. Extract Against Knee Osteoarthritis and Cartilage Degeneration: A Randomized, Double-blind, Multicenter, Placebo-Controlled Clinical Trial.

Osteoarthritis is the prevailing form of inflammatory condition in joints of adults and the aging population, leading to long-term disability and chronic pain. Current therapeutic options have variable therapeutic efficacy and/or several side effects. A randomized, placebo-controlled, double-blind clinical trial was conducted in 62 participants using a nutraceutical [standardized Boswellia serrata Roxb. gum resin (300 mg) and Apium graveolens L. seed extract (250 mg)], to determine its safety and efficacy forsupporting cartilage health and reduction in knee osteoarthritis symptoms. All participants were assessed for physical function and pain with the help of WOMAC, VAS, Physicians' Global Assessment for the six-minute walk test/pain. Knee X-ray, KOOS questionnaire score, and FACIT-F score were assessed. Additionally, inflammatory, cartilage degeneration and regeneration biomarkers in serum and urine were evaluated at baseline and after 90 days of treatment. Oral administration of the nutraceutical resulted in prolonged symptomatic relief with reduced pain, stiffness, and swelling. Inflammatory (serum IL-7, IL-1, IL-6, hs-CRP, TNF-α, ESR) and cartilage degeneration biomarkers (serum CTX-II, COMP, MMP-3 and urinary CTX-II) were decreased in the nutraceutical group compared to baseline and placebo. Furthermore, serum N-propeptide of collagen IIA (PIIANP) and procollagen-type-C propeptide (PIICP) levels were increased in the nutraceutical group, suggesting collagen synthesis contributing to cartilage regeneration. At given doses for 90 days, there were no adverse effects based on the clinical examination, biochemical, hematological, and ECG analysis. Taken together, the combination of Boswellia and celery could be a safe and promising herbal nutraceutical option for managing osteoarthritis and cartilage health effectively.

Continuous serratus anterior block for sternotomy analgesia after cardiac surgery: a single-centre feasibility study.

Moderate-to-severe pain is common after cardiac surgery, peaking during the first and second postoperative days. Several nerve blocks for sternotomy have been described; however, the optimal location for continuous catheters has not been established. This study assessed the feasibility of a larger trial evaluating the efficacy of serratus anterior plane (SAP) catheter analgesia for sternotomy pain. This double-blinded trial included patients undergoing cardiac surgery via sternotomy. Bilateral SAP catheters were placed in all participants, and randomised to ropivacaine or placebo. We assessed feasibility based on predetermined endpoints: (1) average recruitment rate >4 per month; (2) protocol adherence rate >90%; (3) primary outcome measurement rate >90%; and (4) significant catheter-related adverse event rate ≤2%. The quality of recovery index (QoR-15) was compared using an independent t-test. Of 52 participants randomised, feasibility data were available for 50. A definitive study was deemed 'not feasible' in our standalone centre owing to a low recruitment rate (2.4 per month) and a high adverse event rate (pneumothorax rate 12%). There were no major protocol deviations but minor deviations in 12% of participants. Pain, opioid consumption, complications, and quality of recovery were not different between groups. Long-term pain at 3 months was low in both groups. A single-centre trial was deemed not feasible for our setting. With limited data, the quality of recovery was not different with ropivacaine dosing of bilateral SAP catheters for sternotomy pain. NCT04648774.

A Two-for-One Diagnosis: A Rare Case of Chronic Abdominal Pain Caused by Gastroptosis and Wilkie’s Syndrome in a Young Woman

Long-term abdominal pain (LAP) affects 30% to 40% of children, often linked to functional gastrointestinal disorders (FGIDs) such as functional dyspepsia and irritable bowel syndrome. Less common causes include gastroptosis and superior mesenteric artery (SMA) syndrome, conditions that can be challenging to diagnose due to their rarity. Gastroptosis refers to the downward displacement of the stomach, while SMA syndrome, also known as Wilkie’s syndrome, involves the compression of the duodenum between the abdominal aorta and the superior mesenteric artery. While both conditions have been described separately, their coexistence has not been previously documented. Herein, we present the case of a 17-year-old girl with a six-month history of postprandial abdominal pain and vomiting, diagnosed with both gastroptosis and SMA syndrome. Diagnostic tests, including a CT scan and barium radiography, confirmed the presence of a duodenal stricture and severe gastric elongation, providing an insight into the pathophysiology of these rare conditions.

Real-world long-term outcomes of peripheral nerve stimulation: a prospective observational study.

We aimed to evaluate real-world outcomes of peripheral nerve stimulation (PNS) used to treat chronic neuropathic pain (CNP) at a tertiary pain management center. Thirty adults who underwent PNS for CNP between June 2015 and September 2021 completed pain and psychosocial assessments in the 6 months before, and 2-3 years after PNS treatment. Pain intensity was measured using the NIH Patient Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short From (3A). Psychosocial outcomes including depression, anxiety, and sleep disturbance were also measured. Prior to receiving PNS, long-term responders reported significantly fewer depressive symptoms compared to non-responders (PROMIS depression t-score 50.3 [10.7] vs 57.9 [8.9]; p-value = 0.05). Eleven participants (36.7%) reported long-term treatment response. There was a significantly greater improvement in pain intensity among responders compared to non-responders who reported increased pain (PROMIS Pain Intensity score -9.0 [-4.2] vs. +3.1[+3.2]; p-value < 0.0001). Patients report clinically meaningful long-term pain relief after receiving PNS through both 60-day and permanent implant systems, with significant reductions in pain intensity observed in long-term responders. Long-term responders reported fewer depressive symptoms compared to non-responders prior to receiving therapy, emphasizing the importance of psychological screening and psychological optimization prior to receiving PNS.

Endoscopic surgery for multilevel spinal stenosis: a comprehensive meta-analysis and subgroup analysis of uniportal and biportal approaches.

Minimally invasive spine surgery (MIS) has shown promising results, and endoscopic spine surgery has emerged as a less invasive approach. Although studies have examined the effectiveness of endoscopic surgery for spinal stenosis, no meta-analyses have focused on multilevel cases. This meta-analysis aimed to evaluate the efficacy and safety of uniportal and biportal endoscopy in patients with multilevel spinal stenosis. The patient, intervention, comparison, outcomes, and study criteria were established to guide study selection. Four databases were searched. The outcome measures included patient-reported outcome measures (PROMs), radiological and analytical data, complications, surgery time, length of hospital stay, and blood loss. Review Manager ver. 5.4 software (RevMan; Cochrane, UK) was used for the analysis. Heterogeneity was assessed using the chi-square and I2 tests. Ten studies (n=686) were included. PROMs showed significant improvements in Visual Analog Scale (VAS) scores for back pain (mean difference [MD], 4.07; 95% confidence intervals [CI], 3.72-4.42), leg pain (MD, 5.49; 95% CI, 5.17-5.80), and Oswestry Disability Index (MD, 35.97; 95% CI, 32.46-39.47). MacNab scale results were as follows: excellent (55.37%), good (34.93%), fair (7.58%), and poor (4.06%). C-reactive protein levels did not change significantly; however, hemoglobin levels decreased postoperatively (MD, 1.28; 95% CI, 0.91-1.65). Complications included dural tears (5.46%), hematoma (4.30%), incomplete decompression (3.12%), root injury (2.90%), reoperations/revisions (2.22%), conversion to open or microscopic surgery (1.97%), and transfusions (8.50%). Analysis by levels showed worse VAS leg pain in studies analyzing >30% multilevel stenosis (MD, 4.99; 95% CI, 4.47-5.51 vs. MD, 5.82; 95% CI, 5.63-6.01). Uniportal and biportal endoscopy had similar outcomes, except for a higher incidence of dural tears on biportal endoscopy (uniportal, 3.33%; biportal, 7.05%). This meta-analysis supports endoscopy as an effective and safe option for multilevel lumbar stenoses. It improves long-term pain and functionality, with no significant radiological changes or postoperative inflammation. Complications are few; however, dural tears are more common in biportal endoscopy. Higher multilevel stenosis rates were associated with increased leg pain and a lower likelihood of achieving incomplete decompression.

The Use of Fresh Osteoarticular Allografts for Steroid-induced Osteonecrosis of the Femoral Condyle With Collapse in Childhood Cancer Patients: Single-institutional Experience

Background: Despite success in treating childhood acute lymphoblastic leukemia and lymphoma (ALL), modern multiagent chemotherapy regimens containing high-dose corticosteroids can result in osteonecrosis afflicting survivors, frequently involving the knee. Thus, we describe the usage of fresh osteoarticular allograft (FOAG) to treat steroid-induced osteonecrosis of the femoral condyle in pediatric cancer survivors. We assessed the efficacy of FOAGs to heal necrotic bone, provide long-term pain relief, while retrospectively reviewing quality of life and functional status. Methods: We recorded patient demographics, pain, and functional scores preoperatively, postoperatively, and at the most recent follow-up, additional surgical procedures, and radiographic outcomes at each timepoint. Anatomic locations and sizes of the grafts were noted using operative reports and intraoperative photographs. Function and pain scores were collected by direct patient communication or through survey, with data scored using the KOOS (Knee Injury and Osteoarthritis Outcome Score), PROMIS (Patient-Reported Outcomes Measurement Information System), and CTCAE (Common Terminology Criteria for Adverse Events) scoring tools. Results: Eighteen patients, (12 females) over a period of 8 years, underwent the procedure. One patient was excluded due to death before 12 months follow-up. The average age at diagnosis of femoral condyle osteonecrosis was 14.5 years. The average age at the time of surgery was 18.5 years (range, 13 to 25 y). All patients had at least 16 months follow-up (average 60 mo; range 16 to 99 mo). Grafts ranged in size from 18 to 27.5 mm. All patients reported a return to normal function of the knees with KOOS scores approaching normal, PROMIS scores averaging 46, and CTCAE outcomes improving at an average of 34 months post-surgery. Two patients experienced a partial graft failure, which was repaired with new allografts. Conclusions: Although historical reviews indicated unsatisfactory results, our experience highlights the successful usage of FOAG for the management of patients treated for childhood leukemia who develop steroid-induced osteonecrosis of the femoral condyle. This procedure proved effective in managing pain and improving function and quality of life, with good bone ingrowth despite large necrotic lesions. Levels of Evidence: Therapeutic Level IV.

Ankle instability and physiotherapy: Exploring novel rehabilitation approaches

AbstractA common ailment that affects many people, especially athletes, ankle instability is frequently brought on by acute injuries that result in long-term pain and functional restrictions. This article examines both cutting-edge techniques like neuromuscular training, sport-specific drills, and technology-enhanced rehabilitation as well as more conventional approaches like strength training and balance exercises. Physiotherapists can develop customised regimens that enhance recovery results and lower the chance of re-injury by combining these tactics. Validating these novel approaches and improving rehabilitation procedures require ongoing research.

A prospective observational study on persistent postoperative pediatric pain, 4P: The study protocol.

Access to adequate pain treatment is a fundamental right, yet international data suggest that a considerable number of children experience acute and persistent pain. Little is known about the occurrence of both acute and persistent pain in children. The incidence of persistent postoperative pain in children is an unexplored area but international studies suggest that many children experience long-term pain after surgery, with a major impact on daily life. In 4P, Persistent Postoperative Pediatric Pain, we want to estimate the incidence of acute and persistent postoperative pediatric pain. The European Society for Paediatric Anaesthesiology has developed guidelines for perioperative pain management. We aim to examine how well these guidelines are followed and whether adherence to guidelines influences the pain experienced after surgery. 4P is a prospective observational study of children aged 1-17, planned for surgery in southern Sweden 2023-2024. After agreement from all caregivers, data concerning preoperative pain, pre-emptive analgesia, perioperative management and postoperative pain will be collected. Via an electronic management software, pain will be evaluated at home (or in hospital) at 24h, 3, 6 and 12 months after surgery. We will include 1000 patients. 4P will prospectively follow a large number of children after general pediatric surgeries and evaluate the occurrence of postoperative pain, both acute (APOP) and persistent (PPOP). The study will assess pain treatment regimens and identify risk factors associated with the development of acute and persistent pediatric postoperative pain. Prospectively posted at ClinicalTrials.gov, identifier NCT06035042.

Spatial Distribution Dynamics of Sensory Disturbances in the Treatment of Obesity-Related Meralgia Paresthetica Using Transcutaneous Electrical Nerve Stimulation.

Background: To date, there have been no studies on the dynamics of areas of pain, paraesthesia and hypoesthesia after the use of various transcutaneous electrical nerve stimulation in the treatment of meralgia paresthetica. Methods: In this pilot study, we observed 68 patients with obesity-related bilateral meralgia paresthetica. Pain syndrome, paraesthesia symptoms, and hypoesthesia were evaluated using 10-point scores. In addition, pain drawing (PD) was used to determine the area of the spatial distribution of pain syndrome and paraesthesia symptoms, and body drawing was used to determine the area of hypoesthesia. Sham TENS was performed in the control group, and effective TENS was performed in the treatment group. The treatment group consisted of two subgroups. One subgroup underwent HF-LA TENS, and the second subgroup underwent LF-HA TENS. Results: Despite the greatest analgesic effect observed from HF-LA TENS, which was assessed using scoring methods, during and after treatment, the reduction in the area of pain and paraesthesia symptoms and the area of hypoesthesia was moderate, short-term, and reversible. In contrast, LF-HA TENS had a pronounced analgesic and sustained anti-paraesthesia effect, manifested by a noticeable decrease in pain and paraesthesia symptoms area in PD, gradually increasing during the first 2 months of follow-up and accompanied by an irreversible prolonged decrease in the area of hypoesthesia. Conclusion: The areas of paraesthesia and hypoesthesia correlate with affective reactions to long-term chronic pain, which noticeably regress under the influence of LF-HA TENS compared to HF-LA TENS.

Percutaneous ballon compression, a better choice for primary trigeminal neuralgia compared to microvascular decompression?

Demonstrate the superiority of percutaneous balloon compression (PBC) in the treatment of primary trigeminal neuralgia (PTN) compared to trigeminal microvascular decompression (MVD). Clinical data, including immediate, short-term, and long-term pain relief, complications, duration of the operation, and postoperative hospital stay, were retrospectively analyzed for 114 patients diagnosed with PTN who were treated with either PBC or MVD between January 2018 and December 2021. There were no statistically significant differences observed in the pain relief rates between the two surgical methods at 24 h postoperatively (MVD: 91.07%, PBC: 96.55%), at 6 months postoperatively (MVD: 87.5%, PBC: 94.8%), at 1 year postoperatively (MVD: 83.90%, PBC: 94.80%), and at 2 years postoperatively (MVD: 78.60%, PBC: 72.40%). However, the incidence of meningitis following MVD was significantly higher than that following PBC (P < 0.005). Additionally, both the duration of the operation and the length of the postoperative hospital stay in the MVD group were longer than those in the PBC group (P < 0.005). PBC demonstrates efficacy comparable to MVD while offering a simpler procedure, improved safety, and a shorter postoperative hospital stay. Therefore, it may serve as a viable alternative to MVD and could become the preferred surgical approach for treating PTN in the future.

Pudendal Nerve Decompression in Chronic Pudendal Neuralgia: A Case Report

Pudendal neuralgia, a rare but incapacitating condition, is characterized by long-term pelvic pain caused by irritation or entrapment of the pudendal nerve. It has a significant impact on quality of life, and symptoms are often worsened by sitting and other daily activities. While conservative treatments such as physical therapy and medications may not offer sufficient relief for all patients, we describe the case of a 40-year-old man who developed chronic pudendal neuralgia after suffering from chronic constipation. Despite attempts at conservative management, the patient continued to experience persistent perineal pain. Following thorough evaluation, it was decided to proceed with a pudendal nerve block. For patients with chronic pudendal neuralgia who do not respond to conservative treatments, pudendal nerve block can be an effective option. Recognizing the issue early and intervening promptly can lead to better results and improve the quality of life for those who are affected.

From breast cancer diagnosis to survivorship: analyzing perioperative biopsychosocial phenotypes and their relationship to pain on long term.

Persistent breast cancer treatment-related pain affects up to 40% of patients, decreasing their quality of life (QoL). While current research typically utilizes correlation and regression analysis to identify biopsychosocial phenotypes contributing to this pain, this study employs cluster analysis to identify qualitatively different phenotypes based on somatosensory and psychosocial characteristics both before and one week post-breast cancer surgery. Further, it investigates how these phenotypes are related to pain intensity one year post-surgery and examines the evolution of phenotype membership from pre- to post-surgery. Somatosensory and psychosocial functioning was evaluated pre- and post-surgery in 184 women undergoing unilateral breast cancer surgery. Eight different quantitative sensory testing (QST) methods including mechanical detection and pain thresholds, pressure pain thresholds, thermal detection and pain thresholds, and conditioned pain modulation were performed at the surgical area (trunk, arm, major pectoral muscle) and a distant location (quadriceps muscle). Psychosocial functioning was assessed using the Central Sensitization Inventory, Pain Catastrophizing Scale, Depression Anxiety Stress Scale-21, and the McGill Quality of Life Questionnaire. Pain intensity was evaluated one year post-breast cancer surgery using the Visual Analogue Scale. Latent class analysis identified five distinct phenotypes before and post-surgery, characterized by differences in mechanical and pain thresholds alongside psychosocial factors. Moreover, higher psychosocial distress and lower QoL correlated with elevated pain intensity one year post-surgery. These findings underscore the importance of addressing breast cancer patients' mental health perioperatively. Therefore, future research should explore whether psychological interventions perioperatively can reduce long-term pain intensity. PerspectiveThis secondary analysis, utilizing cluster analysis, reveals five distinct phenotype based on somatosensory and psychosocial characteristics both before and post breast cancer surgery. Higher psychosocial distress and lower quality of life correlated with elevated pain intensity one year post-surgery, emphasizing the need to address patients' mental health perioperatively. Trial registrationclinicaltrials.gov (NCT03351075)

Analgesia After Vestibular Schwannoma Surgery in Europe-Potential for Reduction of Postoperative Opioid Usage.

Excessively prescribed opioids promote chronic drug abuse and worsen a highly prevalent public health problem in the era of the opioid epidemic. This study aimed to (a) determine general analgesic prescription patterns after surgery for vestibular schwannoma (VS) with a focus on opioid prescription rates, (b) identify risk factors for receiving narcotics for postoperative pain management, and (c) highlight the feasibility of opioid-free analgesic treatment strategies. Retrospective chart review. Tertiary referral center. A total of 105 adult inpatients who underwent VS surgery. Analgesic prescription patterns were evaluated, and factors associated with opioid prescriptions were identified. Number of prescribed analgesics. Metamizole (=dipyrone) and acetaminophen (=paracetamol) were the most frequently prescribed non-opioid drugs. Sixty-three (60%) patients received an opioid with a median intake of 23.2 ± 24 mg of oral morphine equivalents. Only 10 (9.5%) individuals received opioids for longer than postoperative day 1. Subjects with small tumors undergoing middle cranial fossa tumor removal (p = 0.007) were more likely to receive opioid drugs. In contrast, patients undergoing retrosigmoid craniotomy required fewer opioids for pain control (p = 0.004). Furthermore, individuals receiving opioids were prone to obtain higher dosages of acetaminophen (odds ratio 1.054, 95% confidence interval 1.01-1.10, p = 0.022). Opioids for acute postoperative analgesia after VS surgery may be necessary in many patients. However, middle- and long-term pain control can be accomplished using non-opioid treatment regimens, resulting in a reduction in opioid prescriptions and the accompanying negative effects on individual and public health.

The XP-endo Shaper and Its Impact on Posttreatment Discomfort: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis assess the impact of the XP-endo Shaper (XPS) on postoperative pain following root canal treatment and compare its efficacy with other endodontic systems. A comprehensive literature search was conducted in MEDLINE, Web of Science, Embase, and the Cochrane Library from January 2000-August 2024. Randomized controlled trials using XPS and reporting postoperative pain were included. Pain levels were measured using the Visual Analog Scale at multiple postoperative time points. Data were pooled and analyzed using a random effects model, revealing significant heterogeneity. Six randomized controlled trials involving 731 patients met the inclusion criteria. The pooled analysis revealed that XPS significantly reduced pain scores at the 6, 12, and 24-hour time points (standardized mean difference [SMD] -1.30, 95% confidence interval [CI] [-2.36, -0.24], P=.016; SMD -3.00, 95% CI [-3.54, -2.46], P<.001; SMD -0.91, 95% CI [-1.53, -0.28], P=.005, respectively) compared to other systems, including WaveOne Gold and HyFlex EDM. Pain scores beyond 48hours were comparable between XPS and other file systems. XPS shows substantial short-term efficacy in reducing postoperative pain following root canal treatments, likely due to its flexible design and reduced debris extrusion. The findings suggest that XPS can potentially improve patient comfort, though long-term pain outcomes remain similar to other systems.