Gut microbiota dysbiosis is associated with diarrhea-predominant irritable bowel syndrome (IBS-D). Visceral hypersensitivity (VH) is a hallmark symptom. Twenty-five female rats were allocated to either a control group (sham stress, n = 5) or a stressed group exposed to a 10-day water avoidance (WA) stress protocol to induce VH (n = 20). After stress induction, stressed rats received a 4 week intervention with phosphate-buffered saline (PBS), Bifidobacterium animalis subsp. lactis BB-12 (P1), Lactiplantibacillus plantarum ATCC 14917 (P2), or their combination (P1P2). Control rats were administered PBS. Visceral hypersensitivity was assessed using abdominal withdrawal reflex (AWR) scores, and metabolic changes in plasma, liver, and distal colon were analyzed using proton nuclear magnetic resonance (1H NMR)-based metabolomics. Water avoidance stress induced VH, as evidenced by higher AWR scores (P < 0.05) and lower pain thresholds compared to controls (38.47 ± 3.78 versus 29.48 ± 2.52; P < 0.001). Probiotics significantly reduced AWR scores at 20 and 80 mmHg and increased pain thresholds in comparison with the WA + PBS group (P < 0.05). Metabolomic profiling revealed that WA + PBS rats showed significant dysregulation in energy, amino acid, one-carbon, and lipid metabolism. Notable changes included elevated sarcosine, acetate, taurine, glutamate, tryptophan, 2-hydroxybutyrate, urea, and allantoin, with reduced O-acetylcarnitine in plasma; increased succinate, myo-inositol, isoleucine, threonine, glutamine, betaine, pyroglutamate, and O-phosphocholine with decreased taurine in the liver; and various amino acids, ketone bodies, glucose, glycerol, and one-carbon metabolites in the colon (P < 0.001). Probiotic supplementation largely restored these metabolic changes, with clustering analyses supporting the normalization of metabolic signatures. Probiotic supplementation ameliorated VH and reversed IBS-D-associated metabolic disruptions, illustrating its therapeutic potential and providing insights into the underlying mechanisms. © 2025 Society of Chemical Industry.

Burns are associated with significant inflammation and pain. Topical agents like heparin can modulate these processes and improve outcomes. Our study aims to evaluate the effectiveness of using topical heparin (TH) in patients with burns. On August 7, 2024, we conducted a literature search on PubMed, Scopus, and Web of Science. Only randomized controlled studies were included. Data were extracted on analgesic drug usage, bleeding events, sepsis, visual analog scale pain scores, length of hospital stay, and mortality. Statistical analysis was performed using R software (version 4.4.1), heterogeneous data. Seven randomized controlled trials (503 patients; topical heparin: 249, control: 254) were included. Analgesic use (1-2 times/day: RR= 3.04, P= .68; 3-4 times/day: RR = 0.06, P= .18), bleeding (RR = 5.06, P= .37), sepsis (RR = 0.77, P= .40), hospital stay, and mortality (RR = 0.13, P= .90) showed no significant differences. Topical heparin reduced local wound infections by 60% (RR = 0.40, P< .01) and lowered Visual Analog Scale pain scores (MD = -3.34, P< .01). However, sensitivity analysis excluding an outlier nullified the pain reduction (MD = -4.17, P= .57). All studies had a high risk of bias, especially in outcome measurement and randomization. Topical heparin reduces pain and local wound infections in burn patients without having an impact on other outcomes. Evidence is limited by a high risk of bias. Well-designed randomized trials are needed to determine its broader clinical value.

Childhood burn injuries can lead to physical and psychosocial challenges that linger well beyond the initial phases of the trauma. This study explores the interrelated roles of pain, body image, and physical function in children living with burn injuries using data from the Burn Model System National Longitudinal Database. A cohort of 110 children aged 8-17 was assessed 6 months postinjury. Descriptive and regression analyses revealed that, on average, pediatric burn survivors reported significantly lower pain interference compared with the general pediatric population. However, higher pain interference and number of surgical operations were negatively associated with physical function. Body image was not significantly associated with clinical variables, thus suggesting a more multifaceted nature of psychosocial recovery. These findings underscore the importance of comprehensive pain management and family-centered rehabilitation to foster resilience and enhance functional and emotional outcomes in pediatric burn survivors.

Pleural drainage is essential for preventing and managing respiratory complications after video-assisted thoracoscopic esophagectomy (VATE). Conventional large-bore drains often cause significant pain. Small-bore drains (e.g., 19F Blake drains) may reduce discomfort; however, evidence regarding their use in VATE is limited. This study compared drainage effectiveness and pain between 19F Blake drains and conventional 28F drains after VATE for esophageal cancer. This retrospective study included 77 male patients with middle- or lower-third esophageal cancer who underwent VATE with laparoscopic retrosternal tunneling from November 2018 to November 2022. Fifty-five patients received a 28F conventional drain, and 22 received a 19F Blake drain. Outcomes included drainage duration and volume, pain levels (Visual Analog Scale [VAS]), postoperative pneumonia rates, and pulmonary function (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1]) on postoperative day 3. The 19F group reported significantly lower pain scores on postoperative days 1-3 (VAS: 2.95-3.25 vs. 4.07-4.62, p<0.001). Drainage duration and pneumonia rates were similar between groups. The 19F group demonstrated a trend toward higher drainage volume and significantly better preservation of pulmonary function, with smaller declines in FVC (ΔFVC: 0.24±0.20 L vs. 0.63±0.17 L, p<0.001) and FEV1 (ΔFEV1: 0.38±0.25 L vs. 0.58±0.25 L, p=0.02). 19F Blake drains provide similar drainage effectiveness to that of 28F drains, with reduced postoperative pain and better pulmonary function preservation. These findings support the use of 19F Blake drains to improve patient comfort and recovery following VATE.

Pain control and opioid use as a function of workflow in MRI-guided interstitial cervix brachytherapy.

Long-term functional and radiographic outcomes of anatomic total shoulder arthroplasty using an all-polyethylene cemented glenoid component with a minimum follow-up of 10 years.

This study investigates whether total laparoscopic hysterectomy in trans men can be safely performed as an ambulatory procedure without negatively impacting patient satisfaction with length of stay compared to inpatient surgery. Single-centre non-inferiority randomised controlled trial. Ghent University Hospital, Belgium. Trans men scheduled for total laparoscopic hysterectomy. Participants were randomly allocated to ambulatory surgery (intervention) or overnight stay (comparator). The main outcome was satisfaction with the length of hospital stay, measured on Day 7 postoperatively. Secondary outcomes were pain scores, analgesics use, quality of recovery, hospital anxiety and depression, complications, and readmission. One hundred trans men gave informed consent. Ninety-four underwent surgery (50 allocated inpatient and 44 ambulatory). The non-inferiority margin for the primary outcome was -20 on a 100-point VAS. Total laparoscopic hysterectomy as an ambulatory procedure was non-inferior to the inpatient setting regarding satisfaction with length of hospital stay after 1 week (mean difference 1.45; 95% CI: -6.71 to 9.61). There were lower pain scores in the ambulatory group, along with significantly more use of moderate analgesics on Days 1, 2, and 3 (resp. risk difference 0.35 (95% CI: 0.17-0.53), 0.32 (95% CI: 0.10-0.54), 0.31 (95% CI: 0.10-0.52)). The quality of recovery and hospital anxiety and depression scores were comparable between both groups. The readmission and postoperative complication rates were higher in the inpatient group. This study shows non-inferiority for patient satisfaction with length of hospital stay after hysterectomy in the ambulatory versus inpatient setting in a transgender population. ClinicalTrials.gov: NCT05393583.

Efficacy of esketamine after cesarean section for women with symptoms of prenatal depression: A randomized controlled trial.

Reducing procedural pain and fear in children using a hologram fan and bubble machine: A randomized controlled trial of passive distraction techniques.

Introduction: Total Laparoscopic Hysterectomy (TLH) is associated with significant postoperative pain, necessitating effective analgesia to enhance recovery. Transdermal Fentanyl Patches (TFP) provide a non-invasive, sustained-release opioid delivery system; however, their efficacy in TLH remains underexplored. Aim: To evaluate the postoperative analgesic efficacy of preoperative TFP (25 mcg/hr) compared to placebo in patients undergoing TLH. Materials and Methods: In the present double-blinded, randomised controlled trial, 60 female patients (aged 40-65 years, American Society of Anesthesiologists (ASA) I-II) undergoing elective TLH were randomised to receive either a 25 mcg/hr TFP (n=30) or a placebo patch (n=30) applied 10-12 hours preoperatively. Pain intensity was assessed using the Numeric Rating Scale (NRS) at 2, 4, 6, 8, 10, 12 and 24 hours postoperatively. Secondary outcomes included ambulation scores (0-3), Ramsay Sedation Scores (RSS) (1-6) and incidence of Nausea and Vomiting (N/V, 0-3). Data were analysed using t-tests, chi-square tests and general linear models, with statistical significance set at p&lt;0.05. Results: Baseline characteristics (age, Body Mass Index (BMI), ASA grade and duration of anaesthesia) were comparable between groups (p&gt;0.05). The fentanyl group demonstrated significantly lower pain scores at all time points (e.g., 2 hours: 3.87±0.434 vs. 6.83±0.461; 24 hours: 1.53±0.629 vs. 3.30±0.651; p&lt;0.001). Ambulation scores were higher in the fentanyl group (e.g., 12 hours: 3.00±0.170 vs. 1.70±0.450; p&lt;0.001), indicating better mobility. Sedation scores were lower in the fentanyl group at most time points (e.g., 24 hours: 0.13±0.346 vs. 0.77±0.430; p&lt;0.001). The incidence of nausea and vomiting was significantly reduced in the fentanyl group (e.g., 2 hours: 0.23±0.305 vs. 2.93±0.254. Conclusion: Preoperative application of TFP (25 mcg/hr) significantly reduces postoperative pain, enhances ambulation, minimises sedation and decreases nausea and vomiting in patients undergoing TLH. These findings support the inclusion of TFP as an effective component of multimodal analgesia for gynecologic surgery and warrant further studies to assess longterm outcomes and comparative efficacy

To compare the efficacy, safety, and patient experience between cyanoacrylate tissue adhesive and conventional sutures for periorbital wound closure in children. A prospective comparative study evaluated 145 pediatric patients with periorbital trauma treated with tissue adhesive (n=70) or conventional suturing (n=75) based on clinical assessment from September 2023 to October 2024. Primary outcomes were wound healing grades (grade I/II/III) and complication rates; secondary outcomes included procedure time (median, seconds), pain scores (mean, Wong-Baker FACES), Frankl behavioral compliance scores (mean), and parental satisfaction. Statistical analysis used t tests, Mann-Whitney U tests, and χ 2 tests. The adhesive group had significantly shorter procedure time (184 vs. 692 s, P <0.001), lower pain scores (2.8 vs. 5.6, P <0.001), and higher compliance (Frankl 3.1 vs. 2.3, P <0.01). No significant differences were observed in grade I healing rates (97.1% vs. 93.3%) or complication rates (2.9% vs. 4.0%, P =0.24). In pediatric periorbital trauma, use of tissue adhesive was associated with reduced treatment time and pain scores, with similar healing outcomes compared with sutures, suggesting it may serve as a viable alternative.

Musculoskeletal pain symptoms (MPS) are increasingly common in both occupational and educational settings. University students, particularly those enrolled in health science programs, face multiple risk factors that elevate their likelihood of developing MPS. These include long hours of computer use, prolonged sitting, high academic demands, and physically demanding clinical training. Considering the rising global prevalence of MPS, this study aimed to investigate the impact of MPS on health science students at the Maldives National University and to identify associated risk factors. Using stratified sampling, a cross-sectional survey was conducted among undergraduate health science students from MNU’s Malé campuses. Data was collected from students through a self-administered questionnaire and analyzed using SPSS version 21.0. Chi-square tests were used to examine the associations between selected variables and 12-month MPS prevalence, with a significance threshold of p &lt; .05. Among the 283 participants who completed the survey, 92.57% reported experiencing MPS in at least one body region during the past year. Among those affected, 66.23% indicated that the pain had interfered with their daily tasks. Lower back pain (18.5%) was the most reported, followed by neck (16.99%) and upper back pain (14.5%). MPS was significantly associated with increased stress, heavy physical workload at home, high screen time, and prolonged sitting. The study highlights an urgent need for preventive strategies addressing physical and psychological contributors to MPS among students. Interventions should include early education, ergonomic awareness, stress management, and promotion of healthy routines to reduce the long-term burden of MPS on future healthcare professionals

Background Total hip arthroplasty (THA) in elderly patients is often associated with significant perioperative pain. This study aimed to evaluate the analgesic efficacy of fascia iliaca compartment block (FICB) and pericapsular nerve group block (PENGB) in elderly patients undergoing THA. Methods This retrospective study included two patient groups: the PENGB group (n = 62) and the FICB group (n = 64). The primary outcome was the analgesic efficacy, assessed using Visual Analog Scale (VAS) pain scores at multiple postoperative time points. Secondary outcomes included motor blockade, the time to first rescue analgesia, postoperative analgesia quality and systemic inflammatory responses. Results PENGB provided significantly superior analgesia at 6 and 12 h postoperatively, as evidenced by lower VAS pain scores compared to the FICB group. Motor blockade was also less pronounced in the PENGB group at 3 and 6 h post-surgery. The time to first rescue analgesia was significantly longer in the PENGB group, indicating more sustained pain control. Additionally, PENGB was associated with reduced use of patient-controlled analgesia pumps and lower total sufentanil consumption. At 24 h postoperatively, interleukin-6 levels were significantly lower in the PENGB group, suggesting an attenuated inflammatory response. Conclusions Compared to FICB, PENGB provided superior analgesia in elderly patients undergoing THA.

OnabotulinumtoxinA (BoNT-A) is an established preventive treatment for chronic migraine but involves 31 to 40 injections per session, often causing discomfort and post-procedural headaches. Remote electrical neuromodulation (REN) is a noninvasive therapy with efficacy in migraine treatment via conditioned pain modulation but has not been evaluated for procedural pain. This study evaluated REN's effectiveness in reducing acute procedural pain and postprocedural headache associated with BoNT-A injections. This was an investigator-initiated single-center, randomized, single-blind, sham-controlled crossover study enrolled 80 adults (aged 22 to 74 years) with chronic migraine undergoing routine BoNT-A treatment. Each participant received one injection session without a device, followed by sessions using active REN and sham in randomized order. REN was applied to the upper arm 10 min prior to injections and removed after injection completion. Pain intensity was measured using a visual analog scale (0 to 100) at pre-procedure, intra-procedure, and post-procedure time points. The primary outcome was procedural pain intensity, and secondary outcomes included post-procedural headache incidence and adverse events. Due to clear benefit, the study was terminated early based on predefined stopping criteria. Final analysis of 60 participants (mean age 48.0 years; 49/60, 82% female) demonstrated that pre-procedural pain levels were not significantly different between baseline and the active REN or sham (p > 0.999 and p = 0.485, respectively). However, during and after BoNT-A administration, the active REN group reported significantly lower pain scores compared to both the sham and baseline conditions. At intra-procedure, the REN group experienced a mean pain reduction of 15.0 points (p < 0.001), and at post-procedure experienced a 19.1-point reduction (p < 0.001). Sham treatment did not result in significant pain reduction compared to baseline (p > 0.999 for both intra-procedure and post-procedure). Additionally, REN lowered the incidence of headache as an adverse event, with only 15% (8/52) of participants experiencing post-procedural headache compared to 55% (29/53) in the sham group and 39% (23/59) at baseline (odds ratio = 0.28, 95% confidence interval: 0.10 to 0.69, p = 0.008). No additional adverse events were reported. REN significantly reduces procedural pain and post-procedural headache associated with BoNT-A injections for chronic migraine and may serve as a noninvasive, easily implemented pain management strategy for acute procedural pain. REN represents a promising approach to improving patient comfort during routine migraine treatment as well as reducing post-procedural headache.

There are limited data on the incidence of postoperative fever in children undergoing tonsillectomy and whether the surgical technique has an influence on it. This study aimed to examine the association between surgical technique-cold adenotonsillectomy versus powered intracapsular tonsillectomy and adenoidectomy(PITA)-and the incidence of postoperative fever in children. Prospective cohort study conducted between June 1, 2023, and November 30, 2024. Tertiary referral center. Children who underwent tonsillectomy with or without adenoidectomy. The primary outcome was the incidence of high postoperative fever (> 37.9°C/100.2°F) within 1-week postoperatively. Secondary outcomes included haemorrhage rates, pain levels, days to normal diet, halitosis, referral to treating physician, and readmissions within 1-week postoperatively. Of the 82 children (46[56%] males, mean age:5.1 years interquartile range: [3-5]), 40(48.8%) underwent cold adenotonsillectomy, while the other 42(51.2%) underwent PITA (22 with coblation and 20 with microdebrider). One-week postoperative fever rate was 24.4%. Compared to cold adenotonsillectomy, PITA was associated with higher rates of fever 1-week postoperatively (odds ratio: 4.81, 95% confidence interval:1.29-22.02) and referrals to treating physician (15/42[35.7%] vs. 6/40[15%], p = 0.023). However, PITA showed lower pain levels (mean 1-week daily visual analogue scale: 3.4 ± 0.05 vs.4.13 ± 0.82, p = 0.001) and shorter time to resuming a normal diet (mean 3.4 ± 0.77 vs. 4.07 ± 0.69 days, p = 0.001). No significant differences were observed in haemorrhage, readmission, or halitosis rates between the different surgical techniques. PITA was associated with higher rates of fever 1-week postoperatively. Parents should be informed about the possibility of fever and educated on how to manage it.

Introduction: In adults, scoliosis generally produces biomechanical alterations associated with chronic low back pain, which has promoted the use of therapeutic exercises as a non-invasive option. Objective: To analyze the effectiveness of therapeutic physical exercises in reducing lower back pain in adults with scoliosis, determining which techniques produce superior clinical and functional outcomes. Methodology: A systematic review was conducted in accordance with the PRISMA 2020 guidelines and the PICO methodology. A total of 465 records were obtained from searches in Web of Science, Scopus, and ScienceDirect. Ten studies were selected for in-depth analysis after applying inclusion criteria. Robvis was used to assess the risk of bias, and the Mixed Methods Appraisal Tool was used to evaluate methodological quality. Results: Exercises focused on core activation, myofascial modulation, hypopressive techniques, and sensorimotor training consistently reduced pain, increased functionality, and improved lumbopelvic stability. Combined, progressive, and structured interventions were shown to be more effective than brief or nonspecific programs. Discussion: Additionally, greater adherence was observed when self-regulation or motivational elements were included. Conclusions: The management of low back pain in adults with scoliosis can be effectively and practically achieved thru therapeutic exercises, and their scheduled implementation has the potential to improve functional outcomes and benefit the comprehensive management of this condition.

Introduction: Pregnancy involves both physiological and emotional changes that can impact the expectant mother’s well-being. Physical exercise has been shown to contribute to the body’s adaptation, reduce stress, prevent obstetric complications, and promote overall health during pregnancy. Objective: To analyze the benefits achieved after implementing a systematic physical exercise program in pregnant women, considering its impact on physical fitness, emotional balance, and quality of life. Methodology: A multiple-case study was conducted with three women from Guayaquil who had a normal-course pregnancy. The program incorporated breathing exercises, relaxation, joint mobility, lumbopelvic strengthening, and aerobic exercises. They were performed at a moderate intensity level three times per week. The data were acquired thru semi-structured interviews and analyzed by categories. Results: Participants showed significant improvements in postural stability, respiratory capacity, and muscular endurance, as well as a reduction in lower back pain and fatigue. Participants reported increased energy, improved nighttime sleep quality, and emotional stability, as well as a more optimistic outlook on childbirth and motherhood. Additionally, an improvement in family relationships and an increase in self-confidence were observed during the gestational process. Conclusions: The twelve-week program proved effective in improving the social, physical, and psychological well-being of pregnant women, establishing itself as a preventive and comprehensive empowerment tool in prenatal care.

The number of smartphone users is growing exponentially, and the pervasive use of smartphones is leading to escalated smartphone addiction. Young adults, especially medical students, are more prone to use smartphones for longer hours for educational purposes in addition to communication and social networking. Thus, this vulnerable group is susceptible to severe musculoskeletal issues. The purpose of this study was to assess the impact of excessive smartphone use on musculoskeletal pain in the neck and wrists/hands. This descriptive cross-sectional study was performed with medical and nursing undergraduate students aged 17-34. A total of 151 students were included after written informed consent was obtained, and the study duration ranged from 4th March 2025 to 20th June 2025. The demographic questionnaire, the Smartphone Addiction Scale-Short Version questionnaire, and the modified Nordic musculoskeletal questionnaire were used as data collection tools. The mean SAS-SV score was 29.80 (± 8.28), ranging from 13 to 53, where the mean number of hours of smartphone usage was 4.37 (± 1.57). In this study, 36.4% of the participants were found to be addicted to smartphones, 33.6% of whom were females and 45.7% of whom were males. Neck pain was the most common musculoskeletal issue reported by participants, followed by lower back pain and wrist/hand pain. A significant association was found between the SAS-SV score and neck and wrist/hand pain, suggesting that the participants with higher SAS-SV score reported more frequent neck and wrists/hands pain. However, associations between the SAS-SV score and smartphone screen size and weight could not be established. Smartphone addiction is associated with various musculoskeletal issues such as, pain, fatigue, de Quervain's tenosynovitis and cervical spondylosis. Problematic use of smartphones is increasing and may also be associated with the poor academic performance of the students. Thus, studies in the future should focus on finding measures to mitigate this problem.

Background and Objectives: Surgical stress during robotic-assisted radical prostatectomy (RARP) elicits a measurable systemic inflammatory response despite the minimally invasive approach. Intravenous lidocaine has been increasingly investigated for its potential anti-inflammatory, analgesic, and immunomodulatory benefits, but evidence in robotic urologic oncology remains limited. This study aimed to evaluate whether intraoperative lidocaine infusion attenuates postoperative inflammation, improves analgesic outcomes, and accelerates early recovery following RARP. Materials and Methods: This prospective non-randomized observational study included 80 patients undergoing elective RARP, divided into a Lidocaine Group (n = 40) receiving an intraoperative bolus and continuous infusion, and a Control Group (n = 40) receiving standard anesthesia without lidocaine. Serum IL-6, TNF-α, CRP, and fibrinogen were measured at baseline, end of surgery, and 24 h postoperatively. Postoperative pain scores, opioid consumption, gastrointestinal recovery, ambulation, and length of stay were recorded. Statistical analyses included repeated-measures ANOVA, correlation testing, and between-group comparisons. Results: Baseline characteristics were similar between groups. At 24 h postoperatively, lidocaine administration was associated with a significantly attenuated inflammatory response, with lower levels of IL-6 (45.7 ± 10.8 vs. 68.9 ± 12.6 pg/mL, p &lt; 0.01) and TNF-α (20.5 ± 5.1 vs. 27.2 ± 6.4 pg/mL, p &lt; 0.01) compared with controls. Patients receiving lidocaine reported lower postoperative pain scores and required significantly less opioid analgesia, with a total 24 h consumption of 8.9 ± 3.4 vs. 14.8 ± 5.2 mg morphine milligram equivalents (p &lt; 0.001). Lidocaine was also associated with faster recovery, including earlier oral intake and a shorter length of hospital stay (2.9 ± 0.7 vs. 3.6 ± 0.9 days, p = 0.003). No lidocaine-related adverse events were observed. Conclusions: In this prospective observational study, intraoperative intravenous lidocaine was associated with attenuated early postoperative inflammation, improved analgesic outcomes, and enhanced early recovery following RARP. These findings support the potential role of intravenous lidocaine as a safe adjunct in multimodal perioperative management; however, given the non-randomized observational design, causal inferences should be interpreted with caution. Further randomized controlled trials are warranted to confirm causality and to validate long-term clinical and mechanistic effects. Potential residual confounding inherent to the observational design should be considered when interpreting these findings.

Adult spinal deformity (ASD) surgery often involves extensive spinal realignment to restore spinopelvic parameters and functional alignment. Unfortunately, patients frequently experience significant postoperative pain, often leading to prolonged opioid use. This study investigates patient- and surgery-related factors associated with opioid use and pain following ASD surgery. We conducted a retrospective review of ASD cases performed at our institution between 2016 and 2023. All patients underwent multilevel spinal fusion for correction of scoliosis and/or kyphosis. Of the 264 patients, 231 (88%) required opioids postoperatively, and 22.4% remained on opioids at 12 months. Preoperative opioid use (P < 0.001), pelvic incidence (PI) <55° (P = 0.018) due to inability for pelvic retroversion, revision surgery for proximal junctional kyphosis (P = 0.006), and hardware failure (P < 0.001) were associated with prolonged opioid use. Notably, patients who underwent intradiscal osteotomy (IDO) had a shorter duration of opioid use due to more harmonious correction of their lumbar lordosis (P = 0.006). Pain scores were significantly higher in patients who underwent anterior column release (P < 0.001) and who experienced postoperative complications (proximal junctional kyphosis and hardware failure; P < 0.05). In contrast, patients treated with IDO or pedicle subtraction osteotomy reported lower pain (P < 0.05). In multivariable analysis, preoperative opioid use was the strongest independent predictor of 12-month use (OR = 3.95, P = 0.001), while PI > 55° was independently associated with decreased 12-month use (OR = 0.33, P = 0.009). This study highlights several key risk factors for prolonged opioid dependence and elevated postoperative pain in ASD surgery, including preoperative narcotic use, postoperative PI < 55°, revision surgery for mechanical complications, and specific osteotomy techniques. The protective effect of IDO in reducing pain and opioid duration is most likely due to more harmonious correction of lumbar lordosis and an improvement in lumbar lordosis-PI mismatch. These findings underscore the importance of preoperative optimization, opioid-sparing pain management strategies, and enhanced recovery pathways to mitigate long-term opioid reliance and improve patient outcomes.