Objective To evaluate outcomes of different doses of esketamine in postoperative patient-controlled intravenous analgesia (PCIA) combined with preoperative intercostal nerve block (ICNB) analgesia protocol for acute postoperative pain (APP) relief in patients undergoing thoracoscopic lobectomy. Materials and methods A total of 360 patients scheduled for thoracoscopic lobectomy at Xuzhou Central Hospital between October 2021 and July 2023 were enrolled and randomly assigned into three groups using the random envelope method. Before anesthesia induction, all patients received ICNB, followed by general anesthesia. Group C received PCIA using sufentanil at 0.03 μg/kg/h, Group K1 received a low dose of esketamine at 0.015 mg/kg/h in PCIA, and Group K2 received a moderate dose of esketamine at 0.03 mg/kg/h in PCIA. Numerical Rating Scale (NRS) pain scores were recorded at 2, 4, 24, 48, and 72 h postoperatively. The incidence of APP within 72 h post-surgery, the requirement for rescue analgesia and the occurrence of adverse reactions, were assessed and recorded for the three groups. Results There were significantly lower NRS scores in Group K2 at 2, 4, 24, 48, and 72 h postoperatively, compared to Groups C and K1 (P < 0.01). However, there were no statistically significant differences in NRS scores between Group C and Group K1 (P > 0.05). The incidence of APP within 72 h postoperatively was significantly lower in Group K2, compared to Group C and Group K1 (P < 0.05). Additionally, Group C exhibited a significantly higher the incidence of postoperative nausea and vomiting (PONV) than the other two groups (P < 0.05). Group K2 demonstrated superior postoperative analgesic efficacy, including reduced rescue analgesia needs and lower opioid consumption, without affecting hospital stay length compared to Groups C and K1. Conclusion A dose of 0.03 mg/kg/h esketamine in PCIA combined with preoperative ICNB significantly alleviates APP in patients undergoing thoracoscopic lobectomy, reducing resting pain scores by approximately 30% at 24 h compared to sufentanil-based analgesia. Clinical Trial Registration https://www.chictr.org.cn/ , Identifier ChiCTR2100051000.

Windswept deformity, with varus alignment in one knee and valgus alignment in the contralateral knee, presents asymmetric bone loss and soft-tissue imbalance that complicate total knee arthroplasty (TKA). We report a 70-year-old male with bilateral osteoarthritis and windswept deformity, showing 15° varus on the left and 12° valgus on the right. The left knee also had a 10-mm uncontained medial tibial defect. Staged TKAs were performed 6 weeks apart in a resource-limited setting. The varus knee was reconstructed with a screw-and-cement technique and a primary posterior-stabilized (PS) prosthesis without stems or augments. The valgus knee was managed with graded lateral releases, again allowing implantation of a primary PS prosthesis. At 3 months, both knees achieved 0°-120° range of motion, marked pain relief, and improved Knee Society Scores. At 3-year follow-up, the patient remains pain-free with neutral alignment and stable implants. This case emphasizes decision-making, defect management, and soft-tissue balancing when advanced constrained implants are not routinely available.

Dolichoectatic vertebrobasilar arteries (DBA)-induced trigeminal neuralgia (TGN) is rare, and both medication and surgical decompression often have a substantial treatment failure rate. Surgical techniques that provide sufficient decompression and long-term pain relief are challenging in cases of large DBA with limited posterior fossa space, and have been scarcely described due to their rarity and technical complexity. We present our novel technique involving mobilization of the trigeminal nerve (CN5) combined with macrovascular transposition of the gigantic DBA for curative treatment of this challenging condition. We described our surgical strategy and maneuvers that safely and effectively achieved long-term pain relief for giant DBA-induced TGN. The DBA measured 11.69mm and compressed both the trigeminal nerve root exit zone (TGN-REZ) and the brainstem. The extremely limited posterior fossa space made conventional microvascular decompressionor simple transposition unfeasible. Therefore, we performed a lateral CN5 transposition using a sling-pulling technique in combination with anterior DBA transposition via a combined transpetrosal approach (CTPA). This allowed permanent separation of the DBA from the TGN-REZ, resulting in immediate postoperative symptom relief while preserving critical arteries, veins, and brainstem perforators. The CN5 can be untethered and transposed laterally, anchored to the temporal dura, while the DBA was transposed anteriorly following maximal petroclival bone removal, which created sufficient space for mobilization and secured with Teflon felt soaked with fibrin glue. Postoperative complications include mild facial palsy, which completely resolved within 4months. At the 20-month follow-up, the patient remained pain-free without recurrence. The gigantic DBA-induced TGN can be safely and effectively treated through CN5 transposition combined with DBA transposition, resulting in a permanent contactless TGN-REZ and favorable long-term pain relief. Preoperative counseling regarding the risk of CTPA-related complications is essential, taking into account the potential risks and benefits of the procedure.

Resistance training is currently a widely targeted practice due to its ability to induce vital adaptations resulting from increased muscle strength (MS) and hypertrophy. There are reports of the concomitant use of nonsteroidal anti-inflammatory drugs with this practice for pain relief, which arises from the adaptive signaling of training. Based on this, the present study aimed to investigate whether the use of nimesulide concomitant with training could interfere with MS and hypertrophy. The sample consisted of 18 male Wistar rats, aged 91 days, with a body mass of 331 ± 20g, divided into three groups: Control (CTRL, n = 4); Trained (TR, n = 7); and Trained and Treated with nimesulide (COMB, n = 7). The training protocol followed the ladder-climbing model. Nimesulide was administered orally at a dose of 2.5mg/kg every day after training. Tissue collection of the Flexor Hallucis Longus (FHL) muscle was performed two days after the last training session. After eight weeks of the training protocol, a significant increase in MS was observed in TR and COMB compared to CTRL (p < 0.05). A significant increase in FHL muscle volume was observed in COMB compared to CTRL and TR only when muscle mass was normalized to body mass (p < 0.05), whereas no significant differences were detected among groups for absolute FHL mass. Additionally, there were no differences in training load or volume between COMB and TR (p ≥ 0.05). Therefore, based on the results, it is concluded that the administration of nimesulide during eight weeks of training promoted a greater hypertrophic response of the FHL muscle in rats.

Abstract Objectives This study aims to systematically analyze the effects of acupuncture as an adjunctive therapy for minimizing side effects following miscarriage, particularly focusing on pain relief and physical and emotional stability. By reviewing randomized controlled trials, the study seeks to identify effective acupuncture points and standardize their use in post-abortion care. Methods This study systematically reviewed and analyzed randomized controlled trials on the effectiveness of electroacupuncture in managing pain after miscarriage. The review followed PRISMA guidelines, included eight databases, and focused on comparing electroacupuncture to no intervention, analgesics, or combined treatments, with outcomes centered on pain and uterine bleeding. Results This study reviewed 260 articles on electroacupuncture for post-abortion pain, ultimately including six studies in the qualitative analysis and three in the meta-analysis. The results suggest that electroacupuncture significantly reduces pain compared to no intervention and may be more effective than analgesics, though high heterogeneity in the data requires cautious interpretation. Conclusion This study demonstrates the effectiveness and safety of electroacupuncture for managing miscarriage side effects, with a need for more diverse and standardized research. Graphical Abstract

Recently, complementary and alternative medicine (CAM) has been actively employed for patients experiencing symptoms unresponsive to Western medical treatments like drug therapy. The natural compounds carotenoids and astaxanthin (AST) have demonstrated various beneficial biological actions for human health in several studies. Given their broad pharmacological activities and reduced toxicity, ASTs possess significant potential as resources for the development of natural analgesic drugs. Given recent studies showing that AST can modulate neuronal excitability, including nociceptive sensory transmission through voltage-gated Ca2+ channels and the n-methyl-D-aspartate (NMDA) glutamate receptor, and inhibit the cyclooxygenase-2 cascade, AST holds promise as a CAM, particularly as a therapeutic agent for nociceptive and pathological pain. Based on the in vivo research findings from our laboratory presented in this review, we have confirmed that carotenoid ASTs possess: (i) an intravenous anesthetic effect on both nociceptive and inflammatory pain comparable to existing analgesics such as ketamine; and (ii) an anti-inflammatory effect on chronic pain with an efficacy almost equivalent to that of the commonly used non-steroidal anti-inflammatory drug (NSAID) celecoxib. Therefore, these findings suggest that, as natural compounds, ASTs contribute to the relief of nociceptive and inflammatory pain, implying their potential for clinical application.

Background Iatrogenic hallux varus is a rare but functionally disabling complication most commonly following hallux valgus surgery. Traditional revision techniques, such as tendon transfer or arthrodesis, may compromise joint mobility or require implants. This study evaluates a biologically autologous alternative—local soft tissue myoligamentoplasty—for the correction of flexible deformities. Methods A retrospective case series of seven patients (mean age 62 years) with flexible iatrogenic hallux varus following prior hallux valgus surgery was conducted at a single tertiary care center. All patients underwent local soft tissue myoligamentoplasty using an F-shaped medial capsular flap and lateral release via a double-incision approach. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, the American Orthopaedic Foot &amp; Ankle Society (AOFAS) hallux score, and radiographic measurements (hallux valgus angle [HVA], intermetatarsal angle [IMA]) over a 12-month follow-up. Results Mean VAS improved significantly from 6.1 ± 1.2 preoperatively to 1.4 ± 0.8 at 12 months (p &lt; 0.01), and AOFAS scores increased from 47.6 ± 6.9 to 83.7 ± 7.1 (p &lt; 0.01). HVA was corrected from −15.4° ± 4.3° to 2.7° ± 3.8° (p &lt; 0.01), while IMA remained unchanged (10.3° ± 1.9° to 9.8° ± 2.1°, p = 0.12), indicating mechanical neutrality. No recurrences, reoperations, or complications were reported. Patient satisfaction was high, with 5/7 “completely satisfied” and 2/7 “satisfied with minor concerns.” Conclusion Local soft tissue myoligamentoplasty offers a safe, effective, and joint-preserving surgical option for correcting flexible iatrogenic hallux varus. The technique provides durable pain relief, functional improvement, and cosmetic restoration without the need for tendon harvesting or implants, making it especially suitable for patients with preserved joint surfaces or in resource-limited settings.

Purpose: Patients with end-stage knee osteoarthritis typically undergo total knee arthroplasty (TKA), a surgical procedure that has long been considered a cost-effective treatment. However, moderate to severe postoperative pain is a common problem following TKA. Therefore, in this study, we aimed to compare the effects of postoperative pain management using conventional periarticular infiltration (conventional periarticular infiltration [PA]) versus modified periarticular infiltration (modified PA). Methods: This study was designed as a randomized controlled non-inferiority clinical trial conducted from April 2024 to April 2025. A total of 58 patients undergoing primary unilateral TKA were enrolled and randomly assigned to receive either modified PA or conventional PA. The primary outcome was postoperative pain within the first 24 h after surgery, measured using the visual analog scale. Secondary outcomes included time to first morphine hydrochloride rescue, total morphine consumption during the first 24 postoperative hours, and length of hospital stay (LOS). Results: Modified PA was non-inferior to conventional PA for postoperative pain control at rest and during movement within 24 h after TKA. Time to first morphine rescue, 24 h morphine consumption, and LOS did not differ significantly between the groups. All mean differences and corresponding 95% confidence intervals remained within the predefined non-inferiority margin of 0.5. Conclusions: Modified PA and conventional PA provided comparable pain relief during the first 24 h after TKA and showed similar times to first morphine rescue. Morphine consumption and LOS were similar between the groups. These findings may inform the selection of intraoperative analgesic infiltration techniques.

In the UK, around 7% (3.8 million) of adults have wounds; the number of people with wounds is increasing by 11% every year, whereas the healing rates are falling. Although most acute wounds (89%) heal within 1 year, only 49% of chronic wounds heal in the same time period. Many people with chronic wounds experience pain, which impairs wound healing and impacts quality of life. This article will examine the prevalence of pain in people with leg ulcers, pressure ulcers and diabetic foot ulcers. The author explores the types of pain and how to work with the older person to manage pain, improve wound healing and enhance quality of life.

Purpose This study assessed the efficacy and safety of oliceridine in Korean patients undergoing bunionectomy for moderate-to-severe acute postoperative pain. Patients and methods In this randomized, double-blind, placebo-controlled trial, 182 Korean patients experiencing moderate-to-severe acute postoperative pain after bunionectomy were enrolled. Patients received a loading dose of either placebo or oliceridine (1.5 mg), followed by patient-controlled analgesia with oliceridine (0.35 mg or 0.5 mg) or placebo for 48 h. The primary endpoint was the sum of pain intensity differences over 48 h, analyzed using least squares mean change from baseline via analysis of covariance. Secondary endpoints included pain intensity differences, proportion of responders at various time points, and rescue medication use. The trial was registered at ClinicalTrials.gov (NCT05509868). Results Both oliceridine doses demonstrated significant improvement in sum of pain intensity differences over 48 h compared with placebo. The least squares mean differences were 29.14 for the 0.35 mg group and 35.00 for the 0.5 mg group. Pain intensity differences and the proportion of responders were significantly greater starting 5 min post-dose and sustained for 24 h compared with placebo. The odds of requiring rescue pain medication were significantly lower in the oliceridine 0.35 mg and 0.5 mg groups compared with placebo. Adverse events were reported in 52.54% of patients in the 0.35 mg group, 60.32% in the 0.5 mg group, and 40.32% in the placebo group. No serious adverse events occurred in the oliceridine groups. Conclusion Oliceridine provided rapid and significant pain relief after bunionectomy in Korean patients, with no serious adverse events reported, supporting its potential as an effective and well-tolerated analgesic option.

This study evaluated the long-term outcomes of surgery for chronic pancreatitis (Frey procedure and longitudinal pancreaticojejunostomy), focusing on pain relief, endocrine and exocrine insufficiency, and postoperative quality of life. This was a single-centre prospective longitudinal study using a prospectively maintained database of patients who underwent surgery for chronic pancreatitis between January 2016 and December 2022, with follow-up continued through December 2024. The primary outcome was pain relief, assessed using the Izbicki pain score at 12 months, with descriptive reporting at 24 months. Secondary outcomes included postoperative quality of life (SF-36), endocrine and exocrine function, nutritional status, and occupational rehabilitation. Fifty-seven patients (38 Frey's, 19 LPJ; median age 30yr) were included, with a median follow-up of 41 months (range: 25-108). Idiopathic chronic pancreatitis was the most common etiology (63%). At 12 months, 75% achieved complete pain relief (Izbicki ≤10), and improvements were sustained at 24 months. SF-36 scores showed significant improvements across all domains, particularly pain and general health. New-onset exocrine insufficiency developed in 20% and endocrine insufficiency in 7%. Nearly 95% of patients returned to normal work and daily activities. Both Frey procedure and LPJ provided durable pain relief and improved quality of life. Surgical selection should be guided by pancreatic morphology to optimize long-term pain outcomes.

Evaluating prognostic block selection criteria in lumbar medical branch radiofrequency neurotomy: A retrospective cohort study.

Effects of laser acupuncture on pain and motor function in musculoskeletal disorders: A systematic review and meta-analysis.

Introduction: Rheumatoid Arthritis (RA) is a chronic disease characterised by severe inflammation, leading to degradation of articular cartilage and bony erosions. Women are affected two to three times more frequently than men. Platelet-Rich Plasma (PRP), a regenerative medicine therapy, has prompted interest in its potential use in patients with RA. Aim: To assess the effectiveness of PRP in modulating chronic RA in terms of pain relief, work capacity and overall satisfaction. Materials and Methods: This prospective observational study was conducted at Pain Clinic of R.G.Kar Medical College and Hospital, Kolkata, West Bengal, India, in collaboration with the blood bank. The effectiveness of PRP therapy in relieving knee joint pain was studied among 30 diagnosed cases of RA. Pain relief was analysed using the Visual Analogue Scale (VAS), and functional improvement was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline (0-week), 12th week, and 24th week. Blood samples were collected, and a centrifugation protocol was followed for PRP preparation. A total of 12 mL (6 mL per knee) of PRP was administered intraarticularly into the suprapatellar recess of both knee joints. Data on age, gender, VAS, and KOOS scores were recorded in an Excel sheet. Statistical analysis was performed, and a p-value &lt;0.05 was considered significant. Results: The mean age of participants was 43.70±8.96 years {mean±Standard Deviation (SD)}, with 26 (86.7%) females and 4 (13.3%) males (N=30). Age distribution was as follows: 31-40 years: 46.7%, 41-50 years: 30%, and 51-60 years: 23.3%. Paired sample descriptive statistics for VAS and KOOS scores at 0, 12, and 24 weeks showed statistically significant improvement (p&lt;0.05). Conclusion: The PRP significantly improved pain scores on the VAS and enhanced pain, symptoms, daily activities, sports function, and quality of life as measured by KOOS over 24 weeks. PRP administration was associated with high patient satisfaction and no reported adverse effects or complications.

Chronic postsurgical pain is prevalent in 13%-39% of patients after total knee arthroplasty. This can reduce function and quality of life, yet standard treatment options are limited. There remains a need for effective treatment options. Percutaneous motor peripheral nerve stimulation is a minimally invasive procedure that stimulates motor endpoints to produce muscle contraction of muscles near the painful region. Proof of concept and feasibility of motor peripheral nerve stimulation in chronic postsurgical pain after total knee arthroplasty have not yet been established. We report a series of five cases of motor peripheral nerve stimulation for refractory knee pain after total knee arthroplasty. The primary endpoints for feasibility were adherence related-all five individuals continued stimulation treatment through the 60 day period, five volitionally maintained stimulation for more than 80% of the time, and three of five volitionally maintained stimulation for more than 90% of the time (average 89.7%). Six months after motor peripheral nerve stimulation treatment, three out of five patients continued to have pain relief as measured by the Brief Pain Inventory-Short Form at 0 through 24 wks after implant. Three responders had a mean baseline worst pain of 6.66 reduce to 2 at 6 mos after implant. Motor peripheral nerve stimulation is feasible and may offer effective treatment for chronic refractory pain after total knee arthroplasty.

Conventional pharmacological treatment does not always relieve cancer pain satisfactorily, increasing the need for further medication. Complementary and integrative therapies are offered to cancer inpatients to improve their well-being. Although manual therapies such as massage and reflexology are commonly offered to hospitalized cancer patients in the UK, Shiatsu in this setting is little known and has been studied much less. The purpose of this project is to examine the pain-relieving effects of Heisei Shiatsu in hospitalized cancer patients and to compare those results with other bodywork modalities which have been established for longer in this field. Fifty-five inpatients received 66 Heisei Shiatsu treatments. Interventions are adapted to health issues and specific pain complaints. Patients scored changes in pain intensity, the relief provided, and changes in mood as a result of the treatment using the validated Integrative Medicine Treatment Evaluation Form. The pre- and post-treatment scores for pain and mood were analyzed with both student's t-test and the Wilcoxon signed-rank test. Results for relief are given in percentage points. All results were compared to results for other therapies stated in comparable research articles. Decrease in pain intensity and pain relief was reported after the Shiatsu session by all patients. The average reduction in pain was 40%. Thirty-two percent of the patients said their pain had been completely relieved, and 45% stated the pain had been mostly relieved. Compared to results in similar studies, Shiatsu is more effective than aromatherapy or reflexology in reducing pain among cancer patients. Almost all patients commented on the relaxing and soothing effects of these treatments. Heisei Shiatsu can be delivered alongside conventional care for patients with cancer. Although the sample size is not big enough to draw definite conclusions, it warrants further research into the safety of Heisei Shiatsu in this setting and its relaxing effects as described by many of the patients.

Mu-opioid and D1-like dopamine receptor crosstalk in dorsal CA1 hippocampus modulates inflammatory pain in rats.

Financial status and pain in the last week of life: Insights from a nationally representative mortality follow-back survey in England and Wales.

Nociplastic pain is a type of pain distinct from nociceptive pain (pain from damage to tissues) and neuropathic pain (pain from damage to nerves). Mechanistically, nociplastic pain is incompletely understood but is thought to be secondary to altered pain sensory pathways peripherally and in the central nervous system. Nociplastic pain has been identified in more than one-third of patients presenting for evaluation of hip and knee arthritis. Importantly, many of these patients may not carry a formal diagnosis of fibromyalgia or other nociplastic pain syndrome. Patients with nociplastic pain undergoing arthroplasty surgery experience less pain relief and functional improvement, and exhibit increased opioid use after surgery. With an increasing emphasis being placed on preoperative to postoperative change in patient-reported outcome measures for measures of surgical quality and physician reimbursement, recognition of nociplastic pain by the arthroplasty surgeon before surgery is of critical importance.

Data fusion and multivariate analysis based on near infrared spectroscopy, electronic noses, and high resolution mass spectrometry: A synergetic approach to boost performance on the authenticity analysis of toxic herbs for Aconitum.