Treatment Of Pain Research Articles

Erector Spinae Plane Block for Chronic Lumbosacral Pain: A Case Report

Chronic low back pain is a prevalent and debilitating condition that often resists traditional management strategies such as physical therapy, pharmacotherapy, and interventional procedures. The erector spinae plane (ESP) block, a relatively new regional anesthesia technique, has shown promise in managing various types of pain, including chronic conditions. This case report details the use of the ESP block in a male patient in his late 60’s with chronic low back pain unresponsive to conventional treatments, including acetaminophen, muscle relaxants, gabapentin, epidural steroid injections, diagnostic medial branch blocks, and sacroiliac joint injections. Given the refractory nature of his pain, a right-sided lumbar ESP block was performed under fluoroscopic guidance. This case highlights the potential of the ESP block as an effective treatment for chronic lumbar pain, particularly in patients who have not responded to other interventional modalities. The safety profile of the ESP block, coupled with its efficacy in this case, supports its consideration as a viable option in chronic pain management. Further studies and clinical experience will be essential in defining its role and establishing standardized protocols for its use in chronic pain settings.

Transarterial Embolization for Musculoskeletal Pain Management: AJR Expert Panel Narrative Review.

Musculoskeletal embolization has emerged in recent years as a treatment for chronic joint pain, as the inflammatory cascade responsible for such pain has become better understood. Studies have demonstrated a complex interplay between joint inflammation and synovial hypervascularity that causes growth of new unmyelinated nerve fibers responsible for pain. Embolization targets joint hypervascularity, to disrupt the inflammatory cycle and provide pain relief. The standard treatment algorithm for chronic joint pain is well-established and entails escalating therapeutic options that include exercise, self-management programs, analgesic medications, intra-articular injections, and finally surgical replacement or release. Genicular artery embolization (GAE), targeting abnormal vasculature around the knee joint, is the most heavily studied musucloskeletal embolization procedure, reflecting the high worldwide prevalence and increasing incidence of knee osteoarthritis. GAE is now supported by multiple prospective studies, including randomized control trials comparing GAE versus sham treatment. Embolization has also extended outside of the knee joint to include the shoulder (treatment of adhesive capsulitis or secondary stiff shoulder), elbow (medial/lateral epicondylitis), hip (osteoarthritis, great trochanteric pain syndrome), and ankle (plantar fasciitis). This AJR Expert Panel Narrative Review discusses the current status of transarterial embolization for musculoskeletal pain management, focusing on treatment of knee osteoarthritis and chronic shoulder pain.

Research hotspots and frontiers in non-specific low back pain: a bibliometric analysis.

Extensive research has been conducted worldwide on non-specific low back pain (NSLBP), some researchers published a bibliometric analysis of NSLBP in 2020, but there have been no supplements or updates since then. Therefore, this study aimed to analyze the research hotspots and frontiers in NSLBP over the last decade. Primary sources on NSLBP were obtained from the Web of Science Core Collection database from 2014 to 2023. CiteSpace V6.2. R7 (64-bit) and VOSviewer 1.6.19 software were used to analyze the number and centrality of journals, countries, institutions, authors, references, and keywords, and the functions of co-occurrence and clustering were applied to draw a visual knowledge map. In the past decade, the annual publication volume of studies on NSLBP has shown an overall upward trend year by year, with obvious temporal stages and great development potential. In total, 2,103 articles contained six types of literature, with the highest proportion being original research articles (1,633 articles, 77.65%), published in 200 journals. BMC Musculoskeletal Discourses (90 articles, 4.28%) had the highest number of publications, and the British Medical Journal had the highest impact factor (105.7). Furthermore, the United States of America (329 articles, 15.64%) had the highest publication volume, the University of Sydney (139 articles, 6.61%) was the research institution with the highest production, Maher, Chris G (36 articles, 1.71%) was the author with the most published articles, and Hoy, D (571 articles, 27.15%) was the most frequently cited author. The most cited of articles is "Non-specific low back pain" published in the LANCET, with 1,256 citations. This article summarizes the current research status of NSLBP and predicts future research hotspots and frontiers. In recent years, adolescents have become a high-risk group for NSLBP. Pain neuroscience education, motor control, spinal manipulative therapy, and acupuncture are effective means to treat NSLBP. Biomechanics and trunk muscles as entry points are effective ideas for the treatment of NSLBP pain. Furthermore, anxiety, neck pain, non-specific musculoskeletal pain, fibromyalgia, and musculoskeletal disorders are diseases that are closely related to NSLBP. In the future, attention should be paid to the design of research plans, increasing the research intensity of randomized controlled trials, strengthening follow-up, and the timely updating of guidelines, which will result in higher quality and high-level scientific evidence for research on NSLBP.

Functional expression of the chimera proteins of Nav1.7 and NavAb in Escherichiacoli

Nav1.7 is a eukaryotic voltage-dependent Na channel (Nav) family membrane protein and has four channel domains and four voltage sensor domains (VSD-I–IV). It is involved in pain perception, and VSDs that differ significantly by Nav subtype are targeted in the development of Nav1.7-specific inhibitors. This is expected to result in neuropathic pain treatments with fewer side effects. We previously reported on intra-periplasm secretion and selection (PERISS), a peptide drug discovery system that targets membrane proteins by co-expressing a peptide library and a target membrane protein. For PERISS screening of VSD-specific new Nav1.7 inhibitors, the chimera protein (NavAb/1.7VSD) of Nav from prokaryotic Arcobacter butzleri (NavAb), in which extracellular loops of VSD were replaced with homologous loops from Nav1.7, serves as an effective model. This is because NavAb harbors only one VSD and the biological activity of NavAb/1.7VSD was previously confirmed. To date, NavAb/1.7VSD has only been found to be expressed in insect cells. In this study, we report on the expression and channel activity of NavAb/1.7VSD-II in Escherichia coli (E. coli). The expression of this protein in the inner membrane of E. coli was confirmed by western blotting. Channel activity was assessed by measuring the channel currents of the purified recombinant proteins and inhibition using a Nav1.7-specific peptide inhibitor. The results indicate that NavAb/1.7VSD-II was functionally expressed in E. coli, providing empirical support for the discovery of new VSD-specific Nav1.7 inhibitors using the PERISS screening method.

Natural Products with Potential for the Treatment of Pain: Global Evidence from the NAPRALERT Database.

Natural products (NPs) continue to inform the discovery and development of a diversity of drugs, both marketed and investigational. Pain, one of the most common of human experiences and profound challenges in medicine and biology, has emerged at the core of an urgent societal problem, in the United States and globally. The present study employs a retrospective analysis of an extensive set of published literature curated in the NAPRALERT database to identify NPs with experimental evidence of bioactivity supporting the selection and prioritization of NP leads with promise in pain management. The NAPRALERT pain data set currently documents >38,000 pain-relevant experiments reported in >1,750 distinct journals. The evidence presented here was annotated from >10,000 distinct scientific publications identifying NP extracts and isolates with experimental biological data indicating positive mitigation of pain, inflammation, and/or modulation of nociceptive signaling targets. Correlation of ethnomedical uses with experimental data represents a value-added approach to the selection and prioritization of leads. Dissemination of this unique NP/pain data set, with experimental data and information applicable to basic, translational, and clinical science stakeholders alike, furnishes practical evidence in support of a rational selection of NPs for directed pain research. A large portion of the NAPRALERT pain-relevant data set, along with a set of query tools designed to assist user-directed selection and prioritization of leads, are presented as Supporting Information in order to mitigate the limitations inherent in presenting such a large data set in (print) format. To support user efforts, this report involves explication of NAPRALERT data organization and the articulation of rational approaches to user-guided selection of evidence-based NP leads.

The Rehabilitation of Texter’s Thumb with Virtual Reality Headsets - A Systematic Review

Rationale– In this day and age, it has become a troublesome task for one to resist video games or avoid texting on computers, tablets and cell phones. The continuous use of cell phones for texting and gaming leads to various injuries and one such injury is the Texter’s thumb. Aim- The aim of this systematic literature review was to determine the effectiveness of using virtual reality headsets for Texter’s thumb rehabilitation. Objective- To discuss the causes, symptoms, conventional treatment options and the latest alternatives provided by Artificial Intelligence (AI), i.e., virtual reality headsets, for the rehabilitation of Texter’s thumb. Methods- The present systematic literature review was conducted according to the PRISMA 2020 statement in Web of Science, Scopus, PubMed, ResearchGate and Google Scholar databases and was limited to the title and keywords. The initial electronic search yielded 105 articles and 41 articles were eventually included in the final review. Results- The analysis of the reviewed articles revealed that patients used virtual reality headsets for the rehabilitation of Texter’s thumb. Many subjects found these headsets easy to understand, easy to use, interesting, motivating, engaging, along with an improvement in hand and thumb function, a reduction in pain and an increase in the pinch and grip strength. A few of the users experienced other problems such as headache and visual disturbances. Discussion- Evaluation of the articles included in the review showed that virtual reality headsets ultimately help to make thumb rehabilitation less painful. They follow the attention-distraction method as the patient gets distracted by the vastness of the virtual world and his attention is shifted from the discomfort caused by the injury to his surroundings in the virtual world. This makes VR, one of the simplest psychological therapies for the treatment of pain. Conclusion- To conclude this systematic review, it can be stated that virtual reality headsets have indeed proved to be a boon for all the youngsters out there as the injury caused by strenuous texting can be rehabilitated through the use of AI. Nevertheless, it is still necessary to further enhance our knowledge and study in this field. Keywords: artificial intelligence; virtual reality; texting injuries; Texter’s thumb; hand rehabilitation

Paracetamol and ibuprofen fixed-dose combination for the management of acute mild-to-moderate pain in children: strengthening and enhancing of result of Nominal Group Technique through Delphi consensus

BackgroundParacetamol and ibuprofen are the most commonly used drugs for pain treatment in children and their combination has shown improved analgesic effect compared to treatment with either drug alone. Current literature lacks specific guidelines regarding the settings in which this combination should be adopted.MethodsThe survey, conducted with Delphi methodology, involved 75 hospital and outpatient pediatricians with clinical experience in the management of pain in children. Pediatricians involved were asked to validate or not the results of the previous NominalGroup Tecnique (NGT) consensus and thus specify the optimal clinical settings in which the paracetamol/ibuprofen fixed-dose combination could be adopted.ResultsThe results confirm the importance of the fixed-dose paracetamol and ibuprofen combination for the control of mild-to-moderate acute pain in children. Particularly, this association seems to be appropriate in case of headache, earache, odontalgia and musculoskeletal pain, and in specific settings such as post-operative and post-procedural pain. The broadening of the panel brought to slight variations in clinical management practices between hospital and outpatient specialists. Nonetheless, overall consensus supports the notion that the fixed dose combination is more efficacious than monotherapies and it is well tolerated. Moreover, experts unanimously agree on the usefulness of the combination for caregivers, leading to improved adherence and effectiveness.ConclusionsBoth the NGT consensus and the broader Delphi consensus confirm the usefulness of the paracetamol-ibuprofen fixed-dose combination in pediatric pain. This is attributed to its superior effectiveness compared to monotherapies, a good tolerability profile, and improved compliance and ease of use. Some pain settings related to chronic, inflammatory and rheumatological pathologies remain to be investigated to evaluate the use of this combination.

Cannabidiol (CBD): A Systematic Review of Clinical and Preclinical Evidence in the Treatment of Pain

Background/Objectives: Cannabis sativa L. is a plant that has been used for thousands of years for its industrial and medicinal properties. In recent years, there has been a rise in the study of this plant due to its bioactive compounds for pharmaceutical applications. Particularly, cannabidiol has demonstrated analgesic and non-psychoactive properties. The objective of this systematic review is to update and to gather the clinical and preclinical evidence on CBD in pain treatment. Methods: This study was performed following the PRISMA guidelines and using the following search terms “((cannabidiol) NOT (THC)) NOT (tetrahydrocannabinol)) AND (pain treatment)” in PubMed and Web of Science, with the following inclusion criteria: CBD pain treatment without THC in monotherapy, including both clinical and preclinical trials. From the initial sample of more than 500 articles, a total of 40 studies were selected, eliminating duplicate studies from the databases and considering the inclusion and exclusion criteria. On one hand, clinical trials were analyzed using CBD products without THC used in monotherapy, assigning a Jadad score to evaluate the quality/bias of the trials; on the other hand, the main preclinical trials were analyzed, grouping the results into in vivo and in vitro trials. Results: Based on the review conducted, there is sufficient clinical and preclinical evidence of CBD in pain treatment, so CBD could be an effective and safe treatment in reducing pain due to its analgesic and anti-inflammatory properties. These effects appear to be primarily mediated by the activation of TRPV-1, 5HT-1A, and CB1, with emerging therapeutic relevance in the management of osteoarthritis and chronic pain. Conclusions: Although clinical and preclinical research show promising results, clinical evidence is limited, and more studies should be performed in the future with isolated CBD.

Prevalence and treatment of chronic musculoskeletal pain focused on service gaps: a comparative analysis by age group and body part.

Occupational health, grounded in occupational medicine, aims to enhance the well-being and labor productivity of the working population. Within this realm, there has been growing concern over the increasing instances of labor loss due to diminished physical capacity and the rise in musculoskeletal disorders. Chronic pain is also associated with musculoskeletal disorders. Another pressing issue related to chronic musculoskeletal pain was needed assistance services are underutilized, is referred to as a "service gap". Understanding trends based on age and affected regions of the body is indispensable for developing strategies to address chronic musculoskeletal pain in workers. This study aimed to elucidate age-specific trends in the prevalence and number of pain sites in chronic musculoskeletal pain as well as the patterns of treatment during chronic musculoskeletal pain, categorized by age and affected site. This study was conducted in December 2022 in contract to Cross Marketing Inc. The survey began on December 12, 2022 and ended on December 15, 2022. An online survey was administered to 1,946 participants (973 women and 973 men), and responses were collected, ensuring a roughly equal distribution of samples among men and women across six age groups ranging from their 20 to 70 s. The survey inquired about the presence of chronic pain in each of the eight body parts and the adoption of five different treatments when experiencing pain. Statistical analysis was performed using the chi-square test, with the measurement data categorized by age group and body part. The results indicated a significantly higher prevalence of chronic pain at three or more sites among individuals in their 30 s: the prevalence of pain at each of the eight body sites varied with age. Approximately half of the participants did not engage in specific treatments during episodes of chronic pain. The presence or absence of treatment showed no significant differences according to affected site or age group. This study revealed age- and body part-related relationships with chronic musculoskeletal pain in middle-aged patients and highlighted healthcare service gaps in its management in Japan.

Investigating the role of psychosocial stress factors in back pain patients

Abstract Background In 2022, 27.35 million people in Germany were diagnosed with back pain. This results in a 1-year prevalence of 32.64 percent of the population and 96,8 million days of incapacity to work. Moreover, patients with back pain often suffer from additional mental disorders (e.g. anxiety, depression). This study investigated the influence of other health-related factors such as psychosocial stress in these patients. Methods A randomized controlled study was conducted with 297 gainfully employed participants in a rural rehabilitation center in Germany Bad Zwischenahn who received a 4-week multimodal pain therapy. 150 participants were allocated to the intervention (IG) who received an additional 12-month relapse prevention treatment while 147 were allocated to the control group (CG) who received no such additional treatment. Data was obtained via questionnaire (three measurement points) and claims data. Among other health-related outcomes, the number of sick days was examined. A 10-item subscale of the Patient Health Questionnaire (PHQ) was included to measure common psychosocial stress factors. Results The evaluation of the PHQ (summary) scores revealed a mild stress level at all three dates. Of the ten psychosocial stress factors surveyed, the highest level was reported in the IG and CG on the scale “Worrying about health”. The IG improved significantly (p = .017) compared to the CG after one year reporting decreased health worries. Further analyses carried out by analysis of variance (ANOVA) showed that health worries are significantly associated to a higher number of sick days in the IG (p = .002) and CG (p = .010). Conclusions With regard to psychosocial stressors, the participants were primarily affected by health worries. The results indicate that health concerns are the primary psychosocial stress factor associated with back pain and should be taken into account in the treatment of back pain. Key messages • A 12-month relapse prevention treatment significantly reduced the psychosocial stress experienced by people with back pain after their rehabilitation treatment. • Concerning psychosocial stress factors, the participants of both groups were primarily affected by health worries.

Protocol for remote Tai Chi and wellness for PTSD and pain in veterans

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is a debilitating psychological disorder that is associated with a host of psychosocial and health ailments, including chronic pain. Although evidence-based psychological therapies are recommended as first-line PTSD treatments, a large proportion of individuals either drop out and/or do not achieve a therapeutic response. PTSD is increasingly recognized as a systemic disorder that impacts both physical and mental health, and mind-body approaches, such as Tai Chi, have shown promise. However, to date there have been no randomized clinical trials examining Tai Chi as a treatment for PTSD. Objective: To conduct a fully remote two-phased study designed to adapt, refine, and standardize two group treatments, Tai Chi and a Wellness comparison, for Veterans diagnosed with PTSD and chronic pain. Method: We deploy the project in two phases. In Phase One, we adapt both interventions for delivery via a videoconferencing platform. We then pilot the interventions in a ‘dry run’ with non-random assignment of 12 participants to Tai Chi or a Wellness comparison group. In Phase Two, we randomize 36 participants to one of the two group interventions. The feasibility and acceptability of the two remotely delivered interventions and assessment protocols are evaluated. Conclusions: This is the first study to our knowledge to evaluate the feasibility, acceptability, adherence, and participant burden of the Tai Chi and Wellness comparison interventions for PTSD and chronic pain in Veterans. This information will facilitate the development of a future large, randomized control trial to evaluate the efficacy of Tai Chi to address PTSD and chronic pain in Veterans.

Abdominal Pain in Inflammatory Bowel Disease-Epidemiology, Pathophysiology, and Management: A Narrative Review.

Abdominal pain is a major symptom of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, and has a significant impact on patients' quality of life. Given the evolving understanding of IBD pathology and management strategies, there is an urgent need to review the recent research findings. In this review, we have analyzed the epidemiology, pathophysiology, and management of abdominal pain in IBD over the past decade. We draw on the current literature and highlight emerging trends, challenges, and advances in this field. By synthesizing key findings, this review provides insights into the complex interplay between abdominal pain, disease progression, and therapeutic interventions for IBD.

Comparing the effects of oral sucrose and kangaroo mother care on selected physiological variables and pain resulting from venipuncture in premature newborns admitted to neonatal intensive care units

BackgroundPremature newborns admitted to neonatal intensive care units (NICUs) undergo numerous painful interventions during care and treatment. The purpose of this study was to compare the effects of using sucrose and kangaroo mother care by on selected physiological variables and pain resulting from venipuncture in premature infants admitted to NICUs affiliated with Shiraz University of Medical Sciences.MethodsThis clinical trial included premature infants admitted to 2 NICUs. The sample size consisted of 66 neonates, with 22 newborns in each group. Randomization was performed using the block allocation method. Data collection involved a demographic questionnaire, the neonatal infant pain scale, and a pulse oximetry device. Friedman, Kruskal–Wallis, and Dunn’s post hoc tests employed for data analysis, with a significance level of P < 0.05.ResultsThe use of oral sucrose and kangaroo care demonstrated significant differences in breathing rate, heart rate, and average arterial blood oxygen saturation during and after venipuncture (P < 0.05). Oral sucrose was found to be significantly more effective than kangaroo care. Neonates under kangaroo care exhibited more regular heart rates compared to the other group (P < 0.05). The utilization of oral sucrose and kangaroo care had varying effects on the average pain score resulting from venipuncture in premature neonates (P < 0.05).ConclusionsBoth methods proved effective in reducing pain and improving physiological variables. However, due to the superior effectiveness of sucrose administration, it is recommended as a cost-effective and easily implementable method in NICUs.Trial registration: Iranian Registry of Clinical Trials IRCT20191215045749N1. (29/03/2020).

Pharmacological Pain Treatment in Older Persons.

Pharmacological pain treatment in older persons is presented by a multi-disciplinary group of European pain experts. Drugs recommended for acute or chronic nociceptive pain, also for neuropathic pain and the routes of administration of choice are the same as those prescribed for younger persons but comorbidities and polypharmacy in older persons increase the risk of adverse effects and drug interactions. Not all drugs are available or authorised in all European countries. For mild-to-moderate pain, non-opioids including paracetamol and non-steroidal anti-inflammatory drugs are first-line treatments, followed by nefopam and metamizole. Codeine, dihydrocodeine and tramadol are prescribed for moderate to severe pain and 'strong' opioids, including morphine, hydromorphone, oxycodone, fentanyl, buprenorphine, methadone and tapentadol, for severe pain. Chronic neuropathic pain treatment relies on coanalgesics, including anti-epileptics (gabapentinoids) and anti-depressants with additional option of topical lidocaine and capsaicine. The choice of analgesic(s) and the route of administration should be guided by the pain characteristics, as well as by the patient's comorbidities, organ function and medications. Several directions have been highlighted to optimise pharmacological pain management in older individuals: (1) before starting pain treatment adequately detect and assess pain and always perform a full geriatric assessment, (2) consider kidney function systematically to adjust the doses of analgesics and avoid the risks of overdose, (3) start with the lowest dose of an analgesic and increase it gradually under the control of the effect, (4) involve the older persons and family in their treatment, (5) reevaluate pain regularly during treatment and (6) combine pharmacological treatment with non-pharmacological approaches.

Biopsychosocial Approaches for the Management of Female Chronic Pelvic Pain: A Systematic Review.

Current guidelines recommend biopsychosocial-informed treatment for chronic pelvic pain (CPP). The objective of this systematic review was to describe the available biopsychosocial approaches for the treatment of CPP, and the outcomes reported, to understand how guideline-recommended treatments can be applied. MEDLINE, CINAHL, PsycINFO, EMBASE, Emcare, AMED and Cochrane trial registries were searched (inception to 17 November 2023). CPP Studies in women where the principal treatment modality was a biopsychosocial approach were included. Prospero registration: CRD42022374256. Data extraction included study setting, population, study design, intervention characteristics and outcome measures and is described via a narrative synthesis. The review included 14 RCTs (871 patients) and identified four broad intervention categories (Acceptance Commitment Therapy n = 2, Cognitive Behavioural Therapy n = 6, Mindfulness-based approaches n = 2, and Physiotherapy-based interventions n = 4). Pain science education (PSE) and, exposure/engagement with valued activity were recognised as important aspects of treatment regardless of intervention type. The most utilised outcomes were pain reduction and emotional functioning, with all studies reporting improvements in these domains. Heterogeneity in outcomes prevented efficacy comparison. High risk of bias was identified in six studies (1/4 physiotherapy-based approaches, 2/6 CBT, 1/2 ACT and 2/2 mindfulness-based interventions). CBT and ACT-based biopsychosocial approaches were found effective in reducing pain and improving psychometric outcomes for CPP. Evaluation indicated PSE, and exposure/engagement in valued activity are important components of biopsychosocial management. Outcome heterogeneity needs to be addressed in future trials.

Effectiveness of high-intensity laser therapy on pain in tendinopathy

Introduction: High-intensity laser therapies (HILT) have gained significant attention in therapeutic pain treat-ment. The aim of this systematic review was to determine the effectiveness of HILT therapies in the management of different types of tendinopathy-related pain, and the long-term benefits associated with treatment process.Methodology: A systematic literature review of prospective randomized controlled trials from electronic data-bases: Google Scholar, Pub Med, Embase, Science Direct, and ProQuest, using relevant key words, was per-formed. Randomized trials that included HILT, patients with tendinopathy, pain management, and at least one single clinically pertinent attribute were selected. Standard PRISMA protocols were followed when completing the assessment.Results: The physical, demographic, and theoretical insights from various studies suggest that HILT is a highly promising approach for managing pain in patients with tendinopathy. The most common body parts for treating tendinopathy using this method were the shoulder, elbow, ankle, and knee. Various attributes and parameters, such as Hand function evaluated by Quick Disabilities of Arm, Shoulder and Hand Questionnaire (QDASH) and Hand-grip Strength; pain assessed by the visual analogue score (VAS) during rest or activity, 36-item short-form health survey (SF-36) for physical and mental health, and the shoulder pain and Disability Index (SPADI) for shoulder and elbow assessment, were frequently significant across studies.Conclusion: HILT could be recommended as a treatment of choice for reducing pain and improving function in patients with tendinopathy, with potential benefits when combined with other physical therapy treatments. Further studies are needed to clarify optimal treatment protocols and long- term outcomes.

Comparison of the clinical efficacy on chronic abdominal wall pain between trigger-point electroacupuncture and transversus abdominis plane block

To compare the clinical efficacy between trigger-point (TrP) electroacupuncture and transversus abdominis plane (TAP) block in treatment of chronic abdominal wall pain (CAWP). A total of 62 CAWP patients were randomly divided into a TrP electroacupuncture group (31 cases, 1 case dropped off) and a TAP block group (31 cases, 1 case dropped off). Electroacupuncture at trigger points was delivered in the TrP electroacupuncture group, and TAP block was administered under ultrasonic guidance in the TAP block group. Separately, the score of the numerical pain rating scale (NRS) was observed before treatment and in 1 week, 1 month and 3 months after treatment；the scores of the self-rating anxiety scale (SAS) and the self-rating depressive scale (SDS) observed before treatment and in 1 week and 3 months after treatment；and the score of the short form 36 questionnaire (SF-36) was observed before treatment and in 3 months after treatment. The utilization rate of remedial drugs was recorded during follow-up visit. The clinical efficacy was compared. At each time point after treatment, NRS score decreased in comparison with that before treatment (P<0.05), the scores of SAS and SDS 1 week and 3 months after treatment were reduced (P<0.05) and the each item score of SF-36 increased (P<0.05) 3 months after treatment of each group. Compared with the outcomes in the TAP block group, NRS scores were reduced 1 month and 3 months after treatment respectively (P<0.05), the scores of SAS and SDS decreased (P<0.05) and SF-36 score was elevated (P<0.05) 3 months after treatment in the TrP electroacupuncture group. There was no significant difference in the utilization rate of remedial drugs between the two groups. The clinical efficacy of the TrP electroacupuncture group (96.7%) was superior to that of the TAP block group (83.3%, P<0.05). Both TrP electroacupuncture and TAP block can markedly relieve pain, attenuate the emotional symptoms of anxiety and depression and improve the quality of life in the patients with chronic abdominal wall pain. The clinical efficacy of TrP electroacupuncture is better than that of TAP block 3 months after treatment.

Effect of Dural Puncture Epidural Technique on Management of Breakthrough Pain for Parous Women Receiving Labor Analgesia during Induced Labor: A Retrospective Cohort Study.

This study assessed the effectiveness of the dural puncture epidural (DPE) technique in managing breakthrough pain in parous women receiving labor analgesia during induced labor. This single-center retrospective cohort study included term pregnant women with singleton pregnancies who received treatment for breakthrough pain during labor. All participants underwent induced labor, and some parous women among them underwent DPE. The DPE technique consisted of placing an epidural catheter after dural puncture with a 27-gauge spinal needle. Eligible women were allocated into a DPE group and conventional epidural (CE) anesthesia group. Pain was assessed with a numerical rating scale (NRS), and a patient-controlled epidural analgesia (PCEA) bolus was administered when the NRS score was ≥3. Breakthrough pain was defined as an NRS score ≥3 during PCEA management. The primary outcome was the efficacy of rescue interventions in managing breakthrough pain, as determined by a reduction in pain intensity to an NRS score <3 before birth. Among the 55 parous women who received labor analgesia, 44 required additional rescue administration for breakthrough pain. Of the remaining women, 23 received DPE and 19 received CE anesthesia. The DPE group experienced significantly more effective relief of breakthrough pain before birth than did the CE group (DPE: 100%; CE: 68.4%; p=0.005). In parous women, DPE anesthesia was more effective than CE anesthesia in providing analgesia for breakthrough pain immediately before delivery during induced labor.

Expert consensus on diagnosis and treatment of chronic pelvic pain

Expert consensus on diagnosis and treatment of chronic pelvic pain

The role of neutrophils in pain: systematic review and meta-analysis of animal studies.

The peripheral inflammatory response is an attractive therapeutic target for pain treatment. Neutrophils are the first circulating inflammatory cells recruited to sites of injury, but their contribution to pain outcomes is unclear. We performed a systematic review and meta-analysis of original preclinical studies, which evaluated the effect of preemptive neutrophil depletion on pain outcomes (PROSPERO registration number: CRD42022364004). Literature search (PubMed, January 19, 2023) identified 49 articles, which were meta-analyzed using a random-effects model. The risk of bias was evaluated using SYRCLE's tool. The pooled effect considering all studies showed that neutrophil depletion induced a consistent pain reduction. Inflammatory, joint, neuropathic, and visceral pain showed significant pain alleviation by neutrophil depletion with medium-large effect sizes. However, muscle and postoperative pain were not significantly alleviated by neutrophil depletion. Further analysis showed a differential contribution of neutrophils to pain outcomes. Neutrophils had a higher impact on mechanical hyperalgesia, followed by nociceptive behaviors and mechanical allodynia, with a smaller contribution to thermal hyperalgesia. Interspecies (mice or rats) differences were not appreciated. Analyses regarding intervention unveiled a lower pain reduction for some commonly used methods for neutrophil depletion, such as injection of antineutrophil serum or an anti-Gr-1 antibody, than for other agents such as administration of an anti-Ly6G antibody, fucoidan, vinblastine, CXCR1/2 inhibitors, and etanercept. In conclusion, the contribution of neutrophils to pain depends on pain etiology (experimental model), pain outcome, and the neutrophil depletion strategy. Further research is needed to improve our understanding on the mechanisms of these differences.