Significant Reduction In Pain Intensity Research Articles

Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy.

Neuromodulation therapies (including non-invasive and invasive neuromodulation) are being used to treat painful diabetic neuropathy (PDN). A systematic search of the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted, from their inception until 1 October 2024, to identify randomized controlled trials (RCTs) on neuromodulation therapies for PDN. Data were collected on pain intensity of various adjunctive therapies for PDN, including transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation, pulsed electromagnetic field therapy, spinal cord stimulation (SCS), transcranial direct current stimulation, frequency rhythmic electrical modulation system, mesodiencephalic modulation, and sham. The data from an aggregate of 12 separate studies, comprising a total sample size of 922 participants, was subject to analysis. All seven neuromodulation therapies exhibited better outcomes in pain intensity compared to the Sham intervention, with TENS achieving the highest ranking, followed by SCS. At the final follow-up time point, statistically significant reductions in pain intensity (vs. Sham) was only observed for SCS. The results of this network meta-analysis should facilitate the development of clinical guidance and enhance the decision-making process for both patients and healthcare professionals, thereby identifying the most appropriate PDN treatment options. PROSPERO: CRD42024597208.

Rehabilitation of patients with intervertebral hernias

This paper examines the issue of improving approaches to physical therapy in patients with intervertebral hernias in order to reduce the intensity of pain, improve motor functions of the spinal-motor segment and improve the overall quality of life. The current state of rehabilitation of people suffering from intervertebral hernias was analyzed. The study included patients aged 45 to 70 years with severe pain caused by intervertebral hernias. The aim of the study was to assess the effectiveness of physical therapy in the rehabilitation process of this category of patients. The study involved 40 people who were divided into the main (OG) and control (CG) groups of 20 patients each. Patients in the main group underwent a specially developed course of physical rehabilitation, while participants in the control group received standard treatment, which included general recommendations for physical exercises and massage. The effectiveness of the proposed methods of physical therapy for intervertebral hernias and their effectiveness were proven. Patients in the main group, compared with the control group, demonstrated a significant reduction in pain, improved mobility and stability of the spine. We proposed a physical rehabilitation program for people with intervertebral hernias, which includes four consecutive stages: reducing pain and inflammation through the use of physiotherapy procedures; restoring motor activity through stretching exercises and improving joint flexibility; strengthening the back muscles necessary for stabilizing the spine; teaching patients correct posture and correcting physical activity, which helps prevent relapses of the disease. The program is adapted to the individual characteristics of each patient, which allows achieving maximum therapeutic effect. The results of the study demonstrated the high effectiveness of the comprehensive physical rehabilitation program in the main group: patients experienced a significant reduction in pain intensity, improved mobility and functional status of the spine, as well as an overall improvement in the quality of life.

Hypnobirthing and Its Effects on Pain Management, Birthing Outcomes, and Psychological Well-Being of Mothers: A Literature Review

Background: Childbirth is a transformative experience but comes with pain and psychological stress with long term impact. Pharmacological pain management is a common intervention during childbirth, but there is a growing interest in utilizing non-pharmacological intervention during childbirth. Hypnobirthing is a childbirth preparation method that combines visualization, meditation, affirmations, deep breathing, and relaxation to enhance birthing experiences. As an approachable intervention that is cost-effective with very few complications, hypnobirthing has potential to supplement existing interventions for childbirth. This literature review aims to evaluate the existing research on hypnobirthing and its effects on antepartum, intra-partum, and postpartum outcomes. Methods: A comprehensive literature search was conducted using a combination of Medical Subject Headings (MeSH) and keyword search terms related to hypnosis, pregnancy, and hypnobirthing across databases including PubMed, PsycINFO, and Cochrane Library. The review focused on randomized controlled trials published in the last 20 years that explicitly used hypnobirthing as defined by Varner (2015) as “a childbirth preparation method that combines a mixture of visualization, meditation, positive affirmations, deep breathing, and relaxation to help women achieve a calm and controlled birthing experience.” Initially, 56 articles were retrieved and independently screened by four researchers. Studies were included if they assessed the effects of hypnobirthing on pain management, birthing outcomes, or psychological effects. Articles not meeting these criteria or employing different techniques were excluded, resulting in 18 articles for the final review. Data were synthesized to categorize studies based on whether they supported or did not support the efficacy of hypnobirthing. Additionally, basic statistical analyses were performed to compare outcomes across the studies and assess the consistency of hypnobirthingʼs effects. Results:The majority of studies (15/18) demonstrated significant reductions in pain intensity and decreased reliance on pain medication among hypnobirthing participants. Maternal satisfaction was higher in hypnobirthing groups, with some studies reporting improved APGAR scores and lower rates of labor v. Psychological benefits included increased confidence, reduced anxiety, and more positive childbirth experiences. Conclusions: Hypnobirthing appears to be a promising non- pharmacological approach to improving childbirth experiences. Possible benefits such as reduced pain intensity, lower reliance on pain medications, and enhanced maternal psychological well-being. Due to inconsistencies in study findings, further randomized controlled trials with larger sample sizes and diverse populations are needed to better understand the efficacy and optimize clinical guidelines for hypnobirthing.

Initial Feasibility and Acceptability of Cancer Pain 101: An Interdisciplinary, Single-Session, Telehealth Intervention for Patients With Cancer-Related Pain.

Patients with cancer have limited access to comprehensive pain treatment. We developed a 90-min, single-session, telehealth, interdisciplinary intervention that combines cancer-specific medical education and behavioral pain treatment. We evaluated the intervention's preliminary feasibility and acceptability for patients with cancer-related pain. Adults with cancer-related pain (≥ 4/10, average pain) who are receiving cancer treatment (< 3 months) self-enrolled or were recruited from the Stephenson Cancer Center (SCC) in Oklahoma. Patients completed a baseline survey and attended the 90-min group-based, Zoom-delivered telehealth intervention. They completed post-intervention, 2-week, and 4-week follow-up assessments and an optional debriefing interview. The feasibility benchmark was ≥ 70% attendance and 80% of acceptability items rated ≥ 4/5. Seventy participants (67.5% female; mean age = 52.5 years; 25% rural-dwelling) enrolled. Forty of 70 (57%) attended the intervention. Of those, 95% completed the post-intervention survey, and 90% and 95% completed the 2-week and 4-week follow-ups, respectively. Participants reported high acceptability, understandability (97%), and relevance (90%). Most (80%) would recommend the class to others. Qualitative feedback highlighted reduced helplessness and fear regarding opioid use, adoption of behavioral pain management strategies, and appreciation for the convenience of telehealth. Exploratory analyses showed significant reductions in pain intensity (mean difference [MD] = 1.27, p = 0.001), pain interference (MD = 5.48, p = 0.017), pain catastrophizing (MD = 6.0, p = 0.003), sleep disturbance (MD = 3.64, p = 0.004), and depression (MD = 3.97, p = 0.018) at 4 weeks. While attendance was below feasibility benchmarks, this interdisciplinary, telehealth intervention was acceptable and improved self-reported cancer pain management. Further research will identify barriers to improve attendance, and determine the optimal timing within the cancer trajectory to deliver pain self-management content. Randomized controlled trials are needed to assess intervention efficacy on patient outcomes.

Effectiveness of Self-administered High Frequency pocket TENS in pain intensity, and workability among university students with Primary Dysmenorrhea – A quasi-experimental study design

Background: Primary Dysmenorrhea (PD) is a painful condition affecting women of childbearing age, often hindering daily tasks. In Physical Therapy, Transcutaneous Electrical Nerve Stimulation (TENS) is widely used to relieve pain without side effects. Our study assesses the effectiveness of self-administered high-frequency pocket TENS (HF TENS) in reducing pain and enhancing workability among university students with PD in Jazan, Saudi Arabia. Methods: A quasi-experimental study involving 51 female university students was conducted. Participants received HF TENS with a pulse frequency of 100Hz for 30 minutes from day 1 to day 3 of their menstrual cycle. Pain intensity was assessed using the Numerical Pain Rating Scale (NPRS) for lower abdomen pain (LAP) and low back pain (LBP). The Workability, Location, Intensity, Days of Pain, and Dysmenorrhea (WaLIDD) score was used to determine dysmenorrhea severity. Pre-intervention and post-intervention assessments were conducted on day 1 and day 3 of the menstrual cycle, respectively. Results: The Wilcoxon signed-rank test revealed a significant reduction in pain intensity for both LAP (Median pre-6; post-1) and LBP (Median pre-5; post-1) following HF TENS application (p &lt; 0.001). Similarly, a significant improvement in dysmenorrhea severity was observed (p &lt; 0.001). Fisher's exact test indicated a statistically significant association between HF TENS treatment and dysmenorrhea severit. Conclusion: Self-administered HF pocket TENS application effectively reduces pain intensity and improves workability among university students with PD in Jazan, Saudi Arabia.

Pain intensity in patients using extended-release naltrexone or opioid agonists and its effect on extended-release naltrexone treatment outcomes.

Extended-release naltrexone (XR-NTX) is an opioid antagonist effective for treating opioid use disorder (OUD). However, concerns about inadequate pain management may limit its use. This study will examine changes in pain intensity in OUD patients choosing XR-NTX compared to opioid agonist treatment (OAT), identify subgroups with distinct pain intensity trajectories, and assess the effect of pain intensity on XR-NTX treatment outcomes (retention, relapse, opioid use, and cravings). This 24-week study included OUD patients aged 18-65 years opting for XR-NTX (n = 160). Patients receiving OAT (n = 151) served as controls. Pain intensity was measured every 4 weeks for XR-NTX and at baseline and Week 24 for OAT using the numerical pain rating scale-11 (NPRS-11). Data were analyzed with linear mixed models and group-based trajectory modeling. Between baseline and Week 24, XR-NTX participants with low to moderate pain showed a significant reduction in pain intensity, while those with high pain did not. In the OAT group, no significant reduction in pain intensity was observed (from baseline to Week 24). Pain intensity was not associated with XR-NTX treatment outcomes. Contrary to perception, XR-NTX does not worsen pain intensity, nor did pain intensity affect XR-NTX treatment outcomes. This study is the first to explore the association between changes in pain intensity and XR-NTX treatment outcomes in OUD patients over a 24-week period. The findings challenge the perception that XR-NTX is less suitable for treating OUD patients with pain.

Factors affecting recurrence of pain after surgery for chronic pancreatitis: A retrospective and prospective study.

Postoperative pain recurrence is a challenging issue in chronic pancreatitis (CP). This study explores the incidence and factors contributing to recurrent pain after surgery. An ambispective observational study evaluated patients with painful CP undergoing surgery from 2011 to 2022. The intensity frequency consequence (IFC) pain score and the painDETECT questionnaire were utilized to assess pain before and after surgery. Patients were categorized into 2 groups based on their IFC pain scores: a pain group and a pain-free group. Clinical, radiological, surgical, and post-surgical parameters were compared between these groups using the student t-test and logistic regression for continuous and categorical variables, respectively. A p-value of < 0.05 was deemed significant. Multivariate analysis was conducted. A total of 125 patients were enrolled (pain group, 71 [56.8%]; pain-free group, 54 [43.2%]). In the pain group, 65 experienced mild and 6 experienced moderate pain. The average post-surgery pain score was significantly lower than the pre-surgery score (13.7 vs 2.5, p < 0.001). Multivariate analyses revealed that intravenous (IV) analgesics and preoperative endoscopic interventions were independent predictors of recurrent pain. The incidence of recurrent pain in CP patients post-surgery was 56.8%, with a significant reduction in pain intensity postoperatively. Patients who required preoperative IV analgesics and underwent endoscopic interventions demonstrated a higher risk of recurrent pain. Neuropathic pain was not identified as a cause of pain recurrence in this study.

Evaluating pregabalin in cancer patients with chronic neuropathic pain and depression: an observational case series

BACKGROUND Chronic neuropathic pain and depression are common and debilitating conditions in cancer patients, significantly impacting their quality of life. Pregabalin, an anticonvulsant medication, is used for neuropathic pain and may also influence depressive symptoms. This study evaluates the efficacy and safety of pregabalin on pain intensity, depression severity, and side effects in cancer patients with chronic neuropathic pain and depression. AIM To evaluate the impact of pregabalin on pain intensity, depression severity, and the safety profile in cancer patients with chronic neuropathic pain and depression. METHODS This observational case series included 10 cancer patients experiencing chronic neuropathic pain and depression. Pregabalin was administered at a starting dose of 150 mg twice daily, with adjustments based on patient tolerance and pain response up to 300 mg twice daily. Pain intensity and depression severity were assessed using the brief pain inventory (BPI) and the Hamilton depression rating scale (HDRS) at baseline, 4 weeks, and 8 weeks. Side effects were monitored using a self-reported side effect questionnaire. RESULTS Pregabalin led to a significant reduction in pain intensity and depression severity. The mean BPI score decreased from 7.8 (SD = 1.2) at baseline to 5.2 (SD = 1.4) at 4 weeks and 4.1 (SD = 1.5) at 8 weeks, representing reductions of 33.3% and 47.4%, respectively. The mean HDRS score decreased from 18.5 (SD = 4.0) at baseline to 13.2 (SD = 4.1) at 4 weeks and 9.8 (SD = 3.6) at 8 weeks, showing reductions of 28.4% and 47.0%, respectively. Side effects included dizziness (50%), drowsiness (40%), weight gain (30%), and dry mouth (20%). No severe adverse effects were reported. All patients completed the study, with 30% requiring dose adjustments. CONCLUSION Pregabalin significantly alleviates both chronic neuropathic pain and depression in cancer patients with a manageable safety profile. These findings support the use of pregabalin in this patient population, though further research with larger samples and controlled designs is warranted.

Beyond Depression: The Role of Antidepressants in Managing Chronic Temporomandibular Disorders. A Systematic Review

ABSTRACTBackgroundChronic temporomandibular disorder (TMD) pain significantly impairs quality of life and lacks universally effective treatments. Antidepressants, traditionally used for mood disorders, have shown potential in managing chronic pain conditions. This systematic review evaluates the efficacy and safety of antidepressants for chronic TMD pain management.MethodsEligibility criteria: Included randomised controlled trials (RCTs) assessing antidepressants for chronic TMD pain in adults, reporting pain reduction or functional improvement as outcomes. Information sources: Searches were conducted in MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library through April 2024. Risk of bias: The Cochrane Risk of Bias 2 tool was used to assess study quality. Synthesis of results: Narrative synthesis was performed due to heterogeneity in interventions and outcomes.ResultsIncluded studies: Seven RCTs with sample sizes ranging from 12 to 80 participants. Studies evaluated various antidepressants, including amitriptyline, duloxetine, nortriptyline, and citalopram, alone or combined with non‐pharmacological treatments. Synthesis of results: Amitriptyline and duloxetine demonstrated significant reductions in pain intensity when used in combination therapies. Functional improvements, such as increased mouth opening, were observed in some studies. Side effects, particularly with duloxetine, were more frequent than with placebo. Variability in study designs, populations, and outcome measures limited comparability. Small sample sizes, short follow‐up durations, and heterogeneity in interventions and outcomes reduced the strength of evidence.ConclusionAntidepressants, particularly when combined with non‐pharmacological treatments, may enhance pain relief and functional outcomes for chronic TMD pain. However, high‐quality, long‐term studies are needed.

Effect of Acupressure at Sanyinjiao Point 6 on pain in primary dysmenorrhea among medical students at a private institute in Karachi.

This study aimed to determine the difference in pain intensity before and after acupressure at Sanyinjiao Point 6 (SP6) in medical students with Primary Dysmenorrhea (PD). The research design was quasi-experimental adopting a single group comparing pre and post-intervention data. The study was conducted in a private medical institute in Karachi, Pakistan, from September 2022 to April 2023. To select participants, a modified menstrual symptom questionnaire was used, and to measure the pain, the Visual Analogue Scale (VAS) was used during the four months of the study. A convenient sample of 50 healthy medical students were included who suffered from PD and were not using analgesics. After taking informed written consent, in the first month, VAS scoring was done without intervention on the first three days of the menstrual cycle (MC). In the subsequent three MCs, acupressure was self-applied (after being taught by a qualified acupressurist) three times a day at acupoint SP6 for two to five minutes on both legs one by one during the first three days of each intervention MC and VAS pain scoring was done. A statistically significant reduction in pain intensity (p<0.01) was observed in post-acupressure VAS scores during the first three days of each intervention menstrual cycle. Acupressure at the SP6 point has been shown to effectively reduce pain intensity in medical students with primary dysmenorrhea. As a result, this alternative therapy can be recommended as a non-pharmacological option for pain management.

Harnessing the heat: a comprehensive review of heat therapy's role in managing lumbar pain.

Heat therapy has gained considerable attention as a noninvasive treatment for low back pain, a condition that affects a significant proportion of the world's population. This review examines the physiological mechanisms behind heat therapy, its efficacy in relieving pain, and its role in improving mobility and quality of life. By improving blood circulation, reducing muscle stiffness, and reducing inflammation, heat therapy offers promise as an alternative or complement to conventional treatments. Various methods, including heat packs and thermal pillows, have been studied for their effects on acute and chronic pain. This review highlights key findings from clinical trials and systematic analyses, demonstrating significant reductions in pain intensity and functional impairment. Despite its benefits, aspects such as patient compliance and safety remain important factors in its clinical use. Future research should focus on optimizing treatment parameters and integrating heat therapy with other rehabilitation strategies to maximize its therapeutic potential. This comprehensive review highlights the need for a broader perspective and further research on the long-term effectiveness of heat-based interventions in the treatment of low back pain.

Virtual Reality for Chronic Neuropathic Pain: Systematic Review on the Concept of "Re-Mapping" Body Representation.

Chronic neuropathic pain is a common consequence of neurological conditions, such as spinal cord injury (SCI), complex regional pain syndrome (CRPS), and phantom limb pain (PLP). These conditions are often associated with distorted body representation (BR) and altered sensory processing. Virtual Reality (VR) offers immersive, multisensory experiences that can modulate attention, recalibrate BR, and potentially alleviating pain. This systematic review aims to synthesize the existing evidence on the use of VR-based interventions for managing chronic neuropathic pain in neurological patients. It focuses on exploring how VR can influence pain perception through body re-mapping. Furthermore, this review seeks to identify gaps in current research, offering recommendations for future research directions and clinical applications. We included original research studies that examined VR interventions in neurological patients with chronic neuropathic pain, assessing outcomes related to pain reduction, improvements in body representation, or functional recovery. Exclusion criteria comprised reviews, studies on animal models, migraine-related studies, and those lacking a clear VR intervention or relevant clinical outcome data. A comprehensive literature search was performed in PubMed, Web of Science, and Scopus for studies published between January 2014 and December 2024. The methodological quality of the included studies was evaluated using the Cochrane RoB2 tool for randomized controlled trials and the ROBINS-I tool for non-randomized studies. Given the heterogeneity in study design, VR protocols, and outcome measures, a qualitative synthesis approach was adopted based on the SWiM (Synthesis Without Meta-analysis) framework. Ten studies met the inclusion criteria, comprising both randomized controlled trials and uncontrolled experimental designs. These studies focused on the application of VR in SCI (n=4), CRPS (n=4), and PLP (n=2), utilizing interventions such as immersive VR, mirror visual feedback, visuo-tactile stimulation, and virtual body illusions. Sample sizes ranged from 9 to 70 participants, with varying degrees of neurological impairment. Most studies reported significant reductions in pain intensity and improvements in embodiment and perceived body ownership. In SCI, combining VR with neuromodulation techniques enhanced analgesic effects. In CRPS, modifying the visual appearance of the affected limb improved body image and decreased pain perception. In PLP, kinaesthetic and visual feedback delivered through VR environments significantly reduced phantom limb pain and improved movement representation. Overall, the quality of evidence ranged from moderate to low, mainly due to small sample sizes, protocol heterogeneity, and risk of bias. Evidence regarding adherence to VR therapy was particularly limited. Nonetheless, VR shows strong potential as a non-invasive, patient-tailored therapeutic tool for chronic neuropathic pain. VR could provide innovative and engaging strategies to reduce pain and enhance functional outcomes in neurological populations. Future research should focus on developing standardized protocols and conducting large-scale, high-quality trials to validate its long-term efficacy and integration into routine clinical practice. This review has been registered on Prospero with the following number: CRD42024606150.

Bortezomib-induced peripheral neuropathy in patients with multiple myeloma: pain syndrome and psychopathological aspects

Background. One of the most common causes of peripheral neuropathy in multiple myeloma patients is bortezomib‑induced peripheral neuropathy (bIpN), which is clinically characterized by paresthesia, a burning sensation, numbness, and primarily pain in the limbs. This pain syndrome is often associated with the development of anxiety and depression. Aim. To study the pain syndrome associated with BIPN and determine the relationship between mental disorders and pain descriptors in patients with multiple myeloma at the completion stage of induction therapy and after autologous hematopoietic stem cell transplantation (auto‑HSCT). Materials and methods. From January 2023 to April 2024 a prospective study was conducted to examine pain and its relationship with psychopathological manifestations. The study included 48 patients (38 women and 10 men, median age 54 years) with multiple myeloma and diagnosed bIpN. pain syndrome and psychometric indicators were assessed using various validated algometric and psychometric techniques during hospitalization before auto‑HSCT and on day 100 after transplantation. Electroneuromyography was performed at the same time for an objective assessment of the studied parameters. Results. BIPN was diagnosed in 32 % of patients. pain intensity ranged from minimal to unbearable, With higher BIPN severity correlating with more vivid and diverse descriptions of the pain syndrome. pain localized in the fingers and toes predominated in 58 % of patients. The use of the pain detect questionnaire and the visual Analog Scale allowed for a detailed evaluation of changes in pain syndrome, revealing a statistically significant reduction in pain intensity 100 days after auto‑HSCT (p &lt; 0.05). A control electroneuromyography conducted 100 days after auto‑HSCT confirmedpartial or complete restoration of nerve fibers functional state. Based on the beck Anxiety and depression Inventory questionnaires completed by patients with pronounced pain syndrome, anxiety symptoms were identified in 6 cases (18 %), and depressive states in 8 cases (24 %). A study of patients’ psycho‑emotional states 100 days after auto‑HSCT showed a reduction in the frequency and severity of depressive states. However, unlike depression, anxiety persisted in the same patients. Conclusion. The conducted study, which testifies to the presence and persistence of psychoemotional disorders in a number of patients, indicates the need for a comprehensive approach to treatment, including not only pain therapy, but also psychoemotional support.

Impact of Cooling Diabetic Patients’ Fingertips Compared to Vibrating Stimulation on Pain from the Glucometer Needle: A Cross-Over Trial Study

Impact of Cooling Diabetic Patients’ Fingertips Compared to Vibrating Stimulation on Pain from the Glucometer Needle: A Cross-Over Trial Study

Effectiveness of Pilates based Exercises Versus Blood Flow Restriction Training for Improving Pain and Function in Patellofemoral Pain Syndrome

Background: Pain that originates in the adjacent soft tissues or the patellofemoral joint itself is collectively referred to as patellofemoral pain syndrome (PFPS). In order to improve muscle strength and encourage tissue adaptation without putting the body through strenuous exercise, blood flow restriction (BFR) training has become a popular and promising method. Pilates uses a combination of simple, repetitive exercises to create muscular exertion. The primary goal of the study is to compare the effectiveness of blood flow restriction training and Pilates-based exercises in reducing pain and improving function in patients suffering from patellofemoral pain syndrome. Method: Thirty patients diagnosed with patellofemoral pain were selected as observation subjects and randomly divided into two groups. The treatment period was 3 months (3 sessions/week). In this study, we conducted a comparison and analysis of the Numerical pain rating scale (NRS), Anterior knee pain scale. In this study compared and analyzed the NRS score of the knee, Anterior knee pain scale at two different time points—before treatment and after treatment. Result: After treatment, Group A experienced a significant reduction in pain intensity compared to Group B. Functional status and health-related quality of life improved dramatically in Group A following treatment compared to Group B. Conclusion: The study’s findings demonstrate that teens with PFPS can benefit from Pilates-based core strengthening exercises in a number of ways, including pain reduction, improved functional status, and improved quality of life.

Altius electrical nerve stimulation for post-amputation pain treatment: a comprehensive review.

Post-amputation pain (PAP), which includes both residual limb and phantom limb pain, affects up to 85% of amputees and severely impairs quality of life, mobility, and psychological well-being while incurring substantial healthcare costs. Conventional treatments - pharmacotherapy and neuromodulation techniques such as spinal cord stimulation and peripheral nerve stimulation - often provide inadequate relief and are associated with adverse effects like opioid dependence and systemic toxicity. The Altius High-Frequency Nerve Block System is an innovative therapeutic approach that delivers high-frequency alternating current (HFAC) directly to peripheral nerves, inducing a reversible conduction block without paresthesia. Clinical validation through the pivotal QUEST study - a multicenter, double-blind, randomized, active-sham controlled trial - has shown significant reductions in pain intensity and decreased reliance on pain medications in patients with chronic PAP. This review examines the physiological mechanisms of HFAC nerve block, outlines the development and clinical application of the Altius system, and evaluates its safety profile and broader implications for pain management. The findings suggest that the Altius system addresses a critical gap in PAP treatment, offering sustained pain relief, reduced opioid dependency, and improved quality of life for amputees.

A Prospective Randomized Trial Comparing Effectiveness of Parasagittal and Midline Epidural Steroid Injection in Patients with Lumbar Canal Stenosis Pain

Background: Low back pain (LBP) due to lumbar spinal stenosis presents a significant clinical challenge. Epidural steroid injections (ESIs) are a common treatment option; however, the optimal injection route remains debated. Objectives: To compare the clinical outcomes of parasagittal interlaminar (PIL) versus midline interlaminar (MIL) ESI in patients with LBP attributed to lumbar spinal stenosis. Methods: This prospective, randomized study included patients with LBP and lumbar stenosis. Participants were randomly assigned to receive ESI via either the PIL or MIL route. Clinical outcomes, including pain intensity (measured by the Numeric Rating Scale [NRS]) and functional disability (assessed using the Modified Oswestry Disability Index [MODQ]), were evaluated at 1- and 3-months post-injection. Results: Analysis revealed a significant reduction in pain intensity (NRS) at 3 months post-injection in the PIL group compared to the MIL group (P = 0.014). Additionally, the PIL group demonstrated significantly lower patient satisfaction scores at 3 months (P = 0.033) and higher MODQ scores at 3 months (P = 0.002) compared to the MIL group. No significant differences were observed between groups at baseline or at the 1-month follow-up for any of the assessed outcomes. Conclusions: This study suggests potential differences in efficacy between parasagittal and midline interlaminar ESIs for lumbar stenosis pain. These findings underscore the need for further research to optimize treatment strategies and improve pain management for patients with this condition.

Effect of non-invasive brain stimulation on cancer-related pain: evidence from meta-analyses of randomized controlled trials.

Cancer-related pain (CRP) is one of the most challenging disorders among cancer survivors. Non-invasive brain stimulation (NIBS) is an emerging technique for alleviating pain. Although there is evidence suggesting that NIBS can alleviate CRP, higher level evidence is still required to further substantiate its efficacy and safety. This study aimed to evaluate the efficacy of NIBS interventions for CRP via a meta-analysis. Databases such as MEDLINE, PubMed, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure were systematically searched using key terms related to pain, cancer, and NIBS. The primary outcome was pain intensity and the secondary outcome was depression. After extracting and assessing data from the included literature, we performed Meta-analysis using RevMan 5.4.1 software. The results encompassed 11 randomized controlled trials papers, involving 714 patients. The Meta-analysis findings indicated that NIBS demonstrated a significant reduction in pain intensity scores {SMD -0.72 [95% confidence interval (CI), -1.00 to -0.43], P < 0.00001}. NIBS also had a notable effect on depression [SMD -0.62 (95% CI, -0.93 to -0.31), P = 0.0004]. However, subgroup analysis revealed that one single session of NIBS did not show statistical significance in analgesic effect. Furthermore, no matter targeting the M1 and DLPFC areas, as well as using either rTMS or tDCS, resulted in significant reductions in pain intensity. NIBS exhibited a promising trend in alleviating CRP and enhancing treatment effectiveness. Nonetheless, due to limitations in the quantity and quality of the included studies, these findings warrant further validation through additional research.

Randomised control trial to compare the efficacy of traditional Thai massage and ultrasound therapy for treating plantar heel pain

BackgroundMassage is suggested to be an effective treatment for chronic plantar heel pain (PHP). There is, however, no scientific evidence to support this claim. In the present study Traditional Thai Massage (TTM) has been compared with Ultrasound therapy (US) for treating PHP.MethodsSixty PHP patients with a Myofascial Trigger Point (MTrP) present in the calf were randomly assigned to receive a 40-minute single treatment of either US or TTM. Pain Intensity (VAS), Pressure Pain Threshold (PPT), Ankle Dorsiflexion Range of Motion (DROM), and Foot Skin Temperature (FST), were measured before, immediately after, and 24 h after treatment.ResultsCompared to baseline, both groups showed a significant reduction in pain intensity immediately (CVAS) and 24 h after treatment (MVAS24) (p < 0.01), as well as a significant increase in PPT of the heel immediately after treatment (p < 0.05). However, only the US treatment group showed an increase in PPT in the calf immediately after treatment (p < 0.05). Furthermore, only the US group showed a significant increase in DROM immediately and 24 h after treatment (p < 0.001). The reduction in CVAS and increase in DROM immediately (p < 0.05) and 24 h after treatment (p < 0.01) were significantly greater in the US than the TTM group.ConclusionsThe significant efficacy of US with stretching for providing pain relief in the treatment of PHP is confirmed. For the first time, TTM has also been demonstrated to be effective in providing pain relief for patients with PHP and may have a potentially useful complementary role, in treating PHP.Trial registrationTCTR20210909001 (First Submitted Date: September 2021).

Systematic review and meta-analysis of conventional medical management in a patient population with refractory chronic pain suitable to receive a spinal cord stimulation system.

The aim of this review was to systematically identify all evidence that used conventional medical management (CMM) as a comparator in randomised controlled trials (RCTs) of spinal cord stimulation (SCS) therapy, and to conduct a meta-analysis to investigate if continued CMM provides statistical or clinically meaningful pain relief and whether CMM effects have improved over the last few decades. Databases were searched from inception to June 2024 for RCTs that compared SCS to CMM. The primary outcome of the review was absolute change in pain intensity from baseline to the last available follow-up in the CMM group, measured using a visual analogue scale or numerical rating scale. The measure of treatment effect for absolute change and percentage change in pain intensity from baseline was mean difference (MD) and 95% confidence interval (CI). Risk of bias (RoB) was assessed by using the revised Cochrane RoB tool. The protocol for this review is registered on PROSPERO (CRD42023449215). Meta-analysis of absolute change in pain intensity from baseline to last follow-up shows that CMM is not associated with any significant reductions in pain intensity (MD -0.11; 95% CI: -0.32 to 0.11; moderate certainty). Similar results were observed for percent change in pain intensity from baseline to last follow-up (MD -3.22%; 95% CI: -12.59% to 6.14%; moderate certainty). No significant differences were observed when considering decade of publication of the RCT for absolute (p = 0.065; moderate certainty) or percent change in pain intensity (p = 0.524; moderate certainty). Meta-analysis for 6-month follow-up and sensitivity analysis shows similar numerical results. Our findings show that continued CMM for a population eligible for SCS does not provide meaningful pain relief and has not considerably changed over the last few decades. The use of CMM as the control to evaluate relative SCS treatment effects should be reassessed.