In a recent study published in Science Translational Medicine,Jiang et al.uncovered a novel contribution of sensory neuron-derived follistatin(FST)to neuropathic pain by which FST,generated from A-fiber neurons,promot...In a recent study published in Science Translational Medicine,Jiang et al.uncovered a novel contribution of sensory neuron-derived follistatin(FST)to neuropathic pain by which FST,generated from A-fiber neurons,promotes Nav 1.7-mediated noceptive neuronal excitability via binding to the insulin-like growth factor 1 receptor(IGF1R),making it a potential therapeutic target for neuropathic pain(Fig.1A,B)[1].展开更多
Nerve trauma commonly results in chronic neuropathic pain. This is by triggering the release of proinflammatory mediators from local and invading cells that induce inflammation and nociceptive neuron hyperexcitability...Nerve trauma commonly results in chronic neuropathic pain. This is by triggering the release of proinflammatory mediators from local and invading cells that induce inflammation and nociceptive neuron hyperexcitability. Even without apparent inflammation, injury sites are associated with increased inflammatory markers. This review focuses on how it might be possible to reduce neuropathic pain by reducing inflammation. Physiologically, pain is resolved by a combination of the out-migration of pro-inflammatory cells from the injury site, the down-regulation of the genes underlying the inflammation, up-regulating genes for anti-inflammatory mediators, and reducing nociceptive neuron hyperexcitability. While various techniques reduce chronic neuropathic pain, the best are effective on < 50% of patients, no technique reliably or permanently eliminates neuropathic pain. This is because most techniques are predominantly aimed at reducing pain, not inflammation. In addition, while single factors reduce pain, increasing evidence indicates significant and longer-lasting pain relief requires multiple factors acting simultaneously. Therefore, it is not surprising that extensive data indicate that the application of platelet-rich plasma provides more significant and longer-lasting pain suppression than other techniques, although its analgesia is neither complete nor permanent. However, several case reports indicate that platelet-rich plasma can induce permanent neuropathic pain elimination when the platelet concentration is significantly increased and is applied to longer nerve lengths. This review examines the primary triggers of the development and maintenance of neuropathic pain and techniques that reduce chronic neuropathic pain. The application of plateletrich plasma holds great promise for providing complete and permanent chronic neuropathic pain elimination.展开更多
Sleep is an indispensable part of life−its deficiency has significant implications for overall health and wellbeing[1].In today’s fast-paced society,sleep loss from either stressful or non-stressful origins has becom...Sleep is an indispensable part of life−its deficiency has significant implications for overall health and wellbeing[1].In today’s fast-paced society,sleep loss from either stressful or non-stressful origins has become prevalent.Specifically,active sleep deprivation(ASD),resulting from extended use of smartphones and other recreational activities,has risen as a global health issue.Clinical research has underscored a strong correlation between chronic pain and inadequate sleep[2].The relationship between pain and sleep is reciprocal:pain disturbs sleep,while poor sleep quality,in turn,reduces pain tolerance and exacerbates spontaneous pain sensations[3].While these interplays are well-documented in cases of passive sleep deprivation(PSD)associated with external pressures or illnesses,understanding how and which regions of the brain collaborate to recalibrate the intricate neural circuitry governing pain perception during ASD remains a crucial yet unresolved frontier.展开更多
Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics cl...Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures.Step 1:A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion(DRG)and the spinal nerve,a common cause of low back pain(LBP).Step 2:The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw,followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients.The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy.However,rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw,impaired gait,and reduced spontaneous exploration activity,indicating CPSS.Patch clamp recording revealed a significant augmentation in the intrinsic excitability of smalldiameter DRG neurons in CPSS rats.Administration of Dermorphin[D-Arg2,Lys4](1–4)amide(DALDA,5mg/kg,i.p.),a peripherally acting mu-opioid receptor(MOR)-preferred agonist,attenuated pain hypersensitivity,capsaicin-induced[Ca^(2+)]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats.Our findings suggest that this new model,which mirrors the nature of CPSS developed in patients,may be useful for future studies of the underlying mechanisms.展开更多
Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interac...Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interacts with various receptors in the human body, including CD44, LYVE-1, RHAMM, and TLR2, and is well-known for its analgesic effects when used in intra-articular or ultrasound-guided nerve trunk injections. Studies have shown that hyaluronidase cleaves high molecular weight HA to generate HA35, a low molecular weight fragment with enhanced tissue permeability, capable of binding to HA receptors on cell surfaces to produce broad-spectrum analgesic effects. Methods: Ten patients diagnosed with MPS were treated and assessed in this study. HA35 was administered through injection at a dosage of 100 mg daily for 15 days. Patients evaluated their MPS, overall pain levels, and treatment satisfaction using the Numerical Pain Rating Scale (NPRS), the Global Pain Scale (GPS), and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Follow-up evaluations were performed three months post-treatment to assess the duration of therapeutic effects. Results: Significant improvements were observed in NPRS, GPS, and TSQM scores both during and after the treatment period (P Conclusions: HA35 provides effective and sustained relief from pain associated with MPS, demonstrating a prolonged therapeutic benefit.展开更多
In this editorial,we comment on the article by Nagamine et al,published in the World Journal of Clinical Cases.The authors suggest that virtual reality technology has potential in alleviating pain by enhancing brain n...In this editorial,we comment on the article by Nagamine et al,published in the World Journal of Clinical Cases.The authors suggest that virtual reality technology has potential in alleviating pain by enhancing brain network functionality.Alongside virtual reality,various treatment methods are used to effectively manage musculoskeletal pain.One such method is the use of orthoses,which are applied in clinical settings.We emphasize the need for collaboration between pain physicians and orthotists when applying orthoses for pain management.The efficacy of orthoses is maximized when customized to the physical characteristics of each patient,type of disease,and location of pain.Orthoses are designed to restore anatomical alignment and biomechanical function;however,their success depends on the expertise of trained orthotists,who should effectively communicate with physicians and understand the mechanical principles of musculoskeletal alignment.The professional knowledge of orthotists is critical in ensuring that orthoses are appropriately designed and applied to achieve therapeutic efficacy.Since no single treatment modality typically offers sufficient relief for musculoskeletal pain,effective collaboration between pain physicians and orthotists is crucial to optimize the use of orthoses in the management of pain.展开更多
Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effectiv...Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effective MBTs for improving CRP in this population remain unknown.Therefore,this network meta-analysis(NMA)aimed to assess and rank the relative efficacy of different MBTs for CRP,and to conduct subgroup analyses according to different cancer types and stages of treatment.Content:Eight electronic databases were searched for randomized controlled trials(RCTs)that compared differentMBTs to improve pain in adults living with cancer.RCTs were evaluated using the Cochrane risk of bias tool.A random effects network meta-analysis was performed within a frequentist framework.Of the 4,916 articles retrieved and screened against the selection criteria.36 studies with a total 2,387 participants were eligible to be included in the analysis.Qigong demonstrated significantly greater effects than Usual care(standardized mean difference[SMD]-0.85,95% confidence interval[CI]-1.46 to -0.24),Waitlist(SMD−0.93,-1.77 to -0.08),and Massage(SMD-1.71,-3.20 to -0.23),with the highest surface under the cumulative ranking value of 86.5%,was ranked first.It was preceded by Conventional exercise(75.2%),Taichi(74.9%),with Massage having the lowest rank(7.2%).In a subgroup analysis of breast cancer,Taichi(89.6%),Conventional exercise(68.4%),and Pilates(68.3%)ranked as the top three.Summary and outlook:This network meta-analysis indicates that Qigong and Tai Chi are among the most effective mind–body therapies(MBTs)for managing cancer-related pain and may serve as complementary adjuvant treatments for patients with cancer.展开更多
Chronic pain is a leading cause of disability and affects over 30%of military veterans and active duty personnel[1].Pharmacological approaches to long-term chronic pain management increase the risk of negative effects...Chronic pain is a leading cause of disability and affects over 30%of military veterans and active duty personnel[1].Pharmacological approaches to long-term chronic pain management increase the risk of negative effects such as addiction,cardiovascular complications,and immunosuppression[2].In contrast,non-drug treatments like audio analgesia have demonstrated efficacy in pain relief without these side effects.Given the prevalence of chronic pain in the military population,it is essential to explore new treatments that effectively target its underlying mechanisms.One promising option is the Pannexin 1(Panx1)channel-forming protein.Panx1 is a large-pore ion channel in the plasma membrane of dorsal root ganglion(DRG)neurons that allows for the release of Adenosine triphosphate(ATP).Th is commentary elaborates on the fi ndings of Xing et al.[3],who investigated the role of Panx1 in peripheral pain sensitization following infl ammatory stimuli.We examine the role of Panx1 in chronic pain,critique Xing et al.’s[3]adjuvant selection and power analysis,and discuss the challenges of translating fi ndings from animal models to human conditions.展开更多
Pain has been traditionally understood as a complex phenomenon involving various dimensions,including physical,sensory,cognitive,and emotional aspects,resulting in unpleasant sensations and affective responses.Individ...Pain has been traditionally understood as a complex phenomenon involving various dimensions,including physical,sensory,cognitive,and emotional aspects,resulting in unpleasant sensations and affective responses.Individual responses to pain can vary significantly,even when individuals are exposed to similar nociceptive stimuli or clinical conditions,with some individuals experiencing intense pain and others experiencing milder levels,suggesting the presence of pain resilience.Although recent advances in pain research have focused on susceptibility,the occurrence of pain,and related pathological mechanisms,there remains a dearth of comprehensive analysis of the neural mechanisms that underlie pain resilience,although peripheral mechanisms have begun to be revealed.展开更多
Objective:To explore the clinical effect of multimodal nursing intervention on postoperative pain management in patients undergoing gastrointestinal surgery.Methods:A total of 120 patients who underwent gastrointestin...Objective:To explore the clinical effect of multimodal nursing intervention on postoperative pain management in patients undergoing gastrointestinal surgery.Methods:A total of 120 patients who underwent gastrointestinal surgery in our hospital from January 2023 to January 2024 were selected as the research subjects.They were randomly divided into the intervention group and the control group,with 60 cases in each group.The control group received routine postoperative care,while the intervention group received multimodal pain care intervention.The postoperative pain scores,the rate of using analgesic drugs,postoperative recovery indicators,and nursing satisfaction were compared between the two groups.Results:At 24 hours,48 hours,and 72 hours after surgery,the VAS pain scores of the intervention group were significantly lower than those of the control group(p<0.05);the rate of using analgesic drugs in the intervention group(25.0%)was significantly lower than that in the control group(48.3%)(p<0.05);the first defecation time,first ambulation time,and hospital stay of the intervention group were shorter than those of the control group(p<0.05);the nursing satisfaction of the intervention group(96.7%)was significantly higher than that of the control group(80.0%)(p<0.05).Conclusion:Multimodal pain care intervention can effectively relieve postoperative pain in patients undergoing gastrointestinal surgery,reduce the use of analgesic drugs,promote postoperative recovery,and improve nursing satisfaction.展开更多
BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverage...BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverages the complementary mechanisms of action,providing more effective relief for conditions such as arthritis,muscle spasms,and soft tissue injuries.AIM To evaluate the comparative efficacy of the combination therapy of TCC and NSAIDs vs NSAID monotherapy in pain management.METHODS A systematic search of PubMed and Google Scholar databases through October 2024 was performed to evaluate the effectiveness of combined TCC and NSAID therapy vs NSAIDs alone.A retrospective analysis of electronic medical records from India spanning 3 years(2020-2023)examined treatment patterns and focused on clinical outcomes including pain relief,functional improvement,and adverse effects.Key metrics for assessment included visual analog scale scores and hand-to-floor distance,with secondary outcomes assessing patient satisfaction and adverse event(AE)incidence.RESULTS A systematic literature search revealed seven studies,involving 1137 subjects,aligning with the eligibility criteria from a total of 833 hits.Combination therapy using parenteral TCC with NSAIDs significantly reduced pain intensity[standardised mean difference(SMD):-1.33,P<0.001]and enhanced functional improvement(SMD:-1.08,P<0.001)compared to NSAIDs alone.Patients on combination therapy are 6.7 times more likely to experience over 30%pain relief and 5.2 times more likely to achieve over 50%pain relief.Post surgery pain reduction and patient satisfaction were notably higher in the combination group[odds ratio(OR)=10.14,P<0.001].There were no significant differences in mild/moderate AE rates between the groups(OR=1.30,P=0.378).CONCLUSION Evidence indicates that multimodal therapy,including parenteral TCC with NSAIDs,provides quicker and effective pain relief,reduces muscle spasms,and improves hand-to-floor distance compared to using NSAIDs or TCC alone.展开更多
Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to correspondi...Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to corresponding improvements in balance control.Methods:Randomized controlled trials were identified from 5 databases(MEDLINE,Cochrane Library,Embase,Web of Science,and PsycINFO).Two reviewers independently screened and identified relevant studies that investigated the effects of non-surgical or non-pharmacological CNSLBP treatments on both pain intensity and balance control.Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables.Results:Thirty one studies involving 1280 participants with CNSLBP were included.Moderate-quality evidence suggested that pain reduction was associated with and explained 34%-45%of decreases in body sway,as measured by center-of-pressure(CoP)area and CoP velocity with eyes open.However,no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions.Similarly,there was no significant association between pain reduction and CoP distance or radius.Low-quality evidence indicated that pain relief explained a 15%improvement in one-leg stance with eyes open but not in the eyes-closed condition.Additionally,very low-quality evidence suggested that pain relief explained a 44%decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open,mediolateral,or overall conditions.Furthermore,low-quality evidence indicated that reduced pain was associated with and accounted for 25%-43%of the improved composite and posteromedial scores of the star-excursion balance test,rather than the anterior and posterolateral scores.Conclusion:Depending on the type of balance assessment,pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP.Clinicians should pay close attention to the balance control in patients with CNSLBP,particularly among older adults.展开更多
The somatotopic representation of specific body parts is a well-established spatial organizational principle in the primary somatosensory and motor cortices.
Pain is a subjective and unpleasant sensation that significantly impacts the daily lives of individuals.Chronic pain represents one of the most challenging public health issues,and ensuring effective pain management i...Pain is a subjective and unpleasant sensation that significantly impacts the daily lives of individuals.Chronic pain represents one of the most challenging public health issues,and ensuring effective pain management is a fundamental right of individuals and a sacred duty of healthcare providers.Cannabis,one of the earliest recognized medicinal plants,contains cannabinoids,which are non-opioid substances that modulate nociceptive responses.Electroacupuncture(EA),characterized by its low-risk and well-tolerated nature,is pivotal in pain management.The endocannabinoid system consists of endocannabinoids,cannabinoid receptors,and enzymes involved in endocannabinoid synthesis,degradation,and transport.Recently,the role of the endocannabinoid system in pain development and EA analgesia has attracted considerable research attention.Studies have highlighted the role of the endocannabinoid system in various types of pain,including inflammatory pain,neuropathic pain,and cancer-related pain,as well as in EA analgesia.This study aims to review the mechanisms of endocannabinoid system involvement in pain modulation and EA analgesia to provide insights to inform clinical approaches to pain management.展开更多
Objective:To conduct a scoping review on the application status of the Functional Activity Score(FAS)in postoperative active pain management in China,providing a reference for its standardized and normative promotion....Objective:To conduct a scoping review on the application status of the Functional Activity Score(FAS)in postoperative active pain management in China,providing a reference for its standardized and normative promotion.Methods:Computerized searches of Chinese and English databases were performed to collect studies published by Chinese scholars from 2005 to July 2025 on the application of FAS in postoperative active pain management.After strict screening,the basic characteristics,application fields,assessment models,evaluation timing,types of functional activities,and clinical outcomes of the included literature were systematically analyzed.Results:A total of 18 studies were included,involving surgical types such as thoracic surgery,general surgery,and orthopedics.All studies adopted FAS combined with the Numeric Rating Scale(NRS)for assessment,with evaluation timing mostly concentrated within 72 hours postoperatively.The selected functional activities primarily included respiration-related and limb movements.Evaluation indicators covered pain control,functional recovery,complications,adverse events,patient experience,and tool assessment,with most studies reporting positive outcomes.Conclusion:FAS can effectively enhance pain control and promote functional recovery in postoperative active pain management in China,demonstrating high clinical value.However,existing studies exhibit inconsistencies in assessment criteria,selection of activity types,and research quality.展开更多
In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage ...In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage gastrointestinal tumors.The study undertakes a retrospective analysis comparing traditional opioid therapy to an integrated approach of hyperthermia and opioids across 70 patients,highlighting significant benefits in pain control,reduction of opioid dosage,and minimization of adverse reactions.In our article,we not only discuss these fin-dings but also emphasize the broader implications for clinical practice,parti-cularly in enhancing patient outcomes through innovative pain management strategies.We advocate for further research to establish more robust data su-pporting this approach and to explore the mechanistic insights that enable these benefits.This discussion reflects on the potential paradigm shift in managing debilitating cancer-related pain,urging a reevaluation of current practices to incorporate these findings effectively.展开更多
In this editorial,we comment on the article published in a recent issue of the World Journal of Orthopedics.Although substantial literature regarding pain management of acute musculoskeletal injury has been published ...In this editorial,we comment on the article published in a recent issue of the World Journal of Orthopedics.Although substantial literature regarding pain management of acute musculoskeletal injury has been published over the last three decades,there is still a lack of evidence-based protocol for individual and population disparities.This systematic review gives us a comprehensive view of the evidence-based use of opioid vs opioid-free analgesia.Nevertheless,there is still a need for further investigation at a high level regarding this topic.展开更多
Chronic lower back pain(LBP)is the leading cause of disability worldwide.Due to its close relationship with intervertebral disc(IVD)degeneration(IVDD),research has historically focused more on understanding the mechan...Chronic lower back pain(LBP)is the leading cause of disability worldwide.Due to its close relationship with intervertebral disc(IVD)degeneration(IVDD),research has historically focused more on understanding the mechanism behind IVDD while clinical efforts prioritize pain management.More recently,there has been a shift toward understanding LBP as a distinct pathological entity.This review synthesizes current knowledge on discogenic LBP,combining known pathophysiology,molecular mechanisms,risk factors,diagnostic challenges,and available experimental models.IVDD is a complex,multifactorial process involving biochemical,mechanical,and inflammatory changes within the disc,leading to structural breakdown and potential discogenic pain.Key mechanisms include extracellular matrix degradation,upregulation of inflammatory mediators,immune cell infiltration,and aberrant nerve and vascular ingrowth.However,not all cases of IVDD result in LBP,highlighting the need for further investigation into the cellular,molecular,and biomechanical factors contributing to symptom development.Current diagnostic tools and experimental models for studying discogenic LBP remain limited,impeding the development of targeted treatments.Existing therapies primarily focus on symptom management rather than addressing underlying disease mechanisms.展开更多
The present paper addresses two issues pertaining to the use of virtual reality(VR).One issue pertains to the equipment utilized.VR technology can be classified into two main categories:Immersive and non-immersive.The...The present paper addresses two issues pertaining to the use of virtual reality(VR).One issue pertains to the equipment utilized.VR technology can be classified into two main categories:Immersive and non-immersive.The immersive type of technology necessitates the use of substantial equipment,yet it is demonstrably efficacious.Furthermore,the efficacy of this approach is enhanced when combined with relaxation and biofeedback techniques.The other issue is that the efficacy of this approach is diminished when applied to chronic pain,in comparison to acute pain.The relief of chronic pain is a challenging endeavor due to the diminished functionality of the medial prefrontal cortex(mPFC)within the default mode network.Given the close relationship between the mPFC and the reward system dopamine,it is essential to develop a program that activates the reward system dopamine through the use of VR technology.展开更多
BACKGROUND Hepatic artery infusion chemotherapy(HAIC)is a widely used local therapeutic approach for intermediate to advanced-stage hepatocellular carcinoma(HCC),exhibiting considerable efficacy.However,the prevalence...BACKGROUND Hepatic artery infusion chemotherapy(HAIC)is a widely used local therapeutic approach for intermediate to advanced-stage hepatocellular carcinoma(HCC),exhibiting considerable efficacy.However,the prevalence of postoperative pain highlights the importance of pain management.Owing to the limitations inherent in existing pain management strategies,this study investigates and assesses the analgesic effectiveness of a multimodal treatment protocol in mitigating pain after HAIC procedures.AIM To provide patients with a more comprehensive and effective pain management strategy.METHODS A total of 100 patients with primary HCC who underwent HAIC were randomly assigned to a control group(n=50)and a multimodal group(n=50).Baseline characteristics and perioperative data were collected.Upon enrollment,patients in the multimodal group received parecoxib(40 mg)30 minutes before HAIC,followed by 48 hours of patient-controlled analgesia with sufentanil.In contrast,the control group underwent standard preoperative preparation(psychological support)and received dezocine(5 mg)intraoperatively,with intravenous flurbiprofen(100 mg)administered every 12 hours for 48 hours postoperatively.RESULTS Compared to the control group,the multimodal analgesia group exhibited significantly lower resting and movement visual analog scale pain scores at postoperative 0,2,4,6,and 12 hours(P<0.05).Furthermore,the multimodal group experienced a reduced incidence of postoperative nausea and vomiting,as well as a lower overall frequency of adverse events,compared to the control group(P<0.05).Patient satisfaction was also significantly higher in the multimodal group than in the control group(P<0.05).CONCLUSION Our study demonstrates that multimodal analgesia is effective in reducing postoperative pain,minimizing adverse reactions,and improving patient satisfaction in HCC patients undergoing HAIC.This approach provides valuable clinical strategies for optimizing pain management in this patient population.展开更多
基金supported by the National Natural Science Foundation of China(82474625)Zhejiang Provincial Natural Science Funds(LZ23H270001).
文摘In a recent study published in Science Translational Medicine,Jiang et al.uncovered a novel contribution of sensory neuron-derived follistatin(FST)to neuropathic pain by which FST,generated from A-fiber neurons,promotes Nav 1.7-mediated noceptive neuronal excitability via binding to the insulin-like growth factor 1 receptor(IGF1R),making it a potential therapeutic target for neuropathic pain(Fig.1A,B)[1].
文摘Nerve trauma commonly results in chronic neuropathic pain. This is by triggering the release of proinflammatory mediators from local and invading cells that induce inflammation and nociceptive neuron hyperexcitability. Even without apparent inflammation, injury sites are associated with increased inflammatory markers. This review focuses on how it might be possible to reduce neuropathic pain by reducing inflammation. Physiologically, pain is resolved by a combination of the out-migration of pro-inflammatory cells from the injury site, the down-regulation of the genes underlying the inflammation, up-regulating genes for anti-inflammatory mediators, and reducing nociceptive neuron hyperexcitability. While various techniques reduce chronic neuropathic pain, the best are effective on < 50% of patients, no technique reliably or permanently eliminates neuropathic pain. This is because most techniques are predominantly aimed at reducing pain, not inflammation. In addition, while single factors reduce pain, increasing evidence indicates significant and longer-lasting pain relief requires multiple factors acting simultaneously. Therefore, it is not surprising that extensive data indicate that the application of platelet-rich plasma provides more significant and longer-lasting pain suppression than other techniques, although its analgesia is neither complete nor permanent. However, several case reports indicate that platelet-rich plasma can induce permanent neuropathic pain elimination when the platelet concentration is significantly increased and is applied to longer nerve lengths. This review examines the primary triggers of the development and maintenance of neuropathic pain and techniques that reduce chronic neuropathic pain. The application of plateletrich plasma holds great promise for providing complete and permanent chronic neuropathic pain elimination.
基金supported by the National Natural Science Foundation of China(U21A20418).
文摘Sleep is an indispensable part of life−its deficiency has significant implications for overall health and wellbeing[1].In today’s fast-paced society,sleep loss from either stressful or non-stressful origins has become prevalent.Specifically,active sleep deprivation(ASD),resulting from extended use of smartphones and other recreational activities,has risen as a global health issue.Clinical research has underscored a strong correlation between chronic pain and inadequate sleep[2].The relationship between pain and sleep is reciprocal:pain disturbs sleep,while poor sleep quality,in turn,reduces pain tolerance and exacerbates spontaneous pain sensations[3].While these interplays are well-documented in cases of passive sleep deprivation(PSD)associated with external pressures or illnesses,understanding how and which regions of the brain collaborate to recalibrate the intricate neural circuitry governing pain perception during ASD remains a crucial yet unresolved frontier.
基金supported by the Neurosurgery Pain Research Institute at Johns Hopkins University and by the Lehner Family Foundation.
文摘Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures.Step 1:A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion(DRG)and the spinal nerve,a common cause of low back pain(LBP).Step 2:The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw,followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients.The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy.However,rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw,impaired gait,and reduced spontaneous exploration activity,indicating CPSS.Patch clamp recording revealed a significant augmentation in the intrinsic excitability of smalldiameter DRG neurons in CPSS rats.Administration of Dermorphin[D-Arg2,Lys4](1–4)amide(DALDA,5mg/kg,i.p.),a peripherally acting mu-opioid receptor(MOR)-preferred agonist,attenuated pain hypersensitivity,capsaicin-induced[Ca^(2+)]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats.Our findings suggest that this new model,which mirrors the nature of CPSS developed in patients,may be useful for future studies of the underlying mechanisms.
文摘Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interacts with various receptors in the human body, including CD44, LYVE-1, RHAMM, and TLR2, and is well-known for its analgesic effects when used in intra-articular or ultrasound-guided nerve trunk injections. Studies have shown that hyaluronidase cleaves high molecular weight HA to generate HA35, a low molecular weight fragment with enhanced tissue permeability, capable of binding to HA receptors on cell surfaces to produce broad-spectrum analgesic effects. Methods: Ten patients diagnosed with MPS were treated and assessed in this study. HA35 was administered through injection at a dosage of 100 mg daily for 15 days. Patients evaluated their MPS, overall pain levels, and treatment satisfaction using the Numerical Pain Rating Scale (NPRS), the Global Pain Scale (GPS), and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Follow-up evaluations were performed three months post-treatment to assess the duration of therapeutic effects. Results: Significant improvements were observed in NPRS, GPS, and TSQM scores both during and after the treatment period (P Conclusions: HA35 provides effective and sustained relief from pain associated with MPS, demonstrating a prolonged therapeutic benefit.
文摘In this editorial,we comment on the article by Nagamine et al,published in the World Journal of Clinical Cases.The authors suggest that virtual reality technology has potential in alleviating pain by enhancing brain network functionality.Alongside virtual reality,various treatment methods are used to effectively manage musculoskeletal pain.One such method is the use of orthoses,which are applied in clinical settings.We emphasize the need for collaboration between pain physicians and orthotists when applying orthoses for pain management.The efficacy of orthoses is maximized when customized to the physical characteristics of each patient,type of disease,and location of pain.Orthoses are designed to restore anatomical alignment and biomechanical function;however,their success depends on the expertise of trained orthotists,who should effectively communicate with physicians and understand the mechanical principles of musculoskeletal alignment.The professional knowledge of orthotists is critical in ensuring that orthoses are appropriately designed and applied to achieve therapeutic efficacy.Since no single treatment modality typically offers sufficient relief for musculoskeletal pain,effective collaboration between pain physicians and orthotists is crucial to optimize the use of orthoses in the management of pain.
基金supported by the program of Guangdong Provincial Clinical Research Center for Rehabilitation Medicine(2023B110003)the Research Foundation of Traditional Chinese Medicine Bureau of Guangdong Province(20231,067)the Guangdong Hopson-Pearl River Education Development Foundation(No.H20190116202012724).
文摘Introduction:Current international guidelines encourage cancer patients to engage in physical activity and recommend mind-body therapies(MBTs)as a method for treating cancer-related pain(CRP).However,the most effective MBTs for improving CRP in this population remain unknown.Therefore,this network meta-analysis(NMA)aimed to assess and rank the relative efficacy of different MBTs for CRP,and to conduct subgroup analyses according to different cancer types and stages of treatment.Content:Eight electronic databases were searched for randomized controlled trials(RCTs)that compared differentMBTs to improve pain in adults living with cancer.RCTs were evaluated using the Cochrane risk of bias tool.A random effects network meta-analysis was performed within a frequentist framework.Of the 4,916 articles retrieved and screened against the selection criteria.36 studies with a total 2,387 participants were eligible to be included in the analysis.Qigong demonstrated significantly greater effects than Usual care(standardized mean difference[SMD]-0.85,95% confidence interval[CI]-1.46 to -0.24),Waitlist(SMD−0.93,-1.77 to -0.08),and Massage(SMD-1.71,-3.20 to -0.23),with the highest surface under the cumulative ranking value of 86.5%,was ranked first.It was preceded by Conventional exercise(75.2%),Taichi(74.9%),with Massage having the lowest rank(7.2%).In a subgroup analysis of breast cancer,Taichi(89.6%),Conventional exercise(68.4%),and Pilates(68.3%)ranked as the top three.Summary and outlook:This network meta-analysis indicates that Qigong and Tai Chi are among the most effective mind–body therapies(MBTs)for managing cancer-related pain and may serve as complementary adjuvant treatments for patients with cancer.
基金supported by the Office of Naval Research Grant(N00014-22-1-2184).
文摘Chronic pain is a leading cause of disability and affects over 30%of military veterans and active duty personnel[1].Pharmacological approaches to long-term chronic pain management increase the risk of negative effects such as addiction,cardiovascular complications,and immunosuppression[2].In contrast,non-drug treatments like audio analgesia have demonstrated efficacy in pain relief without these side effects.Given the prevalence of chronic pain in the military population,it is essential to explore new treatments that effectively target its underlying mechanisms.One promising option is the Pannexin 1(Panx1)channel-forming protein.Panx1 is a large-pore ion channel in the plasma membrane of dorsal root ganglion(DRG)neurons that allows for the release of Adenosine triphosphate(ATP).Th is commentary elaborates on the fi ndings of Xing et al.[3],who investigated the role of Panx1 in peripheral pain sensitization following infl ammatory stimuli.We examine the role of Panx1 in chronic pain,critique Xing et al.’s[3]adjuvant selection and power analysis,and discuss the challenges of translating fi ndings from animal models to human conditions.
基金supported by grants from the National Natural Science Foundation of China(82304459).
文摘Pain has been traditionally understood as a complex phenomenon involving various dimensions,including physical,sensory,cognitive,and emotional aspects,resulting in unpleasant sensations and affective responses.Individual responses to pain can vary significantly,even when individuals are exposed to similar nociceptive stimuli or clinical conditions,with some individuals experiencing intense pain and others experiencing milder levels,suggesting the presence of pain resilience.Although recent advances in pain research have focused on susceptibility,the occurrence of pain,and related pathological mechanisms,there remains a dearth of comprehensive analysis of the neural mechanisms that underlie pain resilience,although peripheral mechanisms have begun to be revealed.
文摘Objective:To explore the clinical effect of multimodal nursing intervention on postoperative pain management in patients undergoing gastrointestinal surgery.Methods:A total of 120 patients who underwent gastrointestinal surgery in our hospital from January 2023 to January 2024 were selected as the research subjects.They were randomly divided into the intervention group and the control group,with 60 cases in each group.The control group received routine postoperative care,while the intervention group received multimodal pain care intervention.The postoperative pain scores,the rate of using analgesic drugs,postoperative recovery indicators,and nursing satisfaction were compared between the two groups.Results:At 24 hours,48 hours,and 72 hours after surgery,the VAS pain scores of the intervention group were significantly lower than those of the control group(p<0.05);the rate of using analgesic drugs in the intervention group(25.0%)was significantly lower than that in the control group(48.3%)(p<0.05);the first defecation time,first ambulation time,and hospital stay of the intervention group were shorter than those of the control group(p<0.05);the nursing satisfaction of the intervention group(96.7%)was significantly higher than that of the control group(80.0%)(p<0.05).Conclusion:Multimodal pain care intervention can effectively relieve postoperative pain in patients undergoing gastrointestinal surgery,reduce the use of analgesic drugs,promote postoperative recovery,and improve nursing satisfaction.
文摘BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverages the complementary mechanisms of action,providing more effective relief for conditions such as arthritis,muscle spasms,and soft tissue injuries.AIM To evaluate the comparative efficacy of the combination therapy of TCC and NSAIDs vs NSAID monotherapy in pain management.METHODS A systematic search of PubMed and Google Scholar databases through October 2024 was performed to evaluate the effectiveness of combined TCC and NSAID therapy vs NSAIDs alone.A retrospective analysis of electronic medical records from India spanning 3 years(2020-2023)examined treatment patterns and focused on clinical outcomes including pain relief,functional improvement,and adverse effects.Key metrics for assessment included visual analog scale scores and hand-to-floor distance,with secondary outcomes assessing patient satisfaction and adverse event(AE)incidence.RESULTS A systematic literature search revealed seven studies,involving 1137 subjects,aligning with the eligibility criteria from a total of 833 hits.Combination therapy using parenteral TCC with NSAIDs significantly reduced pain intensity[standardised mean difference(SMD):-1.33,P<0.001]and enhanced functional improvement(SMD:-1.08,P<0.001)compared to NSAIDs alone.Patients on combination therapy are 6.7 times more likely to experience over 30%pain relief and 5.2 times more likely to achieve over 50%pain relief.Post surgery pain reduction and patient satisfaction were notably higher in the combination group[odds ratio(OR)=10.14,P<0.001].There were no significant differences in mild/moderate AE rates between the groups(OR=1.30,P=0.378).CONCLUSION Evidence indicates that multimodal therapy,including parenteral TCC with NSAIDs,provides quicker and effective pain relief,reduces muscle spasms,and improves hand-to-floor distance compared to using NSAIDs or TCC alone.
基金supported by GP Batteries Industrial Safety Trust Fund(Funding number:R-ZDDR).
文摘Purpose:The aim of this study was to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain(CNSLBP)following conservative interventions is related to corresponding improvements in balance control.Methods:Randomized controlled trials were identified from 5 databases(MEDLINE,Cochrane Library,Embase,Web of Science,and PsycINFO).Two reviewers independently screened and identified relevant studies that investigated the effects of non-surgical or non-pharmacological CNSLBP treatments on both pain intensity and balance control.Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables.Results:Thirty one studies involving 1280 participants with CNSLBP were included.Moderate-quality evidence suggested that pain reduction was associated with and explained 34%-45%of decreases in body sway,as measured by center-of-pressure(CoP)area and CoP velocity with eyes open.However,no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions.Similarly,there was no significant association between pain reduction and CoP distance or radius.Low-quality evidence indicated that pain relief explained a 15%improvement in one-leg stance with eyes open but not in the eyes-closed condition.Additionally,very low-quality evidence suggested that pain relief explained a 44%decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open,mediolateral,or overall conditions.Furthermore,low-quality evidence indicated that reduced pain was associated with and accounted for 25%-43%of the improved composite and posteromedial scores of the star-excursion balance test,rather than the anterior and posterolateral scores.Conclusion:Depending on the type of balance assessment,pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP.Clinicians should pay close attention to the balance control in patients with CNSLBP,particularly among older adults.
文摘The somatotopic representation of specific body parts is a well-established spatial organizational principle in the primary somatosensory and motor cortices.
基金supported by the Key Program of the National Natural Science Foundation of China(82130122)the National Natural Science Foundation of China(81973949).
文摘Pain is a subjective and unpleasant sensation that significantly impacts the daily lives of individuals.Chronic pain represents one of the most challenging public health issues,and ensuring effective pain management is a fundamental right of individuals and a sacred duty of healthcare providers.Cannabis,one of the earliest recognized medicinal plants,contains cannabinoids,which are non-opioid substances that modulate nociceptive responses.Electroacupuncture(EA),characterized by its low-risk and well-tolerated nature,is pivotal in pain management.The endocannabinoid system consists of endocannabinoids,cannabinoid receptors,and enzymes involved in endocannabinoid synthesis,degradation,and transport.Recently,the role of the endocannabinoid system in pain development and EA analgesia has attracted considerable research attention.Studies have highlighted the role of the endocannabinoid system in various types of pain,including inflammatory pain,neuropathic pain,and cancer-related pain,as well as in EA analgesia.This study aims to review the mechanisms of endocannabinoid system involvement in pain modulation and EA analgesia to provide insights to inform clinical approaches to pain management.
基金School-level Educational Reform Project of Hangzhou Normal University(Project No.:HLXYJG202304)。
文摘Objective:To conduct a scoping review on the application status of the Functional Activity Score(FAS)in postoperative active pain management in China,providing a reference for its standardized and normative promotion.Methods:Computerized searches of Chinese and English databases were performed to collect studies published by Chinese scholars from 2005 to July 2025 on the application of FAS in postoperative active pain management.After strict screening,the basic characteristics,application fields,assessment models,evaluation timing,types of functional activities,and clinical outcomes of the included literature were systematically analyzed.Results:A total of 18 studies were included,involving surgical types such as thoracic surgery,general surgery,and orthopedics.All studies adopted FAS combined with the Numeric Rating Scale(NRS)for assessment,with evaluation timing mostly concentrated within 72 hours postoperatively.The selected functional activities primarily included respiration-related and limb movements.Evaluation indicators covered pain control,functional recovery,complications,adverse events,patient experience,and tool assessment,with most studies reporting positive outcomes.Conclusion:FAS can effectively enhance pain control and promote functional recovery in postoperative active pain management in China,demonstrating high clinical value.However,existing studies exhibit inconsistencies in assessment criteria,selection of activity types,and research quality.
基金Supported by the Shandong Province Medical and Health Science and Technology Development Plan Project,No.202203030713Science and Technology Program of Yantai Affiliated Hospital of Binzhou Medical University,No.YTFY2022KYQD06.
文摘In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage gastrointestinal tumors.The study undertakes a retrospective analysis comparing traditional opioid therapy to an integrated approach of hyperthermia and opioids across 70 patients,highlighting significant benefits in pain control,reduction of opioid dosage,and minimization of adverse reactions.In our article,we not only discuss these fin-dings but also emphasize the broader implications for clinical practice,parti-cularly in enhancing patient outcomes through innovative pain management strategies.We advocate for further research to establish more robust data su-pporting this approach and to explore the mechanistic insights that enable these benefits.This discussion reflects on the potential paradigm shift in managing debilitating cancer-related pain,urging a reevaluation of current practices to incorporate these findings effectively.
基金Supported by Yuzhong District Natural Science Foundation of Chongqing,No.20240129。
文摘In this editorial,we comment on the article published in a recent issue of the World Journal of Orthopedics.Although substantial literature regarding pain management of acute musculoskeletal injury has been published over the last three decades,there is still a lack of evidence-based protocol for individual and population disparities.This systematic review gives us a comprehensive view of the evidence-based use of opioid vs opioid-free analgesia.Nevertheless,there is still a need for further investigation at a high level regarding this topic.
基金supported by the California Institute for Regenerative Medicine under EDUC4-12751(Giselle Kaneda)DISC2-14049(Dmitriy Sheyn)+1 种基金Additional support was provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award numbers R01AR066517(Debiao Li)R01AR082041(Dmitriy Sheyn).
文摘Chronic lower back pain(LBP)is the leading cause of disability worldwide.Due to its close relationship with intervertebral disc(IVD)degeneration(IVDD),research has historically focused more on understanding the mechanism behind IVDD while clinical efforts prioritize pain management.More recently,there has been a shift toward understanding LBP as a distinct pathological entity.This review synthesizes current knowledge on discogenic LBP,combining known pathophysiology,molecular mechanisms,risk factors,diagnostic challenges,and available experimental models.IVDD is a complex,multifactorial process involving biochemical,mechanical,and inflammatory changes within the disc,leading to structural breakdown and potential discogenic pain.Key mechanisms include extracellular matrix degradation,upregulation of inflammatory mediators,immune cell infiltration,and aberrant nerve and vascular ingrowth.However,not all cases of IVDD result in LBP,highlighting the need for further investigation into the cellular,molecular,and biomechanical factors contributing to symptom development.Current diagnostic tools and experimental models for studying discogenic LBP remain limited,impeding the development of targeted treatments.Existing therapies primarily focus on symptom management rather than addressing underlying disease mechanisms.
文摘The present paper addresses two issues pertaining to the use of virtual reality(VR).One issue pertains to the equipment utilized.VR technology can be classified into two main categories:Immersive and non-immersive.The immersive type of technology necessitates the use of substantial equipment,yet it is demonstrably efficacious.Furthermore,the efficacy of this approach is enhanced when combined with relaxation and biofeedback techniques.The other issue is that the efficacy of this approach is diminished when applied to chronic pain,in comparison to acute pain.The relief of chronic pain is a challenging endeavor due to the diminished functionality of the medial prefrontal cortex(mPFC)within the default mode network.Given the close relationship between the mPFC and the reward system dopamine,it is essential to develop a program that activates the reward system dopamine through the use of VR technology.
基金Supported by Beijing Medical Award Foundation of China,No.YXJL-2023-0638-0048.
文摘BACKGROUND Hepatic artery infusion chemotherapy(HAIC)is a widely used local therapeutic approach for intermediate to advanced-stage hepatocellular carcinoma(HCC),exhibiting considerable efficacy.However,the prevalence of postoperative pain highlights the importance of pain management.Owing to the limitations inherent in existing pain management strategies,this study investigates and assesses the analgesic effectiveness of a multimodal treatment protocol in mitigating pain after HAIC procedures.AIM To provide patients with a more comprehensive and effective pain management strategy.METHODS A total of 100 patients with primary HCC who underwent HAIC were randomly assigned to a control group(n=50)and a multimodal group(n=50).Baseline characteristics and perioperative data were collected.Upon enrollment,patients in the multimodal group received parecoxib(40 mg)30 minutes before HAIC,followed by 48 hours of patient-controlled analgesia with sufentanil.In contrast,the control group underwent standard preoperative preparation(psychological support)and received dezocine(5 mg)intraoperatively,with intravenous flurbiprofen(100 mg)administered every 12 hours for 48 hours postoperatively.RESULTS Compared to the control group,the multimodal analgesia group exhibited significantly lower resting and movement visual analog scale pain scores at postoperative 0,2,4,6,and 12 hours(P<0.05).Furthermore,the multimodal group experienced a reduced incidence of postoperative nausea and vomiting,as well as a lower overall frequency of adverse events,compared to the control group(P<0.05).Patient satisfaction was also significantly higher in the multimodal group than in the control group(P<0.05).CONCLUSION Our study demonstrates that multimodal analgesia is effective in reducing postoperative pain,minimizing adverse reactions,and improving patient satisfaction in HCC patients undergoing HAIC.This approach provides valuable clinical strategies for optimizing pain management in this patient population.
