Background: Post-craniotomy pain has been reported to be moderate to severe. Management of post-craniotomy pain is often inadequate, yet limited by the side effects of opioids. We aim to find out the efficacy of oral ...Background: Post-craniotomy pain has been reported to be moderate to severe. Management of post-craniotomy pain is often inadequate, yet limited by the side effects of opioids. We aim to find out the efficacy of oral oxycodone as compared to oral codeine for the treatment of post-craniotomy pain in our institution. Methods: A randomized, double-blinded controlled trial was used to evaluate the efficacy of oral oxycodone versus oral codeine. 40 patients were randomized to the control group of codeine (n = 20) or the experimental group receiving oxycodone (n = 20) in addition to regular oral paracetamol for both groups of patients. Results: There was no difference in the visual analogue scale scores at 24 hours (2.78 versus 1.85, p = 0.11) or side effects in the oxycodone group compared with the codeine group. Conclusions: Oral oxycodone had similar efficacy as oral codeine in the management of post-craniotomy pain.展开更多
Introduction: The incidence of acute pain after craniotomy differs remarkably in previous studies, and the prevalence of persistent pain is not precisely known. We conducted 6-month follow-up surveys on the incidence ...Introduction: The incidence of acute pain after craniotomy differs remarkably in previous studies, and the prevalence of persistent pain is not precisely known. We conducted 6-month follow-up surveys on the incidence and intensity of acute and persistent pain after elective craniotomy. Methods: We carried out a prospective cohort study via a series of structured questionnaires to record acute pain intensity preoperatively and postoperatively, and the incidence of persistent pain 3 and 6 months after a craniotomy in a tertiary care center. Patients scheduled for elective craniotomy were interviewed the day before surgery, postoperatively before discharge from the hospital, and 3 and 6 months after surgery. Pain was assessed on a numeric rating scale (0 - 10) at rest and movement, as well as expectations of pain before surgery, efficacy of pain therapy, and satisfaction with pain treatment. The incidence of adverse events, sleep time and interruptions caused by pain, different pain types, and drugs used for pain treatment were also recorded. Results: A total of 152 patients were enrolled in the study and completed the preoperative questionnaire;123 (81%) completed postoperative questionnaire and 108 (72%) completed the 3- and 6-month follow-ups. The average pain score at the time of the postoperative questionnaire was moderate, 4 at rest and 5 upon movement. The percentage of patients experiencing mild pain at rest and upon movement was 52% and 49%, and moderate pain was 15% and 16%, respectively. Severe postoperative pain was detected in 5% and 8% of patients at rest and upon movement, respectively. Three months after surgery, 6% of patients reported mild pain at rest, 3% moderate pain at rest, and 1% severe pain at rest. Persistent mild and moderate pain at rest after 6 months was reported by 3% and 1% of patients, respectively. The most common adverse events were postoperative nausea and vomiting (11%) and abdominal discomfort (8%). During postoperative pain treatment in the intensive care unit or post-anesthesia care unit, 92% of patients received acetaminophen, 88% fentanyl, and 24% oxycodone. During neurosurgical ward care, ibuprofen was used in 61% of patients. Satisfaction with analgesia was high throughout the study period with a median satisfaction score of 9 postoperatively and 10 at 3 and 6 months on the 0 - 10 scale. Conclusion: The findings indicate that most patients experience moderate or mild pain after craniotomy, but patient satisfaction with pain treatment is high. Persistent pain after 3 and 6 months is rare and mild in nature.展开更多
Knee osteoarthritis(KOA)represents one of the most common causes of chronic pain.The high prevalence and disability rates of KOA impose a severe burden on both individuals and society.In contrast to cutaneous pain,KOA...Knee osteoarthritis(KOA)represents one of the most common causes of chronic pain.The high prevalence and disability rates of KOA impose a severe burden on both individuals and society.In contrast to cutaneous pain,KOA-induced joint pain is characterized as a deep tissue pain that potentially involves distinct subgroups of peripheral sensory neurons and central processing mechanisms.Furthermore,KOA pain is closely related to locomotion activity.Impaired sensorimotor integration and pain mutually reinforce each other in KOA,forming a vicious cycle that exacerbates disease progression.In this review,we highlight the key differences between KOA pain and cutaneous pain,and the latter has been extensively studied in the pain field.We hope to offer new insights into the central mechanisms and development of new treatment strategies for KOA based on the interactions between impaired sensorimotor integration and chronic joint pain.展开更多
Cancer pain is one of the most prevalent and debilitating symptoms in patients with advanced malignancies,arising from multifactorial mechanisms involving peripheral,central,and systemic pathways.Conventional analgesi...Cancer pain is one of the most prevalent and debilitating symptoms in patients with advanced malignancies,arising from multifactorial mechanisms involving peripheral,central,and systemic pathways.Conventional analgesics,including opioids and nonsteroidal anti-inflammatory drugs,are often limited by their insufficient efficacy,tolerance,and risk of dependence.Traditional Chinese Medicine(TCM),characterized by its multi-component,multi-target,and systemic regulatory properties,has shown promising potential in cancer pain management.This review provides a comprehensive overview of the clinical classification and underlying mechanisms of cancer pain(including nerve infiltration,dysregulation of inflammatory mediators and ion channels,central sensitization,neuro-immune crosstalk,metabolic reprogramming,and gut-brain axis impairment),as well as the analgesic effects of representative TCM agents in cancer pain management.For example,bioactive components such as tetrahydroberberine,levo-tetrahydropalmatine,and piperine exert analgesic effects,thereby improving the quality of life of patients by inhibiting inflammatory cascades,regulating neurotransmitter systems,and preserving neural integrity.Commonly used preclinical models,including bone cancer pain,pancreatic cancer pain,and chemotherapy-induced peripheral neuropathy models,are summarized for their utility in mechanistic studies and efficacy evaluations.This review also discusses the current limitations of clinical evidence,such as small sample sizes,short follow-up periods,and limited translation from animal models,alongside major challenges in standardization,mechanistic elucidation,and clinical trial design.Future directions should focus on precise pain phenotyping,integrated multi-target interventions,rigorous efficacy safety validation,and innovations in drug delivery to facilitate the standardization and global adoption of TCM in cancer pain management.展开更多
Persistent postsurgical pain is a major clinical concern,especially in the aging population,who represent a growing proportion of surgical patients.Although age is a known pain risk factor,the mechanisms driving age-r...Persistent postsurgical pain is a major clinical concern,especially in the aging population,who represent a growing proportion of surgical patients.Although age is a known pain risk factor,the mechanisms driving age-related vulnerability to chronic postoperative pain remain poorly understood.This study aims to investigate how aging influences the resolution of postoperative pain and to elucidate the roles of microglial activation and synaptic remodeling in the spinal dorsal horn.A plantar incision model in young(3-month-old)and aged(18-month-old)male and female mice was used to mimic postoperative pain conditions.Mechanical and thermal hypersensitivity at various postoperative intervals were assessed by von Frey and Hargreaves tests.Microglial activation and inhibitory/excitatory synaptic densities in the spinal dorsal horn were evaluated using immunofluorescence and 3D reconstruction with Imaris software.On postoperative day(POD)3,both age groups exhibited reduced pain thresholds on the ipsilateral side,along with microglial activation in the dorsal horn.On POD 7,pain thresholds in young mice had returned to baseline with no significant microglial activation,while aged mice showed sustained reduction in pain thresholds,continuous microglial activation,and significant loss of inhibitory synapses without detectable changes in excitatory synapse density.These findings are consistent across both sexes,with no sex-related differences.Collectively,these results suggest that aging is associated with persistent postoperative pain,which correlates with microglial activation and inhibitory synapse loss.These insights advance our understanding of age-related pain vulnerability and may inform the development of more effective,targeted,and age-specific therapeutic strategies to prevent or alleviate persistent postoperative pain in elderly patients.展开更多
Pseudounipolar neurons in the dorsal root ganglia(DRG),as the central nodes of primary sensory afferents,possess a distinctive T-junction that is not merely a morphological peculiarity but also performs complex roles ...Pseudounipolar neurons in the dorsal root ganglia(DRG),as the central nodes of primary sensory afferents,possess a distinctive T-junction that is not merely a morphological peculiarity but also performs complex roles in rapid,multiplexed shunting and regulation of sensory signals.This specialized geometry enables separation,filtering,and feedback regulation of neuronal signals,thereby coordinating peripheral and central responses at multiple levels.Recent advances,including spatial transcriptomics,single-cell sequencing,super-resolution microscopy,organoid models,and novel electrophysiological methods,have permitted more precise dissection of the T-junction's molecular composition,ion-channel distribution,and electrophysiological properties.Here,we review current knowledge of the T-junction's developmental regulation and multilayered molecular networks,and we detail its functional alterations in both physiological signaling and pathological pain states,with particular emphasis on ion-channel modulation,signal attenuation,and selective transmission mechanisms.Finally,we discuss contemporary pain-intervention approaches and prospects for precision-targeted therapies,aiming to provide a theoretical foundation for future studies in pain physiology and clinical translation.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
BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making ...BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making it a signifi cant public health concern.This study is to determine the prevalence and factors associated with acute pain among emergency trauma patients.METHODS:A multicenter cross-sectional study was conducted.Data were collected via interviewer-administered questionnaires and patient chart review.The data were analyzed via the statistical package for social science version 25.Bivariable and multivariable logistic regression analyses were used.Variables with a P-value<0.05 were considered statistically signifi cant.RESULTS:A total of 397 patients were included in the study,for a response rate of 96.8%.The prevalence of pain during admission was 91.9%(95%confi dence intervals[95%CIs]:88.8%-94.4%).Blunt trauma(adjusted odds ratio[aOR]=2.82;95%CI:1.23-6.45),analgesia before admission to the emergency department(aOR=2.71;95%CI:1.16-6.36),documentation of pain severity in the chart(aOR=2.71;95%CI:1.16-6.36),analgesia provided within two hours after admission(aOR=7.60;95%CI:2.79-20.68),use of non-pharmacological pain management methods(aOR=3.09;95%CI:1.35-7.08)and availability of analgesia(aOR=3.95;95%CI:1.36-11.43)were associated with acute pain experience.CONCLUSION:The prevalence of acute pain among emergency trauma patients was high in the study area.Analgesia should be administered prior to admission,and non-pharmacological pain management should be implemented.Moreover,training on pain assessment and management should be provided for healthcare providers in the emergency department.展开更多
Objective:To compare the therapeutic efficacy of intravenous pantoprazole and famotidine for the treatment of epigastric pain in patients presenting to the emergency department.Methods:In this triple-blind randomized ...Objective:To compare the therapeutic efficacy of intravenous pantoprazole and famotidine for the treatment of epigastric pain in patients presenting to the emergency department.Methods:In this triple-blind randomized clinical trial,eligible patients presenting with epigastric pain were randomly assigned to receive intravenous pantoprazole or famotidine.Block randomization was used,and patients,treating physicians,and outcome assessors were blinded to treatment allocation.Pain intensity was assessed at baseline and at 30 and 60 minutes after drug administration.Results:Eighty patients were enrolled,with a mean age of 36.6 years(SD,15.0),and 42.5%were male.Mean pain scores decreased significantly over time in both treatment groups.In the pantoprazole group,pain scores declined from 8.02±1.28 at baseline to 4.75±1.31 at 30 minutes and 1.62±1.29 at 60 minutes,whereas in the famotidine group scores decreased from 8.12±1.48 to 5.37±1.23 and 2.35±1.54,respectively.There was no significant difference in baseline pain scores between groups(P=.92).Pantoprazole resulted in greater pain reduction compared with famotidine at both 30 minutes(P=.04)and 60 minutes(P=.05).Conclusions:Both medications were effective in relieving epigastric pain;however,pantoprazole provided greater and more sustained pain reduction,supporting its preferential use in emergency settings.展开更多
BACKGROUND Knee osteoarthritis(KOA),a common disabling pathology characterized by knee joint pain,swelling,and functional impairment,primarily affects middle-aged and older adults.In addition to physical limitations,c...BACKGROUND Knee osteoarthritis(KOA),a common disabling pathology characterized by knee joint pain,swelling,and functional impairment,primarily affects middle-aged and older adults.In addition to physical limitations,chronic pain often leads to psychological problems,including anxiety and depression,which further impact patients’quality of life.AIM To examine the efficacy and safety of celecoxib plus duloxetine in managing chronic pain,anxiety,and depression in patients with KOA.METHODS A retrospective analysis was conducted on 123 patients with KOA treated at our center between February 2020 and February 2023.Of these,66 received celecoxib plus duloxetine,and 57 received celecoxib alone.Outcomes were assessed using the Visual Analog Scale(VAS),the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),and the Self-Rating Anxiety Scales(SAS)/Self-Rating Depression Scales(SDS).Safety was evaluated by monitoring changes in liver function enzymes(alanine aminotransferase,aspartate aminotransferase),creatinine,and blood urea nitrogen.RESULTS Patients receiving celecoxib plus duloxetine showed significantly greater reductions in VAS and WOMAC and greater improvements in SAS and SDS scores compared with those receiving celecoxib alone.Hepatorenal function did not differ significantly between the treatment groups.Logistic regression analysis identified patient age,educational background,and treatment regimen as independent predictors of inadequate improvement in negative emotional symptoms.CONCLUSION In patients with KOA,celecoxib plus duloxetine effectively mitigates chronic pain and improves anxiety and depressive symptoms without increasing adverse hepatic or renal effects.These findings support its use as a safe and effective treatment option.展开更多
Medical history summary:The child has suffered from episodic joint pain in the lower extremities since childhood,with occurrences ranging from 1 to 3 times daily,predominantly during rainy,cold,and humid weather,as we...Medical history summary:The child has suffered from episodic joint pain in the lower extremities since childhood,with occurrences ranging from 1 to 3 times daily,predominantly during rainy,cold,and humid weather,as well as in the afternoons and evenings.Symptoms and signs:The primary manifestation is episodic pain in the distal extremities,predominantly in the lower limbs,knees,and ankles.Occasionally,the pain may ascend to the elbows,wrists,and palms,and may occasionally affect the proximal extremities and waist.Diagnostic methods:Nerve biopsy and related pathological examinations,along with whole exome sequencing,are helpful for diagnosis,particularly the detection of variants in the SCN11A gene.Treatment approaches:(1)Pharmacotherapy:Sodium channel blockers and nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can alleviate pain.(2)Neuromodulation techniques:Techniques such as transcranial magnetic stimulation(TMS)and spinal cord stimulation(SCS)can be employed to improve symptoms.(3)Psychotherapy:Cognitive-behavioral therapy(CBT),relaxation training,or psychological counseling can enhance the patient’s coping abilities.Clinical outcome:Pain relief can be achieved with analgesic medication in children,and pain symptoms generally persist until adulthood,gradually diminishing or even disappearing.Patients can reduce the frequency of episodes by staying warm and avoiding cold and damp conditions.展开更多
Objective:To investigate the clinical efficacy of electrophysiological therapy under different parameter modes in chronic pelvic pain syndrome(CPPS).Methods:A total of 95patients with CPPS from the Department of Urolo...Objective:To investigate the clinical efficacy of electrophysiological therapy under different parameter modes in chronic pelvic pain syndrome(CPPS).Methods:A total of 95patients with CPPS from the Department of Urology,First Affiliated Hospital of Jinan University,were selected and treated with electrophysiological therapy.They were randomly divided into three groups:the fixed-parameter AA7 treatment group,the P2+P4 treatment group,and the precision treatment group(individualized parameter treatment).Pain scores of patients in each group were compared before and after treatment,with a pain score of 0 indicating cure.The cure rate of each group was observed.Results:The average ages of the AA7 group,P2+P4 group,and precision treatment group were 34±14.17 years,35.58±12.57 years,and 35.5±11.27 years,respectively.There was no significant difference in age among the three groups(p>0.05).Before treatment,the pain scores of the AA7 group,P2+P4 group,and precision treatment group were 4.14±1.74,4.64±1.72,and 3.50±1.89,respectively,with no significant differences among the groups(p>0.05).After treatment,the pain scores were 0.71±0.99 for the AA7 group(cure rate:57%),0.49±0.79 for the P2+P4 group(cure rate:67%),and 0.50±0.77 for the precision treatment group(cure rate:64%),with no significant differences among the groups(p>0.05).The cure rates for different pain locations were as follows:83%for lower abdominal pain,74%for perineal pain,62%for dysuria,49%for testicular pain,and 75%for inguinal pain.Conclusion:The pathogenesis of CPPS is complex and diverse,with numerous treatment options and uncertain efficacy,posing significant challenges to clinical practice.This study showed that electrophysiological therapy under different parameter modes significantly reduced pain scores before and after treatment,indicating significant therapeutic effects on CPPS.All three modes demonstrated good cure rates.Individualized precision treatment and fixed-mode P2+P4 or AA7 treatment were safe and effective in CPPS treatment and are worth promoting.Fixed-mode P2+P4 and AA7,due to their easier standardization of parameters and patch modes,reduced the learning curve and had better potential for widespread application.展开更多
Background:The analgesic effects of multiple electroacupuncture(EA)sessions and single EA sessions differ significantly in pain management.Area 24b(A24b)of the anterior cingulate cortex(ACC)is crucial in pain processi...Background:The analgesic effects of multiple electroacupuncture(EA)sessions and single EA sessions differ significantly in pain management.Area 24b(A24b)of the anterior cingulate cortex(ACC)is crucial in pain processing.EA relieves pain by targeting and modulating the neuronal activity within this subregion.However,whether the cumulative effect of EA antinociception is connected to A24b mechanisms has remained unclear.Methods:In our study,we used the Complete Freund's Adjuvant(CFA)model to induce inflammatory pain and the Spared Nerve Injury(SNI)model to induce neuropathic pain,and adult male C57BL/6,FosTRAP,and FosTRAP:Ai9 mice were used as experimental subjects to investigate the cumulative effect of EA antinociception and whether multiple EA sessions and a single EA session regulate different neuronal populations in the A24b.Results:We observed that EA effectively alleviated pain in mice,with three EA sessions yielding superior analgesic effects compared to a single session.Using chemical genetics combined with FosCreER technology to activate EA-TRAPed cells in the A24b,we found that pain relief was more pronounced with three EA sessions.Moreover,chemogenetic inhibition of EA-TRAPed cells in the A24b reversed the analgesic effects of a single EA session but not those of three EA sessions.Fluorescent in situ hybridization results indicated that three EA sessions significantly increased the number of GABAergic neurons in the A24b compared with a single session.Additionally,retrograde tracing revealed that the A24b circuit that monosynaptically innervates EA-TRAPed cells included projections from the central lateral nucleus(CL),lateral mediodorsal thalamic nucleus(MDL),lateral habenula(LHb),dorsal raphe nucleus(DR),caudal linear nucleus of the raphe(CLi),dorsal tuberomamillary nucleus(DTM),periventricular hypothalamic nucleus(Pe)and hippocampal fields CA1,CA2,and CA3.These findings suggest that multiple EA sessions and single EA sessions activated different neuronal populations in the A24b.The enhanced analgesic effect of multiple EA sessions may be attributed to an increase in the proportion of GABAergic neurons within the A24b.Conclusions:Multiple and single EA sessions recruit distinct neuronal populations in A24b,with the stronger analgesic effect of repeated EA linked to a higher proportion of GABAergic neurons in this region.展开更多
BACKGROUND Anterior cruciate ligament(ACL)reconstruction using bone-patellar tendon-bone(BPTB)autografts remains the gold standard for young,active individuals due to its superior biomechanical strength and bone-to-bo...BACKGROUND Anterior cruciate ligament(ACL)reconstruction using bone-patellar tendon-bone(BPTB)autografts remains the gold standard for young,active individuals due to its superior biomechanical strength and bone-to-bone healing.However,donor site morbidity,particularly anterior knee pain(AKP),limits its utilization despite its advantages.Various techniques have been proposed to reduce AKP,but they show variable outcomes and several limitations.AIM To assess the incidence and severity of AKP following BPTB ACL reconstruction using an autologous bone grafting technique.METHODS We conducted a retrospective observational study of 24 patients aged 20-45 years,who had primary ACL reconstruction with BPTB grafts.During surgery,autologous cancellous bone generated from tunnel drilling was used to fill the patellar and tibial donor site voids after graft fixation.All patients were followed up for at least twelve months.Using the Kujala Anterior Knee Pain Score,clinical outcomes were evaluated,including the pain-specific subcomponent.RESULTS With scores ranging from 86 to 100,the average overall Kujala score was 95.67±4.01.No patient scored below 85.There was no complication such as patellar fracture,tibial tuberosity fracture,or infection.Grouped data showed 20.8%of patients scored 100,whereas 54.2%scored between 95 and 99,and 25%scored between 86 and 94.One patient(4.2%)had an 8/10 pain subcomponent,whereas 23 patients(95.8%)had a 10/10.CONCLUSION This procedure is easy to incorporate into routine surgical practice,cost-effective and reproducible without requiring extra incisions or raising the patient’s surgical expenses.Excellent short-term results back up this technique.展开更多
BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship ...BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship with personality traits has not been previously investigated in the Lebanese population.AIM To examine the prevalence of preoperative anxiety,pain perception,and personality traits among Lebanese surgical patients,and to assess the associations between these factors.METHODS A descriptive cross-sectional study was conducted between April 2024 and January 2025 across Lebanese hospitals.A total of 392 adult patients were recruited through convenience sampling.Data were collected using a questionnaire that included sociodemographic,clinical,and surgical variables,the Amsterdam Preoperative Anxiety and Information Scale for anxiety,the Visual Analog Scale and Numerical Pain Rating Scale for preoperative pain,and the Ten-Item Personality Inventory for personality traits.Ethical approval was obtained from the Institutional Review Boards of Makassed General Hospital and Hammoud University Medical Center.RESULTS Overall,25%of participants experienced preoperative anxiety,and 34.5%reported moderate pain.Personality assessment showed that the majority of participants had moderate extraversion(84.1%),moderate emotional stability(65.1%),high conscientiousness(61%),high agreeableness(54.1%),and moderate openness(49.2%).High conscientiousness was significantly associated with higher pain perception(P<0.05),while high emotional stability was associated with lower levels of anxiety(P<0.05).No significant association was found between preoperative anxiety and pain(P>0.05).CONCLUSION This study challenges the assumption that preoperative anxiety and pain are directly correlated and highlights the role of personality traits in shaping patient experience.These findings support the potential value of integrating psychological profiling into preoperative care and lay the groundwork for developing personalized interventions to improve patient-centered surgical outcomes.展开更多
Medical procedures are inherently invasive and carry the risk of inducing pain to the mind and body.Recently,efforts have been made to alleviate the discomfort associated with invasive medical procedures through the u...Medical procedures are inherently invasive and carry the risk of inducing pain to the mind and body.Recently,efforts have been made to alleviate the discomfort associated with invasive medical procedures through the use of virtual reality(VR)technology.VR has been demonstrated to be an effective treatment for pain associated with medical procedures,as well as for chronic pain conditions for which no effective treatment has been established.The precise mechanism by which the diversion from reality facilitated by VR contributes to the diminution of pain and anxiety has yet to be elucidated.However,the provision of positive images through VR-based visual stimulation may enhance the functionality of brain networks.The salience network is diminished,while the default mode network is enhanced.Additionally,the medial prefrontal cortex may establish a stronger connection with the default mode network,which could result in a reduction of pain and anxiety.Further research into the potential of VR technology to alleviate pain could lead to a reduction in the number of individuals who overdose on painkillers and contribute to positive change in the medical field.展开更多
Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairme...Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairments in inhibitory gamma-aminobutyric acid neurotransmission.This review primarily aims to outline the main circuitry(including the input and output connectivity)of the anterior cingulate cortex and classification and functions of different gamma-aminobutyric acidergic neurons;it also describes the neurotransmitters/neuromodulators affecting these neurons,their intercommunication with other neurons,and their importance in mental comorbidities associated with chronic pain disorders.Improving understanding on their role in pain-related mental comorbidities may facilitate the development of more effective treatments for these conditions.However,the mechanisms that regulate gamma-aminobutyric acidergic systems remain elusive.It is also unclear as to whether the mechanisms are presynaptic or postsynaptic.Further exploration of the complexities of this system may reveal new pathways for research and drug development.展开更多
In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poo...In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poor management of postcesarean pain is associated with decreased maternal care for the baby,longer hospitalization,and higher risk of developing postpartum depression.Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies.However,due to its potential adverse effects on the neurological and hemodynamic status of patients,it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain.Before any recommendation for routine perioperative use of esketamine,more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.展开更多
Temporomandibular joint osteoarthritis(TMJ-OA)is a common disease often accompanied by pain,seriously affecting physical and mental health of patients.Abnormal innervation at the osteochondral junction has been consid...Temporomandibular joint osteoarthritis(TMJ-OA)is a common disease often accompanied by pain,seriously affecting physical and mental health of patients.Abnormal innervation at the osteochondral junction has been considered as a predominant origin of arthralgia,while the specific mechanism mediating pain remains unclear.To investigate the underlying mechanism of TMJ-OA pain,an abnormal joint loading model was used to induce TMJ-OA pain.We found that during the development of TMJ-OA,the increased innervation of sympathetic nerve of subchondral bone precedes that of sensory nerves.Furthermore,these two types of nerves are spatially closely associated.Additionally,it was discovered that activation of sympathetic neural signals promotes osteoarthritic pain in mice,whereas blocking these signals effectively alleviates pain.In vitro experiments also confirmed that norepinephrine released by sympathetic neurons promotes the activation and axonal growth of sensory neurons.Moreover,we also discovered that through releasing norepinephrine,regional sympathetic nerves of subchondral bone were found to regulate growth and activation of local sensory nerves synergistically with other pain regulators.This study identified the role of regional sympathetic nerves in mediating pain in TMJ-OA.It sheds light on a new mechanism of abnormal innervation at the osteochondral junction and the regional crosstalk between peripheral nerves,providing a potential target for treating TMJ-OA pain.展开更多
文摘Background: Post-craniotomy pain has been reported to be moderate to severe. Management of post-craniotomy pain is often inadequate, yet limited by the side effects of opioids. We aim to find out the efficacy of oral oxycodone as compared to oral codeine for the treatment of post-craniotomy pain in our institution. Methods: A randomized, double-blinded controlled trial was used to evaluate the efficacy of oral oxycodone versus oral codeine. 40 patients were randomized to the control group of codeine (n = 20) or the experimental group receiving oxycodone (n = 20) in addition to regular oral paracetamol for both groups of patients. Results: There was no difference in the visual analogue scale scores at 24 hours (2.78 versus 1.85, p = 0.11) or side effects in the oxycodone group compared with the codeine group. Conclusions: Oral oxycodone had similar efficacy as oral codeine in the management of post-craniotomy pain.
文摘Introduction: The incidence of acute pain after craniotomy differs remarkably in previous studies, and the prevalence of persistent pain is not precisely known. We conducted 6-month follow-up surveys on the incidence and intensity of acute and persistent pain after elective craniotomy. Methods: We carried out a prospective cohort study via a series of structured questionnaires to record acute pain intensity preoperatively and postoperatively, and the incidence of persistent pain 3 and 6 months after a craniotomy in a tertiary care center. Patients scheduled for elective craniotomy were interviewed the day before surgery, postoperatively before discharge from the hospital, and 3 and 6 months after surgery. Pain was assessed on a numeric rating scale (0 - 10) at rest and movement, as well as expectations of pain before surgery, efficacy of pain therapy, and satisfaction with pain treatment. The incidence of adverse events, sleep time and interruptions caused by pain, different pain types, and drugs used for pain treatment were also recorded. Results: A total of 152 patients were enrolled in the study and completed the preoperative questionnaire;123 (81%) completed postoperative questionnaire and 108 (72%) completed the 3- and 6-month follow-ups. The average pain score at the time of the postoperative questionnaire was moderate, 4 at rest and 5 upon movement. The percentage of patients experiencing mild pain at rest and upon movement was 52% and 49%, and moderate pain was 15% and 16%, respectively. Severe postoperative pain was detected in 5% and 8% of patients at rest and upon movement, respectively. Three months after surgery, 6% of patients reported mild pain at rest, 3% moderate pain at rest, and 1% severe pain at rest. Persistent mild and moderate pain at rest after 6 months was reported by 3% and 1% of patients, respectively. The most common adverse events were postoperative nausea and vomiting (11%) and abdominal discomfort (8%). During postoperative pain treatment in the intensive care unit or post-anesthesia care unit, 92% of patients received acetaminophen, 88% fentanyl, and 24% oxycodone. During neurosurgical ward care, ibuprofen was used in 61% of patients. Satisfaction with analgesia was high throughout the study period with a median satisfaction score of 9 postoperatively and 10 at 3 and 6 months on the 0 - 10 scale. Conclusion: The findings indicate that most patients experience moderate or mild pain after craniotomy, but patient satisfaction with pain treatment is high. Persistent pain after 3 and 6 months is rare and mild in nature.
基金supported by the Natural Science Foundation of Beijing Municipality(No.F252065)the National Natural Science Foundation of China(No.32271190,32571323)the STI 2030 Major Project(No.2021ZD0203202)。
文摘Knee osteoarthritis(KOA)represents one of the most common causes of chronic pain.The high prevalence and disability rates of KOA impose a severe burden on both individuals and society.In contrast to cutaneous pain,KOA-induced joint pain is characterized as a deep tissue pain that potentially involves distinct subgroups of peripheral sensory neurons and central processing mechanisms.Furthermore,KOA pain is closely related to locomotion activity.Impaired sensorimotor integration and pain mutually reinforce each other in KOA,forming a vicious cycle that exacerbates disease progression.In this review,we highlight the key differences between KOA pain and cutaneous pain,and the latter has been extensively studied in the pain field.We hope to offer new insights into the central mechanisms and development of new treatment strategies for KOA based on the interactions between impaired sensorimotor integration and chronic joint pain.
基金supported by the National Natural Science Foundation of China(No.82360238,82071245)。
文摘Cancer pain is one of the most prevalent and debilitating symptoms in patients with advanced malignancies,arising from multifactorial mechanisms involving peripheral,central,and systemic pathways.Conventional analgesics,including opioids and nonsteroidal anti-inflammatory drugs,are often limited by their insufficient efficacy,tolerance,and risk of dependence.Traditional Chinese Medicine(TCM),characterized by its multi-component,multi-target,and systemic regulatory properties,has shown promising potential in cancer pain management.This review provides a comprehensive overview of the clinical classification and underlying mechanisms of cancer pain(including nerve infiltration,dysregulation of inflammatory mediators and ion channels,central sensitization,neuro-immune crosstalk,metabolic reprogramming,and gut-brain axis impairment),as well as the analgesic effects of representative TCM agents in cancer pain management.For example,bioactive components such as tetrahydroberberine,levo-tetrahydropalmatine,and piperine exert analgesic effects,thereby improving the quality of life of patients by inhibiting inflammatory cascades,regulating neurotransmitter systems,and preserving neural integrity.Commonly used preclinical models,including bone cancer pain,pancreatic cancer pain,and chemotherapy-induced peripheral neuropathy models,are summarized for their utility in mechanistic studies and efficacy evaluations.This review also discusses the current limitations of clinical evidence,such as small sample sizes,short follow-up periods,and limited translation from animal models,alongside major challenges in standardization,mechanistic elucidation,and clinical trial design.Future directions should focus on precise pain phenotyping,integrated multi-target interventions,rigorous efficacy safety validation,and innovations in drug delivery to facilitate the standardization and global adoption of TCM in cancer pain management.
基金supported by the National Natural Science Foundation of China(No.82401445 and 82271249)the China Postdoctoral Science Foundation(No.2024M752251)+3 种基金the Postdoctoral Fellowship Program of CPSF(No.GZC20241141)the Sichuan Science and Technology Program(No.2024NSFSC1636 and 2025ZNSFSC1645)the Postdoctoral Research Fund of West China Hospital of Sichuan University(No.2024HXBH013)1-3-5 Project for Disciplines of Excellence of West China Hospital of Sichuan University(No.ZYYC23002)。
文摘Persistent postsurgical pain is a major clinical concern,especially in the aging population,who represent a growing proportion of surgical patients.Although age is a known pain risk factor,the mechanisms driving age-related vulnerability to chronic postoperative pain remain poorly understood.This study aims to investigate how aging influences the resolution of postoperative pain and to elucidate the roles of microglial activation and synaptic remodeling in the spinal dorsal horn.A plantar incision model in young(3-month-old)and aged(18-month-old)male and female mice was used to mimic postoperative pain conditions.Mechanical and thermal hypersensitivity at various postoperative intervals were assessed by von Frey and Hargreaves tests.Microglial activation and inhibitory/excitatory synaptic densities in the spinal dorsal horn were evaluated using immunofluorescence and 3D reconstruction with Imaris software.On postoperative day(POD)3,both age groups exhibited reduced pain thresholds on the ipsilateral side,along with microglial activation in the dorsal horn.On POD 7,pain thresholds in young mice had returned to baseline with no significant microglial activation,while aged mice showed sustained reduction in pain thresholds,continuous microglial activation,and significant loss of inhibitory synapses without detectable changes in excitatory synapse density.These findings are consistent across both sexes,with no sex-related differences.Collectively,these results suggest that aging is associated with persistent postoperative pain,which correlates with microglial activation and inhibitory synapse loss.These insights advance our understanding of age-related pain vulnerability and may inform the development of more effective,targeted,and age-specific therapeutic strategies to prevent or alleviate persistent postoperative pain in elderly patients.
基金supported by grant from the National Key Technology Support Program of the Ministry of Science and Technology of China(No.2021ZD0203204)。
文摘Pseudounipolar neurons in the dorsal root ganglia(DRG),as the central nodes of primary sensory afferents,possess a distinctive T-junction that is not merely a morphological peculiarity but also performs complex roles in rapid,multiplexed shunting and regulation of sensory signals.This specialized geometry enables separation,filtering,and feedback regulation of neuronal signals,thereby coordinating peripheral and central responses at multiple levels.Recent advances,including spatial transcriptomics,single-cell sequencing,super-resolution microscopy,organoid models,and novel electrophysiological methods,have permitted more precise dissection of the T-junction's molecular composition,ion-channel distribution,and electrophysiological properties.Here,we review current knowledge of the T-junction's developmental regulation and multilayered molecular networks,and we detail its functional alterations in both physiological signaling and pathological pain states,with particular emphasis on ion-channel modulation,signal attenuation,and selective transmission mechanisms.Finally,we discuss contemporary pain-intervention approaches and prospects for precision-targeted therapies,aiming to provide a theoretical foundation for future studies in pain physiology and clinical translation.
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.
文摘BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making it a signifi cant public health concern.This study is to determine the prevalence and factors associated with acute pain among emergency trauma patients.METHODS:A multicenter cross-sectional study was conducted.Data were collected via interviewer-administered questionnaires and patient chart review.The data were analyzed via the statistical package for social science version 25.Bivariable and multivariable logistic regression analyses were used.Variables with a P-value<0.05 were considered statistically signifi cant.RESULTS:A total of 397 patients were included in the study,for a response rate of 96.8%.The prevalence of pain during admission was 91.9%(95%confi dence intervals[95%CIs]:88.8%-94.4%).Blunt trauma(adjusted odds ratio[aOR]=2.82;95%CI:1.23-6.45),analgesia before admission to the emergency department(aOR=2.71;95%CI:1.16-6.36),documentation of pain severity in the chart(aOR=2.71;95%CI:1.16-6.36),analgesia provided within two hours after admission(aOR=7.60;95%CI:2.79-20.68),use of non-pharmacological pain management methods(aOR=3.09;95%CI:1.35-7.08)and availability of analgesia(aOR=3.95;95%CI:1.36-11.43)were associated with acute pain experience.CONCLUSION:The prevalence of acute pain among emergency trauma patients was high in the study area.Analgesia should be administered prior to admission,and non-pharmacological pain management should be implemented.Moreover,training on pain assessment and management should be provided for healthcare providers in the emergency department.
文摘Objective:To compare the therapeutic efficacy of intravenous pantoprazole and famotidine for the treatment of epigastric pain in patients presenting to the emergency department.Methods:In this triple-blind randomized clinical trial,eligible patients presenting with epigastric pain were randomly assigned to receive intravenous pantoprazole or famotidine.Block randomization was used,and patients,treating physicians,and outcome assessors were blinded to treatment allocation.Pain intensity was assessed at baseline and at 30 and 60 minutes after drug administration.Results:Eighty patients were enrolled,with a mean age of 36.6 years(SD,15.0),and 42.5%were male.Mean pain scores decreased significantly over time in both treatment groups.In the pantoprazole group,pain scores declined from 8.02±1.28 at baseline to 4.75±1.31 at 30 minutes and 1.62±1.29 at 60 minutes,whereas in the famotidine group scores decreased from 8.12±1.48 to 5.37±1.23 and 2.35±1.54,respectively.There was no significant difference in baseline pain scores between groups(P=.92).Pantoprazole resulted in greater pain reduction compared with famotidine at both 30 minutes(P=.04)and 60 minutes(P=.05).Conclusions:Both medications were effective in relieving epigastric pain;however,pantoprazole provided greater and more sustained pain reduction,supporting its preferential use in emergency settings.
文摘BACKGROUND Knee osteoarthritis(KOA),a common disabling pathology characterized by knee joint pain,swelling,and functional impairment,primarily affects middle-aged and older adults.In addition to physical limitations,chronic pain often leads to psychological problems,including anxiety and depression,which further impact patients’quality of life.AIM To examine the efficacy and safety of celecoxib plus duloxetine in managing chronic pain,anxiety,and depression in patients with KOA.METHODS A retrospective analysis was conducted on 123 patients with KOA treated at our center between February 2020 and February 2023.Of these,66 received celecoxib plus duloxetine,and 57 received celecoxib alone.Outcomes were assessed using the Visual Analog Scale(VAS),the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),and the Self-Rating Anxiety Scales(SAS)/Self-Rating Depression Scales(SDS).Safety was evaluated by monitoring changes in liver function enzymes(alanine aminotransferase,aspartate aminotransferase),creatinine,and blood urea nitrogen.RESULTS Patients receiving celecoxib plus duloxetine showed significantly greater reductions in VAS and WOMAC and greater improvements in SAS and SDS scores compared with those receiving celecoxib alone.Hepatorenal function did not differ significantly between the treatment groups.Logistic regression analysis identified patient age,educational background,and treatment regimen as independent predictors of inadequate improvement in negative emotional symptoms.CONCLUSION In patients with KOA,celecoxib plus duloxetine effectively mitigates chronic pain and improves anxiety and depressive symptoms without increasing adverse hepatic or renal effects.These findings support its use as a safe and effective treatment option.
文摘Medical history summary:The child has suffered from episodic joint pain in the lower extremities since childhood,with occurrences ranging from 1 to 3 times daily,predominantly during rainy,cold,and humid weather,as well as in the afternoons and evenings.Symptoms and signs:The primary manifestation is episodic pain in the distal extremities,predominantly in the lower limbs,knees,and ankles.Occasionally,the pain may ascend to the elbows,wrists,and palms,and may occasionally affect the proximal extremities and waist.Diagnostic methods:Nerve biopsy and related pathological examinations,along with whole exome sequencing,are helpful for diagnosis,particularly the detection of variants in the SCN11A gene.Treatment approaches:(1)Pharmacotherapy:Sodium channel blockers and nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can alleviate pain.(2)Neuromodulation techniques:Techniques such as transcranial magnetic stimulation(TMS)and spinal cord stimulation(SCS)can be employed to improve symptoms.(3)Psychotherapy:Cognitive-behavioral therapy(CBT),relaxation training,or psychological counseling can enhance the patient’s coping abilities.Clinical outcome:Pain relief can be achieved with analgesic medication in children,and pain symptoms generally persist until adulthood,gradually diminishing or even disappearing.Patients can reduce the frequency of episodes by staying warm and avoiding cold and damp conditions.
文摘Objective:To investigate the clinical efficacy of electrophysiological therapy under different parameter modes in chronic pelvic pain syndrome(CPPS).Methods:A total of 95patients with CPPS from the Department of Urology,First Affiliated Hospital of Jinan University,were selected and treated with electrophysiological therapy.They were randomly divided into three groups:the fixed-parameter AA7 treatment group,the P2+P4 treatment group,and the precision treatment group(individualized parameter treatment).Pain scores of patients in each group were compared before and after treatment,with a pain score of 0 indicating cure.The cure rate of each group was observed.Results:The average ages of the AA7 group,P2+P4 group,and precision treatment group were 34±14.17 years,35.58±12.57 years,and 35.5±11.27 years,respectively.There was no significant difference in age among the three groups(p>0.05).Before treatment,the pain scores of the AA7 group,P2+P4 group,and precision treatment group were 4.14±1.74,4.64±1.72,and 3.50±1.89,respectively,with no significant differences among the groups(p>0.05).After treatment,the pain scores were 0.71±0.99 for the AA7 group(cure rate:57%),0.49±0.79 for the P2+P4 group(cure rate:67%),and 0.50±0.77 for the precision treatment group(cure rate:64%),with no significant differences among the groups(p>0.05).The cure rates for different pain locations were as follows:83%for lower abdominal pain,74%for perineal pain,62%for dysuria,49%for testicular pain,and 75%for inguinal pain.Conclusion:The pathogenesis of CPPS is complex and diverse,with numerous treatment options and uncertain efficacy,posing significant challenges to clinical practice.This study showed that electrophysiological therapy under different parameter modes significantly reduced pain scores before and after treatment,indicating significant therapeutic effects on CPPS.All three modes demonstrated good cure rates.Individualized precision treatment and fixed-mode P2+P4 or AA7 treatment were safe and effective in CPPS treatment and are worth promoting.Fixed-mode P2+P4 and AA7,due to their easier standardization of parameters and patch modes,reduced the learning curve and had better potential for widespread application.
基金The National Natural Science Fund of China(82374561,82174490,81873360)the Research Project of Zhejiang Chinese Medical University(2022JKZKTS44,2022FSYYZZ07)the Zhejiang Medical and Health Science and Technology Program(2021RC098)。
文摘Background:The analgesic effects of multiple electroacupuncture(EA)sessions and single EA sessions differ significantly in pain management.Area 24b(A24b)of the anterior cingulate cortex(ACC)is crucial in pain processing.EA relieves pain by targeting and modulating the neuronal activity within this subregion.However,whether the cumulative effect of EA antinociception is connected to A24b mechanisms has remained unclear.Methods:In our study,we used the Complete Freund's Adjuvant(CFA)model to induce inflammatory pain and the Spared Nerve Injury(SNI)model to induce neuropathic pain,and adult male C57BL/6,FosTRAP,and FosTRAP:Ai9 mice were used as experimental subjects to investigate the cumulative effect of EA antinociception and whether multiple EA sessions and a single EA session regulate different neuronal populations in the A24b.Results:We observed that EA effectively alleviated pain in mice,with three EA sessions yielding superior analgesic effects compared to a single session.Using chemical genetics combined with FosCreER technology to activate EA-TRAPed cells in the A24b,we found that pain relief was more pronounced with three EA sessions.Moreover,chemogenetic inhibition of EA-TRAPed cells in the A24b reversed the analgesic effects of a single EA session but not those of three EA sessions.Fluorescent in situ hybridization results indicated that three EA sessions significantly increased the number of GABAergic neurons in the A24b compared with a single session.Additionally,retrograde tracing revealed that the A24b circuit that monosynaptically innervates EA-TRAPed cells included projections from the central lateral nucleus(CL),lateral mediodorsal thalamic nucleus(MDL),lateral habenula(LHb),dorsal raphe nucleus(DR),caudal linear nucleus of the raphe(CLi),dorsal tuberomamillary nucleus(DTM),periventricular hypothalamic nucleus(Pe)and hippocampal fields CA1,CA2,and CA3.These findings suggest that multiple EA sessions and single EA sessions activated different neuronal populations in the A24b.The enhanced analgesic effect of multiple EA sessions may be attributed to an increase in the proportion of GABAergic neurons within the A24b.Conclusions:Multiple and single EA sessions recruit distinct neuronal populations in A24b,with the stronger analgesic effect of repeated EA linked to a higher proportion of GABAergic neurons in this region.
文摘BACKGROUND Anterior cruciate ligament(ACL)reconstruction using bone-patellar tendon-bone(BPTB)autografts remains the gold standard for young,active individuals due to its superior biomechanical strength and bone-to-bone healing.However,donor site morbidity,particularly anterior knee pain(AKP),limits its utilization despite its advantages.Various techniques have been proposed to reduce AKP,but they show variable outcomes and several limitations.AIM To assess the incidence and severity of AKP following BPTB ACL reconstruction using an autologous bone grafting technique.METHODS We conducted a retrospective observational study of 24 patients aged 20-45 years,who had primary ACL reconstruction with BPTB grafts.During surgery,autologous cancellous bone generated from tunnel drilling was used to fill the patellar and tibial donor site voids after graft fixation.All patients were followed up for at least twelve months.Using the Kujala Anterior Knee Pain Score,clinical outcomes were evaluated,including the pain-specific subcomponent.RESULTS With scores ranging from 86 to 100,the average overall Kujala score was 95.67±4.01.No patient scored below 85.There was no complication such as patellar fracture,tibial tuberosity fracture,or infection.Grouped data showed 20.8%of patients scored 100,whereas 54.2%scored between 95 and 99,and 25%scored between 86 and 94.One patient(4.2%)had an 8/10 pain subcomponent,whereas 23 patients(95.8%)had a 10/10.CONCLUSION This procedure is easy to incorporate into routine surgical practice,cost-effective and reproducible without requiring extra incisions or raising the patient’s surgical expenses.Excellent short-term results back up this technique.
文摘BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship with personality traits has not been previously investigated in the Lebanese population.AIM To examine the prevalence of preoperative anxiety,pain perception,and personality traits among Lebanese surgical patients,and to assess the associations between these factors.METHODS A descriptive cross-sectional study was conducted between April 2024 and January 2025 across Lebanese hospitals.A total of 392 adult patients were recruited through convenience sampling.Data were collected using a questionnaire that included sociodemographic,clinical,and surgical variables,the Amsterdam Preoperative Anxiety and Information Scale for anxiety,the Visual Analog Scale and Numerical Pain Rating Scale for preoperative pain,and the Ten-Item Personality Inventory for personality traits.Ethical approval was obtained from the Institutional Review Boards of Makassed General Hospital and Hammoud University Medical Center.RESULTS Overall,25%of participants experienced preoperative anxiety,and 34.5%reported moderate pain.Personality assessment showed that the majority of participants had moderate extraversion(84.1%),moderate emotional stability(65.1%),high conscientiousness(61%),high agreeableness(54.1%),and moderate openness(49.2%).High conscientiousness was significantly associated with higher pain perception(P<0.05),while high emotional stability was associated with lower levels of anxiety(P<0.05).No significant association was found between preoperative anxiety and pain(P>0.05).CONCLUSION This study challenges the assumption that preoperative anxiety and pain are directly correlated and highlights the role of personality traits in shaping patient experience.These findings support the potential value of integrating psychological profiling into preoperative care and lay the groundwork for developing personalized interventions to improve patient-centered surgical outcomes.
文摘Medical procedures are inherently invasive and carry the risk of inducing pain to the mind and body.Recently,efforts have been made to alleviate the discomfort associated with invasive medical procedures through the use of virtual reality(VR)technology.VR has been demonstrated to be an effective treatment for pain associated with medical procedures,as well as for chronic pain conditions for which no effective treatment has been established.The precise mechanism by which the diversion from reality facilitated by VR contributes to the diminution of pain and anxiety has yet to be elucidated.However,the provision of positive images through VR-based visual stimulation may enhance the functionality of brain networks.The salience network is diminished,while the default mode network is enhanced.Additionally,the medial prefrontal cortex may establish a stronger connection with the default mode network,which could result in a reduction of pain and anxiety.Further research into the potential of VR technology to alleviate pain could lead to a reduction in the number of individuals who overdose on painkillers and contribute to positive change in the medical field.
基金supported by the National Natural Science Foundation of China,Nos.82374561(to JD),82174490(to JF)the Medical and Health Science and Technology Program of Zhejiang Province,No.2021RC098(to JD)the Research Project of Zhejiang Chinese Medical University,Nos.2022JKZKTS44(to JD),2022FSYYZZ07(to JF).
文摘Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairments in inhibitory gamma-aminobutyric acid neurotransmission.This review primarily aims to outline the main circuitry(including the input and output connectivity)of the anterior cingulate cortex and classification and functions of different gamma-aminobutyric acidergic neurons;it also describes the neurotransmitters/neuromodulators affecting these neurons,their intercommunication with other neurons,and their importance in mental comorbidities associated with chronic pain disorders.Improving understanding on their role in pain-related mental comorbidities may facilitate the development of more effective treatments for these conditions.However,the mechanisms that regulate gamma-aminobutyric acidergic systems remain elusive.It is also unclear as to whether the mechanisms are presynaptic or postsynaptic.Further exploration of the complexities of this system may reveal new pathways for research and drug development.
文摘In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poor management of postcesarean pain is associated with decreased maternal care for the baby,longer hospitalization,and higher risk of developing postpartum depression.Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies.However,due to its potential adverse effects on the neurological and hemodynamic status of patients,it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain.Before any recommendation for routine perioperative use of esketamine,more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.
基金National Nature Science Foundation of China 82471000(to K.J.)National Nature Science Foundation of China 82170978(to K.J.)+1 种基金National Nature Science Foundation of China 82325012(to L.N.N.)National Key Research and Development Program 2023YFC2509100(to K.J.)。
文摘Temporomandibular joint osteoarthritis(TMJ-OA)is a common disease often accompanied by pain,seriously affecting physical and mental health of patients.Abnormal innervation at the osteochondral junction has been considered as a predominant origin of arthralgia,while the specific mechanism mediating pain remains unclear.To investigate the underlying mechanism of TMJ-OA pain,an abnormal joint loading model was used to induce TMJ-OA pain.We found that during the development of TMJ-OA,the increased innervation of sympathetic nerve of subchondral bone precedes that of sensory nerves.Furthermore,these two types of nerves are spatially closely associated.Additionally,it was discovered that activation of sympathetic neural signals promotes osteoarthritic pain in mice,whereas blocking these signals effectively alleviates pain.In vitro experiments also confirmed that norepinephrine released by sympathetic neurons promotes the activation and axonal growth of sensory neurons.Moreover,we also discovered that through releasing norepinephrine,regional sympathetic nerves of subchondral bone were found to regulate growth and activation of local sensory nerves synergistically with other pain regulators.This study identified the role of regional sympathetic nerves in mediating pain in TMJ-OA.It sheds light on a new mechanism of abnormal innervation at the osteochondral junction and the regional crosstalk between peripheral nerves,providing a potential target for treating TMJ-OA pain.
