BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus ...BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.展开更多
Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate st...Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.展开更多
Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few d...Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p < 0.001), providing greater individualized care (p = 0.01), and decreasing post-operative pain medication dependence (p = 0.04).展开更多
Total knee arthroplasty （TKA） can contribute to significant pain for the patient. Continuous peripheral nerve blocks （CPNBs） have been shown to be efficacious in treating post-surgical pain. The objective of this ...Total knee arthroplasty （TKA） can contribute to significant pain for the patient. Continuous peripheral nerve blocks （CPNBs） have been shown to be efficacious in treating post-surgical pain. The objective of this study is to determine the efficacy of a bupivacaine 0.2% solution administered via CPNB plus standard of care （SOC） compared to SOC alone. SOC for this institution includes the use of opioid analgesics, non-opioid analgesics, regional anesthesia, and other adjuncts. The primary outcome is the overall use of post-operative pain medication. Secondary outcomes include the average length of stay and average pain scores. Methods： A data surveillance system was used to retrospectively identify all patients who underwent TKA with and without the use of CPNB. To be included, patients must have been male or female ≥ 18 years of age who underwent TKA from September 2016 through September 2017. And 70 patients were included in both the CPNB and SOC groups. A retrospective chart review determined the following data： The types and amounts of pain medications used, the length of stay, and patient-reported pain scores. Results： There was an increase in the amount of as needed pain medication use in the CPNB ＋ SOC vs. SOC group with 12.97 administrations vs. 12.67 administrations respectively. Length of stay was increased in the CPNB ＋ SOC vs. SOC group with 3.65 days in the CPNB ＋ SOC group vs. 3.5 days in the SOC group. Pain scores were increased in the CPNB ＋ SOC group with a patient average pain score of 4.5 vs. the SOC groups average pain score of 4.4. Conclusions： The use of a 0.2% bupivacaine solution administered via CPNB in addition to SOC resulted in increased utilization of as needed pain medication administration, increased average length of stay, and increased average pain scores when compared to SOC alone.展开更多
Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analg...Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.展开更多
<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective s...<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. <b>Results:</b> In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. <b>Conclusion:</b> Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.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
Background:Extended-release buprenorphine(XR)is indicated for pain management in rodents,but little is known about its use in mice.This study aimed to investigate whether high dose XR effectively attenuates post-opera...Background:Extended-release buprenorphine(XR)is indicated for pain management in rodents,but little is known about its use in mice.This study aimed to investigate whether high dose XR effectively attenuates post-operative hypersensitivity better than low dose XR in a mouse model of incisional pain.Methods:Mice(n 44)were randomly assigned to 1 of 4 treatment groups:(a)saline(1 ml/kg SC,once);(b)sustained release buprenorphine(Bup-SR,1 mg/kg SC,once);(c)low dose extended-release buprenorphine(XR-lo,3.25 mg/kg SC,once);(d)high dose extended-release buprenorphine(XR-hi,6.5 mg/kg SC,once).On days1,0(4 hours),1,2,and 3,mechanical and thermal hypersensitivities were evaluated,and plasma buprenorphine concentrations were measured.Results:Mechanical(days 0-2)and thermal(days 0-1)hypersensitivities were ob-served in the saline group.Bup-SR,XR-lo,and XR-hi attenuated mechanical hyper-sensitivity on days 0,1,and 2.None of the treatment groups,except XR-Lo on day 0,attenuated thermal hypersensitivity on days 0 or 1.Plasma buprenorphine concen-tration peaked at 4 hours(day 0)in all treatment groups and remained greater than 1 ng/mL on days 0-2.No abnormal clinical observations or gross pathologic findings were seen in any groups.Conclusion:The results indicate XR-hi did not effectively attenuate post-operative hypersensitivity better than XR-lo.Thus both 3.25 and 6.5 mg/kg XR are recom-mended for attenuating post-operative hypersensitivity for at least up to 48 hours in mice.展开更多
BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment...BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.展开更多
<b><span style="font-family:Verdana;">Purpose:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span st...<b><span style="font-family:Verdana;">Purpose:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Persistent Postoperative Low Back Pain (PLBP) is inordinately </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">com</span><span style="font-family:Verdana;">mon, and has been attributed to various pre-operative and post-operative</span><span style="font-family:Verdana;"> anatomical and mechanical factors in the spine. It may or may not be associated with sensory symptoms in the lower extremities—frequently termed “radiculopathy”—with or without Electromyographic (EMG) or imaging abnormalities. The present study aimed to look at these various symptoms in the lower extremities from a different angle and perspective and to clarify the distinc</span><span style="font-family:Verdana;">tion between true radiculopathy and pseudoradiculopathy;and determine</span><span style="font-family:Verdana;"> their possible relationship with the outcome of surgery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Medical records of twenty-four patients with PLBP who were referred to the author for clinical and electrodiagnostic examinations several months after surgery were re</span><span style="font-family:Verdana;">viewed. Clinical symptomatology, with special reference to the presence or</span><span style="font-family:Verdana;"> ab</span><span style="font-family:Verdana;">sence of sensory and motor deficits together with EMG findings, were reviewed and categorized into 4 groups: non</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">radicular, true radiculopathy, </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">pseudoradiculopathy, and peripheral neuropathy. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Lower Back Pain (LBP) in all patients persisted following successful and uncomplicated surgery. LBP in patients with true radiculopathy persisted but was less disabling when the neurologic deficits resolved partially or significantly. As expected</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> the neurologic deficits related to peripheral neuropathy, together with LBP, remained per</span><span><span style="font-family:Verdana;">sistent. </span><b><span style="font-family:Verdana;">Conclusion:</span></b> <span style="font-family:Verdana;">LBP and various sensory and</span></span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">motor symptoms in the</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> lower </span><span style="font-family:Verdana;">extremities are 2 distinct entities, both clinically</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and pathophysiologically.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> These sensory and motor symptoms, together with </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">heightened activity of various</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pro</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">inflammatory cytokines and neurotrophins—setting aside the various</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">anatomical and mechanical factors in the spine—can influence the outcome of surgery, favorably or unfavorably.展开更多
Summary Pain is not pain because people interpret symptoms differently.Neck pain is one of the most common pains and should not be missing from a study on the effects of pain.Depression does not arise solely from pain...Summary Pain is not pain because people interpret symptoms differently.Neck pain is one of the most common pains and should not be missing from a study on the effects of pain.Depression does not arise solely from pain but is multicausal and often caused by this cumulative effect.展开更多
While acute nociceptive pain is a crucial warning system that protects us from injury or disease,chronic pain is not protective,but a pathological condition.As such,it is now recognized as a disease in its own right,w...While acute nociceptive pain is a crucial warning system that protects us from injury or disease,chronic pain is not protective,but a pathological condition.As such,it is now recognized as a disease in its own right,which major classes refer to inflammatory,neuropathic,and idiopathic pain.It is frequent,with up to a third of the population that may suffer at one point from chronic pain.It is often associated with other pathologies,including sleep disorders,anxiety,depression,and is still difficult to treat.It thus represents a significant burden in terms of health and societal impact(Tracey et al.,2019).The mechanisms of chronic pain involve multiple diverse pathways in both the peripheral and central nervous systems(CNS),reflecting its multifaceted biology.Indeed,research over the past decades has established that central sensitization(enhancement in the function of neurons and circuits in central nociceptive pathways),in particular within the dorsal horn,the first central relay of nociceptive inputs plays a key role in the chronicity of pain(Latremoliere and Woolf,2009).展开更多
Neuropathic pain is a complex and debilitating condition caused by lesions or dysfunction within the somatosensory nervous system.Affecting an estimated 7%-10%of the global population,it presents with spontaneous pain...Neuropathic pain is a complex and debilitating condition caused by lesions or dysfunction within the somatosensory nervous system.Affecting an estimated 7%-10%of the global population,it presents with spontaneous pain,hyperalgesia,and allodynia,often accompanied by long-term emotional and cognitive consequences,such as depression and anxiety,which result in a reduced quality of life.Despite extensive research efforts,effective treatments remain limited.This limited efficacy likely stems,in part,from the heterogeneous nature of neuropathic pain,which varies widely across individuals in both clinical presentation and treatment responsiveness.展开更多
Chronic pain represents a significant global health challenge,and the limitations of conventional analgesics have urged a search for alternative therapeutic strategies.Cannabinoids derived from Cannabis sativa have em...Chronic pain represents a significant global health challenge,and the limitations of conventional analgesics have urged a search for alternative therapeutic strategies.Cannabinoids derived from Cannabis sativa have emerged as prominent candidates.While psychotropic cannabinoids are known for their analgesic effects,their psychoactive properties often limit their clinical utility.Consequently,interest has shifted towards non-psychotropic cannabinoids that offer potential pain relief without inducing cognitive or euphoric effects.This comprehensive review investigates the pain-modulating mechanisms of cannabinoids,encompassing interactions with the endocannabinoid system and other non-traditional pathways,and summarizes the existing preclinical and clinical evidence supporting their use in various pain states.Furthermore,it discusses the therapeutic potential,clinical considerations,significant challenges,and the need for product standardization.This review also aims to evaluate the role and prospects of non-psychotropic cannabinoids as a therapeutic option for pain management.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
[Objectives]To investigate the clinical efficacy of core stability training combined with conventional rehabilitation in the functional recovery of patients suffering from chronic low back pain.[Methods]A randomized c...[Objectives]To investigate the clinical efficacy of core stability training combined with conventional rehabilitation in the functional recovery of patients suffering from chronic low back pain.[Methods]A randomized controlled trial design was employed in this study.Ninety patients with chronic low back pain were recruited and randomly assigned to either a control group(n=45),which received conventional rehabilitation,or an experimental group(n=45),which received conventional rehabilitation combined with core stability training.Both groups underwent treatment for 6 weeks.Assessments were conducted using the visual analogue scale(VAS),Oswestry disability index(ODI),and finger-to-floor test prior to treatment,6 weeks following treatment,and during the follow-up period,respectively.[Results]Prior to treatment,no statistically significant differences were observed between the two patient groups in terms of general information and various baseline measurements(P>0.05).Following 6 weeks of treatment and throughout the follow-up period,both groups demonstrated significant improvements in VAS scores,ODI scores,and lumbar anteflexion range of motion compared to baseline measurements(P<0.05).Notably,the magnitude of improvement in the experimental group exceeded that of the control group,with this inter-group difference reaching statistical significance(P<0.05).No serious adverse reactions were reported during the treatment process.[Conclusions]Core stability training combined with conventional rehabilitation can significantly enhance the alleviation of pain and functional impairments in patients suffering from chronic low back pain.This approach holds valuable implications for the optimization of rehabilitation treatment protocols.展开更多
Chronic pain following a spinal cord injury refers to pain that persists or recurs after the injury.This pain can manifest as burning,stinging,or sensations similar to electric shocks.Recent studies have shown that sp...Chronic pain following a spinal cord injury refers to pain that persists or recurs after the injury.This pain can manifest as burning,stinging,or sensations similar to electric shocks.Recent studies have shown that spinal cord stimulation is an effective way to treat chronic pain after spinal cord injury.The purpose of this review is to introduce the technique of spinal cord stimulation,the clinical manifestations of spinal cord injury,and the role of spinal cord stimulation in the treatment of spinal cord injury.The mechanism and clinical application of spinal cord stimulation in the treatment of pain after spinal cord injury are discussed.The mechanism of spinal cord stimulation primarily involves three aspects:neuromodulation,neurochemical regulation,and anti-inflammatory effects,along with nerve repair.In terms of neuromodulation,spinal cord stimulation is based on the gate control theory of pain.It activates large-diameter amyloid-βnerve fibers to promote the release of inhibitory neurotransmitters by gamma-aminobutyric acidergic inhibitory interneurons in the spinal cord,thereby blocking the transmission of pain signals from small-diameter C fibers.Neurochemical studies indicate that spinal cord stimulation can regulate the balance of neurotransmitters within the spinal cord,increasing the release of inhibitory neurotransmitters such as gamma-aminobutyric acid,serotonin,and acetylcholine while reducing the levels of excitatory neurotransmitters.Additionally,spinal cord stimulation exhibits significant anti-inflammatory and neuroprotective effects,downregulating pro-inflammatory factor levels,upregulating anti-inflammatory factor expression,alleviating neuroinflammatory responses,and repairing damaged neural circuits by promoting the secretion of neurotrophic factors and axonal regeneration.Spinal cord stimulation have demonstrated remarkable efficacy in the clinical treatment of pain after spinal cord injury,but there are still limitations such as small sample size and high heterogeneity in clinical studies,as well as insufficient long-term efficacy data.Future research should conduct multi-center large-sample randomized controlled trials,and establish long-term follow-up mechanisms to improve evidence-based medical evidence.展开更多
文摘BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.
文摘Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.
文摘Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p < 0.001), providing greater individualized care (p = 0.01), and decreasing post-operative pain medication dependence (p = 0.04).
文摘Total knee arthroplasty （TKA） can contribute to significant pain for the patient. Continuous peripheral nerve blocks （CPNBs） have been shown to be efficacious in treating post-surgical pain. The objective of this study is to determine the efficacy of a bupivacaine 0.2% solution administered via CPNB plus standard of care （SOC） compared to SOC alone. SOC for this institution includes the use of opioid analgesics, non-opioid analgesics, regional anesthesia, and other adjuncts. The primary outcome is the overall use of post-operative pain medication. Secondary outcomes include the average length of stay and average pain scores. Methods： A data surveillance system was used to retrospectively identify all patients who underwent TKA with and without the use of CPNB. To be included, patients must have been male or female ≥ 18 years of age who underwent TKA from September 2016 through September 2017. And 70 patients were included in both the CPNB and SOC groups. A retrospective chart review determined the following data： The types and amounts of pain medications used, the length of stay, and patient-reported pain scores. Results： There was an increase in the amount of as needed pain medication use in the CPNB ＋ SOC vs. SOC group with 12.97 administrations vs. 12.67 administrations respectively. Length of stay was increased in the CPNB ＋ SOC vs. SOC group with 3.65 days in the CPNB ＋ SOC group vs. 3.5 days in the SOC group. Pain scores were increased in the CPNB ＋ SOC group with a patient average pain score of 4.5 vs. the SOC groups average pain score of 4.4. Conclusions： The use of a 0.2% bupivacaine solution administered via CPNB in addition to SOC resulted in increased utilization of as needed pain medication administration, increased average length of stay, and increased average pain scores when compared to SOC alone.
文摘Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.
文摘<b>Objectives:</b> To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. <b>Methods:</b> This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. <b>Results:</b> In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. <b>Conclusion:</b> Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.
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Background:Extended-release buprenorphine(XR)is indicated for pain management in rodents,but little is known about its use in mice.This study aimed to investigate whether high dose XR effectively attenuates post-operative hypersensitivity better than low dose XR in a mouse model of incisional pain.Methods:Mice(n 44)were randomly assigned to 1 of 4 treatment groups:(a)saline(1 ml/kg SC,once);(b)sustained release buprenorphine(Bup-SR,1 mg/kg SC,once);(c)low dose extended-release buprenorphine(XR-lo,3.25 mg/kg SC,once);(d)high dose extended-release buprenorphine(XR-hi,6.5 mg/kg SC,once).On days1,0(4 hours),1,2,and 3,mechanical and thermal hypersensitivities were evaluated,and plasma buprenorphine concentrations were measured.Results:Mechanical(days 0-2)and thermal(days 0-1)hypersensitivities were ob-served in the saline group.Bup-SR,XR-lo,and XR-hi attenuated mechanical hyper-sensitivity on days 0,1,and 2.None of the treatment groups,except XR-Lo on day 0,attenuated thermal hypersensitivity on days 0 or 1.Plasma buprenorphine concen-tration peaked at 4 hours(day 0)in all treatment groups and remained greater than 1 ng/mL on days 0-2.No abnormal clinical observations or gross pathologic findings were seen in any groups.Conclusion:The results indicate XR-hi did not effectively attenuate post-operative hypersensitivity better than XR-lo.Thus both 3.25 and 6.5 mg/kg XR are recom-mended for attenuating post-operative hypersensitivity for at least up to 48 hours in mice.
文摘BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.
文摘<b><span style="font-family:Verdana;">Purpose:</span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Persistent Postoperative Low Back Pain (PLBP) is inordinately </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">com</span><span style="font-family:Verdana;">mon, and has been attributed to various pre-operative and post-operative</span><span style="font-family:Verdana;"> anatomical and mechanical factors in the spine. It may or may not be associated with sensory symptoms in the lower extremities—frequently termed “radiculopathy”—with or without Electromyographic (EMG) or imaging abnormalities. The present study aimed to look at these various symptoms in the lower extremities from a different angle and perspective and to clarify the distinc</span><span style="font-family:Verdana;">tion between true radiculopathy and pseudoradiculopathy;and determine</span><span style="font-family:Verdana;"> their possible relationship with the outcome of surgery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Medical records of twenty-four patients with PLBP who were referred to the author for clinical and electrodiagnostic examinations several months after surgery were re</span><span style="font-family:Verdana;">viewed. Clinical symptomatology, with special reference to the presence or</span><span style="font-family:Verdana;"> ab</span><span style="font-family:Verdana;">sence of sensory and motor deficits together with EMG findings, were reviewed and categorized into 4 groups: non</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">radicular, true radiculopathy, </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">pseudoradiculopathy, and peripheral neuropathy. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Lower Back Pain (LBP) in all patients persisted following successful and uncomplicated surgery. LBP in patients with true radiculopathy persisted but was less disabling when the neurologic deficits resolved partially or significantly. As expected</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> the neurologic deficits related to peripheral neuropathy, together with LBP, remained per</span><span><span style="font-family:Verdana;">sistent. </span><b><span style="font-family:Verdana;">Conclusion:</span></b> <span style="font-family:Verdana;">LBP and various sensory and</span></span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">motor symptoms in the</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> lower </span><span style="font-family:Verdana;">extremities are 2 distinct entities, both clinically</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and pathophysiologically.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> These sensory and motor symptoms, together with </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">heightened activity of various</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pro</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">inflammatory cytokines and neurotrophins—setting aside the various</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">anatomical and mechanical factors in the spine—can influence the outcome of surgery, favorably or unfavorably.
文摘Summary Pain is not pain because people interpret symptoms differently.Neck pain is one of the most common pains and should not be missing from a study on the effects of pain.Depression does not arise solely from pain but is multicausal and often caused by this cumulative effect.
基金Institut National de la Santéet de la Recherche Médicale(Inserm)UniversitéClermont Auvergne(France)+2 种基金CHU Clermont-Ferrand(to RD)the French government IDEX-ISITE initiative 16-IDEX-0001(to RD)The Fondation pour la Recherche Médicale(FRM)(to SM).
文摘While acute nociceptive pain is a crucial warning system that protects us from injury or disease,chronic pain is not protective,but a pathological condition.As such,it is now recognized as a disease in its own right,which major classes refer to inflammatory,neuropathic,and idiopathic pain.It is frequent,with up to a third of the population that may suffer at one point from chronic pain.It is often associated with other pathologies,including sleep disorders,anxiety,depression,and is still difficult to treat.It thus represents a significant burden in terms of health and societal impact(Tracey et al.,2019).The mechanisms of chronic pain involve multiple diverse pathways in both the peripheral and central nervous systems(CNS),reflecting its multifaceted biology.Indeed,research over the past decades has established that central sensitization(enhancement in the function of neurons and circuits in central nociceptive pathways),in particular within the dorsal horn,the first central relay of nociceptive inputs plays a key role in the chronicity of pain(Latremoliere and Woolf,2009).
基金Institute for Basic Science(IBS)Center for Cognition and Sociality(IBS-R001-D2 to BL).
文摘Neuropathic pain is a complex and debilitating condition caused by lesions or dysfunction within the somatosensory nervous system.Affecting an estimated 7%-10%of the global population,it presents with spontaneous pain,hyperalgesia,and allodynia,often accompanied by long-term emotional and cognitive consequences,such as depression and anxiety,which result in a reduced quality of life.Despite extensive research efforts,effective treatments remain limited.This limited efficacy likely stems,in part,from the heterogeneous nature of neuropathic pain,which varies widely across individuals in both clinical presentation and treatment responsiveness.
文摘Chronic pain represents a significant global health challenge,and the limitations of conventional analgesics have urged a search for alternative therapeutic strategies.Cannabinoids derived from Cannabis sativa have emerged as prominent candidates.While psychotropic cannabinoids are known for their analgesic effects,their psychoactive properties often limit their clinical utility.Consequently,interest has shifted towards non-psychotropic cannabinoids that offer potential pain relief without inducing cognitive or euphoric effects.This comprehensive review investigates the pain-modulating mechanisms of cannabinoids,encompassing interactions with the endocannabinoid system and other non-traditional pathways,and summarizes the existing preclinical and clinical evidence supporting their use in various pain states.Furthermore,it discusses the therapeutic potential,clinical considerations,significant challenges,and the need for product standardization.This review also aims to evaluate the role and prospects of non-psychotropic cannabinoids as a therapeutic option for pain management.
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[Objectives]To investigate the clinical efficacy of core stability training combined with conventional rehabilitation in the functional recovery of patients suffering from chronic low back pain.[Methods]A randomized controlled trial design was employed in this study.Ninety patients with chronic low back pain were recruited and randomly assigned to either a control group(n=45),which received conventional rehabilitation,or an experimental group(n=45),which received conventional rehabilitation combined with core stability training.Both groups underwent treatment for 6 weeks.Assessments were conducted using the visual analogue scale(VAS),Oswestry disability index(ODI),and finger-to-floor test prior to treatment,6 weeks following treatment,and during the follow-up period,respectively.[Results]Prior to treatment,no statistically significant differences were observed between the two patient groups in terms of general information and various baseline measurements(P>0.05).Following 6 weeks of treatment and throughout the follow-up period,both groups demonstrated significant improvements in VAS scores,ODI scores,and lumbar anteflexion range of motion compared to baseline measurements(P<0.05).Notably,the magnitude of improvement in the experimental group exceeded that of the control group,with this inter-group difference reaching statistical significance(P<0.05).No serious adverse reactions were reported during the treatment process.[Conclusions]Core stability training combined with conventional rehabilitation can significantly enhance the alleviation of pain and functional impairments in patients suffering from chronic low back pain.This approach holds valuable implications for the optimization of rehabilitation treatment protocols.
基金supported by Key Tackling Project of the Education Department of Liaoning Province,No.2024C011the Medical-Industrial Joint Innovation Funding Project of the First Hospital of Dalian Medical University and Dalian Institute of Chemical Physics,No.DMU-1&DICP UN202311(both to ZL).
文摘Chronic pain following a spinal cord injury refers to pain that persists or recurs after the injury.This pain can manifest as burning,stinging,or sensations similar to electric shocks.Recent studies have shown that spinal cord stimulation is an effective way to treat chronic pain after spinal cord injury.The purpose of this review is to introduce the technique of spinal cord stimulation,the clinical manifestations of spinal cord injury,and the role of spinal cord stimulation in the treatment of spinal cord injury.The mechanism and clinical application of spinal cord stimulation in the treatment of pain after spinal cord injury are discussed.The mechanism of spinal cord stimulation primarily involves three aspects:neuromodulation,neurochemical regulation,and anti-inflammatory effects,along with nerve repair.In terms of neuromodulation,spinal cord stimulation is based on the gate control theory of pain.It activates large-diameter amyloid-βnerve fibers to promote the release of inhibitory neurotransmitters by gamma-aminobutyric acidergic inhibitory interneurons in the spinal cord,thereby blocking the transmission of pain signals from small-diameter C fibers.Neurochemical studies indicate that spinal cord stimulation can regulate the balance of neurotransmitters within the spinal cord,increasing the release of inhibitory neurotransmitters such as gamma-aminobutyric acid,serotonin,and acetylcholine while reducing the levels of excitatory neurotransmitters.Additionally,spinal cord stimulation exhibits significant anti-inflammatory and neuroprotective effects,downregulating pro-inflammatory factor levels,upregulating anti-inflammatory factor expression,alleviating neuroinflammatory responses,and repairing damaged neural circuits by promoting the secretion of neurotrophic factors and axonal regeneration.Spinal cord stimulation have demonstrated remarkable efficacy in the clinical treatment of pain after spinal cord injury,but there are still limitations such as small sample size and high heterogeneity in clinical studies,as well as insufficient long-term efficacy data.Future research should conduct multi-center large-sample randomized controlled trials,and establish long-term follow-up mechanisms to improve evidence-based medical evidence.
