BACKGROUND: Post-discharge opioid use patterns in opioid-naïve patients following cancer surgery remain poorly characterized, particularly during the early transition period after discharge. AIM: To determine the prevale...BACKGROUND: Post-discharge opioid use patterns in opioid-naïve patients following cancer surgery remain poorly characterized, particularly during the early transition period after discharge. AIM: To determine the prevalence of continued opioid use 7 days after discharge and to identify predictors and cessation trajectories over 30 days post-discharge. METHODS: A prospective single-center cohort study enrolled opioid-naïve patients undergoing curative-intent elective cancer surgery across three surgical specialties (breast, gynecological oncology, and head and neck) between June 2021 and January 2023. The primary outcome was patient-reported opioid use at Day 7 post-discharge. Multivariable logistic regression identified independent predictors; Kaplan-Meier analysis estimated time-to-cessation by pre-discharge opioid exposure group. RESULTS: Among 107 opioid-naïve patients, 42% continued opioid use beyond 7 days. Patients who continued opioids had higher pain interference, more opioid-related adverse events, and higher opioid consumption during 24 h prior to discharge (p < 0.05). In multivariable analysis, having opioids in 24 h prior to discharge (adjusted odds ratio [aOR] 4.46; 95% CI 1.56-12.7), first-time cancer surgery (aOR 6.06; 95% CI 1.45-25.6), and higher stage of cancer (aOR 1.50; 95% CI 1.00-2.23) were independently associated with continued opioid use. Kaplan-Meier graph analysis demonstrated significantly different cessation trajectories between pre-discharge opioid exposure groups (log rank p < 0.001). CONCLUSION: Continued opioid use in the first week following cancer surgery is common. Pre-discharge opioid exposure and disease burden independently predict delayed cessation. Opioid use in the final 24 h before discharge represents a practical, clinically accessible signal for risk stratification and individualized opioid stewardship.
INTRODUCTION: Despite increasing representation of women in medicine overall, significant gender disparities persist in procedural specialties such as interventional pain medicine. Women remain underrepresented as speake...INTRODUCTION: Despite increasing representation of women in medicine overall, significant gender disparities persist in procedural specialties such as interventional pain medicine. Women remain underrepresented as speakers at national pain conferences and in leadership roles. Additionally, a pay gap between female and male pain physicians remains. This study aims to objectively demonstrate the above-mentioned inequities. METHODS: National conference faculty were analyzed across five major pain societies (ASRA, NANS, AAPM, ASIPP, ASPN) from 2020 to 2024 annual conference agendas. Gender was assigned based on publicly available information. Leadership roles were assessed by identifying the gender of pain fellowship program directors and pain medicine department chairs. Lastly, using the Association of American Medical Colleges (AAMC) Faculty Salary Report (2021-2024), we examined the compensation gap and difference in salary growth rates between genders. RESULTS: Across national conferences, only 25% of speakers were female, with ASRA demonstrating the most consistent female representation. Of the pain medicine fellowship programs studied, there were 36 (32.7%) female program directors and 25 (23.8%) female department chairs. Programs led by female program directors had significantly higher proportions of female faculty (OR = 1.97, CI [1.45, 2.68], p < 0.0001). Salary data revealed that at every academic rank, women in pain medicine faculty earned less than their male counterparts. Additionally, there is a statistically significant difference between the salary growth rates of male and female associate professors between 2021 and 2024 (F = 12.25, p < 0.05). CONCLUSION: Substantial gender disparities remain in visibility at national conferences, academic leadership, and compensation in pain medicine. Female-led academic programs demonstrate more gender-diverse faculties, highlighting the importance of representation in leadership. Focused efforts are needed to promote mentorship, equitable hiring, and transparency in pay and speaking opportunities to foster a more inclusive field.
BACKGROUND: This investigation aimed to replicate phenotypes in pediatric complex regional pain syndrome (CRPS) previously identified in adult CRPS patients. The impact of an intensive pain therapeutic approach in pediat...BACKGROUND: This investigation aimed to replicate phenotypes in pediatric complex regional pain syndrome (CRPS) previously identified in adult CRPS patients. The impact of an intensive pain therapeutic approach in pediatric CRPS was also evaluated. METHODS: Neurological examination data were obtained from two samples of children with CRPS (cohort #1; N = 24 and cohort #2; N = 14). The structure among CRPS signs was analyzed on pooled data from cohorts #1 and 2 using hierarchical clustering. A phenotype score was quantified for patients and then submitted to unsupervised k-means clustering. Patients in cohort #2 were enrolled in a 4-6-week treatment program consisting of psychological, physical, and occupational therapy. Questionnaires about pain and mental and physical health were evaluated at treatment admission and discharge. RESULTS: A two-cluster structure of CRPS signs could be replicated in the pediatric population. Cluster #1 includes skin color, temperature, and edema resembling peripheral inflammation ("peripheral" phenotype). Cluster #2 grouped together motor disorders, minor injury, glove/stocking-like sensory deficits, and allodynia ("central" phenotype). K-means clustering also showed three phenotypes, "peripheral" (N = 12), "central" (N = 10), and "mixed" (N = 17), similar to adults. The impact of treatment was revealed for pain affect, pain behavior, psychological distress, depression, pain catastrophizing levels, as well as physical activity and strength (Cohen's d = [0.8-1.3]). CONCLUSIONS: CRPS phenotypes reflecting major pathophysiological mechanisms of peripheral inflammation and central reorganization are identifiable in adult and pediatric patients, suggesting phenomenological features of the disease. An intensive interdisciplinary pain treatment approach was effective in reducing CRPS severity and restoring function in pediatric CRPS.
BACKGROUND: Percutaneous cervical cordotomy (PCC) is a minimally invasive radiofrequency procedure for intractable unilateral cancer pain. Commonly performed under conscious sedation, awake PCC enables real-time patient...BACKGROUND: Percutaneous cervical cordotomy (PCC) is a minimally invasive radiofrequency procedure for intractable unilateral cancer pain. Commonly performed under conscious sedation, awake PCC enables real-time patient feedback, potentially improving targeting precision and expanding eligibility for patients in whom sedation poses risks. METHOD AND TECHNIQUE: This article presents the structured protocol for awake PCC implemented at our center, including pre-procedural training, positioning, fluoroscopic guidance, impedance monitoring, sensory and motoric testing, lesioning strategy, and aftercare. The key principle is to create the smallest effective lesion, applied incrementally until spinothalamic tract disruption is confirmed. DISCUSSION: In our experience, awake PCC enables precise targeting and has yielded up to 90% success in pain relief. The approach requires substantial preparation, including training for both patient and team to ensure cooperation, clear communication, and tolerance of brief intraoperative discomfort. Although these demands can be challenging, we have found awake PCC to be a safe and effective last-resort option for patients facing devastating pain. CONCLUSION: This technical note provides a practical and stepwise approach to awake PCC. It may assist clinicians in adopting or refining the technique.
OBJECTIVE: To evaluate the efficacy of transdermal buprenorphine for treating pain in patients with chronic low back pain (CLBP), with additional assessment of sleep quality and adverse events. METHODS: A systematic lite...OBJECTIVE: To evaluate the efficacy of transdermal buprenorphine for treating pain in patients with chronic low back pain (CLBP), with additional assessment of sleep quality and adverse events. METHODS: A systematic literature search was conducted in PubMed, Scopus, Embase, and Cochrane CENTRAL up to June 2025. Randomized controlled trials (RCTs) comparing transdermal buprenorphine with placebo in adults with CLBP were included. Pain intensity was the primary outcome; secondary outcomes were sleep quality and adverse events. This review followed PRISMA guidelines and was registered in PROSPERO (CRD42024629751). RESULTS: Six RCTs, including 698 patients, were analyzed. Transdermal buprenorphine did not significantly reduce pain intensity compared to placebo (Mean Difference = -0.32; 95% CI: -1.04 to 0.40; p = 0.380; I = 77.4%). However, a small but statistically significant improvement in sleep quality was found (Standardized Mean Difference = -0.24; 95% CI: -0.37 to -0.10; p < 0.001; I = 28%). Adverse events were more frequent in the buprenorphine group, although not statistically significant for total adverse events (RR = 1.98; 95% CI: 0.97 to 4.02; p = 0.060). CONCLUSION: These findings suggest a limited benefit of transdermal buprenorphine for pain relief in CLBP. While sleep quality may improve slightly, the potential for increased adverse events must be considered. Current evidence does not support the routine use of transdermal buprenorphine for CLBP due to insufficient analgesic effect and possible safety concerns.
OBJECTIVES: Low back pain is a common pathology in the general population. In people over 60 years of age, it is associated with degenerative changes that cause narrowing of the vertebral canal. Its treatment includes co...OBJECTIVES: Low back pain is a common pathology in the general population. In people over 60 years of age, it is associated with degenerative changes that cause narrowing of the vertebral canal. Its treatment includes conservative measures and even surgery with decompression and fusion. In those patients with moderate symptoms, the use of interspinous spacers emerged as a minimally invasive therapeutic option. This scoping review seeks to map the existing literature on the use of interspinous spacers and identify knowledge gaps to clarify their real position in the stepwise approach to low back pain. MATERIALS AND METHODS: This study as a scoping review, conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the PRISMA-ScR guidelines. The type of synthesis chosen was descriptive and mapping-based, allowing for the inclusion of diverse study designs (randomized controlled trials, observational studies, case series, clinical guidelines, and relevant reviews) to capture a comprehensive overview of the field. This approach was selected because the existing literature is heterogeneous in terms of intervention protocols, clinical outcomes, and follow-up duration, and the effectiveness and indications for interspinous spacers (ISD) remain controversial. The search was extended from the inception of the databases until November 2025. The program "Rayyan" was used to collect the information and facilitate the analysis process. Each of the authors independently reviewed the summary of all the articles found and applied the following inclusion criteria: systematic review, clinical trials, observational studies, and case series. EXCLUSION: articles in cadavers or made in the laboratory. RESULTS: A total of 522 articles were found in the databases consulted, of which 95 duplicate articles were eliminated. The criteria (Inclusion/Exclusion) were applied to the 427 identified articles based on the independent reading of the abstracts by each of the authors in the Rayyan platform, and 110 articles were excluded. The 317 selected articles were reviewed completely by each of the authors to finally obtain 101 articles included in the review. CONCLUSIONS: The use of ISD in the treatment of moderate LSS may be controversial. Although the clinical results seem conclusive about the usefulness in controlling symptoms, more studies are needed to compare these technologies with new surgical procedures and especially new biomechanical concepts. The efforts made to treat patients with moderate LSS appropriately should continue to be channeled into optimizing techniques.
Gabapentin is one of the most frequently prescribed analgesic medications in the United States, commonly used for treating neuropathic pain conditions. While generally thought to have a favorable adverse effect profile,...Gabapentin is one of the most frequently prescribed analgesic medications in the United States, commonly used for treating neuropathic pain conditions. While generally thought to have a favorable adverse effect profile, emerging data have implicated gabapentin in cases of respiratory depression and overdose-deaths, especially when combined with opioids and other central nervous system depressants. As a result, a growing number of states have reclassified gabapentin as a Schedule-V controlled substance. However, such regulations may risk varied unintended consequences, such as restricting access to a valuable nonopioid analgesic and potentially facilitating illicit market activity. As such, vulnerable populations, particularly those in rural and low-income areas, may face increased barriers to care. This commentary evaluates the rationale for regulating gabapentin, examines the potential risks associated with such oversight, and suggests a way forward to reduce misuse while maintaining access to gabapentin for patients who genuinely need it.
BACKGROUND: Pain is a common symptom in palliative care and affects patients' quality of life considerably. Standard analgesics are sometimes insufficient and are associated with substantial side effects. Neurolysis, the...BACKGROUND: Pain is a common symptom in palliative care and affects patients' quality of life considerably. Standard analgesics are sometimes insufficient and are associated with substantial side effects. Neurolysis, the targeted destruction of nerves using thermal or chemical agents, offers an additional option for managing localized pain in palliative care. Phenol, a widely available chemical neurolytic agent known for its painless injection and hyperbaric properties when dissolved in glycerin, can effectively relieve refractory cancer pain. METHODS: A literature review was conducted on the pharmacology, toxicology, and indications of phenol in interventional pain and palliative medicine. RESULTS: Despite its use as a neurolytic agent for nearly a century, our current understanding of phenol's pharmacological properties, toxicity, and efficacy stems mainly from case series and small studies, often published decades ago. To date, no uniform guidelines exist, nor is there consensus on the optimal application of phenol in clinical practice, resulting in variability among practitioners. Chronic pain syndromes affect up to 30% of the global population, prompting the expansion of phenol neurolysis to new applications, such as joint denervation and sympathetic blocks in non-cancer pain. Understanding the mechanism of action of phenol and standardizing its clinical use are crucial for integrating this technique into broader pain management strategies. CONCLUSION: This review provides a comprehensive overview of the mechanisms, indications, benefits, and safety of phenol neurolysis in pain and palliative medicine, aiming to support its evidence-based use in clinical practice.
BACKGROUND: Rosacea is an inflammatory, persistent erythema that can present under several clinical subtypes. Recently, a neurogenic type of rosacea has been suggested that can be associated with chronic pain and headach...BACKGROUND: Rosacea is an inflammatory, persistent erythema that can present under several clinical subtypes. Recently, a neurogenic type of rosacea has been suggested that can be associated with chronic pain and headaches. AIMS: Here we describe a successful interventional treatment for severe, likely neurogenic rosacea associated with severe migraines previously treated using various conservative approaches. MATERIALS AND METHODS: Radiofrequency ablation of the sphenopalatine ganglion (SPG) was completed for the patient's primary chronic pain problem, severe migraine headaches. RESULTS: Completion of the left-sided ganglion denervation resulted in resolution of left facial rosacea symptoms/signs. After the right radiofrequency denervation (about 2 weeks later), rosacea signs/symptoms disappeared from the right side of the patient's face as well. Twelve months following the sphenopalatine radiofrequency ablation, the patient is still rosacea-free. CONCLUSION: A larger case series is needed to assess the efficacy of sphenopalatine radiofrequency ablation in long-term management of the facial subtype of rosacea.
INTRODUCTION: Complementary, alternative, and integrative medicine (CAIM) has gained popularity among patients experiencing pain, used alongside conventional medical treatments. This study aimed to explore the perception...INTRODUCTION: Complementary, alternative, and integrative medicine (CAIM) has gained popularity among patients experiencing pain, used alongside conventional medical treatments. This study aimed to explore the perceptions of pain clinicians and researchers on CAIM interventions. METHODS: An anonymous, online survey was distributed to 46,223 authors who had published pain-related research in MEDLINE-indexed journals. The survey included multiple-choice questions and open-ended sections to gather detailed opinions. RESULTS: A total of 1024 participants responded, 900 of which were eligible to participate; most identified as either pain researchers (n = 435/900, 48.33%) or both researchers and clinicians (n = 398/900, 44.22%). Many held senior positions (n = 549/892, 61.55%). Among the CAIM modalities, mind-body therapies such as meditation, yoga, and biofeedback were viewed as the most promising for pain prevention, treatment, and management, with 68.47% (n = 569/831) of participants endorsing these approaches. While (n = 341/777, 43.89%) of the respondents believed that most CAIM therapies are safe, only 25.55% (n = 198/775) disagreed with the idea that such therapies are effective. There was broad agreement on the need for more research into CAIM therapies, with 45.88% (n = 356/776) agreeing and 42.53% (n = 330/776) strongly agreeing that further investigation is valuable. Additionally, many respondents supported the inclusion of CAIM training in clinician education, either through formal programs (n = 361/778, 46.40%) or supplementary courses (n = 409/776, 52.71%). CONCLUSIONS: Mind-body therapies received the most positive feedback, while biofield therapies were met with the most skepticism. These findings highlight the interest in CAIM among pain researchers and clinicians and emphasize the need for more research and education tailored to this area.
BACKGROUND: Trigeminal neuralgia (TN) is a pain condition characterized by paroxysmal, electric shock-like facial pain, affecting one or more areas of the branches. Approximately 33%-50% of patients require invasive trea...BACKGROUND: Trigeminal neuralgia (TN) is a pain condition characterized by paroxysmal, electric shock-like facial pain, affecting one or more areas of the branches. Approximately 33%-50% of patients require invasive treatment. Radiofrequency thermocoagulation (RFTC) is an established method for managing drug-resistant and chronic TN. This study evaluates treatment response quality and complication rates in repeated RFTC procedures for TN patients. METHODS: In this retrospective analysis, patient records were extracted from the electronic medical records of Kuopio University Hospital, using the trigeminal neuralgia diagnosis code and the procedure code for thermal destruction of a cranial nerve. Data collected included sex, age, treatment outcomes at 3-month follow-up, presence of complications, technical details, and procedural success for each intervention. RESULTS: Data from 140 patients were analyzed. An excellent or good response was observed in 79% of patients after the first procedure, 62.9% after the second, and 42.3% after the third. Complication rates were 15.7%, 19.6%, and 42.9%, respectively. Logistic regression analysis showed that complication risk was significantly associated with tertiary procedure and female sex. Development of painful post-traumatic trigeminal neuropathy (PTTN) was more common after repeated interventions; 1.4% after the first, 3.1% after the second, and 13.8% after the third procedure. CONCLUSIONS: RFTC is an effective and safe method for treatment for persistent trigeminal neuralgia when conservative treatment fails. However, its benefits diminish, and risks increase with each additional procedure, particularly the third. Based on these findings, reintervention should generally be limited to a single repeat procedure.
BACKGROUND: Spontaneous intracranial hypotension (SIH) is a disorder caused by low cerebrospinal fluid (CSF) pressure due to a CSF leak located anywhere within the neuroaxis. Risk factors include trauma, degenerative dis...BACKGROUND: Spontaneous intracranial hypotension (SIH) is a disorder caused by low cerebrospinal fluid (CSF) pressure due to a CSF leak located anywhere within the neuroaxis. Risk factors include trauma, degenerative disc disease, and especially connective tissue disorders. In most cases, SIH presents with orthostatic headache, worsening when upright and characteristic radiological features as diffuse pachymeningeal enhancement on MRI [4, 6]. There are a lot of publications concerning treatment of CSF leaks located in the lumbar and thoracic spine, but only scant information regarding treatment and its outcomes of CSF leaks in the upper cervical spine, e.g., C1-2. CASE SERIES: Three women presented with persistent headaches, worsening when standing, lasting weeks to months. Two reported cervical pain, one had double vision, and all experienced dizziness. Symptoms resolved in recumbency. All had connective tissue disorders: patient 1 had systemic lupus erythematosus (SLE) and Sjögren's syndrome, patient 2 had polymyositis, and patient 3 was under observation for SLE. The MRI showed typical SIH features, and the cervical spine MRI was unremarkable except for spinal longitudinal epidural collection (SLEC) in two patients. CT-myelography identified CSF leaks at C1-2 in all cases. Epidural blood patching (EBP) at C1-2 under CT guidance resolved symptoms, with only one patient experiencing a brief post-procedural headache. At 3 months' follow-up, all patients remained symptom-free. Repeated CT-myelography in one patient showed no residual CSF leak. CONCLUSIONS: SIH is a very rare and frequently misdiagnosed condition. Administration of EBP at the C1-2 level of the spine is troublesome; therefore, it should be performed under guidance of computed tomography. All three patients were discharged symptom free within 24-72 h.
BACKGROUND: Pain in Parkinson's disease (PD) manifests clinically in a variety of ways and several pain types have been identified, however, their characteristics have not been extensively studied. OBJECTIVE: To describe...BACKGROUND: Pain in Parkinson's disease (PD) manifests clinically in a variety of ways and several pain types have been identified, however, their characteristics have not been extensively studied. OBJECTIVE: To describe the characteristics of common pain types in people with PD. METHODS: A survey of people with PD that experience pain symptoms was conducted. Participants were recruited using a combination of sampling methods. The survey questions focused on collecting information about the topographical, sensory, and temporal characteristics of pain. Descriptive statistics were used to report results. RESULTS: Two hundred and sixteen participants were included in the data analyses. A median of 5 (interquartile range [IQR] 4-7) pain types were experienced by participants. Pain was commonly localized in the lower limbs but often affected several different body segments. Acute attacks of pain were characteristic for many participants in most pain types and were typically frequent (two to six times per week or more) and prolonged (minutes to hours). Periods of pain accentuation were most likely to occur in the morning, evening, and night and appear to be associated with PD medication pharmacology and a variety of exacerbating and ameliorating factors. Fluctuations in pain were found to range from mild to severe in all pain types. CONCLUSIONS: This study makes a valuable contribution to the existing literature by providing the most detailed assessment of the topographical, sensory, and temporal characteristics of common PD pain types to date that may be used to guide clinical diagnosis and treatment.
BACKGROUND: Sacroiliitis is a debilitating condition causing significant lower back pain. Current treatment options, including medication, physical therapy, and invasive procedures, have limitations. High-intensity focus...BACKGROUND: Sacroiliitis is a debilitating condition causing significant lower back pain. Current treatment options, including medication, physical therapy, and invasive procedures, have limitations. High-intensity focused ultrasound (HIFU) offers a noninvasive, image-guided approach to treat chronic pain. In this study, we aimed to evaluate the safety and efficacy of HIFU for the treatment of sacroiliitis in patients with sacroiliac joint (SIJ) pain. METHODS: A single-arm, open-label, pilot study was conducted on eight patients with SIJ pain. HIFU treatments were performed using a fluoroscopy-guided system. Primary outcomes included pain intensity, functional disability, and quality of life. RESULTS: The HIFU procedure was well-tolerated, with no significant adverse events reported. Patients demonstrated a statistically significant reduction in pain intensity (p < 0.005) along with a nonsignificant improvement in functional disability and quality of life over the 6-month follow-up period. Additionally, MRI imaging confirmed precise ablation of the targeted tissue. CONCLUSION: HIFU shows potential as a noninvasive treatment option for sacroiliitis. However, additional larger-scale studies are needed to further explore these findings and refine treatment parameters.