Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379700
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The World Health Organization's definition of palliative care emphasizes its role as a quality-of-life-enhancing intervention for patients and families experiencing life-threatening illnesses, recommending its early impl...The World Health Organization's definition of palliative care emphasizes its role as a quality-of-life-enhancing intervention for patients and families experiencing life-threatening illnesses, recommending its early implementation alongside curative therapies. This paradigm shift represents a fundamental evolution from traditional end-of-life care models to the proactive integration of palliative care throughout the cancer continuum. This paper examines the current evidence base for integrating early palliative care, analyzes key implementation barriers across diverse health care settings, and proposes evidence-based strategies. Furthermore, it explores innovative care delivery models, discusses the development of quality metrics for integrated care, and outlines future research priorities.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379699
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Chronic pain is increasing in prevalence worldwide, and practitioners should stay up to date regarding best practices for this population of patients. Certain populations can be more vulnerable to chronic pain and specia...Chronic pain is increasing in prevalence worldwide, and practitioners should stay up to date regarding best practices for this population of patients. Certain populations can be more vulnerable to chronic pain and special attention must be paid. This article will highlight 3 special populations: children and adolescents, the elderly, as well as pregnant patients. The aim of this article is to delve into chronic pain syndromes that each population may face, as well as particular management strategies for each.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379698
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This article reviews 6 categories of regenerative therapies for chronic pain, including cell-based therapies, biologics, gene therapy, exosomes, tissue engineering, and biophysical stimuli. While mesenchymal stem cells,...This article reviews 6 categories of regenerative therapies for chronic pain, including cell-based therapies, biologics, gene therapy, exosomes, tissue engineering, and biophysical stimuli. While mesenchymal stem cells, bone marrow aspirate concentrate, and adipose-derived stem cells show promise for mild conditions like knee osteoarthritis and lateral epicondylitis, no regenerative therapy is Food and Drug Administration (FDA)-approved for chronic pain. Platelet-rich plasma and autologous conditioned serum are not FDA-approved as stand-alone treatments. Clinical guidance includes holding nonsteroidal anti-inflammatory drugs, avoiding cytotoxic anesthetics, and managing expectations. The article highlights legal risks related to biologics and stresses need for standardized protocols and high-quality trials.
Polston K, Maoli F, Selassie M
… +1 more, Nagpal A
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379697
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Central pain syndromes arise from direct damage to, or dysfunction of, the central nervous system. This article traces the advances of pain theory from early human history to modern medical models. It distinguishes betwe...Central pain syndromes arise from direct damage to, or dysfunction of, the central nervous system. This article traces the advances of pain theory from early human history to modern medical models. It distinguishes between central pain syndromes, centralization, and nociplastic pain. Relevant neuroanatomy and physiology for pain pathways and related neurotransmitters are discussed. Key pathologies, including stroke, traumatic brain injury, and spinal cord injury are explored in the context of central pain. The diagnostic approaches available, along with clinical therapies from conservative care to surgical management, are discussed along with future direction for research and potential advances on the horizon.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379696
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Toll-like receptors (TLRs) play a significant role in the development and maintenance of neuropathic pain and are expressed widely within the central nervous system on neurons, microglia, and astrocytes. TLRs detect both...Toll-like receptors (TLRs) play a significant role in the development and maintenance of neuropathic pain and are expressed widely within the central nervous system on neurons, microglia, and astrocytes. TLRs detect both external (pathogen-associated molecular patterns) and internal (damage-associated molecular patterns) signals of inflammation. Chronic neuropathic pain has a prevalence of 6.9% and 10% of the general population. The diagnosis of neuropathic pain in the clinical setting commonly relies on a thorough history and physical examination. A multimodal and multidisciplinary approach is the gold standard of treatment, with medication management with pharmacotherapy as the primary treatment option.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379695
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This article provides a comprehensive, multidisciplinary approach to chronic pain management that integrates pharmacologic treatments, physical therapy, psychological interventions, and complementary therapies. It emphas...This article provides a comprehensive, multidisciplinary approach to chronic pain management that integrates pharmacologic treatments, physical therapy, psychological interventions, and complementary therapies. It emphasizes individualized care, highlighting both traditional and novel approaches, from nonsteroidal anti-inflammatory drugs to acupuncture and spinal cord stimulation. The article also underscores the importance of lifestyle modifications, including nutrition, sleep hygiene, and stress reduction for improving outcomes. Central to this approach is the active involvement of the patient and coordination by a multidisciplinary team focused on symptom control, flare-up prevention, and enhancing quality of life.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379694
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The principles of acute pain management are grounded in an understanding of the biopsychosocial factors that shape the pain experience. In individuals with acute pain, the interaction of biological, psychological, and so...The principles of acute pain management are grounded in an understanding of the biopsychosocial factors that shape the pain experience. In individuals with acute pain, the interaction of biological, psychological, and social factors can influence pain reporting, pain-related behaviors, coping ability, and treatment outcomes. The Biopsychosocial Model for Acute Pain is a valuable framework to optimize multimodal pain care and coordinate efforts of the interdisciplinary team. The overall goal is to improve an individual's ability to manage acute pain, improve function, hasten recovery, and improve quality of life.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379693
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Neuromodulation is an expanding field within pain medicine that modifies nervous system activity by applying electrical stimulation. Devices may be applied internally or externally, ranging from non-invasive devices appl...Neuromodulation is an expanding field within pain medicine that modifies nervous system activity by applying electrical stimulation. Devices may be applied internally or externally, ranging from non-invasive devices applied to the skin, such as transcutaneous electrical nerve stimulation, to more invasive methods that require the surgical implantation of a device, such as spinal cord stimulation. The literature supports the use of these techniques in multimodal pain regimens or for managing chronic and refractory pain when specific criteria are met. Further research is essential in understanding long-term safety, efficacy, and application for various patient populations and pain conditions.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379692
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When caring for spine patients, accurate diagnosis is essential, as interventional treatments are only effective when the true pain generator is correctly identified. Diagnostic procedures generally fall into provocative...When caring for spine patients, accurate diagnosis is essential, as interventional treatments are only effective when the true pain generator is correctly identified. Diagnostic procedures generally fall into provocative tests, which reproduce pain, and analgesic blocks, which relieve pain through anesthetic injections. However, both approaches are limited by false positives, particularly with uncontrolled medial branch or sacroiliac blocks. Controlled comparative blocks improve accuracy, but predictive value remains modest unless combined with history, examination findings, and imaging. This principle underlies the broader theme of interventional spine care: technical skill alone is insufficient; outcomes depend on diagnostic precision and careful patient selection.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379691
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Chronic pain affects over 50 million Americans and contributes to rising disability, opioid dependence, and healthcare utilization. As the limitations of pharmacologic-only strategies become increasingly evident, integra...Chronic pain affects over 50 million Americans and contributes to rising disability, opioid dependence, and healthcare utilization. As the limitations of pharmacologic-only strategies become increasingly evident, integrative approaches offer a compelling, evidence-based alternative. This article reviews complementary, alternative, and integrative medicine modalities commonly used in chronic pain management, including manual therapies (craniosacral, chiropractic, and massage), movement-based therapies (yoga, tai chi, Alexander technique, Feldenkrais method, Pilates, qigong), acupuncture, transcutaneous electrical nerve stimulation, scrambler therapy. These approaches support holistic, patient-centered care that engages the body's innate healing capacity and may reduce reliance on opioids.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379690
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Movement-based therapies use physical activity to alleviate pain, improve function, and enhance overall well-being. Evidence shows that regular movement can reduce inflammation, modulate pain pathways, and reduce the inc...Movement-based therapies use physical activity to alleviate pain, improve function, and enhance overall well-being. Evidence shows that regular movement can reduce inflammation, modulate pain pathways, and reduce the incidence of chronic health conditions. These therapies include physical therapy, dance, aquatic exercise, walking, and cycling. Many types of chronic pain respond well to exercise that builds strength, boosts cardiovascular health, and improves flexibility. Movement-based programs should be manageable, offer variety, and align with each patient's individual goals. Emerging technologies such as wearables, virtual reality, and artificial intelligence-guided coaching are expanding access and personalization in pain management through movement.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379689
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The use of pain medications with distinct mechanisms of action exemplifies precise prescribing aimed at enhancing pain relief, reducing side effects, and improving the patient experience in both acute and chronic pain. A...The use of pain medications with distinct mechanisms of action exemplifies precise prescribing aimed at enhancing pain relief, reducing side effects, and improving the patient experience in both acute and chronic pain. A thorough understanding of pharmacologic mechanisms, dosing, and potential adverse effects is essential for individualized patient-centered treatment. Commonly used medications such as acetaminophen, nonsteroidal anti-inflammatory drugs, opioids, gabapentinoids, antidepressants (ie, serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants), and muscle relaxants may be used alone or in combination to achieve safe and effective pain control.
Phys Med Rehabil Clin N Am
· 2026 Aug · PMID 42379688
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Effective pain assessment is critical for optimal pain management and improving patient outcomes. This article explores the fundamental principles of pain evaluation, emphasizing the subjective nature of pain and the imp...Effective pain assessment is critical for optimal pain management and improving patient outcomes. This article explores the fundamental principles of pain evaluation, emphasizing the subjective nature of pain and the importance of patient self-report. It reviews a range of validated assessment tools suitable for diverse populations, including children, the elderly, and cognitively impaired individuals. The article also highlights the role of a multidimensional approach to pain assessment. Emerging technologies, such as digital pain tracking and Extended Reality, offer promising advances but come with practical challenges.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062024
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This article examines artificial intelligence (AI) applications in spasticity assessment, analyzing technological innovations from 2020 to 2024 literature. Key findings demonstrate potential. Sensor-based systems achieve...This article examines artificial intelligence (AI) applications in spasticity assessment, analyzing technological innovations from 2020 to 2024 literature. Key findings demonstrate potential. Sensor-based systems achieve 91% to 94% accuracy in automated clinical assessment; computer vision enables precise markerless motion analysis, and natural language processing facilitates automated goal extraction. Digital twin technologies offer personalized treatment simulation capabilities. However, implementation challenges persist, including validation requirements, workflow integration demands, and ethical considerations. The authors conclude that AI represents a transformative paradigm shift toward data-driven, multidomain, objective, reliable, and patient-centered spasticity evaluation methodologies, although large-scale validation studies and seamless clinical integration remain development priorities.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062023
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Spasticity is a common and disabling consequence of central nervous system injury that evolves progressively over time. Although traditionally viewed as an unavoidable sequela, emerging preclinical and clinical evidence...Spasticity is a common and disabling consequence of central nervous system injury that evolves progressively over time. Although traditionally viewed as an unavoidable sequela, emerging preclinical and clinical evidence suggests that spasticity may be preventable or mitigated through early, targeted interventions. This article explores the pathophysiology and natural history of spasticity across multiple conditions (stroke, spinal cord injury, traumatic brain injury, cerebral palsy, and multiple sclerosis), reviews early identification strategies, and critically examines preclinical and clinical data supporting spasticity prevention.
Phys Med Rehabil Clin N Am
· 2026 May · PMID 42062022
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This article reviews nerve-based surgical approaches for treating upper-limb spasticity, focusing on their anatomic targets and functional outcomes. Central procedures, like selective dorsal rhizotomy and contralateral C...This article reviews nerve-based surgical approaches for treating upper-limb spasticity, focusing on their anatomic targets and functional outcomes. Central procedures, like selective dorsal rhizotomy and contralateral C7 transfer, reduce tone at the root level but lack muscle specificity. In contrast, peripheral techniques-including hyperselective neurectomy, neurotomy, and nerve transfers-enable targeted modulation of spastic muscles while preserving strength or restoring volition. These interventions provide durable, functionally meaningful results and can be combined with other therapies as part of a precise, patient-based treatment plan.