Douleur chronique

BMC Surg. 2026 Mar 10. doi: 10.1186/s12893-026-03631-7. Online ahead of print.ABSTRACTBACKGROUND: Chronic pain resulting from postoperative adhesions represents a significant clinical concern due to its substantial impact on patient quality of life; however, optimal therapeutic management remains contentious. This systematic review and meta-analysis aimed to evaluate the efficacy of laparoscopic adhesiolysis in alleviating chronic pain attributable to postoperative adhesions, and to assess the influence of adhesion barriers on treatment outcomes.METHODS: A comprehensive systematic review was conducted by searching PubMed, Embase, and Web of Science from database inception through August 2025. Studies reporting pain improvement as the primary outcome, along with safety outcomes (including complication incidence and mortality), were eligible for inclusion. Pooled estimates were calculated using a random-effects model, and heterogeneity was quantified employing the I2 statistic..RESULTS: A total of 30 studies involving 1,450 patients were included in the systematic review. In 27 single-arm observational studies (n = 1,150), laparoscopic adhesiolysis was associated with a pooled pain improvement rate of 67.3% (95% CI 57.5-76.2%), with substantial heterogeneity (I2 = 91%). In contrast, pooled analysis of four randomized controlled trials (n = 271) demonstrated no statistically significant difference in pain improvement between laparoscopic adhesiolysis and diagnostic laparoscopy alone (38.9% vs 36.2%; risk ratio 1.05, 95% CI 0.61-1.83).CONCLUSION: Although observational studies report relatively high rates of pain improvement, these findings should be interpreted as descriptive and hypothesis-generating. The highest level of available evidence from randomized controlled trials does not demonstrate a clinically meaningful benefit of laparoscopic adhesiolysis over diagnostic laparoscopy alone.TRIAL REGISTRATION: PROSPERO CRD42023478049.PMID:41808065 | DOI:10.1186/s12893-026-03631-7

Neuromodulation. 2026 Mar 6:S1094-7159(26)00028-0. doi: 10.1016/j.neurom.2026.02.001. Online ahead of print.ABSTRACTOBJECTIVES: Spinal cord stimulation (SCS) is a safe and effective modality for management of neuropathic pain; however, it can lead to loss of therapy and subsequent device explant in some patients. This systematic review aims to identify risk factors for device explant.MATERIALS AND METHODS: A comprehensive search of the data bases (MEDLINE through PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature [CINAHL], Scopus, Web of Science, and Cochrane Database of Systematic Reviews) was performed from Jan 1, 2003 to Dec 31, 2024. The inclusion criteria were English full-text articles in patients aged ≥18 years with SCS implanted for primary neuropathic condition and subsequently explanted after any period, which studied ≥one risk factor for explant. Two reviewers independently screened articles for inclusion and extracted data. The Newcastle-Ottawa Quality Assessment Scale was used to assess risk of bias. Data on risk factors were categorized and described, with meta-analysis using random effects if amenable.RESULTS: The data base search identified 682 unique studies, of which 21 were included. The risk factors identified for SCS device explant were categorized into device (n = 6 studies: eg, older devices, conventional rechargeable devices, percutaneous electrodes), patient (18 studies: eg, age, sex, mental health, other comorbidities, chronic perioperative opioid use, and preoperative diazepam use), and disease indications (three studies: eg, complex regional pain syndrome, persistent spinal pain syndromes, and chronic pain of surgical origin) and other (eg, two studies: eg, infection). Meta-analysis was not possible owing to heterogeneity in variable definition and analyses among included studies.CONCLUSIONS: This systematic review identified various risk factors for device explant in adult patients receiving SCS for primary neuropathic pain. These factors require further studies to improve patient selection, insertion, and management of SCS devices and chronic pain outcomes.PMID:41793406 | DOI:10.1016/j.neurom.2026.02.001

J Pain. 2026 Mar 13:106220. doi: 10.1016/j.jpain.2026.106220. Online ahead of print.ABSTRACTSingle session interventions (SSIs) for chronic pain are a novel and scalable intervention approach that are far less burdensome than typical 8-session behavioral treatments, and have demonstrated improvements in pain outcomes. Therefore, the current review focuses on systematically summarizing evidence from randomized controlled trials (RCTs) on behavioral SSIs for chronic pain. The review was prospectively registered (PROSPERO CRD42023447224), and the search strategy included seven electronic databases up until 11/2024. Title, abstract, and full text review was conducted with 17 RCTs identified and summarized. Eligible studies were RCTs testing a psychological SSI that targeted pain among adults with chronic pain. Study quality was analyzed using National Institute of Health (NIH)'s Quality Assessment Tool for RCTs. The review focused on synthesizing: 1) the main contents, mode, frequency and duration of interventions for patients with chronic pain; and 2) the effects of SSIs on psychological and physical outcomes. Overall, we found that various SSIs demonstrated efficacy in improving pain outcomes. Specifically, small but significant effects of SSIs were observed for pain intensity (Standardized mean difference [SMD]=0.17) and pain interference (SMD=0.27) compared to control conditions. SSIs also demonstrated significant reductions in pain catastrophizing, anxiety, and depression (SMD = 0.37, 0.29, and 0.25 respectively). Of the 17 RCTs, 13 (76%) had good internal validity, and 4 (24%) had fair internal validity. SSIs can be low burden and improve behavioral pain care access. Finally, we discuss design and methodology recommendations for future research on SSIs for chronic pain. PERSPECTIVE: Findings suggest that SSIs are generally effective in improving pain and other health outcomes across various types of chronic pain conditions. SSIs can be low burden and improve behavioral pain care access, especially in settings where longer-course behavioral treatments are infeasible or not offered.PMID:41833852 | DOI:10.1016/j.jpain.2026.106220

Am J Lifestyle Med. 2026 Mar 18:15598276261436778. doi: 10.1177/15598276261436778. Online ahead of print.ABSTRACTPolycystic Ovary Syndrome (PCOS) persists across the lifespan, yet management during perimenopause and menopause remains underexplored. This scoping review examined non-pharmacological and non-surgical interventions for adult women with PCOS, with particular attention to lifestyle modifications, complementary approaches, and the influence of chronic pain and mental health on quality of life. Guided by the Arksey and O'Malley five-step framework and Joanna Briggs Institute recommendations, studies published in English from 2000 to 2024 were included. Eligible studies examined adult women with PCOS during perimenopause, menopause, or both, and reported on lifestyle interventions, complementary therapies, chronic pain, or quality-of-life outcomes. Twenty-nine studies met inclusion criteria. Diet and physical activity were the most commonly investigated interventions. More than 15 supplement categories were identified; however, none specifically targeted chronic pain or mental health outcomes. Only two studies addressed chronic pain management, both through dietary supplements. Exercise was the only intervention associated with mental health outcomes. PCOS management during perimenopause and menopause requires a holistic, person-centered approach integrating lifestyle and complementary strategies to address physical, hormonal, chronic pain, and mental health challenges.PMID:41868826 | PMC:PMC12999536 | DOI:10.1177/15598276261436778

J Pain Res. 2026 Jan 23;19:549827. doi: 10.2147/JPR.S549827. eCollection 2026.ABSTRACTBACKGROUND: Chronic pain after spinal surgery (CPSS), formerly known as failed back surgery syndrome (FBSS), is a persistent and complex condition that often resists conventional treatments. Recent attention has turned toward paraspinal muscle degeneration as a contributing factor. Injectable type I porcine atelocollagen, known for its anti-adhesive and regenerative properties, has been proposed as a potential intervention, but clinical evidence remains scarce. This study aimed to evaluate the effect of ultrasound-guided atelocollagen injection into paraspinal muscles for patients with CPSS and to identify potential predictors of treatment response.METHODS: This single-center retrospective cohort study was conducted at a tertiary academic institution. 34 adult patients (≥20 years) with a diagnosis of lumbosacral CPSS who received ultrasound-guided purified porcine atelocollagen injections between October 2020 and December 2023 and completed 3-month follow-up without concurrent interventional procedures or medication escalation were included in the analysis. The injection was performed into the paraspinal muscles at the surgical level. The primary outcome was change in pain intensity on the 11-point numeric rating scale (NRS) at 3 months post-treatment. A composite outcome was defined as a ≥1-point reduction in NRS or a Patient Global Impression of Change (PGIC) score of 4 or 5. Exploratory analyses were conducted to identify potential predictive factors.RESULTS: The mean NRS score significantly decreased by 1.62 points (95% CI 0.91-2.33, p<0.001) at 3 months after atelocollagen injection compared to baseline. Neither univariable nor multivariable logistic regression analysis revealed any significant predictive factors for a positive composite outcome. When comparing the responder and non-responder groups based on the composite outcome, the proportion of patients taking anticonvulsants or antidepressants was significantly higher in the non-responder group (54.2% vs 100%, p = 0.028).CONCLUSION: Ultrasound-guided atelocollagen injection into the paraspinal muscles was associated with pain reduction in patients with CPSS. Although the absence of a control group limits causal interpretation, this suggests that atelocollagen injection may have potential as an adjunctive or investigational treatment option for this patient population.PMID:41868300 | PMC:PMC13005222 | […]

J Vasc Interv Radiol. 2026 Mar 3:107954. doi: 10.1016/j.jvir.2025.107954. Online ahead of print.ABSTRACTThe Women's Health Clinical Specialty Council and Venous Clinical Specialty Council of the Society of Interventional Radiology (SIR) formed a workgroup in collaboration with the SIR Guidelines and Statements Division to create up-to-date society-based consensus recommendations for the diagnosis and treatment of venous origin chronic pelvic pain in women. This practice guidance document serves as a summary of what is required to treat women with this condition, including pre-procedural imaging, treatment options, complication management, and follow-up care.PMID:41786126 | DOI:10.1016/j.jvir.2025.107954

J Am Coll Radiol. 2026 Mar 5:S1546-1440(26)00054-2. doi: 10.1016/j.jacr.2026.01.033. Online ahead of print.ABSTRACTChronic pelvic pain, which persists longer than 6 months by definition, is a common condition which affects women of all ages with causes differing by age group. This document will focus on gynecologic origins of chronic pelvic pain, etiologies including chronic pelvic inflammatory disease, postsurgical changes, vaginal or vulvar cysts, and pelvic venous congestion disorder. Ultrasound is the initial imaging modality of choice with MRI or CT of the pelvis may be used in select cases when initial ultrasound is inconclusive. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.PMID:41784596 | DOI:10.1016/j.jacr.2026.01.033

J Am Coll Radiol. 2026 Mar 12:S1546-1440(26)00071-2. doi: 10.1016/j.jacr.2026.02.011. Online ahead of print.ABSTRACTThis document details imaging approaches for children with suspected juvenile idiopathic arthritis in the axial and appendicular skeleton. It provides recommendations for the initial radiologic evaluation as well as for follow-up imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.PMID:41817472 | DOI:10.1016/j.jacr.2026.02.011

J Am Coll Radiol. 2026 Mar 12:S1546-1440(26)00066-9. doi: 10.1016/j.jacr.2026.02.006. Online ahead of print.ABSTRACTChronic ankle pain is common and can be caused by a variety of osseous or soft tissue abnormalities, either alone or in combination. Common etiologies of chronic ankle pain include osteoarthritis, impingement, osteochondral lesion, tarsal coalition, instability, or a chronic sequela of ligament or tendon injury. This document summarizes the current evidence for the appropriate use of specific imaging modalities for each of these clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.PMID:41817475 | DOI:10.1016/j.jacr.2026.02.006

Br J Pain. 2026 Mar 4:20494637261429225. doi: 10.1177/20494637261429225. Online ahead of print.ABSTRACTAdverse childhood experiences (ACEs) are well-documented risk factors for later health problems, such as chronic pain and mental illness. We aimed to synthesise the impact of childhood trauma on psycho-emotional disorders, pain perception and cognitions, and quality of life in individuals with chronic pain. A systematic review was conducted following PRISMA guidelines for systematic reviews and meta-analyses. Eligible studies were identified by searching PubMed, PsychINFO, Embase, and Web of Science, with publication dates from 1988 to April 2023. Inclusion criteria were formulated according to the PECOS framework, and relevant research articles were screened for inclusion. Evidence from 18 studies highlights the significant impact of ACEs (and their typologies) on patients' psycho-emotional well-being, pain outcomes, and overall quality of life, with a cumulative effect emerging. However, significant methodological limitations, such as the lack of standardised measures to classify childhood adversity, prevent us from drawing definitive conclusions about the reported associations. The findings underscore the importance of integrated approaches to pain management that centre on the patient's life history and psycho-emotional status. Future research should address current limitations to strengthen our understanding of the role of ACEs in chronic pain research.PMID:41799412 | PMC:PMC12960269 | DOI:10.1177/20494637261429225