Pudendal neuralgia is an under-recognized cause of chronic, disabling neuropathic perineal pain affecting both women and men. Real-world data on its presentation, its treatment within a specialty pain service, and the factors that accompany escalation to interventional therapy are scarce. We hypothesized that an iatrogenic (postsurgical) origin and relief after a diagnostic pudendal nerve block would identify the patients who reach neuromodulation. We performed a retrospective manual review of the complete electronic records of all adults with documented pudendal neuralgia, pudendal neuropathy, or pudendal nerve entrapment managed at a single tertiary pain clinic between 2009 and 2026. Demographics, clinical presentation, presumed etiology, treatments, and outcomes were abstracted from the free-text record. Ascertainment was in two stages: variables were first identified by structured text screening of the free-text record, and the two variables most susceptible to false-positive screening, a postsurgical etiology and receipt of neuromodulation, were then verified against the source charts by manual review of every screen-positive record. The chart-verified definitions are used throughout. Associations between binary variables were tested by the chi-squared test, with odds ratios (OR) and 95
Pain management in hospitalized internal medicine patients is challenging due to multimorbidity, polypharmacy, and behavioral symptoms. Antipsychotics are frequently co-prescribed with analgesics in this population alongside other central nervous system-active medications, yet their relationship with acute pain trajectories remains poorly understood. This retrospective cohort study examined whether antipsychotic co-prescription was associated with pain trajectories and rehospitalization among hospitalized medical patients receiving analgesic therapy, including an opioid-treated subgroup. Internal medicine inpatients receiving in-hospital analgesic therapy were included. Pain outcomes comprised mean, maximum, and last visual analog scale (VAS) scores and peak-to-last change in VAS (ΔVAS); all-cause rehospitalization was assessed after discharge. Propensity score matching accounted for demographic and clinical factors. Additional analyses examined timing of antipsychotic exposure and co-treatment with other central nervous system-active medications. Among 18,387 patients hospitalized for ≥ 48 h, 6166 with at least one VAS assessment within the first 2 days of hospitalization formed the analgesic-treated cohort, including 2388 receiving opioids. After matching, antipsychotic co-prescription was associated with lower mean and maximum VAS scores in the analgesic-treated cohort, particularly among older adults. The association was most evident among patients already receiving antipsychotics at admission, whereas findings among those initiated during hospitalization were limited. No consistent differences in pain outcomes were observed in the opioid subgroup, while associations in the broader analgesic cohort persisted across central nervous system (CNS) co-medication strata. Antipsychotic co-prescription was not associated with sustained increases in rehospitalization risk. Antipsychotic co-prescription was associated with lower peak pain intensity in the broader analgesic-treated cohort, particularly among older adults, but not in the opioid subgroup. This context-dependent pattern differed according to analgesic treatment and timing of antipsychotic exposure and may reflect differences in multidimensional pain processing. These findings highlight the importance of considering central nervous system-active co-medications in pain management and warrant prospective investigation.
Postherpetic neuralgia (PHN) is the most frequent chronic complication of herpes zoster (HZ), the incidence of PHN gradually increases with age, and the persistent pain brings a heavy burden to patients with PHN. Virtual reality (VR) is an emerging tool for relieving acute and chronic pain. However, there is currently no research on applying VR to patients with PHN. This study aimed to explore the effectiveness and safety of VR in reducing the pain levels of patients with PHN. Providing an evidence-based medical rationale for the use of VR in pain management for patients with PHN. Fifty patients with PHN were randomly divided into the experimental group and the control group, with 25 cases in each group. The control group received PHN conventional therapy. The experimental group received VR therapy plus conventional therapy, namely 10-min VR sessions twice daily for five consecutive days (T1 T5). Primary outcome measure was patients reported pain levels at the sixth day after admission (T6). We also measured anxiety, depression and self-efficacy levels, as well as inflammatory factor levels of patients in both groups. Patients reported side effects and satisfaction in the experimental group were also recorded. Significant improvements were observed for pain (2.48 ± 1.23 vs 3.28 ± 1.37, P = 0.035), anxiety (31.44 ± 3.89 vs 33.72 ± 3.80, P = 0.041), depression (34.00 ± 5.91 vs 37.64 ± 5.02, P = 0.023), self-efficacy (32.68 ± 3.60 vs 29.92 ± 5.38, P = 0.038), IL-2 (3.30 ± 0.59 vs 2.67 ± 0.27, P<0.001), IL-6 (2.94 ± 1.38 vs 4.13 ± 2.43, P = 0.038), IL-10 (6.36 ± 1.03 vs 5.26 ± 1.09, P = 0.001), TNF-α (1.76 ± 0.48 vs 2.10 ± 0.59, P = 0.033), and INF-γ (3.82 ± 1.06 vs 3.00 ± 0.48, P = 0.001). No participants complained of severe side effects and patients’ satisfaction with VR reached 80
Butorphanol is sometimes added to multimodal intravenous patient-controlled analgesia (PCA), but its incremental analgesic benefit and adverse symptom burden when combined with an established sufentanil-based regimen remain uncertain. This single-center retrospective cohort study used routinely collected perioperative, postoperative PCA follow-up, and hospital billing data from July 2022 to June 2025. Patients who underwent gynecologic surgery and received one of four eligible base PCA regimens were included. Movement-evoked pain on postoperative day 1 was the primary effectiveness outcome, and any dizziness was the primary safety outcome. Propensity score overlap weighting was used for the primary analysis. The cohort included 1557 PCA treatment records, of which 239 contained butorphanol and 1318 did not. After overlap weighting, the adjusted mean differences were 0.01 points [95
This systematic review aimed to investigate neuraxial administration errors, examine their contributing factors, and evaluate clinical outcomes using a novel harm scale. The author searched PubMed, Web of Science, Scopus, EBSCOhost, and Google Scholar for reports from 1981 to 2025 in any language. Exclusions were reviews, overdose incidents, and non-neuraxial administrations. Harm was classified using a novel five-level scale, and contributing factors were identified using the Human and Systemic Factors Analysis Classification System (HFACS). The search revealed 50 reports (54 patients), mainly involving the epidural route (38 vs 16 intrathecal), non-obstetric patients (35 vs 17 obstetric), and female gender (73
