Background Chronic nonspecific neck pain (CNSNP) is a leading cause of disability worldwide. Alterations in upper trapezius tissue hardness and pain sensitivity may be closely associated with pain intensity and disability. This study aimed to investigate the associations of upper trapezius tissue hardness and pressure pain threshold (PPT) with pain intensity and neck disability in patients with CNSNP. Methods This single‐center cross‐sectional study enrolled 426 patients with CNSNP (244 women and 182 men; mean age, 44.22 ± 8.84 years) at the Health Examination Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between August 2024 and August 2025. Bilateral upper trapezius tissue hardness and PPT were measured using the OE220 outcome evaluation system (ITO, Japan). Pain intensity was assessed with a composite visual analog scale (VAS) score, and neck disability with the neck disability index (NDI). Spearman correlation analysis and linear regression models were used to evaluate the associations among variables, followed by prespecified subgroup analyses to explore the heterogeneity of these associations across demographic and clinical subgroups. Results Spearman correlation analysis showed that mean hardness was positively correlated with VAS ( r = 0.328, p < 0.001) and NDI ( r = 0.173, p < 0.001), whereas mean PPT was negatively correlated with VAS ( r = −0.307, p < 0.001) and NDI ( r = −0.121, p < 0.05). Multiple linear regression analysis showed that, after full adjustment for confounding factors, mean hardness remained positively associated with VAS ( B = 0.071, β = 0.268, 95% CI: 0.051∼0.091, p < 0.001), while mean PPT was negatively associated with VAS ( B = −0.187, β = −0.113, 95% CI: −0.316∼−0.058, p = 0.005); the adjusted model explained 40.8% of the variance. Regarding the NDI, only mean hardness was significantly and positively associated with it ( B = 0.180, β = 0.160, 95% CI: 0.075∼0.286, p < 0.001). In prespecified subgroup analyses, formal interaction tests showed no statistically significant effect modification for either outcome (all p for interaction > 0.05); the smallest p value, for the hardness‐by‐work‐type interaction on the NDI, was 0.122, and this exploratory observation was not regarded as evidence of effect modification. Conclusion In patients with CNSNP, increased tissue hardness and elevated local pain sensitivity of the upper trapezius are closely associated with pain intensity, and tissue hardness is a relevant factor associated with cervical dysfunction. These findings suggest that objective upper trapezius muscle status indicators may provide complementary descriptive information in the assessment of CNSNP, although their incremental clinical value beyond conventional assessment has not been established; longitudinal studies are needed to determine whether these indicators can guide treatment or predict outcomes.
Background Lumbar disc herniation (LDH) commonly induces low back and leg pain. Manual therapy (MT) is effective in relieving such pain clinically, but its mechanism remains unclear. Given that acupoint regions are enriched with mast cells that respond to mechanical stimulation, this study explored whether MT alleviates CCD‐evoked neuropathic pain and its association with the modulation of cutaneous mast cells. Methods Sprague‐Dawley (SD) rats were randomized into sham, chronic compression of dorsal root ganglion (CCD), MT, and mast cell inhibition (MCI) groups. After CCD modeling, MT was administered at BL57 starting on day 4 for 14 days, while MCI received acupoint cromolyn sodium injection. Paw withdrawal threshold (PWT) was measured. Mast cell activation was assessed using immunofluorescence and toluidine blue staining. Calcitonin gene‐related peptide (CGRP), substance P (SP), Piezo1, and Piezo2 were determined via immunofluorescence; inflammatory cytokines and neurotransmitters by ELISA; expression of MAPK, Piezo1, and Piezo2 by qRT‐PCR. MAPK expressions were also detected by Western blot. Results CCD reduced PWT from day 3, whereas MT significantly restored PWT from day 11. In skin, CCD increased mast cell activation, CGRP, SP, tumor necrosis factor (TNF)‐α, interleukin (IL)‐6, IL‐1β, 5‐hydroxytryptamine (5‐HT), and histamine (HA), all of which were attenuated by both interventions. In DRG, CCD elevated p‐ERK, p‐JNK, and p‐p38 MAPK without altering total MAPK expression, and both interventions suppressed MAPK phosphorylation. Piezo2 was upregulated in CCD and reduced by MT and MCI in both tissues. In skin, Piezo1 remained unchanged, while in DRG, CCD downregulated Piezo1 significantly. Conclusion MT can relieve CCD‐induced mechanical allodynia, an effect associated with inhibited cutaneous mast cell activation, attenuated peripheral neuroinflammation, and reduced MAPK hyperphosphorylation in the DRG.
Objectives Transcranial electrical stimulation (tES) is a neuromodulation technique that can serve as an adjuvant tool during the perioperative period. With emerging randomized controlled trials (RCTs) supporting its efficacy across various surgical procedures, synthesis of current evidence and evaluation of its potential for postoperative analgesia in elective‐surgery patients and related outcomes are urgently needed. Materials and Methods We initially searched PubMed, the Cochrane Library, MEDLINE, and Embase for RCTs investigating perioperative tES in patients undergoing elective surgery. The search period covered from the inception of each database to September 2025, and an updated search for newly published studies was conducted in September 2026. We analyzed the outcomes, including postoperative pain scores, opioid consumption, quality of recovery, incidence of postoperative delirium, and adverse events. The Cochrane Risk of Bias 2 (RoB 2) tool was used to evaluate the risk of bias in included studies. Sensitivity and publication bias analyses were performed. Exploratory subgroup analysis and meta‐regression were performed to identify sources of heterogeneity. We also analyzed outlier studies. Trial sequential analysis (TSA) was further performed to evaluate the robustness of evidence. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence. Results A total of 21 RCTs with 2186 participants were included in this meta‐analysis. Compared with the control group, the tES group showed lower pain scores on postoperative day 1 (standardized mean difference [SMD] = −0.57, 95% CI: −0.84 to −0.30, p < 0.01), reduced total opioid consumption (SMD = −0.47, 95% CI: −0.74 to −0.20, p < 0.01), a lower incidence of postoperative delirium (risk ratio [RR] = 0.45, 95% CI: 0.25 to 0.79, p < 0.01), and a lower incidence of postoperative nausea or vomiting (RR = 0.84, 95% CI: 0.75 to 0.95, p < 0.01). No significant differences were observed between the two groups in postoperative day 1 quality of recovery (SMD = 0.44, 95% CI: −0.18 to 1.05, p = 0.16) and dizziness or headache (RR = 1.01, 95% CI: 0.70 to 1.47, p = 0.94). In addition, tES might increase the risk of mild and transient stimulation site discomfort (RR = 3.10, 95% CI: 1.96 to 4.90, p < 0.01). The initial timing and number of stimulation sessions were potential sources of heterogeneity for postoperative day 1 pain scores, while initial stimulation timing, stimulation modality, and target sites were associated with heterogeneity in total opioid consumption. TSA results indicated that the current sample size was sufficient to confirm the beneficial effects of tES on postoperative day 1 pain, total opioid consumption, and postoperative delirium. The certainty of evidence ranged from very low to moderate. Conclusions Current evidence suggests that tES, as an adjuvant perioperative intervention, may alleviate postoperative pain, reduce opioid consumption, and decrease the incidence of postoperative delirium. However, the effect of tES on postoperative quality of recovery remains unclear. Considering the limited overall quality of current evidence, whether tES can serve as a universal adjuvant analgesic method for patients undergoing elective surgery still needs further clarification.
Background Although pain is among the most common reasons for emergency department (ED) attendance, oligoanalgesia remains a persistent global issue. While the 2026 EUSEM guidelines provide evidence‐based pharmacological recommendations, translating these into the crowded ED environment is often constrained by systemic overcrowding and a traditional reliance on technical skills, with limited integration of human factors and nontechnical skills relevant to suffering. The objective of this position paper is to propose a practical, human‐centred operational framework that bridges scientific guidelines with clinical realities. Discussion The resulting 10‐domain cognitive and operational toolkit synthesises technical and nontechnical skills without implying a mandatory sequence. The domains comprise: (1) establishing psychological safety and therapeutic engagement; (2) multidimensional assessment, including potential indicators of pain and selective neuropathic screening; (3) shared goals and care planning; (4) context‐triggered caregiver integration; (5) severity‐matched, mechanism‐informed multimodal analgesia; (6) individualised opioid stewardship for opioid exposure, tolerance and Opioid Use Disorder; (7) an independent palliative and end‐of‐life domain, including proportional palliative sedation only for appropriately assessed refractory suffering; (8) contextual assessment of broader palliative and social needs; (9) anticipatory workflow, reassessment and rescue planning and (10) handoff and continuity of care. Domains 1, 2, 3, 5, 9 and 10 are core; domains 4, 6, 7 and 8 are context‐triggered. All 10 are briefly considered, while specific tools and actions are activated only when clinically relevant. Perspective This position paper addresses the persistent gap between evidence‐based guidelines and the operational realities of overcrowded EDs. By integrating pharmacology with essential nontechnical skills, the proposed 10‐domain toolkit provides a human‐centred cognitive and operational model for daily clinical practice. It is nonsequential: all domains are briefly considered, while core and context‐triggered actions are activated according to clinical relevance. The model requires local adaptation and prospective evaluation. Conclusions Effective pain management is an ethical imperative that requires both pharmacological competence and nontechnical skills. This framework serves as a cultural, cognitive and operational guide, helping clinicians embed proactive, individualised pain relief, reassessment and continuity into the demanding workflow of the modern ED. As an expert‐informed toolkit rather than a validated pathway, it requires local adaptation and prospective evaluation.
