Background:Effective perioperative pain management for patients undergoing hand surgery is critical because of the risk of opioid misuse. Complementary approaches, including auriculotherapy (AT), for perioperative pain management have gained increasing attention. This study was designed to assess the analgesic properties of AT in patients undergoing endoscopic carpal tunnel surgery (CTR). Materials and methods:This retrospective study analyzed medical records of patients who underwent unilateral ambulatory CTR performed by a single surgeon under a regional block plus sedation, with or without the use of AT using a cryogenic approach. All procedures were performed between 1 October 2016 and 30 May 2017. A total of 38 consecutive patients were included in the analysis. At discharge, patients received a standard analgesic prescription for 3 days and were asked to record pain scores, using a verbal scale (0-10), and analgesic consumption on postoperative days (POD) 1, 2, and 3. The primary end points were overall consumption-expressed as the area under the curve (AUC) for oral morphine equivalent (OME) in mg-and pain scores between POD1 and POD3. Secondary end points included pain and opioid and non-opioid analgesic consumption. Data are presented as median (interquartile range) (25-75 percentile); p < 0.05 was considered significant. Results:A total of 38 consecutive patients were included in the analysis. There were 19 patients in the AT group (16 women and three men), with a mean age 54 ± 7.9 years, and 19 patients in the control group (15 women and four men), with a mean age of 57 ± 12.8 years. The use of cryo-AT was associated with a 44% reduction in OME consumption (0.0 [0.0; 10.0] OME mg in the AT group vs. 10 mg [0.0; 30.0] OME mg in the control group; p = 0.015) and lower pain scores (AUC POD1- 3; 0.33 [0.0;1.0] in the AT group vs. 1.67 [0.67; 2.3] in the control group; p = 0.0061). Naproxen consumption was not significantly different. At 21 days, no patient required further medication. Discussion:Our study suggests that cryogenic AT is an effective complementary alternative to opioids to control postoperative pain following CTR. Further investigations are required to confirm these findings.

Background/Objectives: Opioid-free anesthesia (OFA) has emerged as a potential alternative to opioid-based anesthesia (OBA) to reduce opioid-related adverse effects. This meta-analysis compares OFA and OBA with respect to postoperative pain and opioid consumption. Methods: PubMed, Cochrane, and Embase libraries were searched for OFA studies published through 12 June 2025. Randomized controlled trials (RCTs) conducted on adult humans were selected; observational studies, studies including neuraxial anesthesia, and RCTs currently awaiting approval were excluded. A forest plot was used to summarize findings of a random-effects meta-analysis to compare OFA (treatment) and OBA (control). Results: Of 1446 citations found, twenty-nine articles met our inclusion criteria. Twenty-six studies reported pain scores with a 0-10 scale. OFA was associated with lower postoperative pain scores (Hedges' g = -0.34; 95% CI -0.55 to -0.13; p < 0.001; I2 = 84%) but with high heterogeneity, limiting clinical significance or strong interpretation of results. Eleven trials were analyzed for opioid use, showing a small reduction with OFA (Hedges' g = -0.55; 95% CI -1.10 to -0.005; p = 0.048; I2 = 96.22%). Subgroup outcomes favored OFA, with an overall reduction in pain found specifically in endoscopic abdominal surgeries. Some secondary outcomes also indicated potential improved recovery profiles through OFA for certain surgeries. Conclusions: OFA was associated with statistically significant lower postoperative pain scores, along with opioid consumption, but with a small effect size and high heterogeneity when compared to OBA. This is potentially comparable in pain control and opioid consumption with limited clinical significance. Overall, outcomes support the continued controlled study of OFA as an alternative to conventional analgesia.

ABSTRACTBackgroundIn the context of the current opioid crisis, there is a growing interest in evaluating non-pharmacological solutions to manage post-operative pain. Evidence supports the concept that auriculotherapy may provide significant analgesiaObjectiveInvestigating the efficacy of cryo-auriculotherapy to reduce postoperative opioid consumption following a rotator cuff surgery.SettingsAcademic medical center, USAMethodsThis trial was registered to Clinicaltrials.gov (NCT03860259). A total of 39 subjects undergoing rotator cuff surgery and randomized to receive either an active cryo-auriculotherapy treatment (Auriculotherapy; n=20) or a placebo treatment (placebo; n=19) were included in the analysis. For each cryo-auriculotherapy subject, the treatment was performed in the recovery room. The primary endpoint was overall opioid consumption (oral morphine equivalent = OME). Secondary endpoints included pain and overall non-narcotic analgesic consumption on postoperative day 5, patient satisfaction and function recovery using the 12-Item Short Form Health Survey (SF-12), time to discharge from the recovery room and the hospital and patient satisfaction, as well as the number of subjects from each group readmitted because of pain-related issues.ResultsThe use of cryo-auriculotherapy was associated with a 35% decrease in total opioid requirement over the first five-day recovery period and a 15% decrease in pain with movement. Pain with movement in the auriculotherapy group remained lower compared to the placebo group for at least 14 days (4.47 ± 2.12 vs 5.84 ± 2.39, respectively; p=0.0394).ConclusionsOur data suggests that cryo-auriculotherapy represents an alternative to opioids in patients undergoing rotator-cuff surgery.

Overprescription of opioids after surgery contributes to persistent postoperative opioid use, with 11% of total knee arthroplasty (TKA) patients continuing opioid use beyond 3 months. In response to the growing demand for opioid-free surgery, we developed a patient-driven, opioid-free surgical pathway (PDOFSP). This team-based pathway enhances communication, education, and multimodal pain management, including nerve blocks and complementary techniques tailored to the patient's preferences. This case report describes a 69-year-old patient who underwent opioid-free TKA due to drug allergies and personal preferences. The program was individualized to the patient's choices and enabled the patient to achieve her goal.

Background/Objectives: In the current opioid crisis, medical hypnosis has been proposed as an alternative to opioids to control acute and chronic pain. The aim of this study was to use a meta-analysis to conduct an objective assessment of the value of medical hypnosis for the management of acute and chronic pain and opioid consumption. Methods: An initial PubMed search showed 111 relevant studies out of 1115. Twelve randomized controlled studies (RCTs) were identified, published from January 2014 to December 2024, focusing on acute and chronic pain. These RCTs were analyzed to compare the effects of medical hypnosis vs. standard care. Results: The use of medical hypnosis for acute pain was found to decrease pain by 0.54 standard deviations (SD) compared to the standard care, and the effect was medium and statistically significant (95% CI [0.19–0.90]; p = 0.0024). Oral morphine equivalents (OME) in the hypnosis group were 1.5 SD lower than in the placebo group, which was statistically significant (95% CI [0.12, 2.88]; p = 0.03). Unlike the effectiveness of hypnosis for acute pain treatment, hypnosis was not found to have any impact on the treatment of chronic pain. The mean pain value difference in the hypnosis group had little effect and showed a statistically insignificant result—a Hedges’ g score of 0.07 (95% CI [−0.14–0.27]; p = 0.518). Conclusions: The use of medical hypnosis was associated with a statistically significant decrease in acute pain scores and OME, suggesting it is a potential alternative to opioids, but our analysis indicates that hypnosis does not reduce chronic pain.

Significance:Auriculotherapy is a technique based on stimulation applied to specific ear points. Its mechanism of active and clinical efficacy remain to be established. This study aims to assess the role that primary somatosensory cortex may play to validate auriculotherapy mechanisms. Aim:This study examined whether tactile stimulation at specific auricular points is correlated with distinct cortical activation in the primary somatosensory cortex. Approach:Seventeen healthy adults participated in the study. Tactile stimuli were delivered to the thumb, shoulder, and skin master points on the ear using von Frey filaments. Functional near-infrared spectroscopy was used to measure and spatially map cortical responses. Results:This study revealed distinct hemodynamic activity patterns in response to ear point stimulation, consistent with the classic homunculus model of somatotopic organization. Ipsilateral stimulation showed specific cortical activations for the thumb and shoulder points, while contralateral stimulation showed less significant activity. Functional near-infrared spectroscopy effectively captured localized cortical responses to ear tactile stimuli, supporting the somatotopic mapping hypothesis. Conclusion:These findings enhance the understanding of sensory processing with auricular stimulation and supports the concepts of auricular cartography that underpins some schools of auriculotherapy practice. Future research should explore bilateral cortical mapping and the integration of other neuroimaging techniques.

BackgroundChronic post-surgical pain (CPSP) significantly impacts patients' recovery and quality of life. Although environmental risk factors are well-established, genetic risk remains less understood.MethodsA meta-analysis of genome-wide association studies followed by partitioned heritability was performed on 1350 individuals across five surgery types: hysterectomy, mastectomy, abdominal, hernia, and knee. In subsequent animal studies, withdrawal thresholds to evoked mechanical stimulation were measured in Rag1 null mutant and wild-type mice after plantar incision and laparotomy. Cell sorting by flow cytometry tracked recruitment of immune cell types.ResultsWe discovered 77 genome-wide significant single-nucleotide polymorphism (SNP) hits, distributed among 24 loci and 244 genes. Meta-analysis of all cohorts estimated a SNP-based narrow-sense heritability for CPSP at ∼39%, indicating a substantial genetic contribution. Partitioned heritability analysis across a wide variety of tissues revealed enrichment of heritability in immune system-related genes, particularly those associated with B and T cells. Rag1 null mutant mice lacking both T and B cells exhibited exacerbated and prolonged allodynia up to 42 days after surgery, which was rescued by B-cell transfer. Recruitment patterns of B cells but not T cells differed significantly during the first 7 days after injury in the footpad, lymph nodes, and dorsal root ganglia.ConclusionsThese findings suggest a key protective role for the adaptive immune system in the development of chronic post-surgical pain.

Background: Music-based intervention has been advocated as a nonpharmacologic approach for the perioperative control of pain and anxiety in surgical patients. However, its impact on patients with preoperative anxiety has not been clearly established. Our study aimed to examine the impact of music-based intervention administered before, during, and after surgery on postoperative opioid consumption and pain levels, as well as preoperative anxiety, depression, and pain catastrophizing. We hypothesized that, compared to a control group, music-based intervention would be effective in reducing opioid requirements and mood disorders. Methods: This study was a single-center, prospective, single-blinded, randomized controlled trial. Inclusion criteria isame-day or observation surgery. Exclusion criteria included American Society of Anesthesiologists physical status IV, use of spinal anesthesia, PROMIS Anxiety T-scores ≤ 57.4 and ≥74.1, preoperative chronic opioid use, transgender surgery, and history of drug or alcohol abuse. Music-based intervention was developed by a certified music therapist. Each patient was randomized to receive standard of care (SC) or SC plus music-based intervention before, during, and after surgery. The primary end point was postoperative oral morphine equivalents (OMEs) over 5 days following surgery using the area under the curve (AUC)Secondary end points were PROMIS Anxiety, PROMIS Depression scores Pain Catastrophizing Scale scores, postoperative nausea and vomiting, time of hospital discharge, and patient satisfaction (0 = totally unsatisfied to 10 = completely satisfied). Results: A total of 75 patients were randomized to a music-based intervention (n = 33) or control (n = 42) group. Patients in the music-based intervention group consumed 56.7% less opioids than those in the control group (AUC was 2.8 in the music-based intervention group vs. 6.4 in the control group, absolute standardized mean difference (aSMD) = 0.34 (−0.17, 0.85)). No difference in pain scores was recorded between groups. Music-based intervention also reduced anxiety on postoperative day (POD)2 (aSMD = 0.38 (−0.16, 0.91)), depression on POD2 (aSMD = 0.31 (−0.23, 0.84)) and POD4 (aSMD = 0.24 (−0.29, 0.77)), and pain catastrophizing on POD1 (aSMD = 0.24 (−0.3, 0.77)). Conclusions: Our data support the use of music-based intervention to reduce postoperative opioid requirements. Music-based intervention may also reduce anxiety, depression, and pain catastrophizing.

Introduction: In the context of the current opioid crisis, non-pharmacologic approaches to pain management have been considered important alternatives to the use of opioids or analgesics. Advancements in nano and quantum technology have led to the development of several nanotransporters, including nanoparticles, micelles, quantum dots, liposomes, nanofibers, and nano-scaffolds. These modes of nanotransporters have led to the development of new drug formulations. In pain medicine, new liposome formulations led to the development of DepoFoam™ introduced by Pacira Pharmaceutical, Inc. (Parsippany, NJ, USA). This formulation is the base of DepoDur™, which comprises a combination of liposomes and extended-release morphine, and Exparel™, which comprises a combination of liposomes and extended-release bupivacaine. In 2021, Heron Therapeutics (San Diego, CA, USA) created Zynrelef™, a mixture of bupivacaine and meloxicam. Advancements in nanotechnology have led to the development of devices/patches containing millions of nanocapacitors. Data suggest that these nanotechnology-based devices/patches reduce acute and chronic pain. Methods: Google and PubMed searches were conducted to identify studies, case reports, and reviews of medical nanotechnology applications with a special focus on acute and chronic pain. This search was based on the use of keywords like nanotechnology, nano and quantum technology, nanoparticles, micelles, quantum dots, liposomes, nanofibers, nano-scaffolds, acute and chronic pain, and analgesics. This review focuses on the role of nanotechnology in acute and chronic pain. Results: (1) Nanotechnology-based transporters. DepoDur™, administered epidurally in 15, 20, or 25 mg single doses, has been demonstrated to produce significant analgesia lasting up to 48 h. Exparel™ is infiltrated at the surgical site at the recommended dose of 106 mg for bunionectomy, 266 mg for hemorrhoidectomy, 133 mg for shoulder surgery, and 266 mg for total knee arthroplasty (TKA). Exparel™ is also approved for peripheral nerve blocks, including interscalene, sciatic at the popliteal fossa, and adductor canal blocks. The injection of Exparel™ is usually preceded by an injection of plain bupivacaine to initiate analgesia before bupivacaine is released in enough quantity from the depofoarm to be pharmacodynamically effective. Finally, Zynrelef™ is applied at the surgical site during closure. It was initially approved for open inguinal hernia, abdominal surgery requiring a small-to-medium incision, foot surgery, and TKA. (2) Nanotechnology-based devices/patches. Two studies support the use of nanocapacitor-based devices/patches for the management of acute and chronic pain. A randomized study conducted on patients undergoing unilateral primary total knee (TKA) and total hip arthroplasty (THA) provided insight into the potential value of nanocapacitor-based technology for the control of postoperative acute pain. The results were based on 2 studies, one observational and one randomized. The observational study was conducted in 128 patients experiencing chronic pain for at least one year. This study suggested that compared to baseline, the application of a nanocapacitor-based Kailo™ pain relief patch on the pain site for 30 days led to a time-dependent decrease in pain and analgesic use and an increase in well-being. The randomized study compared the effects of standard of care treatment to those of the same standard of care approach plus the use of two nanocapacitor-based device/patches (NeuroCuple™ device) placed in the recovery room and kept in place for three days. The study demonstrated that the use of the two NeuroCuple™ devices was associated with a 41% reduction in pain at rest and a 52% decrease in the number of opioid refills requested by patients over the first 30 days after discharge from the hospital. Discussion: For the management of pain, the use of nano-based technology has led to the development of nano transporters, especially focus on the use of liposome and nanocapacitors. The use of liposome led to the development of DepoDur™, bupivacaine Exparel™ and a mixture of bupivacaine and meloxicam (Zynrelef™) and more recently lidocaine liposome formulation. In these cases, the technology is used to prolong the duration of action of drugs included in the preparation. Another indication of nanotechnology is the development of nanocapacitor device or patches. Although, data obtained with the use of nanocapacitors are still limited, evidence suggests that the use of nanocapacitors devices/patches may be interesting for the treatment of both acute and chronic pain, since the studies conducted with the NeuroCuple™ device and the based Kailo™ pain relief patch were not placebo-controlled, it is clear that additional placebo studies are required to confirm these preliminary results. Therefore, the development of a placebo devices/patches is necessary. Conclusions: Increasing evidence supports the concept that nanotechnology may represent a valuable tool as a drug transporter including liposomes and as a nanocapacitor-based device/patch to reduce or even eliminate the use of opioids in surgical patients. However, more studies are required to confirm this concept, especially with the use of nanotechnology incorporated in devices/patches.

Fewer than 30% of all medical schools have programs that encourage medical design innovation or entrepreneurship at the trainee level. This is particularly evident in the fields of anesthesiology and pain medicine, where utilizing medical devices constitutes a significant part of a clinician's daily practice. To fix this gap, our institution has developed an incubator club where trainees can learn about medical devices and entrepreneurship. Our goal is to present how this can be incorporated at other institutions because these clubs are a low resource utilization investment that can teach trainees valuable skills in innovation and entrepreneurship.

Introduction: This report describes the effects of auriculotherapy (AT) using cryogenic needles in a small cohort of chronic low back pain patients. Methods: The effects of AT on pain, mood, and functioning were recorded in 10 patients with chronic back pain before and after cryogenic AT using patient-reported outcome instruments: Brief Pain Inventory (BPI), Patient Health Questionnaire (PHQ-9), General Anxiety Disorder (GAD-7), and Patient-Reported Outcomes Measurement Information System (PROMIS-29). In addition, resting-state MRI data collected before and 5-7 days after AT treatment were analyzed for changes in functional connectivity in 4 patients. Results: GAD-7 scores decreased from 10.0 to 7.7 (95% confidence interval of difference= 0.2 - 4.4, p=0.036). Other patient-reported outcomes showed non-significant differences in this pilot cohort. Significant functional MRI connectivity changes were observed in 4 patients, suggesting that AT affected areas of the brain involved in pain processing. Conclusion: Cryogenic AT is a technique that may reduce the psychological burden of low back pain, but further study is needed. Preliminary functional connectivity changes support the concept that the effect of AT is centrally mediated.### Competing Interest StatementThe authors have declared no competing interest.### Clinical TrialNCT06358287### Funding StatementThis study was funded by a seed grant from the Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The IRB of the University of Pittsburgh gave ethical approval for this work.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors.

Background Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks. Methods We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as >= 75% agreement and weak consensus as 50%-74% agreement. Results A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research. Conclusions We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.

Chronic post-surgical pain affects a large proportion of people undergoing surgery, delaying recovery time and worsening quality of life. Although many environmental variables have been established as risk factors, less is known about genetic risk. To uncover genetic risk factors we performed genome-wide association studies in post-surgical cohorts of five surgery types- hysterectomy, mastectomy, abdominal, hernia, and knee- totaling 1350 individuals. Genetic associations between post-surgical chronic pain levels on a numeric rating scale (NRS) and additive genetic effects at common SNPs were evaluated. We observed genome-wide significant hits in almost all cohorts that displayed significance at the SNP, gene, and pathway levels. The cohorts were then combined via a GWAS meta-analysis framework for further analyses. Using partitioned heritability, we found that loci at genes specifically expressed in the immune system carried enriched heritability, especially genes related to B and T cells. The relevance of B cells in particular was then demonstrated in mouse postoperative pain assays. Taken altogether, our results suggest a role for the adaptive immune system in chronic post-surgical pain.

Background: The potential effectiveness of the non-pharmacological and nanotechnology-based NeuroCuple™ device in reducing postoperative surgical pain and opioid consumption remains unknown. Methods: This randomized controlled open-label study was conducted in patients undergoing a primary unilateral total knee or total hip arthroplasty. In the recovery room, patients were randomized to receive either standard of care (control group) or standard of care plus two NeuroCuple™ devices. The outcome variables included pain and opioid consumption (oral morphine equivalent, OME in milligrams). Results: A total of 69 patients were randomized to either the NeuroCuple™ group (n = 38) or the control group (n = 31). Use of the NeuroCuple™ devices was associated with a significant 34% reduction in pain at rest (means of area under the curve: 6.3 vs. 9.5; p = 0.018) during postoperative days 1–3. Opioid consumption was reduced by 9%. More importantly, use of the NeuroCuple™ devices reduced the number of patients requesting an opioid prescription following discharge from the hospital by 52% (26% vs. 55%, p = 0.016). Conclusions: Our data suggest that the NeuroCuple™ device may be an effective non-pharmacological alternative to opioids to manage postoperative pain following unilateral arthroplasty due to its ability to reduce postoperative opioid use.