Expert consensus of Chinese Association for the Study of Pain on the radiofrequency therapy technology in the Department of Pain

On the basis of continuous improvement in recent years,radiofrequency therapy technology has been widely developed,and has become an effective method for the treatment of various intractable pain.Radiofrequency therapy is a technique that uses special equipment and puncture needles to output ultra-high frequency radio waves and accurately act on local tissues.In order to standardize the application of radiofrequency technology in the treatment of painful diseases,Chinese Association for the Study of Pain(CASP)has developed a consensus proposed by many domestic experts and scholars.

Chinese Association for the Study of Pain:Expert consensus on diagnosis and treatment for lumbar disc herniation

Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally.According to the expert consensus,clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

Myofascial pain syndrome(MPS)is characterized by myofascial trigger points and fascial constrictions.At present,domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS.Due to the lack of specific laboratory indicators and imaging evidence,there is no unified diagnostic criteria for MPS,making it easy to confuse with other diseases.The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS.This article reviews relevant domestic and foreign literature on the definition,epidemiology,pathogenesis,clinical manifestation,diagnostic criteria and treatments of MPS.The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors,including pain physicians to manage patients with MPS.

Expert consensus of Chinese Association for the Study of Pain on the application of ozone therapy in pain medicine

This consensus was compiled by first-line clinical experts in the field of pain medicine and was organized by the Chinese Association for the Study of Pain.To reach this consensus,we consulted a wide range of opinions and conducted indepth discussions on the mechanism,indications,contraindications,operational specifications and adverse reactions of ozone iatrotechnique in the treatment of pain disorders.We also referred to related previous preclinical and clinical studies published in recent years worldwide.The purpose of this consensus is to standardize the rational application of ozone iatrotechnique in pain treatment,to improve its efficacy and safety and to reduce and prevent adverse reactions and complications in this process.

Expert consensus of the Chinese Association for the Study of Pain on ion channel drugs for neuropathic pain

Neuropathic pain(NPP)is a kind of pain caused by disease or damage impacting the somatosensory system.Ion channel drugs are the main treatment for NPP;however,their irregular usage leads to unsatisfactory pain relief.To regulate the treatment of NPP with ion channel drugs in clinical practice,the Chinese Association for the Study of Pain organized first-line pain management experts from China to write an expert consensus as the reference for the use of ion channels drugs.Here,we reviewed the mechanism and characteristics of sodium and calcium channel drugs,and developed recommendations for the therapeutic principles and clinical practice for carbamazepine,oxcarbazepine,lidocaine,bulleyaconitine A,pregabalin,and gabapentin.We hope this guideline provides guidance to clinicians and patients on the use of ion channel drugs for the management of NPP.

Expert panel’s guideline on cervicogenic headache:The Chinese Association for the Study of Pain recommendation

Cervicogenic headache(CEH)has been recognized as a unique category of headache that can be difficult to diagnose and treat.In China,CEH patients are managed by many different specialties,and the treatment plans remain controversial.Therefore,there is a great need for comprehensive evidence-based Chinese experts’recommendations for the management of CEH.The Chinese Association for the Study of Pain asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with CEH.A group of multidisciplinary Chinese Association for the Study of Pain experts identified the clinically relevant topics in CEH.A systematic review of the literature was performed,and evidence supporting the benefits and harms for the management of CEH was summarized.Twenty-four recommendations were finally developed through expert consensus voting for evidence quality and recommendation strength.We hope this guideline provides direction for clinicians and patients making treatment decisions for the management of CEH.

Expert consensus of the Chinese Association for the Study of Pain on pain treatment with the transdermal patch

Chronic pain lasting more than 3 mo,or even several years can lead to disability.Treating chronic pain safely and effectively is a critical challenge faced by clinicians.Because administration of analgesics through oral,intravenous or intramuscular routes is not satisfactory,research toward percutaneous delivery has gained interest.The transdermal patch is one such percutaneous delivery system that can deliver drugs through the skin and capillaries at a certain rate to achieve a systemic or local therapeutic effect in the affected area.It has many advantages including ease of administration and hepatic first pass metabolism avoidance as well as controlling drug delivery,which reduces the dose frequency and side effects.If not required,then the patch can be removed from the skin immediately.The scopolamine patch was the first transdermal patch to be approved for the treatment of motion sickness by the Food and Drug Administration in 1979.From then on,the transdermal patch has been widely used to treat many diseases.To date,no guidelines or consensus are available on the use of analgesic drugs through transdermal delivery.The pain branch of the Chinese Medical Association,after meeting and discussing with experts and based on clinical evidence,developed a consensus for promoting and regulating standard use of transdermal patches containing analgesic drugs.

Chinese Association for the Study of Pain:Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China(2020 edition)

Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.

Chinese Association for the Study of Pain:Expert consensus on chronic postsurgical pain

Chronic postsurgical pain is a common surgical complication that severely reduces a patient’s quality of life.Many perioperative interventions and management strategies have been developed for reducing and managing chronic postsurgical pain.Under the leadership of the Chinese Association for the Study of Pain,an editorial committee was formed for chronic postsurgical pain diagnosis and treatment by experts in relevant fields.The editorial committee composed the main content and framework of this consensus and established a working group.The working group conducted literature review(1989-2020)using key words such as“surgery”,“post-surgical”,“post-operative”,“pain”,“chronic”,and“persistent”in different databases including MEDLINE,EMBASE,PubMed,Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews.Only publications in the English language were included.The types of literature included systematic reviews,randomized controlled studies,cohort studies and case reports.This consensus was written based on clinical practice combined with literature evidence.The first draft of the consensus was rigorously reviewed and edited by all the editorial committee experts before being finalized.The level of evidence was assessed by methodological experts based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence.The strength of recommendation was evaluated by all editorial committee experts,and the opinions of most experts were adopted as the final decision.The recommendation level“strong”generally refers to recommendations based on high-level evidence and consistency between clinical behavior and expected results.The recommendation level“weak”generally refers to the uncertainty between clinical behavior and expected results based on low-level evidence.

Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain

BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain.However,ganglion impar block combined with pulsed radiofrequency(GIB-PRF)for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance.AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIBPRF in treating perineal pain.METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016.Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure,and visual analogue scale(VAS)scores at 24 h before and after treatment and 1,3,and 6 mo later were analyzed to evaluate clinical efficacy.RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients,and no complications occurred.Compared with pretreatment scores,the VAS scores were significantly lower(P<0.05)at the four time points after treatment.The VAS scores at 1 and 3 mo were slightly lower than those at 24 h(P>0.05)and were significantly lower at 6 mo after treatment(P<0.05).There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo(P>0.05).CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain.The 6-mo short-term clinical efficacy was favorable,but the long-term outcomes need future study.

Expert consensus of Chinese Association for the Study of Pain on the non-opioid analgesics for chronic musculoskeletal pain

Chronic musculoskeletal pain(CMP)is a common occurrence in clinical practice and there are a variety of options for the treatment of it.However,the pharmacological therapy is still considered to be a primary treatment.The recent years have witnessed the emergence of opioid crisis,yet there are no relevant guidelines on how to treat CMP with non-opioid analgesics properly.The Chinese Medical Association for the Study of Pain convened a panel meeting to develop clinical practice consensus for the treatment of CMP with non-opioid analgesics.The purpose of this consensus is to present the application of nonsteroidal antiinflammatory drugs,serotonin norepinephrine reuptake inhibitors,serotonin and norepinephrine reuptake inhibitors,muscle relaxants,ion channel drugs and topical drugs in CMP.

Contributions of aversive environmental stress to migraine chronification:Research update of migraine pathophysiology

Clinical studies have suggested that internal and/or external aversive cues may produce a negative affective-motivational component whereby maladaptive responses(plasticity)of dural afferent neurons are initiated contributing to migraine chronification.However,pathophysiological processes and neural circuitry involved in aversion(unpleasantness)-producing migraine chronification are still evolving.An interdisciplinary team conducted this narrative review aimed at reviewing neuronal plasticity for developing migraine chronicity and its relevant neurocircuits and providing the most cutting-edge information on neuronal mechanisms involved in the processing of affective aspects of pain and the role of unpleasantness evoked by internal and/or external cues in facilitating the chronification process of migraine headache.Thus,information presented in this review promotes the understanding of the pathophysiology of chronic migraine and contribution of unpleasantness(aversion)to migraine chronification.We hope that it will bring clinicians’attention to how the maladaptive neuroplasticity of the emotion brain in the aversive environment produces a significant impact on the chronification of migraine headache,which will in turn lead to new therapeutic strategies for this type of pain.

Editorial for the special issue of the Chinese Association for the Study of Pain

The Ministry of Health of China officially issued a document,adding the first level diagnosis and treatment discipline“Algology”in the list of diagnosis and treatment subjects of medical institutions on July 16,2007.As the most important pain academic organization in China,the Chinese Association for the Study of Pain has made outstanding contributions in promoting the development of pain discipline and in establishing pain standards and disease diagnosis and treatment guidelines.In this special issue,under the leadership of Yan-Qing Liu,Chairman of the 7th Committee of the Chinese Association for the Study of Pain,nine consensus and one guideline were included.

Cervical intervertebral disc degeneration and dizziness

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness.Anterior cervical surgery can eliminate not only chronic neck pain,cervical radiculopathy or myelopathy,but also dizziness.Immunohistochemical studies show that a large number of mechanoreceptors,especially Ruffini corpuscles,are present in degenerated cervical discs.The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease(i.e.cervical discogenic dizziness).Disc degeneration is characterized by an elevation of inflammatory cytokines,which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization.Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system,resulting in sensory mismatches with vestibular and visual information and leads to dizziness.In addition,neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles.Like cervical discogenic pain,the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out.Conservative treatment is effective for the majority of patients.Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.

Intratunical bupivacaine and methylprednisolone instillation for scrotal pain after testicular sperm retrieval procedures

<abstract>Aim: To investigate the effect of intratunical instillation of bupivacaine and methylprednisolone for scrotal pain, swelling and peritesticular fibrosis due to testicular sperm retrieval procedures. Methods: A total of 65 patients were randomly divided into two groups. In the instillation group (GI), 34 patients were administered 2.5 mL of 0.5 % bupivacaine combined with 10 mg/mL methylprednisolone before closure of the tunica vaginalis. In the control group (GC), 31 patients only received analgesics postoperatively by intramuscular route. The pain (by visual analogue scale, VAS) and duration of pain-free period after surgery between the two groups were evaluated at 2 and 4 h and at days 2 and 7 postoperatively. Results: The mean pain scores were significantly lower in the GI than in the GC group at 2 and 4 h after surgery (P<0.05 and P<0.01, respectively). The mean duration of pain free interval after the procedure was 47.8±16.9 (12-72) h in GI, which was significantly longer than that in GC [(9.9±3.6; 4-20) h]. Besides, in the GI, 29 % of patients were completely free from pain and 67 % had no scrotal swelling, but in the GC, all the patients required additional NSAID injection due to pain and only 3 % had no scrotal swelling. Conclusion: This study confirms that direct intratunical instillation of bupivacaine and methylprednisolone around the testis reduces the postoperative pain, scrotal swelling and peritesticular fibrosis.

Fungal diversity notes 1387-1511:taxonomic and phylogenetic contributions on genera and species of fungal taxa

This article is the 13th contribution in the Fungal Diversity Notes series,wherein 125 taxa from four phyla,ten classes,31 orders,69 families,92 genera and three genera incertae sedis are treated,demonstrating worldwide and geographic distri-bution.Fungal taxa described and illustrated in the present study include three new genera,69 new species,one new com-bination,one reference specimen and 51 new records on new hosts and new geographical distributions.Three new genera,Cylindrotorula(Torulaceae),Scolecoleotia(Leotiales genus incertae sedis)and Xenovaginatispora(Lindomycetaceae)are introduced based on distinct phylogenetic lineages and unique morphologies.Newly described species are Aspergillus lan-naensis,Cercophora dulciaquae,Cladophialophora aquatica,Coprinellus punjabensis,Cortinarius alutarius,C.mammil-latus,C.quercoflocculosus,Coryneum fagi,Cruentomycena uttarakhandina,Cryptocoryneum rosae,Cyathus uniperidiolus,Cylindrotorula indica,Diaporthe chamaeropicola,Didymella azollae,Diplodia alanphillipsii,Dothiora coronicola,Efibula rodriguezarmasiae,Erysiphe salicicola,Fusarium queenslandicum,Geastrum gorgonicum,G.hansagiense,Helicosporium sexualis,Helminthosporium chiangraiensis,Hongkongmyces kokensis,Hydrophilomyces hydraenae,Hygrocybe boertmannii,Hyphoderma australosetigerum,Hyphodontia yunnanensis,Khaleijomyces umikazeana,Laboulbenia divisa,Laboulbenia triarthronis,Laccaria populina,Lactarius pallidozonarius,Lepidosphaeria strobelii,Longipedicellata megafusiformis,Lophiotrema lincangensis,Marasmius benghalensis,M.jinfoshanensis,M.subtropicus,Mariannaea camelliae,Mel-anographium smilaxii,Microbotryum polycnemoides,Mimeomyces digitatus,Minutisphaera thailandensis,Mortierella solitaria,Mucor harpali,Nigrograna jinghongensis,Odontia huanrenensis,O.parvispina,Paraconiothyrium ajrekarii,Par-afuscosporella niloticus,Phaeocytostroma yomensis,Phaeoisaria synnematicus,Phanerochaete hainanensis,Pleopunctum thailandicum,Pleurotheciella dimorphospora,Pseudochaetosphaeronema chiangraiense,Pseudodactylaria albicolonia,Rhexoacrodictys nigrospora,Russula paravioleipes,Scolecoleotia eriocamporesi,Seriascoma honghense,Synandromyces makranczyi,Thyridaria aureobrunnea,Torula lancangjiangensis,Tubeufia longihelicospora,Wicklowia fusiformispora,Xenovaginatispora phichaiensis and Xylaria apiospora.One new combination,Pseudobactrodesmium stilboideus is pro-posed.A reference specimen of Comoclathris permunda is designated.New host or distribution records are provided for Acrocalymma fici,Aliquandostipite khaoyaiensis,Camarosporidiella laburni,Canalisporium caribense,Chaetoscutula juniperi,Chlorophyllum demangei,C.globosum,C.hortense,Cladophialophora abundans,Dendryphion hydei,Diaporthe foeniculina,D.pseudophoenicicola,D.pyracanthae,Dictyosporium pandanicola,Dyfrolomyces distoseptatus,Ernakula-mia tanakae,Eutypa flavovirens,E.lata,Favolus septatus,Fusarium atrovinosum,F.clavum,Helicosporium luteosporum,Hermatomyces nabanheensis,Hermatomyces sphaericoides,Longipedicellata aquatica,Lophiostoma caudata,L.clematidis-vitalbae,Lophiotrema hydei,L.neoarundinaria,Marasmiellus palmivorus,Megacapitula villosa,Micropsalliota globocys-tis,M.gracilis,Montagnula thailandica,Neohelicosporium irregulare,N.parisporum,Paradictyoarthrinium diffractum,Phaeoisaria aquatica,Poaceascoma taiwanense,Saproamanita manicata,Spegazzinia camelliae,Submersispora variabi-lis,Thyronectria caudata,T.mackenziei,Tubeufia chiangmaiensis,T.roseohelicospora,Vaginatispora nypae,Wicklowia submersa,Xanthagaricus necopinatus and Xylaria haemorrhoidalis.The data presented herein are based on morphological examination of fresh specimens,coupled with analysis of phylogenetic sequence data to better integrate taxa into appropriate taxonomic ranks and infer their evolutionary relationships.