Bangladesh Journal of Pain

A New Era of Pharmacotherapy for Neuropathic Pain with Mirogabalin

Shigeki Yamaguchi — Tue, 30 Jun 2026 00:00:00 +0000

Pharmacotherapy for neuropathic pain has advanced significantly over the past 20 years. In the treatment of chronic pain, it is necessary to consider the balance between efficacy and safety, rather than evaluating them separately. The efficacy and safety of mirogabalin for neuropathic pain have been demonstrated in numerous clinical trials. It has been emphasized that mirogabalin strikes a balance between efficacy and safety and has the potential to serve as an alternative treatment option for neuropathic pain.

Situation Analysis of Pain Management Practices in Bangladesh: Identifying Gaps and Challenges

Tue, 30 Jun 2026 00:00:00 +0000

Background: Chronic pain is a global burden affecting over 30% of patients worldwide. The issue is particularly challenging in low- and middle-income countries, where there are limited dedicated pain services. In Bangladesh, national evidence on pain management practice and barriers to care is unexplored. Therefore, this study aimed to conduct a situational analysis of pain management practices among physicians in Bangladesh to identify gaps in training, resources, and multidisciplinary care, and to plan strategies to improve patient outcomes.

Methods: A cross-sectional study was conducted using an online survey. Physicians practicing pain management across Bangladesh were invited to participate. Data were collected regarding professional background, training in pain medicine, institutional capacity, use of pain assessment tools, treatment modalities, and barriers to pain management. Descriptive statistics were used for data analysis.

Results: Sixty-seven participants participated, predominantly anaesthesiologists (96.4%) practicing in an urban area (70.9%). 47.2% had no formal training in pain medicine, and 62.3% did not have training on Essential Pain Management (EPM). There are no dedicated pain management units in 60.4% of institutions. Application of standardized pain assessment tools remained variable. Pain management is largely medication-based (67.4%), with limited availability of multidisciplinary services (48.8%). Only 30.2% reported implementation of clinical practice guidelines. Key challenges included limited multidisciplinary support (66.7%), lack of training (56.4%), high treatment costs (38.5%), and poor patient adherence (41.0%).

Conclusion: This study identifies substantial gaps in current pain management practices in Bangladesh, including inadequate training, limited multidisciplinary care, and limited implementation of clinical practice guidelines. Addressing these challenges requires a coordinated national strategy focused on strengthening education and training, implementing clinical practice guidelines, and expanding multidisciplinary pain services.

Pericapsular Nerve Group Block versus Femoral Nerve Block for Positioning During Spinal Anaesthesia in Patients with Hip Fracture: A Randomized Controlled Trial

Tue, 30 Jun 2026 00:00:00 +0000

Background: Hip fractures are a leading cause of morbidity in elderly patients globally. Subarachnoid block (SAB) is the preferred anaesthetic technique for surgical repair, but positioning patients for SAB causes severe pain. Peripheral nerve blocks offer effective pre-procedural analgesia. The Pericapsular Nerve Group (PENG) block is a novel motor-sparing technique targeting articular branches of the anterior hip capsule, proposed as an alternative to the conventional Femoral Nerve Block (FNB). The objective of this study was to compare the analgesic efficacy of ultrasound-guided PENG block versus FNB for positioning patients with hip fracture prior to SAB.

Methods: A randomised controlled trial was conducted in Dhaka Medical College Hospital from August 2023 to March 2025. One hundred patients (aged 45–80 years, ASA I–II) were randomised: Group F (FNB, n=50) received 0.25% bupivacaine 10 mL + 1% lignocaine with adrenaline 5 mL (15 mL total); Group P (PENG block, n=50) received 0.25% bupivacaine 10 mL + 1% lignocaine with adrenaline 10 mL (20 mL total). Primary outcomes: VAS pain score at 30 minutes post-block and pain grade during SAB positioning. Secondary outcomes: best sitting angle, performer-rated positioning quality, haemodynamic parameters, and adverse events.

Results: Baseline demographics were comparable (p > 0.05). PENG block produced significantly lower VAS at 30 min (1.66±0.66 vs 2.98±1.30; p < 0.001); 100% of Group P achieved VAS <4 versus 70% in Group F (p < 0.001). Optimal sitting angle (>90°) was more frequent with PENG block (88% vs 58%; p = 0.002). Pain-free (Grade 1) positioning was achieved in 88% of Group P vs 36% of Group F (p < 0.001). Performer-rated positioning quality was superior in Group P (p = 0.007). Haemodynamic parameters and adverse event rates were comparable (p > 0.05). Number needed to treat for optimal sitting angle: 3.3.

Conclusion: PENG block is superior to FNB for pre-procedural analgesia in hip fracture patients undergoing SAB, providing better pain control, optimal positioning, and higher operator satisfaction without increased adverse effects. It should be considered the preferred regional technique for this indication at centres with ultrasound capability.

Efficacy and Safety of Genicular Nerve Block with Intraarticular Morphine in Knee Arthroscopic Procedures under Spinal Anaesthesia

Tue, 30 Jun 2026 00:00:00 +0000

Background: Knee arthroscopy, a minimally invasive procedure, often results in significant postoperative pain, which may delay recovery. Traditional approaches, including non-steroidal anti-inflammatory drugs and opioids, can result in various adverse effects and often do not provide sufficient analgesia. The genicular nerve block (GNB) may be a preferable alternative for pain relief, as it specifically targets the sensory nerves surrounding the knee. However, because the duration of action of local anesthetics is brief, they may not provide lasting analgesia. Therefore, the addition of intra-articular morphine in the knee joint can extend the analgesic effects, ensuring optimal pain relief. This study aims to assess the efficacy and safety of the combination of genicular nerve block (GNB) and intraarticular morphine compared to genicular nerve block alone for postoperative pain management in knee arthroscopic procedures.

Methods: This was a double-blind, randomized controlled trial in which patients were enrolled after obtaining informed written consent, who were scheduled for knee arthroscopic surgery under spinal anaesthesia at Bangladesh Medical University. Participants were randomized into two groups: Control group (Group GN) received ultrasound-guided genicular nerve block (GNB) with intraarticular normal saline and intervention group (Group GM) received ultrasound-guided genicular nerve block with intraarticular morphine. Postoperative pain scores were assessed by Numeric Rating Scale (NRS) scoring system immediately at recovery, every hourly up to 6 hours followed by at 12 hours and 24 hours. Total opioid consumption (mg) in 24 hours, time to first rescue analgesia (hours), incidence of postoperative nausea and vomiting (PONV), and haemodynamic parameters (systolic blood pressure,diastolic blood pressure,mean arterial pressure in mmHg and heart rate in beat/min) were assessed for up to 24 hours.

Results: A total of 30 patients were enrolled in this study. They were randomized into 2 groups (15 in each group). Baseline demographic and clinical parameters were comparable between groups. Group GM showed significantly lower total morphine consumption (mg) in 24 hours (4.16 ± 0.88) compared to group GN (5.93 ± 1.79) , with a p value of 0.02. The time to first analgesic request (hours) was significantly longer in Group GM (5.91 ± 1.48) compared to Group GN (4.2 ± 1.87) with a p value of 0.03. No significant differences were found in the incidence of postoperative nausea vomiting (p = 0.54).

Conclusions: Combining a genicular nerve block with intraarticular morphine is safe and effective for postoperative pain management after knee arthroscopy. This strategy prolongs analgesia and reduces total morphine consumption compared to the genicular nerve block alone.

Prevalence and Impact of Neuropathic Pain on Quality of Life in Chronic Pain Patients: A Cross-Sectional Study

Tue, 30 Jun 2026 00:00:00 +0000

Background: Neuropathic pain (NeP) represents a significant global healthcare burden, frequently leading to profound morbidity and functional incapacity. Unlike nociceptive pain, NeP arises from a primary lesion or dysfunction of the somatosensory nervous system. This study aimed to evaluate the prevalence of NeP among chronic pain patients in a tertiary care setting in Bangladesh and investigate its specific impact on health-related quality of life (HRQoL).

Methods: A cross-sectional study was conducted at the Pain Outpatient Department (OPD), Kosaka Pain Clinic, and Pain Skill Lab of the Bangladesh Medical University (BMU), Dhaka, over a one-year period. A total of 220 adult patients with chronic pain (duration >3 months) were evaluated. NeP was screened using the Douleur Neuropathique 4 (DN4) questionnaire (threshold ≥4). Pain intensity was measured using the Numeric Rating Scale (NRS), and HRQoL was evaluated across nine domains using the Short Form-36 (SF-36) Health Survey. Data were analyzed using SPSS version 27.

Results: The mean age of the respondents was 44.36±13.28 years, with a distinct female predominance (65.9%). According to the DN4 questionnaire, the prevalence of NeP was 49.1% (n = 108). The most prevalent sensory descriptors were burning sensations (85.9%), tingling (76.4%), and numbness (70.0%). On the NRS, 75.5% reported moderate pain, and 24.5% experienced severe pain. Increasing age group was significantly associated with both higher pain severity (p = 0.009) and positive NeP status (p = 0.001), with individuals over 50 bearing the highest burden (73.13% positive). HRQoL was profoundly lower in the neuropathic group compared to the non-neuropathic group across multiple domains (p < 0.05), most notably in Physical Functioning (39.41±17.67 vs. 49.51±14.11, p < 0.0001), Vitality (31.32±13.39 vs. 44.34± 13.43, p < 0.0001), and Mental Health (35.55±12.19 vs. 43.56±14.27, p < 0.0001).

Conclusion: Neuropathic pain is highly prevalent among chronic pain sufferers in Bangladesh, particularly among older individuals. It induces a devastating decline in physical mobility, mental health, and vital energy, necessitating mandatory clinical screening with tools like the DN4 and early multidisciplinary interventions.

Opioid-Sparing Effect of Fluoroscopy-Guided Neurolytic Coeliac Plexus Block in Advanced Upper Abdominal Malignancy: A Prospective Comparative Study in Bangladesh

Tue, 30 Jun 2026 00:00:00 +0000

Background: Pain associated with advanced upper abdominal cancer is frequently intense, chronic, and difficult to manage. Although opioids remain the cornerstone of treatment, increasing dosages can produce drowsiness, nausea, constipation, and cognitive impairment, compromising patients' functional status and quality of life. Neurolytic coeliac plexus block disrupts visceral pain transmission, which may offer long-term analgesia while lowering opioid use and treatment-related side effects. However, comparable data is sparse in resource-constrained areas like Bangladesh.

Objective: To compare fluoroscopy-guided NCPB with conventional opioid-based therapy for pain relief, opioid consumption, quality of life and adverse events in adults with advanced upper abdominal malignancy.

Methods: This prospective observational comparative study was conducted at Bangladesh Medical University from July 2025 to June 2026. Thirty consecutively enrolled adults with confirmed advanced upper abdominal malignancies and moderate-to-severe pain (VAS ≥5) were included. Based on clinical decision-making, 15 underwent fluoroscopy-guided bilateral NCPB with 50% alcohol, while 15 received conventional opioid therapy. VAS scores, opioid consumption in morphine milligram equivalents per day (MME/day), EORTC QLQ-C30 scores, and adverse events were assessed at baseline, Day 7, 1 month, and 3 months. Group differences and changes during follow-up were analysed, with p<0.05 considered statistically significant.

Results: Baseline characteristics were comparable between the groups. At 3 months, the NCPB group had significantly lower VAS scores (4.2 ± 1.5 vs 7.4 ± 1.6) and opioid consumption (38.00 ± 13.47 vs 101.67 ± 19.61 MME/day) than the conventional opioid group (both p<0.001). NCPB also produced greater improvement in EORTC QLQ-C30 functional and quality-of-life scores, with lower pain and fatigue scores (all p<0.001). Nausea/vomiting, constipation, and sedation were less frequent after NCPB, although procedure-related pain was more common.

Conclusion: Fluoroscopy-guided NCPB provided superior, sustained pain relief, marked opioid sparing and better quality of life than conventional opioid therapy, with a favourable safety profile.

Protocol for Optimising the Host for Favourable Outcomes of Platelet-Rich Plasma Therapy for Musculoskeletal Pain: A Review of the Literature

Sudheer Dara, Minal Chandra, L Sudhakar — Tue, 30 Jun 2026 00:00:00 +0000

Platelet-rich plasma (PRP) therapy has become a potential regenerative treatment for joint pain, particularly in the area of osteoarthritis and tendinopathies. Nonetheless, clinical results continue to be inconsistent, with significant inter-patient variability in response rates. Recent findings suggest that PRP bioactivity is strongly conditioned by patient specific biological and lifestyle factors. This systematic review aims to summarize modifiable patient-related factors that may be optimized before PRP therapy to improve platelet function, growth factor release, and clinical outcomes when treating joints for pain. A structured search of PubMed, MEDLINE, Cochrane Library and Embase databases was performed for studies investigating the effects of patient factors on PRP efficacy in musculoskeletal applications. We included studies published from 2010 to 2025.