Sara Fonseca

Background/Objectives: Postoperative pain remains a major clinical and public health challenge, contributing to delayed recovery, increased opioid use, and risk of chronic postsurgical pain. A variety of postoperative analgesic interventions and strategies, including multimodal analgesia, regional anesthesia, local analgesic techniques, adjunctive pharmacological agents and structured perioperative care pathways have been proposed to improve pain management and reduce opioid exposure. This systematic review evaluated the effectiveness of perioperative analgesic interventions and strategies in major orthopedic and spine surgeries. Methods: The study was registered in PROSPERO and followed the PRISMA guidelines. A comprehensive search was performed to identify controlled trials involving major surgeries. Risk of bias was assessed using Cochrane tools, and the certainty of evidence was evaluated using the GRADE approach. Results: Across 37 included studies, a range of perioperative analgesic interventions and strategies was evaluated. They were associated with reduced postoperative pain or opioid consumption in some studies, whereas other studies reported no significant differences between intervention and control groups. Recovery outcomes and patient satisfaction were generally comparable between groups. Although 20 studies were classified as having a low risk of bias, these results should be interpreted within the context of very low certainty of evidence. Conclusions: Despite the need for studies with long-term follow-up, perioperative analgesic interventions and strategies appear promising for improving postoperative pain control and reducing opioid exposure in major orthopedic and spine surgery without compromising recovery. However, substantial clinical and methodological heterogeneity across interventions, comparators and outcomes limits direct comparisons and prevents conclusions regarding a single optimal analgesic approach.

Giant cell tumor of bone (GCTB) is a distinctive, intermediate-grade primary bone neoplasm defined by a neoplastic mesenchymal stromal compartment and a prominent osteoclast-rich microenvironment. Although histologically benign, GCTB is clinically consequential due to its locally destructive behavior, propensity for recurrence, and rare capacity for metastasis and malignant transformation. Over the past decade, the identification of recurrent H3F3A p.G34 mutations has fundamentally reshaped the understanding of GCTB pathogenesis, establishing the stromal cell as the true neoplastic driver and positioning the tumor as a paradigmatic epigenetically driven osteolytic disease. This narrative review focus on biology, pathophysiology, and histopathology in the era of H3F3A. H3F3A-mutant stromal cells orchestrate pathological osteoclastogenesis through dysregulated RANKL signaling and chromatin reprogramming, giving rise to the characteristic cellular admixture of osteoclast-type giant cells, mononuclear histiocytic cells, and neoplastic stromal elements. The targeted inhibition of osteoclast activity with denosumab has transformed clinical management, inducing profound morphological changes and bone formation. However, its long-term impact on local control, recurrence patterns, and malignant progression remains unclear. Collectively, GCTB exemplifies a molecularly defined bone tumor in which advances in epigenetic biology and tumor–microenvironment interactions have directly influenced diagnostic practice and therapeutic strategy. Ongoing challenges include refining risk stratification, optimizing treatment sequencing, and clarifying the biological consequences of sustained osteoclast suppression.

Background/Objectives: Trigeminal Neuralgia (TN) is a chronic neuropathic condition characterized by sudden, severe facial pain. Anticonvulsants are the cornerstone of pharmacological management, yet comparative evidence based on pharmacological class remains scarce. This systematic review aimed to evaluate the efficacy and safety of anticonvulsants in TN, stratified by their mechanism of action. Methods: A systematic search in PubMed, Scopus and Web of Science was conducted following PRISMA 2020 guidelines. Studies employing a pharmacological approach including human patients with TN, published in English since 2000, were included. Risk of bias was assessed using the Cochrane RoB 2, the ROBINS-I and the ROBINS-E tools, according to the study design. Results: Out of 922 initial records, 12 studies met the eligibility criteria. Sodium channel inhibitors showed high efficacy but frequent adverse effects, particularly hyponatremia and central nervous system symptoms. Calcium channel modulators offered a more favorable safety profile. Combination therapies showed benefits, levetiracetam and topiramate were moderately effective and well tolerated. Although the evidence has limitations, anticonvulsants continue to be the primary treatment for TN. Sodium-channel blockers demonstrate strong efficacy, whereas alternative agents generally provide superior tolerability. Conclusions: These findings support selecting drugs according to their underlying mechanisms of action. Equally important is tailoring therapy to pain phenotype and patient characteristics, balancing mechanism with tolerability and efficacy.

Despite technical and pharmacological advancements in recent years, including optimized therapies and personalized medicine, postoperative pain management remains challenging and sometimes undertreated. This review aims to summarize and update how genotype-guided therapeutics within personalized medicine can enhance postoperative pain management. Several studies in the area have demonstrated that genotype-guided therapy has the ability to lower opioid consumption and improve postoperative pain. Gene mutations, primarily OPRM1, CYP2D6, CYP2C9, COMT and ABCB1, have been shown to exert nuanced influences on analgesic response and related pharmacological outcomes. This review underscores the integration of pharmacogenetic-guided personalized medicine into perioperative care, particularly when there is uncertainty regarding opioid prescriptions. This approach leads to superior outcomes in terms of postoperative pain relief and reduced morbidity for numerous patients.

Chronic pain is an important cause of disability with a high burden to society. Quantitative sensory testing (QST) is a noninvasive multimodal method used to discriminate the function of nerve fibers. The aim of this study is to propose a new, reproducible, and less time-consuming thermal QST protocol to help characterize and monitor pain. Additionally, this study also compared QST outcomes between healthy and chronic pain subjects. Forty healthy young/adult medical students and fifty adult/elderly chronic pain patients were evaluated in individual sessions including pain history, followed by QST assessments divided into three proposed tests: pain threshold, suprathreshold, and tonic pain. In the chronic pain group, a significantly higher pain threshold (hypoesthesia) and a higher pain sensibility (hyperalgesia) were demonstrated at threshold temperature when compared to healthy participants. The sensitivity to the suprathreshold and tonic stimulus did not prove to be significantly different between both groups. The main results demonstrated that the heat threshold QST tests can be helpful in evaluating hypoesthesia and that the sensitivity threshold temperature test can demonstrate hyperalgesia in individuals with chronic pain. In conclusion, this study demonstrates the importance of using tools such as QST as a complement to detect changes in several pain dimensions.

The use of neuraxial procedures, such as spinal and epidural anaesthesia, has been linked to some possible complications. In addition, spinal cord injuries due to anaesthetic practice (Anaes-SCI) are rare events but remain a significant concern for many patients undergoing surgery. This systematic review aimed to identify high-risk patients summarise the causes, consequences, and management/recommendations of SCI due to neuraxial techniques in anaesthesia. A comprehensive search of the literature was conducted in accordance with Cochrane recommendations, and inclusion criteria were applied to identify relevant studies. From the 384 studies initially screened, 31 were critically appraised, and the data were extracted and analysed. The results of this review suggest that the main risk factors reported were extremes of age, obesity, and diabetes. Anaes-SCI was reported as a consequence of hematoma, trauma, abscess, ischemia, and infarction, among others. As a result, mainly motor deficits, sensory loss, and pain were reported. Many authors reported delayed treatments to resolve Anaes-SCI. Despite the potential complications, neuraxial techniques are still one of the best options for opioid-sparing pain prevention and management, reducing patients’ morbidity, improving outcomes, reducing the length of hospital stay, and pain chronification, with a consequent economic benefit. The main findings of this review highlight the importance of careful patient management and close monitoring during neuraxial anaesthesia procedures to minimise the risk of spinal cord injury and complications.