Regional Anesthesia & Pain Medicine

Regional Anesthesia & Pain Medicine RAPM is your authoritative medical source for regional anesthesia and pain knowledge – from pediatric

🚨 US Department of Defense consensus guidelines on neuromodulation for pain management in active-duty military personnel...
06/12/2026

🚨 US Department of Defense consensus guidelines on neuromodulation for pain management in active-duty military personnel 🚨

🎖️The first military-specific consensus guidelines for neuromodulation have arrived. Developed by pain medicine leaders from the Army, Navy, and Air Force and endorsed by the Defense Health Agency, these recommendations aim to standardize care for Service Members with chronic pain.

🔑 Key considerations include command involvement, opioid tapering before implantation trials, military occupational requirements, limited-duty periods after certain procedures, and functional testing before deployment.

💡 Neuromodulation can be transformative for select Service Members, but decisions must balance pain relief and function with military readiness, deployability, and career demands.

📖 An important step toward improving consistency, equity, and outcomes in military pain care.

🔗 READ HERE: https://doi.org/10.1136/rapm-2026-107787

🩻 Rib Fracture Analgesia: Beyond Pain ScoresRib fractures in older adults are associated with substantial morbidity, par...
06/09/2026

🩻 Rib Fracture Analgesia: Beyond Pain Scores

Rib fractures in older adults are associated with substantial morbidity, particularly pulmonary complications.

📚 This pilot randomized study compared three analgesic strategies:
• Erector Spinae Plane (ESP) catheter
• Intravenous lidocaine infusion
• Multimodal analgesia alone

✨ Key findings:
• Similar pain scores across groups
• Similar opioid consumption across groups
• Lower delirium rates in the ESP group
• Pneumonia occurred only in control patients
• Possible LAST symptoms were observed in 3 lidocaine patients

🔍 These findings suggest that future studies may need to focus on outcomes beyond pain and opioid use, including delirium, pulmonary complications, and safety.

📖 Schwenk ES, Bloom R, Torjman MC, et al.

🔗 Discover more in RAPM: https://doi.org/10.1136/rapm-2026-107865

🚨 Preoperative vitamin D level and postoperative pain in patients undergoing breast cancer surgery🔬 A new prospective ob...
06/07/2026

🚨 Preoperative vitamin D level and postoperative pain in patients undergoing breast cancer surgery

🔬 A new prospective observational study published in RAPM found that preoperative vitamin D deficiency was associated with:
🔹 Higher postoperative pain scores
🔹 Increased opioid consumption
🔹 Greater likelihood of moderate-to-severe pain after breast cancer surgery

📈 In patients undergoing unilateral modified radical mastectomy, vitamin D deficiency independently increased the odds of significant postoperative pain during the first 24 hours (adjusted OR 3.12).

💡 These findings highlight the potential importance of preoperative nutritional and metabolic optimization in perioperative pain management.

READ HERE -> https://lnkd.in/ejd6KTEN

🚨 Can GLP-1 medications do more than help with weight loss?📚 In a large study of patients with knee osteoarthritis, GLP-...
06/05/2026

🚨 Can GLP-1 medications do more than help with weight loss?

📚 In a large study of patients with knee osteoarthritis, GLP-1 receptor agonists were associated with a lower risk of progressing to total knee replacement surgery. The greatest benefit was seen with longer treatment duration and newer agents such as semaglutide and tirzepatide.

📉 After 3 years of treatment, patients on semaglutide or tirzepatide had a 28% lower risk of knee replacement compared with matched controls.

💡 While more prospective research is needed, these findings suggest GLP-1 therapies may have disease-modifying effects in osteoarthritis beyond weight loss alone.

📖 READ HERE -> https://doi.org/10.1136/rapm-2026-107658

🧠 Can spinal cord stimulation reduce opioid use in chronic pain patients?This systematic review and meta-analysis evalua...
06/03/2026

🧠 Can spinal cord stimulation reduce opioid use in chronic pain patients?

This systematic review and meta-analysis evaluated opioid consumption following spinal cord stimulation (SCS) implantation across 43 studies involving more than 3,000 patients.

✨ Key findings:
• SCS was associated with a 32% reduction in opioid consumption
• Mean opioid dose decreased by 18 MME/day at 12 months
• Odds of continued opioid use decreased by 53%
• Benefits appeared sustained up to 24 months after implantation

🔍 These findings support the potential opioid-sparing role of SCS as part of multimodal chronic pain management strategies, although certainty of evidence remains very low.

📖 Hunter Soleymani et al.

👉 Read the full article in RAPM: https://doi.org/10.1136/rapm-2026-107603

🚨 Sub-perception dorsal root ganglion stimulation vs sham stimulation in established responders📚 A new randomized, doub...
05/27/2026

🚨 Sub-perception dorsal root ganglion stimulation vs sham stimulation in established responders

📚 A new randomized, double-blind crossover clinical trial examined subperception (paresthesia-free) dorsal root ganglion (DRG) stimulation versus sham stimulation in established DRG responders with chronic neuropathic or nociplastic pain.

Key findings:
🔹 Active subperception DRG stimulation significantly reduced pain compared with sham stimulation
🔹 Improved patient satisfaction and PGIC outcomes
🔹 No serious or device-related adverse events reported

✅ These findings provide important sham-controlled evidence supporting the efficacy of subperception DRG stimulation during the maintenance phase of chronic pain treatment.

LINK -> https://doi.org/10.1136/rapm-2026-107906

🚨 Preoperative vitamin D level and postoperative pain in patients undergoing breast cancer surgery🔬 A new prospective ob...
05/20/2026

🚨 Preoperative vitamin D level and postoperative pain in patients undergoing breast cancer surgery

🔬 A new prospective observational study published in RAPM found that preoperative vitamin D deficiency was associated with:
🔹 Higher postoperative pain scores
🔹 Increased opioid consumption
🔹 Greater likelihood of moderate-to-severe pain after breast cancer surgery

📈 In patients undergoing unilateral modified radical mastectomy, vitamin D deficiency independently increased the odds of significant postoperative pain during the first 24 hours (adjusted OR 3.12).

💡 These findings highlight the potential importance of preoperative nutritional and metabolic optimization in perioperative pain management.

READ HERE -> https://doi.org/10.1136/rapm-2025-107495

🎙️ New RAPM Focus Podcast EpisodeIn Episode 51 of RAPM Focus, RAPM Social Media Editor Alopi Patel, MD, speaks with Sesh...
05/18/2026

🎙️ New RAPM Focus Podcast Episode

In Episode 51 of RAPM Focus, RAPM Social Media Editor Alopi Patel, MD, speaks with Sesh Mudumbai, MD, MS, and Oluwatobi “Tobi” Hunter, DNP, RN-BC, AGACNP-BC, about their recent study:

“Utilization and opioid outcomes of a transitional pain service in high-risk surgical veterans: a cohort study.”

This discussion explores:
🔹 Transitional pain services in high-risk surgical veterans
🔹 Opioid outcomes and perioperative pain management
🔹 Multidisciplinary approaches to improving surgical recovery and long-term outcomes

💡 An insightful conversation on perioperative care, pain trajectories, and innovative models in pain medicine.

🎧 Listen here -> https://rapmfocusbmj.podbean.com/e/episode-51-utilization-and-opioid-outcomes-of-a-transitional-pain-service-in-high-risk-surgical-veterans-a-cohort-study/

📊 Can early postoperative pain predict long-term recovery after knee replacement surgery?This study applied machine lear...
05/05/2026

📊 Can early postoperative pain predict long-term recovery after knee replacement surgery?

This study applied machine learning to a large cohort of 17,200 total knee arthroplasty patients to better understand postoperative pain patterns.

⚡️ Key findings:
• Two distinct pain trajectories were identified:
– Low pain trajectory
– High pain trajectory
• The high pain group showed:
– Higher pain scores
– Greater opioid consumption
– Increased need for pain consultations
• A predictive model achieved:
– 64% accuracy
– Moderate discrimination in identifying high-risk patients

💡 The most important insight:
Pain patterns within the first 12–24 hours after surgery already provide meaningful information about future pain trajectories.

📈 Why this matters:
• Moves beyond isolated pain scores → captures dynamic pain evolution over time
• Enables early risk stratification
• Opens the door to targeted, proactive pain management strategies

⚠️ Reality check:
Prediction is still moderate — but this is a proof of concept for scalable clinical tools using electronic health record data.

‼️ Bottom line:
We are moving from reactive pain control to early identification and intervention.

🔗 https://doi.org/10.1136/rapm-2026-107626

⚡️ From electrical dose to neural dose: redefining spinal cord stimulationThis study investigates whether dorsal column ...
05/04/2026

⚡️ From electrical dose to neural dose: redefining spinal cord stimulation
This study investigates whether dorsal column activation—measured via evoked
compound action potential threshold (ECAPT)—drives analgesia in spinal cord stimulation (SCS).

🔍 What they did:
Rats with neuropathic pain received SCS at doses based on ECAP threshold (ECAPT):
• Subthreshold: 0–0.5×ECAPT
• Suprathreshold: 1.1–1.4×ECAPT (closed-loop)

‼️ Key findings:
✅ Only suprathreshold doses (≥1.1×ECAPT) produced analgesia
✅ 1.2–1.3×ECAPT provided the most sustained pain relief
⚠️ 1.1×ECAPT showed reduced efficacy
⚠️ 1.4×ECAPT offered no additional benefit
❌ Subthreshold stimulation (≤0.5×ECAPT) was ineffective

💡 Why this matters:
Traditional SCS dosing relies on electrical output or motor thresholds, which poorly reflect actual neural activation.

📊 This study demonstrates that:
• Analgesia is directly linked to dorsal column recruitment
• ECAP threshold (ECAPT) is a clinically relevant, objective dosing marker
• Closed-loop systems can maintain consistent neural activation despite physiological variability

📈 The big picture:
This work identifies a therapeutic window for SCS and supports ECAP-guided dosing as a translational bridge between preclinical and clinical practice.

🔗 https://doi.org/10.1136/rapm-2026-107607

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