The research team, led by Catherine Paterson of Flinders University in Australia alongside collaborators from institutions across Australia, the United States, Norway and Singapore, screened nearly 3,000 articles and included 34 randomised or quasi-randomised trials involving 1,988 children and adolescents across 17 countries. Unlike previous syntheses that focused narrowly on long-term survivors, this review deliberately covered the entire cancer care continuum, from diagnosis through active treatment and into survivorship, and evaluated three distinct outcome domains: neurocognitive function, psychological wellbeing and health-related quality of life. The scale and breadth of the analysis make it, according to the authors, the most comprehensive of its kind for this population to date.

The clearest signal emerged for neurocognitive outcomes. Cognitive interventions, including structured cognitive rehabilitation and computerised training programmes, produced a significant moderate benefit, with a standardised mean difference of 0.51 and, remarkably, zero heterogeneity across studies, meaning the effect was strikingly consistent. The benefit was strongest for working memory, which showed a standardised mean difference of 0.54, followed by a composite of other cognitive domains including metacognitive skills, executive function, processing speed and attention. This consistency matters clinically because neurocognitive impairment affects nearly half of survivors treated with central nervous system-directed therapy, damaging precisely the attention, working memory and processing-speed systems that these interventions appear to target. The mechanistic logic is plausible: repetitive, structured cognitive training exercises the very neural circuits that chemotherapy and radiotherapy disrupt.

Psychological outcomes told a more complicated story. Interventions spanning play and creative therapies, animal-assisted therapy, self-management education and physical activity produced a significant overall improvement, with a standardised mean difference of 0.42, but the heterogeneity statistic of 70.1 percent revealed substantial variability between studies. Drilling down, the benefit was driven almost entirely by anxiety, which showed a significant reduction with a standardised mean difference of 0.57. Depression, coping and self-worth showed no statistically significant effects. The authors offer a compelling explanation: many psychosocial interventions act on acute, state-based arousal around procedures and treatment, which anxiety responds to readily, whereas depression and self-concept are more trait-like constructs that evolve over longer horizons and may require higher-intensity or longer-duration programmes. The null findings may also simply reflect insufficient statistical power, given the small number of studies per outcome.

The largest pooled effect appeared for health-related quality of life, where animal-assisted therapy, play and creative therapies and physical activity interventions achieved a standardised mean difference of 0.80, a large effect by conventional benchmarks. Yet this headline number comes with a caveat: heterogeneity was very high at 87.1 percent, indicating that true effects varied enormously across contexts. Within this domain, pain showed the most dramatic benefit, with a standardised mean difference of 1.10, while fatigue and general quality of life showed no significant effects. The divergence between strong domain-specific pain relief and null effects on global quality of life likely reflects both measurement inconsistency, with generic and disease-specific instruments capturing different constructs, and the inherent difficulty of shifting a multidimensional construct with single-modality interventions delivered over short periods.

The interventions themselves were remarkably diverse. The included trials tested art therapy, jewellery making, cognitive rehabilitation, child life services, aqua therapy, web-based and game-based physical activity, immersive virtual reality, self-management education, massage, music therapy and complementary therapies, with durations ranging from a single session to 24 weeks. Study populations were similarly heterogeneous, mixing clinically diverse cancer samples with cohorts focused specifically on leukaemia or brain tumours. This diversity is both a strength, demonstrating the breadth of approaches being trialled worldwide, and a limitation, because pooling across such varied modalities means the estimates speak to the promise of psychosocial intervention as a category rather than to the precise efficacy of any single therapy.

Perhaps the most sobering finding concerns what has not been tested. Not a single trial in the review targeted the pre-treatment window, the prehabilitation phase where early psychosocial support could theoretically prevent rather than react to treatment-related harm. The authors note that while urgent treatment initiation often precludes preparation time, solid-tumour pathways frequently allow lead time during which coordinated, interprofessional psychosocial input could begin. Equally striking was the absence of theory: most included studies did not report using any theoretical framework to guide intervention design, and only four explicitly referenced models such as Social Cognitive Theory, self-efficacy theory or Lazarus’ transactional model of stress and coping. Co-design with children, families and clinicians was almost entirely absent, and many trials applied a one-size-fits-all approach across age spans as wide as 1 to 18 years, despite the profound developmental differences between a toddler and a teenager.

Methodological quality was moderate overall: 44 percent of studies were judged at low risk of bias, 53 percent at moderate risk and one at high risk. The main concerns centred on blinding, an inherent challenge for behavioural interventions where participants and providers inevitably know what treatment is being delivered, rather than on retention or statistical conduct, which were generally well handled. The authors also acknowledge that publication bias could not be formally assessed because each meta-analysis included fewer than ten studies, and that non-English-language research may have been missed. Developmental age could not be explored quantitatively because most trials reported age only as aggregate data across broad, overlapping ranges, making age-stratified analysis statistically underpowered and potentially misleading.

For clinicians and families, the practical takeaways are reasonably clear. Cognitive remediation is a credible candidate for integration into survivorship pathways for children treated with CNS-directed therapy, though optimal timing, dose and delivery format remain undefined. Brief psychosocial interventions show the most promise for state anxiety around procedures and treatment, while symptom-targeted approaches for procedural pain represent the most mature near-term application. Durable effects on mood, self-concept and global quality of life, by contrast, will likely require sustained, multimodal, theory-driven models of supportive care rather than short, single-modality programmes. The authors also call for wider adoption of paediatric oncology core outcome sets to improve comparability across future trials.

The review ultimately paints a field in transition: one where the promise of psychosocial care for young cancer patients is real and measurable in specific domains, but where the evidence base remains fragmented by small samples, inconsistent measures and atheoretical design. Future trials, the authors argue, should identify optimal intervention timing, dosage and delivery format, stratify outcomes by age, diagnosis and treatment intensity, and embrace implementation science to ensure that effective interventions actually reach routine clinical practice. For the hundreds of thousands of children diagnosed each year, and for the survivors who carry cognitive and psychological scars long into adulthood, the message is that help exists and works, but the science of exactly what to deliver, when and to whom is still being written.

Subject of Research: Effectiveness of psychosocial interventions for neurocognitive, psychological and quality-of-life outcomes in children and adolescents with cancer across the care continuum

Article Title: Psychosocial interventions for children and adolescents across the cancer care continuum: A systematic review and meta-analysis

Article References: Paterson, C., McCarthy, M. C., Sansom-Daly, U. M., Wakefield, C. E., Turner, M. R., Christina, J., Roberts, C., Moss, C., Thamm, C., Carmichael, M.-A., Johansen, S., Atkinson, M., Osborn, M., Singh, B., & Ramsey, I. (2026). Psychosocial interventions for children and adolescents across the cancer care continuum: A systematic review and meta-analysis. Supportive Care in Cancer, 34(10), Article 995. https://doi.org/10.1007/s00520-026-11176-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11176-x

Keywords: psychosocial interventions, pediatric oncology, systematic review, meta-analysis, cognitive rehabilitation, working memory, anxiety, pain management, quality of life, animal-assisted therapy, cancer survivors, supportive care

The study, led by Hiroto Ishiki of the Department of Palliative Medicine at the National Cancer Center Hospital in Tokyo and published in the journal Supportive Care in Cancer, examined a program the researchers call multimodal Japanese-style acupuncture and moxibustion, abbreviated MJAM. Unlike a single-technique acupuncture session, MJAM is a composite intervention that weaves together several distinct components: filiform needle acupuncture, in which fine needles are inserted into the skin; non-insertive needle therapy using a Teishin, a blunt instrument pressed against the skin without puncturing it; motion-style acupuncture, in which needling is combined with guided movement of the affected limb; indirect moxibustion, which applies the gentle heat of burning mugwort above the skin; hot pack application; and structured self-care instruction that patients continue at home.

The rationale for testing such a program rests on a substantial body of evidence suggesting that acupuncture can modulate chronic pain. Individual patient data meta-analyses have shown that acupuncture outperforms both sham procedures and usual care for chronic musculoskeletal pain, and systematic reviews have associated acupuncture and acupressure with improved cancer pain outcomes. Yet the picture for CIPN specifically has remained murky. Randomized trials of acupuncture for CIPN, including a large sham-controlled trial published in JAMA Network Open, have produced mixed results, and international guidelines from ASCO and ESMO currently offer few validated options for treating established CIPN, with duloxetine being one of the only pharmacological approaches supported by randomized evidence.

To explore whether the Japanese multimodal approach might help, the researchers conducted a single-center, single-arm study at the National Cancer Center Hospital. They enrolled women who had completed curative treatment for stage I to III breast cancer at least three months earlier and who were experiencing moderate to severe taxane-related CIPN pain, defined as a score of 4 or greater on item 5 of the Brief Pain Inventory, a validated instrument that asks patients to rate their average pain on a scale from 0 to 10. Between October 2022 and April 2024, 30 women with a median age of 58.0 years joined the study. On average, these patients were not fresh out of chemotherapy: the median time since completing treatment was 2.47 years, meaning their neuropathy had become a chronic, entrenched problem rather than a transient side effect.

Each participant received 12 weekly sessions of the standardized MJAM program, delivered over roughly three months. The researchers then tracked outcomes through week 16, four weeks after the final session, to see whether any benefit would persist beyond the treatment period itself. The primary endpoint was the change in the Brief Pain Inventory item 5 score, the patient’s rating of average pain, from baseline to week 16. At the start of the study, the mean baseline score was 5.3, with a standard deviation of 1.7, indicating that most participants were living with pain that was more than moderate on a daily basis.

The results showed a clear and statistically significant decline in pain over the course of the program. At week 4, after roughly a month of sessions, the mean change from baseline was only −0.1 points, a difference that could easily have arisen by chance, with a 95 percent confidence interval ranging from −0.6 to 0.3 and a p-value of 0.56. But by week 8, the mean reduction had grown to −0.7 points, a change that reached statistical significance. By week 12, the mean reduction was −1.1 points, and at the primary endpoint of week 16 it stood at −1.2 points, with a 90 percent confidence interval of −1.7 to −0.8 and a p-value below 0.0001. Notably, the benefit continued to accrue after the final session, suggesting that the effects of the program did not evaporate the moment treatment stopped.

The magnitude of the improvement matters as much as its statistical significance. In chronic pain research, the consensus recommendations from the IMMPACT initiative suggest that a reduction of roughly one point on a 0-to-10 pain scale can be clinically meaningful, and a drop of about 1.2 points on the Brief Pain Inventory average pain item approaches the thresholds often considered clinically important. For patients whose pain had persisted for more than two years after chemotherapy, a sustained reduction of this size, achieved without adding any new medication, represents a meaningful shift in daily comfort, even if it does not amount to a cure.

Safety and feasibility were equally central to the study’s conclusions. Twenty-eight of the 30 participants, or 93.3 percent, completed all 12 sessions, an adherence rate that speaks to the tolerability of the program and the practicality of weekly visits. Adverse events were uncommon and uniformly mild: nine participants, or 30.0 percent, experienced grade 1 events, the lowest severity category, with no serious harms reported. For a population of cancer survivors who are often wary of adding further interventions to their care, this safety profile is an important part of the story.

The researchers are careful to frame these findings as preliminary rather than definitive. Because the study was single-arm, with no control group, there is no way to rule out explanations such as the natural course of the condition, regression to the mean, or a strong placebo response, all of which are particularly relevant in pain research, where patient expectations can powerfully shape reported outcomes. The relatively small sample of 30 women and the single-center design further limit how far the results can be generalized. What the study does establish is that MJAM is safe, feasible, and associated with a reduction in pain severe enough to justify the confirmatory randomized clinical trial that the authors say is warranted.

Even so, the trial occupies an important position in a growing research landscape. Electroacupuncture trials for taxane-induced neuropathy are underway, pragmatic trials of acupuncture added to standard care have shown signals of benefit, and dose-response meta-analyses are beginning to explore how the timing and frequency of acupuncture sessions influence outcomes in CIPN. Integrative oncology guidelines from the Society for Integrative Oncology and ASCO already encourage the consideration of acupuncture for pain management in cancer care. If a rigorous randomized trial confirms what this exploratory study suggests, a centuries-old Japanese practice, refined with modern standardization and delivered alongside self-care education, could become a genuine option for the many breast cancer survivors whose nerve pain has, until now, had nowhere to go.

Subject of Research: Multimodal Japanese-style acupuncture and moxibustion as a treatment for taxane-related chemotherapy-induced peripheral neuropathy in breast cancer survivors

Article Title: Multimodal Japanese-style acupuncture and moxibustion for taxane-related chemotherapy-induced peripheral neuropathy in breast cancer survivors

Article References: Ishiki, H., Satomi, E., Matsuoka, H., Arakawa, S., Kawasaki, N., Horiguchi, Y., Takahashi, A., Takagi, T., Kobayashi, S., Oyamada, S., Ariyoshi, K., Kihara, K., Suto, A., Murata, T., & Takayama, S. (2026). Multimodal Japanese-style acupuncture and moxibustion for taxane-related chemotherapy-induced peripheral neuropathy in breast cancer survivors. Supportive Care in Cancer, 34(10), Article 997. https://doi.org/10.1007/s00520-026-11237-1

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11237-1

Keywords: chemotherapy-induced peripheral neuropathy, breast cancer, acupuncture, moxibustion, taxanes, pain management, survivorship, integrative oncology, clinical trial, non-pharmacological therapy, Brief Pain Inventory, Japan

The research, led by Sophie Tribolet and Vincent Rigo of the neonatology division at University Hospital of Liège, together with a large team of collaborators across the country, drew on data from the SUPREMEneo prospective cohort. In June 2024, the investigators captured every laryngoscopy performed in all 19 neonatal intensive care units in Belgium, making it an exhaustive national snapshot rather than a sample from a handful of willing centers. The analysis focused on 142 laryngoscopies: 91 were performed to intubate newborns for mechanical ventilation, and 51 were performed to administer surfactant through a less invasive technique known as LISA, or less invasive surfactant administration, which has become the preferred approach for many preterm infants with respiratory distress syndrome. Fourteen of the intubations occurred in immediate life-threatening situations, where speed understandably takes precedence over comfort.

The headline numbers are sobering. Premedication was given before 56 of 77 non-emergency intubations, a rate of 73 percent, and before 35 of 51 LISA procedures, a rate of 69 percent. In other words, roughly three in ten elective, non-urgent laryngoscopies were carried out on unsedated newborns. The study also identified exactly where and when the practice falters. Premedication was significantly less likely when intubation was urgent, defined as needing to happen within ten minutes, and when the procedure took place in the delivery room rather than in the neonatal unit. For LISA procedures, no such delivery room penalty appeared, suggesting that the gap is not simply about location but about the perceived urgency and logistics surrounding intubation specifically.

Who performs the procedure also matters, in ways that differ between the two types of laryngoscopy. For LISA, premedication rates varied according to the operator’s professional status and their previous laryngoscopy experience, with statistical significance at p equal to 0.04 and 0.05 respectively. For intubation, the rates differed according to whether the operator had previously performed a successful laryngoscopy, at p equal to 0.01, but not according to operator status. These patterns hint at a cultural and educational dimension: clinicians who are more experienced, or more confident, may be more comfortable taking the extra minutes needed to sedate a baby, while those under pressure or in training may default to proceeding without drugs.

The pharmacology itself revealed remarkable heterogeneity. There was no single standard regimen across the country. The most commonly used drug was propofol, a short-acting anesthetic agent that provides rapid sedation but requires careful monitoring of blood pressure and breathing. Atropine, a drug given to protect against the slowing of heart rate that laryngoscopy can provoke, was administered before 37 of 128 non-life-threatening procedures, or 29 percent. Interestingly, atropine was given far more frequently in combination with fentanyl, an opioid, with or without a muscle relaxant, than alongside propofol, a difference that was highly statistically significant. This split reflects two competing philosophies of neonatal premedication: one favoring anesthetic agents with predictable short duration, the other favoring analgesia-based combinations with cardiovascular protection.

Perhaps the most actionable finding concerned protocols. Units that had a specific written premedication protocol behaved very differently from those without one. In units without protocols, 70 percent of non-emergency intubations and a staggering 90 percent of LISA procedures went ahead without premedication. In units with protocols, those figures fell to 24 percent and 53 percent respectively, differences that were statistically significant. The message is blunt: simply having a protocol, even before considering what it says, dramatically changes behavior. Standardization appears to convert premedication from an individual judgment call, vulnerable to habit and time pressure, into a default practice that clinicians must actively decide to bypass.

The researchers also asked clinicians why they skipped premedication, and the answers paint a nuanced picture. In 24 percent of unsedated laryngoscopies, the stated reason was the perception that the infant was comfortable or did not need it, a judgment that the authors implicitly challenge given the well-documented physiological stress response to laryngoscopy. Lack of venous access accounted for 19 percent of cases, a genuine practical obstacle in tiny premature infants whose veins are difficult to cannulate, though it raises questions about whether alternative routes or timing of line placement could help. Unit protocol was cited in 16 percent of cases, implying that some existing protocols may themselves be inadequate or permissive of omission, and personal habits accounted for 11 percent, an admission that routine rather than reasoning drives some decisions.

The context for these findings is a decade-long international debate. The American Academy of Pediatrics and the Canadian Paediatric Society both recommend premedication before elective neonatal intubation, and the French Neonatology Society has issued similar guidance. Yet audits in multiple countries have repeatedly shown that adherence lags far behind the recommendations. Part of the hesitation stems from legitimate clinical concerns: premedication drugs can cause hypotension, prolong the procedure if the baby becomes too sedated, and in the case of muscle relaxants, leave the infant apneic and dependent on the operator’s skill to secure the airway quickly. In units where operators have variable experience, these risks can feel more immediate than the longer-term harms of pain. The Belgian data showing that operator experience correlates with premedication rates suggests these concerns are being weighed differently by different hands at the bedside.

The stakes extend beyond the moment of discomfort. Repeated painful procedures in the neonatal period have been associated in longitudinal research with altered pain processing, differences in brain development, and poorer neurodevelopmental outcomes, although the evidence base for the benefits of any specific premedication regimen remains incomplete, which is itself part of why practice varies so widely. LISA, which avoids intubation and mechanical ventilation in many preterm infants, was developed partly to reduce procedural burden, but it still requires the same laryngoscopy to visualize the glottis and pass a thin catheter, so the pain problem does not disappear with the gentler technique. The Belgian study’s finding that 90 percent of LISA procedures in protocol-less units were done without premedication indicates that the shift toward less invasive surfactant delivery has not automatically carried analgesia with it.

The authors conclude that substantial inter-center variability persists, and that the development and implementation of premedication protocols may improve compliance and ultimately enhance the quality and safety of laryngoscopies in newborns. Because the study captured every NICU in a single country over a defined month, it offers an unusually complete picture of the gap between guideline and bedside, and its protocol findings provide a concrete lever for change: units seeking to improve need not wait for new drugs or new evidence, but can start by writing down, agreeing on, and enforcing a standard approach. For the smallest patients, who cannot advocate for themselves and whose pain is easy to underestimate, that administrative act may be one of the simplest available protections.

Subject of Research: Premedication practices before neonatal laryngoscopy in neonatal intensive care units

Article Title: Premedication practices prior to neonatal laryngoscopy: a nationwide observational study in Belgian NICUs

Article References: Tribolet, S., Legros, L., Laval, N., Derriks, F., Naessens, P., Debuf, M.-J., Van Poucke, J., Godart, V., Guevorkian, D., Schögler, A., Perceval, C., Ceulemans, L., Reibel, R., Plaskie, K., Debeer, A., Hocq, C., Rohaert, C., Avino, D., De Buyst, J., … Tauzin, M. (2026). Premedication practices prior to neonatal laryngoscopy: a nationwide observational study in Belgian NICUs. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07813-3

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07813-3

Keywords: neonatology, laryngoscopy, premedication, intubation, LISA, surfactant, NICU, propofol, pain management, preterm infants, clinical protocols, Belgium

That patient, anonymized as “Michelle” in a new perspective article published in the Journal of General Internal Medicine, became a test case for a bold institutional experiment. A team led by hospitalist physicians at the University of California, San Francisco, launched a program embedding a community health worker, a trained health professional drawn from the community she serves, directly into the medicine wards. The worker, anonymized as “Alicia,” was a Black community health worker with experience in health care navigation, hired specifically to help Black patients navigate their hospitalizations, self-advocate, and communicate with clinicians. Over a single year, from November 2022 to October 2023, she supported 162 Black patients on the medicine wards, with the goal of improving patient experience, communication, and quality of care.

The rationale for the program rests on a substantial body of evidence documenting how anti-Black racism operates at both interpersonal and structural levels within US health care. Interpersonal racism, discriminatory interactions between individuals based on race-related assumptions, damages trust and impedes communication. Studies have shown that physicians engage in less patient-centered communication and display more negative affect with Black patients than with others. Two particularly well-documented manifestations involve pain: false beliefs that Black patients have higher pain tolerance and are more likely to be opioid-seeking. The consequences are measurable. Black patients are less likely to receive primary care pain screenings or opioid analgesics in emergency departments, even when presenting with the same conditions as non-Black patients. They are also less likely to receive physical therapy or surgery for pain management.

Structural racism extends far beyond individual encounters. Black people in the United States are systematically disadvantaged by inequities in health care, housing, education, and the criminal justice system, rooted in historic injustices that persist today. Even Black patients with high socioeconomic status and education face persistent barriers to care and health disparities. These structural forces produce earlier multimorbidity and mortality and a greater chronic disease burden. The authors note that Michelle’s difficulty refilling her pain medications reflects wider trends: Black patients on opioid analgesics are more likely to face restricted early refills, urine testing requirements, and lowered dosages, despite pain medication misuse being least common among Black patients.

These structural harms produce predictable downstream effects on trust and communication. Patients who have previously experienced racism in health care settings remain on higher alert for future racist encounters and may reasonably ascribe new challenges to racism regardless of their immediate cause. Michelle’s history of mistreatment, including wrongful diagnoses and an overdose from overprescribed medication, led her to view health care institutions as untrustworthy, which in turn complicated every interaction with her care team. The authors argue that while clinician compassion matters, the positive intentions of individuals are insufficient to overcome structural injustices. Institutions need interventions that operate at the level of the system itself.

For Michelle, the Health Advocate’s role was concrete and practical. Alicia attended care team meetings, listened, took notes, asked questions, and added context about Michelle’s preferences and goals. She validated Michelle’s frustrations, helped synthesize complex medical information, and brainstormed questions to ask physicians. She also helped manage expectations, reminding Michelle that surgery might not be possible and counseling her to stay focused on her core goals of increased mobility and pain control. Crucially, Alicia met with Michelle’s physicians separately, helping them understand Michelle’s perspective and relaying her concern about being perceived as non-compliant if she declined a proposed analgesic regimen she feared she could not refill. Michelle found the support so valuable that she requested no physician speak to her without Alicia present.

The program’s design drew on established models of cultural mediation and community-based advocacy, which have succeeded in reducing barriers to quality care for minoritized ethnic populations. Physician leadership recruited a Community Advisory Board of Black community members with patient or caregiving experience, which met monthly with Alicia and program leadership to advise on patient needs. The program used a patient-centered, participatory approach in which community members were active collaborators co-creating goals and outcomes, and early cases were discussed with leadership through a preceptorship model. Demand quickly exceeded capacity: patients expressed widespread appreciation, readmitted patients sought Alicia out immediately, and clinicians requested her support for additional patients, forcing her to prioritize the most urgent cases.

The evidence base for community health workers more broadly is encouraging. Because they share identities with the populations they serve, they are uniquely positioned to advocate for patients historically marginalized in health care. Randomized trials have shown that community health worker support improves patient-reported quality of care, satisfaction, and mental health, while benefiting health systems through reduced hospitalizations and shorter lengths of stay. By increasing trust, strengthening communication, promoting care access, and improving outcomes, the authors argue, these workers can address the downstream effects of structural racism that no individual clinician can dismantle alone.

Yet the program’s challenges were as instructive as its successes. There were no clear guidelines for integrating the role into the hospital, and although the Centers for Medicare and Medicaid Services and California’s CalAIM initiative have since published guidance, discrepancies remain and uncertainty persists about how best to incorporate community health workers. The team faced coordination difficulties with care teams, concerns that the role was redundant, and the absence of a clear department to house it. Sustainable financing proved equally difficult: a year-long internal grant protected faculty time and the health system funded the salary, but securing longer-term support was hard, even though the services were billable under Medicare, Medi-Cal, and commercial insurance.

The deepest challenges reflect the complexity of racism itself. The authors observed that attempts to minimize structural racism can inadvertently worsen interpersonal racism, for example if clinicians wrongly infer that community health workers are needed because Black patients are difficult to communicate with, or redirect racist comments toward the workers themselves. Community health workers, who share marginalized identities with their patients, are vulnerable to the same harms, along with moral distress and burnout. The team protected Alicia by rapidly involving leadership in difficult cases and escalating as needed, and they recommend hiring cohorts of workers within their own departments to build peer support, alongside clinician education and anti-racism training. They also flag a final concern: patients could become dependent on workers to speak for them, which the program countered by focusing on self-efficacy and empowering patients to advocate for themselves. If fully embraced and supported, the authors conclude, community health workers can help health systems deliver high-quality, anti-racist care to patients like Michelle, who have for too long been harmed by the very institutions meant to heal them.

Subject of Research: Community health worker integration to address structural racism and care inequities among hospitalized Black patients

Article Title: The Promise of Community Health Workers for Addressing Structural Drivers of Inequities Among Hospitalized Patients

Article References: Axelrod, J. K., Weiss Goitiandia, S., Brooks-Smith-Lowe, S., Sankaran, S., Shahram, Y., Oreper, S., Arrington, R., Burt, H., Garrison, X., Jr., Jones-Taplin, J., Loggins-Miller, I., John, M., & Dzeng, E. (2026). The Promise of Community Health Workers for Addressing Structural Drivers of Inequities Among Hospitalized Patients. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10872-y

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10872-y

Keywords: community health workers, structural racism, health disparities, hospital medicine, patient advocacy, health communication, pain management, health equity, patient trust, hospitalization, anti-racism, health care financing

The physiological backdrop to the study is well established. Dysmenorrhea, the medical term for painful menstrual cramps, arises when excessive production of prostaglandins during menstruation triggers intensified contractions of the myometrium, the muscular wall of the uterus, along with vasoconstriction and heightened sensitivity of local nerves. The result is a cramping pain in the lower abdomen that is frequently accompanied by headache, nausea, vomiting, diarrhea, bloating, backache, and leg pain. Clinicians distinguish primary dysmenorrhea, which occurs in the absence of any underlying pelvic pathology, from secondary dysmenorrhea, which is linked to conditions such as endometriosis, ovarian cysts, pelvic inflammatory disease, and uterine fibroids. Globally, estimates suggest that between 50 and 90 percent of adolescent girls experience dysmenorrhea, with 10 to 25 percent enduring pain severe enough to substantially diminish their quality of life.

The Kumasi survey placed itself within that global picture while sharpening the focus on a setting where menstrual health support is often scarce. Using Cochran’s formula for prevalence studies and adjusting for an anticipated 10 percent non-response rate, the team calculated a target sample of 431 participants. Schools were selected purposively to represent different educational levels and geographic contexts, and students were then drawn through proportional allocation and simple random sampling from class registers, with random numbers generated in SPSS. Data were collected with a structured, interviewer-administered questionnaire that had been pilot tested among 30 adolescents, translated into Twi using a forward and back-translation process, and shown to have acceptable internal consistency with a Cronbach’s alpha of 0.73. Ethical clearance came from the Committee on Human Research, Publications and Ethics at KNUST, and written informed consent or assent was obtained from all participants and their guardians.

The headline numbers are sobering. The mean age at menarche among respondents was 12.3 years, and 68.9 percent reported experiencing menstrual pain, most frequently rating its intensity between 5 and 7 on a 10-point numeric pain rating scale. Fatigue was the most common accompanying symptom, reported by 46.2 percent of respondents, followed by lower back pain at 34.8 percent and headache at 33.2 percent. Most girls reported pain lasting one to two days, though nearly one in ten endured it for more than four days. Perhaps most consequentially for their futures, 33.6 percent of participants said they had missed school because of menstrual pain, most commonly for a single day within the preceding six months. In a region where menstrual pain is already associated with absenteeism rates of 20 to 30 percent among youth, the finding underscores how period pain quietly compounds existing educational disparities.

Against that burden, the uptake of non-pharmacological interventions was strikingly low. Only 33.9 percent of respondents reported using any drug-free method to manage their pain. Among those who did, sleep and relaxation led the list at 25.3 percent, followed by dietary changes at 13.1 percent, exercise at 12.8 percent, and herbal remedies at 8.1 percent. Heat therapy, one of the most widely validated and inexpensive self-care measures internationally, was used by a mere 2.7 percent of respondents, and massage by just 1 percent. The authors note that this pattern contrasts sharply with evidence from other Ghanaian and international contexts: students in Ghana’s Western Region have reported far greater reliance on relaxation and hot water therapy, nursing trainees in Northern Ghana predominantly use sleep and heat application, and Brazilian women report high use of heat therapy and massage. The near-absence of heat therapy in Kumasi points to gaps in both awareness and access rather than any inherent unsuitability of the technique.

Why, then, do so many girls forgo these options? The study catalogued a cluster of interlocking barriers. The most frequently cited was a preference for quick relief through medication, reported by 40.4 percent of respondents, followed closely by time constraints at 40.1 percent, limited access to resources at 39.9 percent, and fear that non-drug methods would be ineffective, also at 39.9 percent. Lack of knowledge was cited by 38.7 percent, and cultural or religious beliefs by 36.7 percent. These obstacles do not operate in isolation. Previous qualitative work in Moshi, Tanzania, documented how cultural taboos and insufficient funds left adolescent girls unable to embrace non-drug treatments, while Ghanaian stakeholder research has highlighted the financial burden of menstrual supplies and the perception of menstruation as a private or even dirty matter that discourages open discussion. In such an environment, girls often normalize their pain or fall back on inconsistent remedies rather than adopting recommended strategies.

The pathways of information reveal a further structural weakness. Family, cited by 14.2 percent of respondents, and peers, cited by 13.9 percent, were the most common sources of menstrual health information, with healthcare providers, school programs, and social media each mentioned by roughly 12 to 14 percent. Formal guidance was rare, and a notable share of girls reported coping with their pain entirely alone, a pattern the authors link to stigma and unsupportive environments. Comparable findings among Irish students describe social stigma compelling young women to bear pain in silence, suggesting that the isolation of menstruating adolescents is not confined to any one country. Yet the appetite for change is unmistakable: while 38.7 percent of respondents wanted counselling from a healthcare provider, 79.8 percent expressed interest in attending workshops or seminars on menstrual health, and roughly half of the sample identified menstrual health education, affordable medication, counselling, and non-pharmacological resources as priority needs.

On the statistical front, the study’s search for predictors came back largely empty, and that null result is itself informative. No sociodemographic variable, including study site, educational level, age, religion, family financial status, parental education, age at menarche, or menstrual cycle regularity, was significantly associated with either the presence of dysmenorrhea or the use of non-pharmacological methods. In univariate logistic regression, middle-income status showed a nominally significant association with dysmenorrhea, with a crude odds ratio of 1.70, but this attenuated to non-significance after adjustment. A Spearman’s rank-order correlation found no relationship between menstrual cycle length and pain intensity, with a coefficient of just minus 0.019 and a p-value of 0.751. The practical implication is that menstrual pain in this population is essentially universal in its reach, cutting across income, geography, and family background, which means interventions cannot be narrowly targeted but must be systemic.

The authors are candid about the limitations of their design. The cross-sectional approach captures only a snapshot and cannot establish causation, self-reported data carry the risk of recall and social desirability bias, and the school-based setting without clinical evaluation meant the team could not definitively distinguish primary from secondary dysmenorrhea, leading them to frame their outcome as self-reported menstrual pain consistent with dysmenorrhea. Findings among students may also not generalize to out-of-school adolescents. Nevertheless, the large sample, the combination of proportional and random sampling, the pilot-tested instrument, and the inclusion of both junior and senior high students across rural and urban settings lend the results considerable weight in an under-researched field.

The recommendations that flow from the study are concrete and, notably, inexpensive. The authors call for in-service training so that practicing nurses and midwives can guide adolescents in both the safe use of over-the-counter analgesics and drug-free options such as heat therapy, relaxation techniques, and lifestyle modification. They urge that school health clinics be stocked with heat packs, sanitary products, and informational leaflets, and that menstrual health education be fully integrated into high school curricula through interactive sessions that address the biology of menstruation, self-care practices, and the misconceptions and taboos that currently suppress open dialogue. They further propose collaboration between Ghana’s Ministries of Health and Education, local authorities, and non-governmental organizations to subsidize menstrual products and heat therapy devices, alongside policies mandating teacher and counsellor training and school-based accommodations. With nearly four in five girls saying they would attend a workshop if one were offered, the demand is already there. What remains is for schools, health systems, and families to meet it, turning a silent monthly burden into a manageable, openly discussed part of adolescent health.

Subject of Research: Non-pharmacological management of dysmenorrhea among female high school adolescents in Ghana

Article Title: Patterns and determinants of non pharmacologic management of dysmenorrhea among female adolescents in high schools in a developing country

Article References: Owusu, L. B., Issifu, J. S., Zakaria, A.-F. S., Eshun, S. A., Cobbina, S., Asiedu, B., Peprah, P. S., Acquah, R., Adjeso, Y. N., Dwumfour, C. K., Emikpe, A. O., Poku, C. A., & Lumor, D. A. (2026). Patterns and determinants of non pharmacologic management of dysmenorrhea among female adolescents in high schools in a developing country. Discover Social Science and Health, 6(1), Article 97. https://doi.org/10.1007/s44155-026-00424-4

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00424-4

Keywords: dysmenorrhea, menstrual pain, adolescent health, Ghana, non-pharmacological interventions, school absenteeism, menstrual health education, pain management, cross-sectional study, cultural stigma, heat therapy, public health

The research, published as an open-access article in BMC Complementary Medicine and Therapies, was conducted by a team of Korean medicine researchers led by Ji-eun Yu of Pusan National University and Yohan Choi, Hanbit Jin, Eunji Ahn and corresponding author Dongsu Kim of Dongshin University. Rather than running a clinical trial, the investigators turned to one of the most powerful tools available in Korean health research: the National Health Insurance Service National Sample Cohort, a large, de-identified database drawn from the claims records of the country’s single-payer health system. Because virtually every medical encounter in South Korea generates an insurance claim, this cohort allows researchers to track diagnoses, prescriptions and healthcare visits across millions of citizens with a completeness that few other data sources can match.

The study design was a retrospective cohort analysis. The researchers identified patients diagnosed with gastric cancer and assigned each person an index date anchored to that diagnosis. They then looked backward one year to characterize each patient’s baseline healthcare utilization, including total outpatient visits, and forward one year to measure outcomes. Patients were classified as Korean medicine users if they received outpatient Korean medicine services during the defined exposure window; everyone else was treated as a non-user. This distinction matters because Korean medicine in South Korea is not a fringe practice. It encompasses herbal medicine prescriptions, acupuncture, moxibustion and other therapies delivered by licensed practitioners in dedicated clinics, and it occupies a formal, regulated place in the national health system.

The outcomes the team examined came in two distinct forms, and that distinction turned out to be the intellectual heart of the paper. The first outcome was binary: whether a patient used any analgesics, or any opioids, at all during the follow-up year, recorded simply as yes or no. The second outcome was a count: the number of analgesic prescriptions and the number of opioid prescriptions each patient received over the same period. Separating these two measures allowed the researchers to ask two different questions. Does Korean medicine change whether a cancer patient ends up on pain medication? And does it change how much pain medication that patient receives?

To answer those questions credibly, the investigators had to confront a stubborn methodological problem that plagues nearly all observational research on complementary therapies: confounding by indication and by healthcare behavior. Patients who seek out Korean medicine are, almost by definition, different from those who do not. They tend to be heavier users of healthcare in general, they may have different symptom profiles, and they may hold different attitudes toward medication. If those differences are not accounted for, any apparent association between Korean medicine and painkiller use could simply reflect the underlying characteristics of the patients rather than any effect of the treatment itself.

The team addressed this with multivariable regression analyses that adjusted for a broad set of demographic and clinical characteristics, including measures of healthcare utilization in the year before the index date. They went further, running sensitivity analyses with stricter definitions of what counted as Korean medicine use, to test whether the results depended on how liberally the exposure was defined. They also performed stratified analyses, dividing the cohort into quartiles of total outpatient visits during the exposure window and re-examining the association within each stratum. Supplementary tables in the published article document the ATC codes used to define analgesics and opioids, the distribution of annual prescription counts, and the model-based predicted outcomes for each group, giving readers an unusually transparent view of the analytical machinery behind the headline findings.

What emerged was a nuanced and, in some ways, counterintuitive result. Korean medicine use was not significantly associated with the likelihood that a gastric cancer patient would use analgesics or opioids at all during follow-up. In other words, patients who used Korean medicine were not meaningfully more or less likely than non-users to end up taking pain medication in the first place. But when the researchers turned to the intensity of medication use, a different picture appeared. In the adjusted analyses, Korean medicine use was associated with significantly lower prescription counts for both analgesics and opioids. The association was with the volume of prescribing, not the presence of prescribing.

The authors interpret this pattern as suggesting that Korean medicine may play a complementary role in medication-based pain management, one that operates on the medication burden rather than on whether medication is used. For patients living with cancer, that distinction could carry real clinical weight. Long-term analgesic and opioid use is associated with a cascade of concerns, including adverse drug events, drug interactions with chemotherapy agents, constipation, sedation and the risk of dependence. If a complementary therapy were to reduce the number of prescriptions a patient needs over a year of care, even without eliminating the need for pain drugs entirely, it could meaningfully lighten that pharmacological load. The stratified analyses, which examined the association within quartiles of prior outpatient visit intensity, were designed in part to check whether this signal simply reflected differences in how often patients see doctors, and the sensitivity analyses using stricter exposure definitions tested the robustness of the classification itself.

At the same time, the researchers are careful about what their study can and cannot show. As a retrospective analysis of insurance claims, it captures associations, not causal effects. It cannot reveal whether patients used Korean medicine because their pain was already better controlled, whether herbal prescriptions or acupuncture directly modulated pain, or whether unmeasured differences between user and non-user groups still shaped the results. Claims data also record prescriptions, not necessarily consumption, and they cannot capture over-the-counter medication use. The authors explicitly call for further studies to confirm the findings and to elucidate the underlying mechanisms, a caution that is standard in this field but particularly warranted given the complexity of cancer pain and the heterogeneity of Korean medicine practice itself.

Nevertheless, the study adds a genuinely useful data point to an international conversation about integrative oncology and opioid stewardship. Conducted under the Declaration of Helsinki with approval from the Institutional Review Board of Dongshin University, and funded by the Korea Health Industry Development Institute through grants from the Ministry of Health and Welfare, it exemplifies the kind of large-scale, claims-based evidence that health systems with integrated traditional medicine can generate. For the growing number of gastric cancer patients who already use Korean medicine alongside conventional care, the findings suggest that such use is associated with a lighter prescription burden rather than a change in whether painkillers are used at all. For policymakers weighing how complementary therapies fit into cancer care pathways, the message is subtler: the value of traditional medicine in this context may lie not in replacing conventional analgesia, but in reducing how much of it patients ultimately need. Confirming that promise will require prospective studies, but this analysis provides a rigorous starting point built on national-scale data.

Subject of Research: The association between traditional Korean medicine use and analgesic and opioid utilization in gastric cancer patients

Article Title: Association between Korean medicine use and analgesic and opioid utilization among patients with gastric cancer

Article References: Yu, J.-E., Choi, Y., Jin, H., Ahn, E., & Kim, D. (2026). Association between Korean medicine use and analgesic and opioid utilization among patients with gastric cancer. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05583-0

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05583-0

Keywords: Korean medicine, gastric cancer, analgesics, opioids, pain management, complementary and alternative medicine, National Health Insurance Service, retrospective cohort study, prescription counts, integrative oncology, healthcare utilization, South Korea

The research team, led by Anh Ly, Anika Sehgal, and colleagues at the University of Calgary’s Cumming School of Medicine, set out to explore an underexamined dimension of the opioid epidemic: the perspectives of the physicians who actually prescribe opioids and care for Indigenous patients with opioid use disorder. While previous scholarship has documented risk factors for opioid-related harm among Indigenous peoples, including overprescribing, trauma rooted in ongoing colonization, systemic racism, socioeconomic disadvantage, and barriers to culturally safe health services, the role of healthcare providers and the systems they operate within has received comparatively little attention. The new study addresses that gap directly.

Methodologically, the study relied on in-person, open-ended, semi-structured interviews with a convenience sample of 13 physicians working across a striking range of practice environments: urban centers, rural communities, and on-reserve settings. This diversity matters, because the structural conditions surrounding opioid care differ dramatically depending on geography and jurisdiction. The researchers employed an inductive thematic analysis, with transcripts independently examined and coded by two research associates using an iterative coding process designed to surface overarching themes and their associated sub-themes. The study received ethics approval from the Conjoint Health Research Ethics Board at the University of Calgary, and all participants provided written informed consent before taking part.

Four predominant themes emerged from the analysis. First, physicians emphasized the fundamental importance of maintaining relationships with their patients, positioning continuity and trust as the bedrock of effective care for opioid use disorder. Second, participants called for increased attention to pain management strategies, pointing to a tension at the heart of opioid medicine: the need to treat genuine suffering while avoiding the harms of overprescribing. Third, the physicians described the considerable challenges and goals inherent in a de-prescribing approach, the deliberate, careful process of tapering patients off opioids when clinically appropriate. Fourth, and perhaps most sobering, they described the structural and social contexts that shape care for opioid use disorder, from colonial legacies to poverty and systemic inequity.

That fourth theme carries the study’s most consequential implications. Participants explicitly highlighted the influence of colonization, intergenerational trauma, poverty, and systemic inequities on patient outcomes. Yet they also candidly expressed the difficulty of addressing these forces within the confines of a standard clinical encounter. A physician may recognize that a patient’s opioid use is entangled with housing instability, food insecurity, or the accumulated weight of historical and ongoing discrimination, but the fifteen-minute appointment slot offers few tools to respond. The study captures this dissonance between awareness and action, showing that physicians are not blind to structural determinants of health; they are often simply unequipped to act on them.

The interviews also revealed substantial variation in physicians’ experience, knowledge, and comfort when working with Indigenous patients. This inconsistency is significant because it means the quality of care a patient receives may depend heavily on which physician they happen to see. Some providers bring deep cultural understanding and trauma-informed practice; others lack training in the history and ongoing realities that shape Indigenous patients’ interactions with the healthcare system. The participants themselves pointed to this unevenness as a problem, and several offered suggestions for improving medical education curricula, arguing that better preparation during training could reduce the variability that patients currently experience.

Practical constraints compounded these knowledge gaps. Physicians described being squeezed by clinical schedules that left too little time for the complex, trust-dependent work that opioid use disorder care demands. Resource availability varied widely across settings, and access to services, particularly in rural and on-reserve communities, was frequently limited. A physician who wants to connect a patient with culturally safe addiction treatment, mental health support, or social services may find that those services simply do not exist nearby, or that waitlists stretch for months. In such circumstances, the prescription becomes the path of least resistance, not because clinicians are careless, but because the system offers few alternatives.

The de-prescribing theme deserves particular attention. Reducing or discontinuing opioids in patients who have been on them long-term is clinically delicate work, requiring careful tapering schedules, monitoring for withdrawal and relapse, and robust alternative pain management options. The physicians in this study described de-prescribing as a goal, but one fraught with obstacles: patients with untreated chronic pain, limited access to multidisciplinary pain services, and the risk that abrupt changes could push patients toward illicit and far more dangerous drug supplies. In the context of a toxicity crisis driven increasingly by fentanyl-contaminated street drugs, poorly managed de-prescribing can be as dangerous as overprescribing, a nuance the study’s participants clearly understood.

Taken together, the findings point toward what the authors describe as the necessity for fundamental changes in how care for Indigenous peoples with opioid use disorder is conceptualized and delivered. Physicians, the study concludes, function within a disjointed system influenced by persistent colonial dynamics, unequal resources, and inconsistent training. Progress, the researchers argue, will depend on approaches that engage patients’ social realities, strengthen clinical relationships, and confront the structural factors that shape health outcomes. In other words, the prescription problem is not merely a prescribing problem; it is a systems problem, and it demands systems-level solutions.

The study arrives at a moment when Canada, like the United States, is grappling with the devastating legacy of both aggressive opioid marketing in the 1990s and the subsequent tightening of prescribing that pushed many patients toward illicit drugs. For Indigenous communities, these national dynamics intersect with a distinct history: residential schools, the Sixties Scoop, jurisdictional ambiguities in health service delivery, and ongoing racism within healthcare institutions, all documented contributors to health inequity. What this new research adds is the physician’s-eye view of that intersection, showing that even providers who recognize these forces feel constrained by the structures around them. The message for policymakers is clear: supporting Indigenous patients with opioid use disorder means investing in culturally safe services, reforming medical education, giving clinicians the time and resources to build real relationships, and dismantling the structural inequities that no individual prescription can fix.

Subject of Research: Physicians' perspectives on opioid prescribing and structural factors shaping opioid use disorder care for Indigenous patients in Canada

Article Title: What’s behind the pain? Exploring physicians’ views on prescribing practices and structural factors that contribute to opioid use among Indigenous patients

Article References: Ly, A., McInnes, A., Annan, J., Crowshoe, L. L., Henderson, R., & Sehgal, A. (2026). What’s behind the pain? Exploring physicians’ views on prescribing practices and structural factors that contribute to opioid use among Indigenous patients. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15610-y

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15610-y

Keywords: Indigenous health, opioid use disorder, opioid prescribing, physicians, health inequities, pain management, de-prescribing, colonization, intergenerational trauma, qualitative research, primary care, Canada

The trial, led by Chunmei Zhao and Fang Luo of Beijing Tiantan Hospital at Capital Medical University, together with colleagues at multiple centers in China and Nepal, enrolled 80 patients whose episodic cluster headache had resisted oral medications. To be eligible, participants had to present to a pain clinic within five days of the onset of a new cluster period, a narrow window that allowed the researchers to capture the natural arc of an episode from its earliest days. Patients were randomly assigned in equal numbers to one of two procedures targeting the sphenopalatine ganglion: pulsed radiofrequency treatment or a conventional nerve block. Everyone in both groups then took oral verapamil at a dose of 360 milligrams per day, the standard preventive drug for cluster headache, ensuring that the comparison isolated the effect of the procedure itself.

The sphenopalatine ganglion, also called the pterygopalatine ganglion, has long fascinated headache specialists because it acts as a major relay station for the facial pain pathways and parasympathetic autonomic signals that surge during cluster attacks. Attacks of cluster headache involve intense pain around one eye or temple, typically accompanied by tearing, nasal congestion, eyelid drooping, and restlessness, all hallmarks of trigeminal-autonomic activation in which the sphenopalatine ganglion plays a central role. Blocking this ganglion with local anesthetics has been a recognized short-term rescue strategy for years, but the effects of a nerve block fade within days. Pulsed radiofrequency, by contrast, applies brief bursts of an alternating electrical field to the ganglion through a needle electrode, generating controlled thermal and electromagnetic effects that are thought to modulate pain signaling without destroying nerve tissue, potentially offering relief that lasts for months.

The technical execution of the procedure demands precision. Under imaging guidance, clinicians advance a specialized electrode through the face to reach the pterygopalatine fossa, the small anatomical pocket where the ganglion sits, and confirm correct placement before delivering the pulsed radiofrequency cycles. In this trial the technique was performed as an add-on to verapamil rather than a replacement for it, reflecting the reality that most patients with cluster headache need layered treatment. The researchers registered the study prospectively on ClinicalTrials.gov as NCT03567590, obtained ethics approval from the Institutional Review Board of Beijing Tiantan Hospital, and followed Consolidated Standards of Reporting Trials guidelines, with a blinded-endpoint design and a Data and Safety Monitoring Board overseeing the study, features that strengthen confidence in the findings.

The primary endpoint was the duration of the cluster period, and the difference between the groups was dramatic. Patients treated with pulsed radiofrequency had a median cluster-period duration of 15.0 days, with an interquartile range of 6.2 to 30.0 days, while those treated with nerve block had a median duration of 61.0 days, with an interquartile range of 17.0 to 90.0 days. The median difference between groups was minus 34.0 days, with a 95 percent confidence interval of minus 56.0 to minus 17.0 days and a P value below 0.001, a result that is both statistically robust and clinically profound. In practical terms, patients who received the pulsed radiofrequency treatment were spared roughly an additional month of recurrent attacks compared with those receiving the standard block.

Secondary endpoints told a consistent story across nearly every measure of attack burden. Pain intensity during attacks, scored on the numerical rating scale, was significantly lower in the pulsed radiofrequency group at day 3, week 1, week 2, and month 1, with median between-group differences of minus 1.0, minus 2.0, minus 3.0, and minus 4.0 points respectively, the last representing a large shift on a scale where every point matters to a patient in agony. Attack frequency and attack duration were also significantly reduced in the pulsed radiofrequency group at week 1, week 2, month 1, and month 3, and patients used less rizatriptan, a fast-acting triptan medication taken to abort individual attacks, over the same follow-up points. By month 6 and year 1 the between-group differences on these secondary measures were no longer statistically significant, which is consistent with the episodic nature of the disease, since many patients in both groups had exited their cluster periods by then.

Safety is always a central question when a procedure involves threading an electrode near critical structures at the skull base, and the trial reported few adverse effects with pulsed radiofrequency treatment. The authors concluded that in patients with episodic cluster headache resistant to oral medications, sphenopalatine ganglion pulsed radiofrequency combined with verapamil provided greater pain relief than sphenopalatine ganglion nerve block combined with verapamil, with few adverse effects. The study was supported by the National Key Research and Development Program of China and by Capital’s Funds for Health Improvement and Research, among other funders, which had no role in the design, analysis, or decision to publish. The authors declared no competing interests, and all participants provided written informed consent before enrollment.

The implications reach beyond the immediate result. Cluster headache affects roughly one in a thousand people, and while abortive options such as subcutaneous sumatriptan, high-flow oxygen, and newer CGRP-targeting therapies exist, preventive options remain limited and verapamil, the mainstay, requires slow titration and cardiac monitoring. For patients in the midst of a cluster period, every day of shortened episode duration translates into dozens of avoided attacks, restored sleep, and reduced reliance on acute medications. If pulsed radiofrequency of the sphenopalatine ganglion can reliably compress a cluster period from two months to two weeks, it could reshape the treatment algorithm for medication-refractory episodic disease, positioning a one-time procedural intervention alongside pharmacology rather than as a last resort.

Important caveats temper the enthusiasm. The trial focused specifically on episodic cluster headache, the form in which attacks occur in bounded bouts separated by remission periods, and its results cannot be assumed to extend to chronic cluster headache, in which attacks persist for a year or more without relief. The comparison arm was an active control, a nerve block rather than a sham procedure, which is methodologically respectable but means the study cannot fully separate the specific neuromodulatory effects of pulsed radiofrequency from the general effect of any ganglion-directed intervention combined with verapamil. The sample of 80 patients, while adequate for the primary endpoint, is modest, and the open nature of the treatment delivery, with only the endpoint assessment blinded, leaves some room for expectation effects on the self-reported secondary outcomes.

Even with those limitations, the trial stands as one of the most convincing demonstrations to date that targeted neuromodulation of the sphenopalatine ganglion can alter the natural history of a cluster period rather than merely blunting individual attacks. The prospective registration, blinded endpoint assessment, multicenter recruitment, and consistent signal across primary and secondary outcomes give the finding unusual weight for a procedural pain study. For the patients who spend their cluster seasons pacing dark rooms waiting for the storm to pass, the message from this research is concrete and hopeful: a precisely delivered field of pulsed electrical energy, aimed at a ganglion the size of a grain of rice hidden behind the cheek, may cut weeks of suffering from the cruelest headache disorder medicine knows. Larger studies and replication in other populations will be needed before the procedure becomes standard practice, but the direction of the evidence now points firmly toward the sphenopalatine ganglion as the right target at the right time.

Subject of Research: Pulsed radiofrequency neuromodulation of the sphenopalatine ganglion for treating episodic cluster headache

Article Title: Efficacy and safety of sphenopalatine ganglion pulsed radiofrequency in episodic cluster headache: a randomized controlled trial

Article References: Zhao, C., Bian, J., Ren, H., Wu, D., Meng, L., Shen, Y., Wang, B., Shrestha, N., & Luo, F. (2026). Efficacy and safety of sphenopalatine ganglion pulsed radiofrequency in episodic cluster headache: a randomized controlled trial. BMC Medicine. https://doi.org/10.1186/s12916-026-05242-8

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05242-8

Keywords: cluster headache, sphenopalatine ganglion, pulsed radiofrequency, randomized controlled trial, verapamil, nerve block, neuromodulation, pain management, neurology, headache, trigeminal-autonomic, BMC Medicine

The trial enrolled 370 nulliparous individuals, meaning participants who had never carried a pregnancy to term, a group in which IUD insertion is often reported as more uncomfortable. Nulliparity is associated with a narrower cervical canal and a uterus that has not been stretched by previous pregnancy or delivery, both of which are thought to contribute to the discomfort of passing instruments through the cervix and positioning a device inside the cavity. The investigators focused specifically on placements of smaller-diameter IUDs, devices that are commonly chosen for people who have not previously given birth. By concentrating on this population, the study targeted the clinical scenario in which insertion pain is most frequently reported and in which an effective pain-management strategy would have the greatest practical impact.

The intervention itself was straightforward. Participants received an intrauterine instillation of 10 milliliters of mepivacaine at a concentration of 20 milligrams per milliliter, while the comparison group received an instillation of placebo saline in the same volume. Mepivacaine belongs to the amide family of local anesthetics, the same pharmacological class as lidocaine, and works by blocking voltage-gated sodium channels in nerve membranes. When sodium channels are prevented from opening, nociceptive neurons in the uterine wall and cervix cannot generate and propagate the action potentials that carry pain signals toward the spinal cord and brain. Instilling the anesthetic directly into the uterine cavity places the drug in immediate contact with the endometrial surface, where the mechanical stimulation of the insertion process, including tenaculum use, sounding of the cavity, and passage of the insertion tube, activates those pain-sensing fibers.

The route of administration is a key part of why the findings are notable. Existing approaches to insertion pain have included oral analgesics, nonsteroidal anti-inflammatory drugs, intracervical or paracervical nerve blocks, and topical anesthetic gels applied to the cervix, but the evidence supporting many of these measures has been mixed, and some require additional injections or trained personnel to administer. An intrauterine instillation, by contrast, involves introducing a liquid anesthetic through the cervical canal into the cavity itself, a step that can be integrated into the routine preparation for the procedure. The trial’s results indicate that this delivery method achieves sufficient mucosal exposure to blunt pain during the most uncomfortable phases of placement, without the need for injections, specialized equipment, or a change in the basic workflow of the visit.

According to the study’s summary findings, mepivacaine instillation reduced pain during IUD placement compared with placebo saline and improved tolerability of the procedure. Pain during insertion is typically assessed with validated patient-reported scales, and the improvement in tolerability suggests that the benefit extended beyond a numerical pain score to the subjective experience of the procedure as a whole. Tolerability matters clinically in ways that raw pain scores do not always capture. A patient who finds the procedure bearable is more likely to remain still and comfortable during device positioning, which can make the insertion technically easier for the clinician, and is more likely to leave the visit with a positive impression of the method. That impression can influence whether the patient continues with the IUD for its full duration of effectiveness and whether she recommends the method to others.

The public health significance of improving the insertion experience is considerable. IUDs are highly effective, with failure rates far lower than those of oral contraceptives, and they provide years of protection without requiring daily adherence. Professional guidelines in many countries recommend long-acting reversible contraception as a first-line option for a broad range of patients, including adolescents and nulliparous women. Yet surveys and clinical experience consistently show that fear of insertion pain is one of the most commonly cited reasons for hesitancy, and that anticipated pain can influence both the choice to accept an IUD and the counseling conversation that precedes it. A simple, low-risk technique that demonstrably reduces insertion pain addresses one of the last practical objections to a method whose contraceptive performance is otherwise outstanding.

The multicenter design of the trial strengthens the generalizability of the result. By recruiting across multiple sites rather than a single clinic, the investigators reduced the likelihood that their findings reflect the techniques, patient populations, or measurement habits of one particular center. Randomization to mepivacaine or placebo saline, with both groups receiving an identical-appearing instillation, helps control for placebo effects and for the expectation component of procedural pain, which can be substantial. Because both arms underwent the same instillation procedure, the comparison isolates the pharmacological effect of the anesthetic from the mechanical and psychological effects of simply receiving an intervention before insertion.

Mepivacaine itself has a long clinical history in regional and infiltration anesthesia, and its safety profile in other contexts is well characterized. Amide local anesthetics are metabolized in the liver and carry well-understood dose-dependent risks, chiefly central nervous system and cardiovascular toxicity at excessive plasma concentrations. The dose used in the trial, 10 milliliters of a 20 milligram per milliliter solution, corresponds to 200 milligrams of the drug, a quantity consistent with established dosing ranges for local anesthetic use. Instillation into a body cavity also raises the question of systemic absorption through the endometrium, an aspect that the full publication addresses in its safety reporting. The editors’ note accompanying the release directs readers to the article for the complete author list, conflict of interest and financial disclosures, and funding and support information, underscoring the standard transparency expectations for a trial of this kind.

For clinicians, the practical takeaway is that a simple instillation step, performed immediately before insertion, can change the experience of one of the most common gynecological procedures. For patients, particularly those who have never given birth and who are considering an IUD for the first time, the finding offers a concrete reason for optimism that the insertion visit need not be the ordeal that anecdote and online forums often make it out to be. The authors describe mepivacaine instillation as a simple approach that could improve the IUD placement experience, and the trial’s data support that characterization. As with any new procedural practice, adoption will depend on how the technique is incorporated into clinical guidelines, training, and routine counseling, but the underlying result is clear: a few milliliters of local anesthetic, placed where the pain originates, can make IUD placement significantly easier to tolerate.

The study, published in JAMA with the DOI 10.1001/jama.2026.14217, adds a well-controlled data point to an ongoing effort to make contraceptive care less painful and more patient-centered. Pain management during IUD insertion has been the subject of repeated investigation, and this trial distinguishes itself by testing a delivery method that requires no injections and no departure from standard equipment. If the findings are confirmed and adopted broadly, the instillation technique could become a routine part of insertion protocols, particularly for nulliparous patients, closing the gap between the contraceptive effectiveness of the IUD and the comfort of the procedure that provides it.

Subject of Research: Intrauterine mepivacaine instillation for pain relief during IUD placement

Article Title: Intrauterine mepivacaine instillation vs placebo for pain during IUD placement

Article References: Intrauterine mepivacaine instillation vs placebo for pain during IUD placement. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: IUD placement, mepivacaine, local anesthetic, pain management, randomized clinical trial, contraception, nulliparous patients, uterine instillation, JAMA, reproductive health, Intrauterine, instillation

The study, published in BMC Complementary Medicine and Therapies, was conducted by a team led by Sultan Çeçen of Hitit University together with colleagues from Hitit University Erol Olçok Training and Research Hospital and Erciyes University. The trial enrolled 75 patients diagnosed with knee osteoarthritis and randomly assigned them to three groups. One group received Nigella sativa oil, a second received a combination of naproxen and lidocaine gel, a topical formulation pairing a nonsteroidal anti-inflammatory drug with a local anesthetic, and a third received plain vaseline as a control. Each participant applied one milliliter of their assigned preparation to both knees with a two-minute massage, three times daily, for 21 days.

The design of the trial reflects a growing effort to test traditional remedies with the same rigor expected of pharmaceutical agents. Randomization was computer-generated, and the sample size was calculated in advance using the statistical power program G*Power, ensuring the study had a defined chance of detecting a real effect if one existed. The researchers measured outcomes with two well-established clinical tools: the Western Ontario and McMaster Universities Osteoarthritis Index, universally known as WOMAC, which quantifies pain, stiffness, and physical function through validated questionnaires, and direct measurement of knee joint range of motion, abbreviated KJROM, using goniometry. Results were reported as mean differences with 95 percent confidence intervals, the standard language of modern clinical evidence.

The findings were striking. Compared with patients who rubbed vaseline on their knees, those using black cumin oil experienced substantially greater reductions in WOMAC pain scores by day 21, with a between-group mean difference of minus 4.56 points and a confidence interval running from minus 7.99 to minus 1.13, a difference that was statistically significant at p equals 0.010. Stiffness improved as well, with a mean difference of minus 2.12 points and a confidence interval of minus 3.58 to minus 0.66, yielding p equals 0.005. Perhaps most importantly for daily living, physical function scores, the domain that captures how well patients can walk, climb stairs, and manage everyday tasks, dropped by a mean difference of minus 17.32 points, with a confidence interval from minus 28.61 to minus 6.03 and p equals 0.003.

The benefits extended beyond symptoms to joint mechanics. After the researchers adjusted for baseline measurements, the final knee joint range of motion values were significantly better in the black cumin oil group than in the vaseline group. The right knee showed an adjusted mean difference of 4.10 degrees, with a confidence interval of 1.83 to 6.36, and the left knee showed a difference of 5.84 degrees, with a confidence interval of 3.73 to 7.94, both highly significant at p less than 0.001. For patients whose stiffening joints gradually steal the ability to squat, kneel, or walk comfortably, a gain of several degrees of flexion is not a trivial statistic; it can translate into real functional differences in ordinary life.

Equally notable is the safety record. No adverse events were reported in any group during the three-week intervention, a clean profile that stands in contrast to the gastrointestinal, cardiovascular, and renal risks associated with long-term oral nonsteroidal anti-inflammatory drugs, the mainstay of pharmacological osteoarthritis treatment. The trial was approved by the Clinical Research Ethics Committee of the Kayseri City Hospital Traditional and Complementary Medicine Practices Center under the Turkish Ministry of Health, and all participants provided written and verbal informed consent. The study was registered in the Clinical Trials protocol registration system as NCT05541185, although the registration was retrospective, dated August 28, 2022, a methodological caveat that careful readers will notice.

Why might an oil pressed from the seeds of Nigella sativa, a flowering plant cultivated for millennia across the Middle East, South Asia, and North Africa, produce these effects? The seed and its oil contain thymoquinone, the compound most often credited with the plant’s pharmacological activity, along with thymohydroquinone, thymol, and a rich mixture of unsaturated fatty acids including linoleic and oleic acid. Laboratory and animal studies have repeatedly described anti-inflammatory and analgesic properties for these constituents, including modulation of inflammatory mediators and oxidative stress pathways that are also implicated in the cartilage degradation and synovial inflammation of osteoarthritis. The mechanical element of the intervention, a two-minute massage with each application, adds a second layer of plausibility, since massage itself is known to influence local circulation, muscle tension, and pain perception, though the vaseline control group received the identical massage, which helps isolate the specific contribution of the oil.

The trial’s comparative design adds an intriguing dimension. The naproxen and lidocaine gel arm was intended as an active comparator, representing a conventional topical pharmaceutical approach, yet the headline results reported in the paper compare the black cumin oil group against the vaseline placebo group. The authors frame Nigella sativa oil as an adjunct to standard medical treatment rather than a replacement for it, a positioning that matters clinically: patients in the study continued their usual care, and the oil was layered on top as a complementary therapy. This framing aligns with a broader shift in rheumatology and rehabilitation medicine toward multimodal management of osteoarthritis, where topical agents, exercise, weight management, and patient education are combined to delay or avoid more invasive interventions.

Caution, however, remains essential. The authors themselves emphasize that the sample size of 75 patients is relatively small and that the study carries methodological limitations, and they explicitly call for larger, adequately powered, multicenter randomized controlled trials to confirm the results. A three-week intervention cannot speak to long-term safety or to whether the benefits persist, accumulate, or fade after treatment stops. The retrospective trial registration, the absence of reported funding, and the open questions about blinding and adherence all warrant attention as the evidence base matures. Osteoarthritis research has a long history of promising early results from supplements and topical remedies that failed to hold up under larger, more rigorous scrutiny, so single trials, however encouraging, should be read as hypothesis-generating rather than practice-changing.

Still, the study is a welcome contribution to a field where patients desperately need more options. Knee osteoarthritis affects hundreds of millions of people worldwide, its prevalence rising with aging populations and obesity, and the gap between conservative care and joint replacement leaves many patients managing chronic pain for decades. If future trials confirm that a simple, inexpensive, topically applied seed oil can meaningfully reduce pain and improve joint mobility with no reported adverse effects, it could become a genuinely useful addition to the conservative management toolkit, particularly in settings where access to pharmacological treatment is limited or where patients prefer natural products. For now, the message from the Çorum researchers is measured but hopeful: black cumin oil, an ancient remedy subjected to a modern randomized trial, may be a promising complementary approach for knee osteoarthritis symptoms, and the scientific community now has a clear mandate to test that promise at scale.

Subject of Research: Topical Nigella sativa oil treatment for pain and physical function in knee osteoarthritis

Article Title: Effects of Nigella sativa oil on pain intensity and physical functions in patients with knee osteoarthritis: a comparative randomized controlled trial

Article References: Çeçen, S., Doğan, A. G., Taşcı, S., Şahin, S., & Doğan, M. (2026). Effects of Nigella sativa oil on pain intensity and physical functions in patients with knee osteoarthritis: a comparative randomized controlled trial. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05567-0

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05567-0

Keywords: knee osteoarthritis, Nigella sativa, black cumin oil, randomized controlled trial, WOMAC, pain management, complementary medicine, joint range of motion, thymoquinone, topical therapy, anti-inflammatory, physical function