Acute moderate-to-severe pain is common after surgery, trauma, or musculoskeletal injury, but its management remains suboptimal. Current single-agent treatments are limited by safety concerns, narrow therapeutic windows, and abuse potential, leaving substantial unmet needs. Here, we aimed to review guidelines for the management of acute moderate-to-severe post-surgical, trauma-related, or musculoskeletal pain in adults and discuss existing and potential future analgesics in this setting. We searched PubMed to identify relevant guidelines and existing analgesics for acute pain. To identify compounds in development, we searched ClinicalTrials.gov and the European Union Clinical Trials Register. Guidelines universally recognize the limitations of single-agent analgesics (particularly those with a single mechanism of action [MoA]) and recommend a multimodal approach as an established standard for acute pain. The benefit–risk profiles of traditional treatments, including paracetamol (acetaminophen), nonsteroidal anti-inflammatory drugs, selective cyclooxygenase-2 inhibitors, and opioids, can be improved by combining agents targeting different pain pathways. In multimodal approaches, lower doses of constituent agents can be used to achieve the same or superior analgesic effects relative to the individual agents. In some cases, novel formulations and co-crystal technology offer enhanced physicochemical and pharmacokinetic properties over individual agents. Lastly, initiatives to increase patient awareness and education around pain management may improve treatment satisfaction and quality of life, and hasten recovery. In conclusion, management of acute moderate-to-severe pain remains inadequate. Multimodal analgesics may offer advantages over traditional single-agent treatments (that often have a single MoA) for acute moderate-to-severe post-surgical, trauma-related, or musculoskeletal pain in adults. Multimodal analgesics, combined with patient education initiatives and non-pharmacological measures, when necessary, offer promise in addressing unmet needs in this setting.

Background/Objectives: Radiculopathy leads to pain, consequently reducing patient’s quality of life (QoL). Research indicates that certain nucleotides, such as cytidine and uridine, along with vitamins B1 and B12, may help alleviate pain and enhance QoL. This study assessed the impact of adding a supplement containing cytidine and uridine nucleotides and vitamins B1 and B12, alongside standard treatment, on radiculopathy-associated pain. Methods: A multicenter, prospective, two-cohort, randomized, open-label study was conducted. The control group received standard treatment, while the experimental group received standard treatment plus the supplement. The primary endpoint was pain reduction measured by a Visual Analog Scale (VAS). Secondary endpoints included functional improvement (Roland Morris questionnaire), clinical improvement (Clinical Global Impression [CGI] scale), and QoL improvement (EQ-5D-5L questionnaire). Results: A total of 122 patients were included from 17 centers across Spain. Both groups showed pain improvement, but the VAS reduction (control: 24.58 vs. experimental: 31.35) was not statistically significant. The Roland Morris score decreased significantly in the experimental group (estimate: −1.70, 95% CI −3.29 to −0.10; p = 0.038), and these patients were 5 times more likely to progress to a better CGI category (OR = 0.20, 95% CI 0.07 to 0.57; p = 0.003). No significant differences were observed in EQ-5D-5L scores or analgesic consumption. Conclusions: The addition of supplemental pyrimidine nucleotides and vitamins B1 and B12 to standard of care treatment improved radiculopathy functional and clinical outcomes. Regarding pain, however, although there was a numerical improvement, it did not reach statistical significance.

Background: The CADOR study aimed to obtain consensus on the diagnosis, management, and follow‐up of patients with chronic noncancer pain (CNCP) in Spain, including beliefs about central sensitization (CS), and addressing multidisciplinary care and referral processes. Methods: A Delphi consensus of two successive rounds (July 2023–November 2023) among 100 panelists working in Primary Care (PC), Traumatology, Rehabilitation, and Pain Units (Anesthesiology) was performed. Consensus was defined as ≥ 70% of panelists agreeing or disagreeing with a statement. The questionnaire included 30 questions with some Likert‐type scale items systematized as follows: 1 to 3 ( disagreement ), 4 to 6 ( neutral ), and 7 to 9 ( agreement ). A scientific committee (SC) of five experts in the field validated the questionnaire and its results. Results: Panelists considered pain as an entity and underlined the need to include it in medical records. CNCP should be addressed holistically and managed by a multidisciplinary team. Experts agreed to specifically investigate the presence of pain in patients with mood disorders and among the elderly. Moreover, the panelists considered it important to highlight the role of CS in CNCP evolution, a concept not well established in real clinical practice. Panelists emphasized the need to enhance knowledge to prevent the chronification of pain, address symptoms potentially associated with CS, and to improve patients’ prognosis. Finally, panelists highlighted the need for ongoing training initiatives for clinicians and patients, promoting awareness, with a particular focus on the patients’ needs. Conclusion: This study underscores the importance of early detection, personalized treatment, and structured follow‐up for the correct therapeutic approach of CNCP in the Spanish setting. These recommendations may also help to anticipate symptoms potentially associated with CS by improving conceptual understanding in CNCP patients. Finally, respondents also highlighted the relevance of multidisciplinary care and referral processes in patients with CNCP.

Parece ser que existen otras vías indirectas como, por ejemplo, la vitamina D y la PTH, que también pueden verse alteradas por la contaminación y están implicadas en el remodelado óseo¹-⁸. En primer lugar, la contaminación del aire (micropartículas y ozono) presenta una barrera física a la radiación solar ultravioleta B, contribuyendo, por lo tanto, a una menor producción cutánea de vitamina D²,⁴,⁵. Igualmente, un estudio realizado en Estados Unidos⁹ evidenció la relación entre bajos niveles de PTH en sangre y niveles elevados de micropartículas y carbón en el aire, provocando efectos nocivos indirectos en la masa ósea.