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Pain: What Do Doctors Need to Know?

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Medical Education | Vol 6 | Issue 1 |  January-June 2026 | page: 6-8 | Ricardo Kobayashi, Carolina Besser Cozac Kobayashi, Lin Tchia Yeng, Manoel Jacobsen Teixeira

DOI: https://doi.org/10.13107/jrs.2026.v06.i01.189

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2026; The Author(s).

Submitted Date: 06 Feb 2026, Review Date: 19 Mar 2026, Accepted Date: April 2026 & Published: 30 June 2026

Author: Ricardo Kobayashi [1], Carolina Besser Cozac Kobayashi [1], Lin Tchia Yeng [1], Manoel Jacobsen Teixeira [1]

[1] Department of Neurology, Pain Center, University of Neurology, São Paulo, Brazil.
.

Address of Correspondence
Dr. Ricardo Kobayashi,
Department of Neurology, Pain Center, University of São Paulo, São Paulo, Brazil.
E-mail: koba@globo.com

Abstract

Pain is one of the leading causes of medical consultations and emergency department visits, making its accurate assessment and management essential components of quality healthcare. Pain can be classified according to duration, intensity, and pathophysiology, including nociceptive, neuropathic, nociplastic, and mixed mechanisms. Chronic pain represents a major public health challenge because of its high prevalence and its impact on physical and psychological functioning. A comprehensive evaluation based on medical history, physical examination, and appropriate use of complementary studies is crucial for establishing an accurate diagnosis and guiding treatment. Mechanical and inflammatory pain patterns, comorbidities, mood disorders, and functional impairment should be considered during assessment. Multimodal pain management addresses the multifactorial nature of pain through pharmacological and non-pharmacological strategies. Pharmacological options include non-opioid analgesics, opioids, nonsteroidal anti-inflammatory drugs, nutraceuticals, muscle relaxants, antidepressants, anticonvulsants, and topical agents, with treatment tailored to the underlying pain mechanism and individual patient characteristics. Opioids should be used cautiously, particularly in chronic pain, with clearly defined functional goals. Non-pharmacological interventions, including physical rehabilitation, exercise, postural education, pain neuroscience education, and mind-body approaches, are fundamental for restoring function and improving quality of life. Effective pain management prioritizes functional recovery and reduction of suffering rather than complete pain elimination, emphasizing individualized, mechanism-based, and multidisciplinary approaches.
Keywords: Musculoskeletal pain, Chronic pain, Mixed pain, Neuropathic pain, Pain management.

References

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How to Cite this article: Kobayashi R, Kobayashi CBC, Yeng LT, Teixeira MJ | Pain: What Do Doctors Need to Know?. | Journal of Regenerative Science | Jan-Jun 2026; 6(1): 06-08.

 

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Extracorporeal shock wave treatment in plantar fasciitis with an associated neuropathic component. How to optimize the result?

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Case Report | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 21-23 | Lauro Schledorn de Camargo , Ricardo Kobayashi
DOI: 10.13107/jrs.2022.v02.i02.59

Author: Lauro Schledorn de Camargo [1], Ricardo Kobayashi [2]

[1] Orthopedic Surgeon at LC Clinic, Jundiai-SP Brazil, Brazil,
[2] Pain Center, Department of Neurology, University of São Paulo, Brazil.

Address of Correspondence
Dr. Lauro Schledorn de Camargo, MD,
Orthopedic Surgeon at LC Clinic, Jundiai-SP Brazil, Brazil.
E-mail: laurosch@hotmail.com

Abstract

Introduction: Current evidence supports the use of radial pressure wave and focused extracorporeal shock wave treatment (ESWT) for the treatment of chronic plantar fasciitis that does not improve with conservative treatment. Studies show that a quarter of plantar fasciitis may have an associated neuropathic component and the literature shows that neuropathic pain causes more intense pain and greater functional disability. However, there is a lack of literature on the results of ESWT in tendinopathies associated with the neuropathic pattern.
Case report: We report a case of plantar fasciitis with central sensitization and associated neuropathic component. At first, pregabalin 75mg twice a day was used, which improved the neuropathic pattern. After that, 3 sessions were performed with piezoelectric ESWT with energy of 0.12 mJ/mm2, 2000 impulses at a frequency of 8 Hz, once a week for three weeks. The patient was followed up for 3 months and had complete improvement of symptoms without functional limitation for activities of daily living.
Conclusion: This case report serves to draw attention to the importance of evaluating and treating the neuropathic pattern associated with tendinopathies in order to optimize the therapeutic result. However, randomized clinical trials are lacking to determine the real difference in results between using ESWT in nociceptive pain or in mixed pain with an associated neuropathic component.

Keywords: Chronic pain, plantar fasciitis, mixed pain, neuropathic pain, shockwaves.

References:

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How to Cite this article: Camargo Lsd, Kobayashi R |Extracorporeal shock wave treatment in plantar fasciitis with an associated neuropathic component. How to optimize the result?. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 21-23.

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