European Journal of Pain最新文献_第5页

Preoperative resting-state electrophysiological signals predict acute but not chronic postoperative pain 术前静息状态电生理信号可预测急性术后疼痛，但不能预测慢性术后疼痛。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-23 DOI: 10.1002/ejp.4757

Qi Han, Hailu Wang, Xuejing Lu, Yaru Li, Yutong Guo, Xiangyue Zhao, Yi Feng, Li Hu

Background

The prevalence of postoperative pain is notably high among the elderly population, which poses significant challenges for their postoperative recovery. In this study, we aimed to identify preoperative predictors for acute and chronic postoperative pain in patients undergoing lumbar spinal surgery through a longitudinal investigation.

Methods

We recruited 75 patients (mean age 68.29 ± 5.60 years) and collected their resting-state electroencephalography (EEG) data two hours before the surgery. The aperiodic and periodic signal components were extracted from the resting-state EEG using the Fitting Oscillations and One-Over-F algorithm. We also collected the preoperative pain ratings, demographic information and the Hospital Anxiety and Depression Scale from all patients. The postoperative pain ratings were collected ten times from Day 1 to Week 12 after surgery.

Results

We observed a high incidence of postoperative acute and chronic pain among older patients. Preoperative pain and peak alpha frequency in resting-state EEG were the primary predictors of acute postoperative pain. Although age is a significant predictor of chronic postoperative pain, its predictive performance is poor.

Conclusions

Overall, our study provides valuable insights into the complex pattern of preoperative EEG features, preoperative pain and age in predicting postoperative pain at different stages. Our findings highlight the significance of exploring preoperative features to identify patients who are at a higher risk of developing severe postoperative pain, which can aid in the development of more personalized and effective pain management strategies.

Significance

The heightened occurrence of postoperative pain among the elderly presents formidable obstacles to their recuperation. This study delves into identifying preoperative factors influencing acute and chronic postoperative pain. Our findings indicate that preoperative pain and peak alpha frequency are crucial predictors of acute postoperative pain. However, the predictive performance for chronic postoperative pain is limited, although age was a significant predictor of chronic postoperative pain. These insights contribute to the identification of patients at elevated risk for severe acute and chronic postoperative pain, offering valuable guidance for pre-surgical risk assessment.

背景：老年人术后疼痛的发生率很高，这给他们的术后恢复带来了巨大挑战。在本研究中，我们旨在通过纵向调查确定腰椎手术患者术前预测急性和慢性术后疼痛的因素：我们招募了 75 名患者（平均年龄 68.29 ± 5.60 岁），并在手术前两小时收集了他们的静息状态脑电图（EEG）数据。使用拟合振荡和 One-Over-F 算法从静息状态脑电图中提取非周期性和周期性信号成分。我们还收集了所有患者的术前疼痛评分、人口统计学信息和医院焦虑抑郁量表。从术后第 1 天到第 12 周，我们共收集了 10 次术后疼痛评分：结果：我们观察到老年患者术后急性和慢性疼痛的发生率很高。术前疼痛和静息状态脑电图中的α频率峰值是预测术后急性疼痛的主要因素。虽然年龄是预测术后慢性疼痛的一个重要因素，但其预测性能较差：总之，我们的研究为了解术前脑电图特征、术前疼痛和年龄在预测不同阶段术后疼痛方面的复杂模式提供了宝贵的见解。我们的研究结果凸显了探索术前特征对识别术后严重疼痛高风险患者的重要意义，这有助于制定更个性化、更有效的疼痛管理策略：老年人术后疼痛的发生率较高，这给他们的康复带来了巨大障碍。本研究旨在确定影响急性和慢性术后疼痛的术前因素。我们的研究结果表明，术前疼痛和阿尔法频率峰值是预测急性术后疼痛的关键因素。然而，虽然年龄是慢性术后疼痛的一个重要预测因素，但对慢性术后疼痛的预测效果有限。这些见解有助于识别严重急性和慢性术后疼痛风险较高的患者，为手术前风险评估提供有价值的指导。

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引用次数: 0

Expectation of analgesia increases the inhibitory response of conditioned pain modulation in healthy participants who at baseline have a non-inhibitory profile 对镇痛的预期会增加健康参与者对条件性疼痛调节的抑制性反应，而这些参与者的基线是非抑制性的。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-17 DOI: 10.1002/ejp.4747

Allen Matheus S. Nascimento, Soraya S. Ardestani, Isabela C. Novaes, Paulo César R. Conti, Leonardo R. Bonjardim, Fernando G. Exposto, Peter Svensson, Yuri M. Costa

Background

This study assessed the effect of expectation of analgesia on conditioned pain modulation (CPM) in healthy participants stratified into inhibitors and non-inhibitors.

Methods

A parallel CPM protocol was assessed on 21 women and 22 men across two sessions: baseline and expectation of analgesia, which was induced by a standardized audiovisual suggestion. The CPM assessment involved two different test stimuli (TS): mechanically controlled palpation and the pressure pain threshold, applied to two different regions: anterior temporalis and thenar eminence of the hand. The conditioning stimulus (CS) involved immersing the non-dominant forearm in cold water. The order of the TS and regions was randomized for each participant. The CPM protocol was performed three times, with a 1-min interval between TS/region sequences. After a 20-min rest, the CPM assessment was repeated (two blocks in total). The standard error of measurement (SEM) was computed to identify inhibitors (inhibitory responses) and non-inhibitors (including non-inhibitors and facilitatory responses). Cochran's Q, ANOVA and ANCOVA were applied to the data (p < 0.05).

Results

There was a significant decrease in the proportion of non-inhibitors during the expectation of analgesia session (32.6%–44.2%) when compared with the baseline session (51.2%–72.1%). The non-inhibitors exhibited a lower inhibitory CPM magnitude than the inhibitors only in block 1 of the baseline session. The expectation of analgesia resulted in an increased magnitude of the inhibitory CPM solely in non-inhibitors.

Conclusion

Expectation of analgesia can increase the inhibitory response of the CPM beyond the measurement error in healthy participants with a baseline non-inhibitory profile.

Significance

Several studies have investigated whether cognitive modulation can alter the magnitude of the inhibitory response of conditioned pain modulation (CPM), yet some gaps remain. This study accounted for measurement error to accurately determine changes in CPM influenced by expectation of analgesia.

背景：本研究评估了镇痛预期对条件性疼痛调节（CPM）的影响：本研究评估了镇痛预期对条件性疼痛调节（CPM）的影响，研究对象为健康参与者，分为抑制者和非抑制者：方法：对 21 名女性和 22 名男性进行了平行 CPM 方案评估，分为两个阶段：基线和镇痛预期，镇痛预期由标准化视听暗示诱导。CPM 评估包括两种不同的测试刺激（TS）：机械控制的触诊和压力痛阈，分别作用于两个不同的区域：颞前肌和手部的肩峰。条件刺激（CS）是将非优势前臂浸入冷水中。每位受试者的 TS 和区域顺序都是随机的。CPM 方案进行三次，TS/区域序列之间间隔 1 分钟。休息 20 分钟后，重复 CPM 评估（共两组）。计算测量标准误差 (SEM) 以确定抑制剂（抑制性反应）和非抑制剂（包括非抑制剂和促进性反应）。对数据进行了 Cochran's Q、方差分析和方差分析（P 结果：与基线疗程（51.2%-72.1%）相比，预期镇痛疗程中的非抑制剂比例（32.6%-44.2%）明显下降。非抑制剂仅在基线训练的第 1 区块表现出比抑制剂更低的抑制性 CPM 幅值。仅在非抑制剂中，对镇痛的期望导致抑制性 CPM 幅度增加：结论：对于基线非抑制性特征的健康参与者来说，镇痛预期会增加 CPM 的抑制性反应，超出测量误差：有几项研究探讨了认知调节是否能改变条件性疼痛调节（CPM）抑制性反应的大小，但仍存在一些不足。本研究考虑了测量误差，以准确确定受镇痛预期影响的 CPM 变化。

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引用次数: 0

Correction to ‘Systematic review and co-ordinate based meta-analysis to summarize the utilization of functional brain imaging in conjunction with human models of peripheral and central sensitization’ 更正 "系统回顾和基于协调的荟萃分析，总结大脑功能成像与外周和中枢敏化人体模型的结合使用情况"。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-14 DOI: 10.1002/ejp.4744

Clarke, S., Rogers, R., Wanigasekera, V., Fardo, F., Pia, H., Nochi, Z., Macian, N., Leray, V., Finnerup, N. B., Pickering, G., Mouraux, A., Truini, A., Treede, R.-D., Garcia-Larrea, L., & Tracey, I. (2024). Systematic review and co-ordinate based meta-analysis to summarize the utilization of functional brain imaging in conjunction with human models of peripheral and central sensitization. European Journal of Pain, 28, 1069–1094.

The Funding Information ‘This project has received funding from the Innovative Medicines Initiative 2 Joint undertaking under grant agreement No 777500. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and EFPIA (www.imi.europa.eu; www.imi-paincare.eu). The statements and opinions presented here reflect the author's view and neither IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained therein. This research was also partly supported by the NIHR Oxford Health Biomedical Research Centre (NIHR203316) and by the Wellcome Trust (203139/Z/16/Z and 203139/A/16/Z). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.’ was incomplete.

This should have read: ‘This project has received funding from the Innovative Medicines Initiative 2 Joint undertaking under grant agreement No 777500. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and EFPIA (www.imi.europa.eu; www.imi-paincare.eu). The statements and opinions presented here reflect the author's view and neither IMI nor the European Union, EFPIA or any associated partners are responsible for any use that may be made of the information contained therein. This research was also partly supported by the NIHR Oxford Health Biomedical Research Centre (NIHR203316), by the Wellcome Trust (203139/Z/16/Z and 203139/A/16/Z) and by the European Research Council (ERC-2020-StG-948838). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care’.

We apologize for this missing information.

克拉克，S.，罗杰斯，R.，瓦尼加塞克拉，V.，法尔多，F.，皮亚，H.，诺奇，Z.，马西恩，N.，勒雷，V.，芬纳鲁普，n.b.，皮克林，G.，莫拉，A.，特鲁尼，A.，特里德，R. d .。，加西亚-拉利亚，L.；崔西，I.（2024）。系统回顾和基于协调的荟萃分析，总结与人类外周和中枢致敏模型相结合的功能性脑成像的应用。欧洲疼痛杂志，28,1069-1094。“该项目已获得创新药物计划2联合项目的资助，资助协议编号777500。这项联合事业得到了欧盟“地平线2020”研究和创新计划以及EFPIA (www.imi.europa.eu；www.imi-paincare.eu)。这里提出的陈述和意见反映了作者的观点，IMI、欧洲联盟、EFPIA或任何相关合作伙伴都不对其中所含信息的任何使用负责。这项研究也得到了NIHR牛津健康生物医学研究中心（NIHR203316）和Wellcome Trust （203139/Z/16/Z和203139/A/16/Z）的部分支持。所表达的观点是作者的观点，不一定是国家卫生研究院或卫生和社会保障部的观点。是不完整的。它应该是这样写的：“本项目已获得创新药物计划2联合项目的资助，资助协议编号777500。这项联合事业得到了欧盟“地平线2020”研究和创新计划以及EFPIA (www.imi.europa.eu；www.imi-paincare.eu)。这里提出的陈述和意见反映了作者的观点，IMI、欧洲联盟、EFPIA或任何相关合作伙伴都不对其中所含信息的任何使用负责。本研究也得到了NIHR牛津健康生物医学研究中心（NIHR203316）、Wellcome Trust （203139/Z/16/Z和203139/A/16/Z）和欧洲研究理事会（ERC-2020-StG-948838）的部分支持。所表达的观点是作者的观点，不一定是国家卫生研究院或卫生和社会保障部的观点。”我们为遗漏的信息道歉。

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引用次数: 0

Exploring signs of central sensitization in adolescents with hypermobility Spectrum disorder or hypermobile Ehlers-Danlos syndrome 探索患有活动过度频谱障碍或活动过度埃勒斯-丹洛斯综合征的青少年的中枢敏感化迹象。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-11 DOI: 10.1002/ejp.4754

Elke Schubert-Hjalmarsson, Anders Fasth, Kelly Ickmans, Ann-Charlott Söderpalm, Mari Lundberg

<div> <section> <h3> Background</h3> <p>Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS) are two overlapping heritable connective tissue disorders characterized by joint hypermobility, chronic pain, impaired body perception, and musculoskeletal symptoms. Central sensitization has been proposed as a plausible explanation for symptoms like widespread pain, fatigue, mood disorders, and sleep disturbances in patients with HSD/hEDS.</p> </section> <section> <h3> Objective</h3> <p>The aim of this study was to investigate signs of central sensitization, including exercise-induced hypoalgesia (EIH), and fatigue severity in adolescents with HSD/hEDS.</p> </section> <section> <h3> Methods</h3> <p>In this prospective, experimental, case–control study, thirty-seven adolescents with HSD/hEDS and 47 healthy adolescents (all aged 13–17 years) were included. Pressure pain thresholds (PPTs) were measured at four muscle groups using a pressure algometer. EIH was evaluated by measuring PPTs on two muscle groups immediately after an exercise test on a bicycle ergometer. Participants also completed questionnaires on fatigue and cognitive/emotional factors.</p> </section> <section> <h3> Results</h3> <p>The study demonstrated significantly lower PPTs in four different muscle groups in adolescents with HSD/hEDS compared to the healthy control group. Both groups achieved a significantly higher PPTs after exercise in the muscle involved in the activity. Adolescents with HSD/hEDS reported higher fatigue levels and more cognitive/emotional difficulties than the control group.</p> </section> <section> <h3> Conclusion</h3> <p>Adolescents with HSD/hEDS showed generalized hyperalgesia measured through PPTs at different body sites. EIH was partly affected in adolescents with HSD/hEDS, presenting as unchanged pain sensitivity in the remote muscle. Pain should be considered as a phenomenon that is influenced by different biopsychosocial factors, including possible central sensitization, which increase its complexity.</p> </section> <section> <h3> Significance statement</h3> <p>This study breaks new ground by showing signs of central sensitization, including diminished EIH, in adolescents with HSD or hEDS. Given that exercise is a key element in pain management, these findings offer valuable insights when developing treatment plans for adolescents w

背景：活动过度频谱障碍（HSD）和活动过度埃勒斯-丹洛斯综合征（hEDS）是两种重叠的遗传性结缔组织疾病，其特征是关节活动过度、慢性疼痛、身体知觉受损和肌肉骨骼症状。中枢敏化被认为是 HSD/hEDS 患者广泛性疼痛、疲劳、情绪障碍和睡眠障碍等症状的一种合理解释：本研究旨在调查患有 HSD/hEDS 的青少年的中枢敏化迹象，包括运动诱发的低痛感（EIH）和疲劳严重程度：在这项前瞻性、实验性、病例对照研究中，共纳入了 37 名患有 HSD/hEDS 的青少年和 47 名健康青少年（年龄均为 13-17 岁）。研究人员使用压痛计测量了四个肌肉群的压痛阈值（PPT）。在自行车测力计上进行运动测试后，立即测量两组肌肉的压痛阈值，以评估 EIH。参与者还填写了有关疲劳和认知/情绪因素的问卷：研究表明，与健康对照组相比，患有 HSD/hEDS 的青少年四个不同肌肉群的 PPT 值明显较低。两组青少年在运动后参与活动的肌肉的 PPT 值都明显较高。与对照组相比，患有 HSD/hEDS 的青少年表现出更高的疲劳度和更多的认知/情感困难：结论：患有 HSD/hEDS 的青少年通过身体不同部位的 PPTs 测量，表现出全身性痛觉减退。HSD/hEDS 青少年的 EIH 部分受到影响，表现为远处肌肉的痛觉敏感性不变。疼痛应被视为一种受不同生物心理社会因素影响的现象，包括可能的中枢敏感化，这增加了疼痛的复杂性：本研究开创性地显示了患有 HSD 或 hEDS 的青少年中枢敏感化的迹象，包括 EIH 的减弱。鉴于运动是疼痛治疗的关键因素，这些发现为制定 HSD 或 hEDS 青少年的治疗计划提供了宝贵的见解。

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引用次数: 0

Moving towards the use of artificial intelligence in pain management 将人工智能应用于疼痛治疗。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-10 DOI: 10.1002/ejp.4748

Ryan Antel, Sera Whitelaw, Genevieve Gore, Pablo Ingelmo

Background and Objective

While the development of artificial intelligence (AI) technologies in medicine has been significant, their application to acute and chronic pain management has not been well characterized. This systematic review aims to provide an overview of the current state of AI in acute and chronic pain management.

Databases and Data Treatment

This review was registered with PROSPERO (ID# CRD42022307017), the international registry for systematic reviews. The search strategy was prepared by a librarian and run in four electronic databases (Embase, Medline, Central, and Web of Science). Collected articles were screened by two reviewers. Included studies described the use of AI for acute and chronic pain management.

Results

From the 17,601 records identified in the initial search, 197 were included in this review. Identified applications of AI were described for treatment planning as well as treatment delivery. Described uses include prediction of pain, forecasting of individualized responses to treatment, treatment regimen tailoring, image-guidance for procedural interventions and self-management tools. Multiple domains of AI were used including machine learning, computer vision, fuzzy logic, natural language processing and expert systems.

Conclusion

There is growing literature regarding applications of AI for pain management, and their clinical use holds potential for improving patient outcomes. However, multiple barriers to their clinical integration remain including lack validation of such applications in diverse patient populations, missing infrastructure to support these tools and limited provider understanding of AI.

Significance

This review characterizes current applications of AI for pain management and discusses barriers to their clinical integration. Our findings support continuing efforts directed towards establishing comprehensive systems that integrate AI throughout the patient care continuum.

背景和目的：虽然人工智能（AI）技术在医学领域的发展十分显著，但其在急慢性疼痛治疗中的应用却没有得到很好的体现。本系统综述旨在概述人工智能在急慢性疼痛管理中的应用现状：本综述已在国际系统综述注册中心 PROSPERO（ID# CRD42022307017）注册。检索策略由一名图书管理员制定，并在四个电子数据库（Embase、Medline、Central 和 Web of Science）中运行。收集到的文章由两名审稿人进行筛选。纳入的研究描述了人工智能在急性和慢性疼痛治疗中的应用：在初步搜索中确定的 17,601 条记录中，有 197 条被纳入本综述。已确定的人工智能应用于治疗计划和治疗实施。描述的用途包括疼痛预测、个性化治疗反应预测、治疗方案定制、程序干预的图像指导以及自我管理工具。人工智能的应用涉及多个领域，包括机器学习、计算机视觉、模糊逻辑、自然语言处理和专家系统：有关将人工智能应用于疼痛管理的文献越来越多，其临床应用具有改善患者预后的潜力。然而，这些技术的临床整合仍面临多重障碍，包括缺乏在不同患者群体中的应用验证、支持这些工具的基础设施缺失以及提供者对人工智能的理解有限：本综述描述了目前人工智能在疼痛管理方面的应用，并讨论了其临床整合的障碍。我们的研究结果支持继续努力建立综合系统，将人工智能整合到整个患者护理过程中。

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引用次数: 0

Chronic pain among primary fentanyl users: The concept of self-medication 初级芬太尼使用者的慢性疼痛：自我药疗的概念。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-06 DOI: 10.1002/ejp.4753

Jane J. Kim, Dianah Hayati, Milad Zamany, Fiona Choi, Kerry Jang, Martha Ignaszewski, Pouya Azar, Michael Krausz

Background

Chronic pain is among the leading causes of disability worldwide, of which only a small percentage of patients receive adequate treatment for. Non-prescribed opioid analgesics are commonly sought out in effort to alleviate unrelieved pain. This study assesses the prevalence and correlates of chronic pain among primary fentanyl users.

Methods

A cross-sectional and structured survey was conducted with 200 adults who reported fentanyl as their drug of choice from a Vancouver acute care hospital. Presence and levels of chronic pain were determined through self-report.

Results

The majority of participants (n = 130, 72.6%) reported having chronic pain in the past 6 months, with the mean level of pain on a typical day to be 7.6 out of a scale of 10 (SD = 1.9). Majority (n = 85, 65.4%) reported using street opioids to self-medicate, while only 9 (6.9%) reported that their chronic pain was unrelated. Regression analysis indicated that increasing age and co-use of cannabis and opioids were independent associated factors of chronic pain. Higher levels of reported pain on a typical day were further associated with age and self-medication.

Conclusions

The findings of this study demonstrate a significant association between self-medication and chronic pain among primary fentanyl users in British Columbia. For these individuals, inadequate pain relief may drive continued opioid use, which in turn may increase risks of treatment discontinuation and overdose. Appropriate pain management strategies are crucial to avoid opioid misuse and decrease the large societal burden caused by chronic pain.

Significance

Our work points to the high prevalence of self-reported chronic pain among individuals who primarily use fentanyl. Among those with self-reported fentanyl use and chronic pain, self-medication with street opioids was found to be common and associated with higher reported pain levels on a typical day. This highlights the need for pain management strategies to be integrated into opioid dependence treatment and more research in the overlap of pain and fentanyl use.

背景：慢性疼痛是导致全球残疾的主要原因之一，其中只有一小部分患者得到了适当的治疗。患者通常会寻求非处方阿片类镇痛药来缓解无法缓解的疼痛。本研究评估了初级芬太尼使用者中慢性疼痛的发生率和相关性：我们对温哥华一家急症护理医院的 200 名成人进行了横断面结构性调查，这些人称芬太尼是他们的首选药物。通过自我报告确定慢性疼痛的存在和程度：大多数参与者（n = 130，72.6%）表示在过去 6 个月中有过慢性疼痛，在 10 分制的评分中，平均每天的疼痛程度为 7.6（SD = 1.9）。大多数人（85 人，65.4%）报告说他们使用街头阿片类药物进行自我治疗，只有 9 人（6.9%）报告说他们的慢性疼痛与此无关。回归分析表明，年龄增加以及同时使用大麻和阿片类药物是慢性疼痛的独立相关因素。平日报告的疼痛程度较高与年龄和自我药物治疗进一步相关：本研究结果表明，在不列颠哥伦比亚省的芬太尼初级使用者中，自我药疗与慢性疼痛之间存在显著关联。对于这些人来说，疼痛缓解不足可能会促使他们继续使用阿片类药物，这反过来又会增加中断治疗和用药过量的风险。适当的疼痛管理策略对于避免滥用阿片类药物和减轻慢性疼痛造成的巨大社会负担至关重要：我们的研究表明，在主要使用芬太尼的人群中，自我报告的慢性疼痛发生率很高。在自我报告使用过芬太尼并患有慢性疼痛的人群中，发现使用街头阿片类药物进行自我治疗的情况很普遍，并且与报告的平日疼痛程度较高有关。这凸显了将疼痛管理策略纳入阿片类药物依赖治疗的必要性，以及对疼痛和芬太尼使用重叠问题进行更多研究的必要性。

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引用次数: 0

Plasma neurofilament light chain in fibromyalgia: A case control study exploring correlation with clinical and cognitive features 纤维肌痛中的血浆神经丝轻链：一项病例对照研究，探讨与临床和认知特征的相关性。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-04 DOI: 10.1002/ejp.4752

Maddalena Ruggieri, Giulia Paparella, Livio Clemente, Giuseppe Libro, Concetta Domenica Gargano, Marina de Tommaso

Background

Plasma neurofilament light chain (NFL) has been measured as a biomarker of neuronal damage in various neurological disorders. Elevated tau and β-amyloid levels have been found in patients with fibromyalgia (FM). The aim of the present study was to compare plasma neurofilament levels in fibromyalgia patients with normal controls and to investigate the correlation with clinical features and cognitive tests.

Methods

Plasma NFL levels were assessed in 33 FM patients and compared with 22 age-matched controls. All patients were also assessed with clinical scales examining fibromyalgia disability, sleep quality and duration, fatigue, anxiety, and depression, and a neuropsychological battery examining executive function, verbal short-term memory, and working memory, as well as attentional executive function and selective attention, interference sensitivity, and inhibition of automatic responses.

Results

NFL levels were higher in FM patients (controls 6.19± 1.92; FM 17.28± 15.94 pg/mL ANOVA p 0.002). Working memory was the most impaired cognitive function significantly correlated with high NFL scores (Pearson p 0.034). Short sleep times also correlated with higher NFL scores (Pearson p 0.02) and poorer working memory performance (Pearson p 0.02). No correlation was found with indices of disease severity and duration.

Conclusions

Plasma NFL levels are elevated in fibromyalgia patients, suggesting neuronal damage and correlating with a slight decrease in working memory and short sleep duration.

Significance Statement

Plasma neurofilament levels are elevated in patients with fibromyalgia, regardless of disease severity and duration. Neurofilament levels are higher in patients with mild working memory impairment and sleep disorders. Subgroups of patients with primary neuronal damage phenomena could be individualized for prospective evaluation with regard to the possible development of cognitive decline and sleep disturbances, which would justify a tailored therapeutic approach.

背景：血浆神经丝蛋白轻链（NFL）已被测定为各种神经系统疾病中神经元损伤的生物标志物。在纤维肌痛（FM）患者中发现 tau 和 β 淀粉样蛋白水平升高。本研究旨在比较纤维肌痛患者与正常对照组的血浆神经丝蛋白水平，并研究其与临床特征和认知测试的相关性：方法：对 33 名纤维肌痛患者的血浆神经丝蛋白水平进行评估，并与 22 名年龄匹配的对照组进行比较。所有患者还接受了纤维肌痛残疾、睡眠质量和持续时间、疲劳、焦虑和抑郁等临床量表评估，以及执行功能、言语短期记忆和工作记忆、注意执行功能和选择性注意、干扰敏感性和自动反应抑制等神经心理测试：FM患者的NFL水平更高（对照组为6.19± 1.92；FM为17.28± 15.94 pg/mL ANOVA p 0.002）。工作记忆是认知功能受损最严重的一项，与高 NFL 分数显著相关（Pearson p 0.034）。睡眠时间短也与较高的 NFL 分数（Pearson p 0.02）和较差的工作记忆能力（Pearson p 0.02）相关。结论：血浆 NFL 水平的升高与心血管疾病的严重程度和持续时间有关：结论：纤维肌痛患者的血浆神经丝蛋白水平升高，表明神经元受损，并与工作记忆和短睡眠时间的轻微下降相关：纤维肌痛患者的血浆神经丝蛋白水平升高，与疾病的严重程度和持续时间无关。轻度工作记忆障碍和睡眠障碍患者的神经丝水平较高。可以对具有原发性神经元损伤现象的亚组患者进行个体化的前瞻性评估，以了解其可能出现的认知能力下降和睡眠障碍，从而有理由采取有针对性的治疗方法。

{"title":"Plasma neurofilament light chain in fibromyalgia: A case control study exploring correlation with clinical and cognitive features","authors":"Maddalena Ruggieri, Giulia Paparella, Livio Clemente, Giuseppe Libro, Concetta Domenica Gargano, Marina de Tommaso","doi":"10.1002/ejp.4752","DOIUrl":"10.1002/ejp.4752","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Plasma neurofilament light chain (NFL) has been measured as a biomarker of neuronal damage in various neurological disorders. Elevated tau and β-amyloid levels have been found in patients with fibromyalgia (FM). The aim of the present study was to compare plasma neurofilament levels in fibromyalgia patients with normal controls and to investigate the correlation with clinical features and cognitive tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Plasma NFL levels were assessed in 33 FM patients and compared with 22 age-matched controls. All patients were also assessed with clinical scales examining fibromyalgia disability, sleep quality and duration, fatigue, anxiety, and depression, and a neuropsychological battery examining executive function, verbal short-term memory, and working memory, as well as attentional executive function and selective attention, interference sensitivity, and inhibition of automatic responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NFL levels were higher in FM patients (controls 6.19± 1.92; FM 17.28± 15.94 pg/mL ANOVA <i>p</i> 0.002). Working memory was the most impaired cognitive function significantly correlated with high NFL scores (Pearson <i>p</i> 0.034). Short sleep times also correlated with higher NFL scores (Pearson <i>p</i> 0.02) and poorer working memory performance (Pearson <i>p</i> 0.02). No correlation was found with indices of disease severity and duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Plasma NFL levels are elevated in fibromyalgia patients, suggesting neuronal damage and correlating with a slight decrease in working memory and short sleep duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>Plasma neurofilament levels are elevated in patients with fibromyalgia, regardless of disease severity and duration. Neurofilament levels are higher in patients with mild working memory impairment and sleep disorders. Subgroups of patients with primary neuronal damage phenomena could be individualized for prospective evaluation with regard to the possible development of cognitive decline and sleep disturbances, which would justify a tailored therapeutic approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-04 DOI: 10.1002/ejp.4749

Allan V. Danielsen, Jan J. Andreasen, Birthe Dinesen, John Hansen, Kristian K. Petersen, Kirsten S. Duch, Carsten Simonsen, Lars Arendt-Nielsen

<div> <section> <h3> Background</h3> <p>Persistent postsurgical pain (PPSP) following thoracic surgery affects 40%–60% of patients undergoing lung resection due to malignancies. Postoperative pain-related symptoms are common, leading to limitations in activities of daily living (ADL) and deterioration in physical function, which significantly impacts quality of life. Pain-related limitations are of interest, as postsurgical pain may present as a target for intervention to improve postoperative rehabilitation. This study aimed to evaluate the association between PPSP and ADL limitations during the first 12 postoperative months after surgery for lung cancer.</p> </section> <section> <h3> Methods</h3> <p>A total of 124 patients undergoing surgery for lung cancer were followed for 12 months. Every 2 months, participants reported ADL limitations attributed to PPSP. Cumulative pain impairment scores were calculated from reported limitations in 14 daily activities, and recovery trajectory patterns were analysed.</p> </section> <section> <h3> Results</h3> <p>Daily activities most affected by PPSP were carrying bags, arm elevation, climbing stairs, cleaning floors and coughing, with >50% reporting limitations across all assessment times. Reported pain intensities were generally mild (NRS≤3), but still associated with significant impairment. Some recovery was observed in patients reporting pain at rest, but PPSP was consistently associated with higher cumulative pain impairment scores at all assessments during the 12-month follow-up period.</p> </section> <section> <h3> Conclusions</h3> <p>Findings indicate that persistent postsurgical pain, even of mild intensity, is associated with significant limitations in daily activities up to 12 months post-surgery. Some improvement in pain-related impairment was observed, although limitations remained significantly higher in patients reporting persistent postsurgical pain, as compared to pain-free patients.</p> </section> <section> <h3> Significance</h3> <p>Surgery remains a cornerstone in the treatment of early-stage lung cancer. Despite advances in minimally invasive techniques and rehabilitation, persisting postsurgical pain and pain-related limitations in daily activities may endure. This study investigated specifically the pain-related limitations in activities of daily living and described recovery trajectories during the first 12 postoperative months. Patients with persistent postsurgical pain experienced m

背景：40%-60%因恶性肿瘤接受肺切除术的患者在胸外科手术后会出现持续性术后疼痛（PPSP）。术后疼痛相关症状很常见，导致日常生活活动（ADL）受限和身体功能退化，严重影响生活质量。由于术后疼痛可能会成为改善术后康复的干预目标，因此与疼痛相关的限制引起了人们的关注。本研究旨在评估肺癌术后头12个月内PPSP与ADL限制之间的关系：共对 124 名接受肺癌手术的患者进行了为期 12 个月的随访。每 2 个月，参与者报告一次因 PPSP 导致的 ADL 受限情况。根据所报告的 14 项日常活动受限情况计算出累积疼痛损伤评分，并对恢复轨迹模式进行分析：结果：受 PPSP 影响最大的日常活动是拎包、抬高手臂、爬楼梯、清洁地板和咳嗽，在所有评估时间内，有超过 50% 的人报告受到限制。所报告的疼痛强度一般较轻（NRS≤3），但仍有明显的功能障碍。在报告休息时疼痛的患者中观察到了一些恢复情况，但在 12 个月的随访期间，在所有评估中，PPSP 始终与较高的累积疼痛损伤评分相关：结论：研究结果表明，手术后持续疼痛，即使是轻度疼痛，也会导致患者在术后 12 个月内的日常活动严重受限。尽管与无痛患者相比，术后持续疼痛患者的活动受限程度仍然明显更高，但与疼痛相关的功能障碍已有所改善：手术仍是治疗早期肺癌的基石。意义：手术仍是治疗早期肺癌的基石，尽管微创技术和康复治疗取得了进步，但术后疼痛和与疼痛相关的日常活动受限仍可能持续存在。本研究特别调查了日常生活中与疼痛相关的限制，并描述了术后前 12 个月的恢复轨迹。与无痛患者相比，术后持续疼痛的患者受到多种限制。虽然观察到了部分恢复，但在术后长达 12 个月的时间里，这些障碍仍然很明显。

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引用次数: 0

Neural correlates of pain acceptance and the role of the cerebellum: Comment 接受疼痛的神经相关性和小脑的作用：评论。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-11-03 DOI: 10.1002/ejp.4751

Hinpetch Daungsupawong, Viroj Wiwanitkit

引用次数: 0

Prescription time trends in patients with high-impact chronic pain: A National Patient Registry Study 影响较大的慢性疼痛患者的处方时间趋势：全国患者登记研究。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2024-10-28 DOI: 10.1002/ejp.4746

Karin D. Bruun, Caroline T. Thorarinsson, Henrik B. Vaegter, Floor D. Zegers, Bente M. Nørgård, Mette Wod

Background

High-impact chronic pain (HICP), defined as chronic pain with a significant impact on daily function, affects approximately 8% of the Western population. In Denmark, HICP still remains to be described at the population level. Some patients with HICP are referred to the Danish pain centres, where they are registered with a procedural code. We conducted a nationwide registry-based study of all Danish patients registered with a visit to a pain centre from January 2005 to March 2022, to explore time trends in the prescription of analgesics and sedatives in this HICP subpopulation. Furthermore, data on socioeconomics and hospital diagnoses are reported.

Methods

We used data from the Central Person Registry, the Danish National Patient Registry, the Danish National Prescription Registry, combined with data on socioeconomic information from Statistics Denmark. Data was collected on prescriptions 3 months before the first visit to a pain centre. Prescriptions were stratified into five calendar periods: before 2011, 2011–2013, 2014–2016, 2017–2019, and 2020–2022.

Results

We identified 66,577 patients referred to a pain centre. Over 15 years, prescriptions before referral declined for opioids (from 53.2% to 31.7%), NSAIDs (from 28.3% to 23.5%), antidepressants (from 20.5% to 16.8%), anxiolytics (from 12.3% to 3.2%), and sleep medication (from 15.8% to 7.6%). In contrast, prescriptions increased for paracetamol (from 31.1% to 48.9%) and gabapentinoids (from 19.2% to 27.7%).

Conclusions

In patients with HICP visiting Danish pain centres, prescriptions before referral decreased for opioids over 15 years, with a simultaneously increased prescription of gabapentinoids (gabapentin and pregabalin).

Significance Statement

This nationwide study of 66,577 Danish patients with high-impact chronic pain reveals a significant decrease in filled opioid prescriptions over the past 15 years, with a simultaneous rise in gabapentinoid use before referral to pain centres. These findings suggest a shift in clinical practice towards alternative pain management strategies. The study underscores the need for continued research into the long-term effects of these changes and their impact on patient outcomes.

背景：高影响慢性疼痛（HICP）是指对日常功能有重大影响的慢性疼痛，约占西方人口的 8%。在丹麦，HICP 仍未在人口层面上得到描述。一些 HICP 患者会被转诊到丹麦疼痛中心，并在那里进行程序代码登记。我们对 2005 年 1 月至 2022 年 3 月期间在疼痛中心登记就诊的所有丹麦患者进行了一项全国范围的登记研究，以探讨 HICP 亚群中镇痛剂和镇静剂处方的时间趋势。此外，我们还报告了有关社会经济学和医院诊断的数据：我们使用了来自中央人员登记处、丹麦全国患者登记处和丹麦全国处方登记处的数据，以及丹麦统计局提供的社会经济信息数据。我们收集了首次到疼痛中心就诊前 3 个月的处方数据。处方被分为五个日历期：2011 年前、2011-2013 年、2014-2016 年、2017-2019 年和 2020-2022 年：结果：我们确定了 66577 名转诊至疼痛中心的患者。15年间，转诊前阿片类药物（从53.2%降至31.7%）、非甾体抗炎药（从28.3%降至23.5%）、抗抑郁药（从20.5%降至16.8%）、抗焦虑药（从12.3%降至3.2%）和睡眠药物（从15.8%降至7.6%）的处方量均有所下降。相比之下，扑热息痛（从31.1%增至48.9%）和加巴喷丁类药物（从19.2%增至27.7%）的处方量有所增加：结论：在丹麦疼痛中心就诊的 HICP 患者中，阿片类药物在转诊前的处方量在 15 年内有所减少，而加巴喷丁类药物（加巴喷丁和普瑞巴林）的处方量同时有所增加：这项针对 66577 名丹麦高影响慢性疼痛患者的全国性研究显示，在过去 15 年中，阿片类药物的处方大幅减少，与此同时，在转诊至疼痛中心之前使用加巴喷丁类药物的情况有所增加。这些发现表明，临床实践正在向替代性疼痛管理策略转变。该研究强调，有必要继续研究这些变化的长期效果及其对患者预后的影响。

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引用次数: 0