Pub Date : 2024-04-04DOI: 10.3389/fpain.2024.1337734
Katie Herron, Alison Bradshaw, Matthew Liptrot, Gina Wieringa, Kerry Mathews, John Wiles, Selina Johnson
Introduction In response to Coronovirus Disease (COVID-19) health care restrictions, the pain management programme delivered group treatment digitally (OPMP). We aimed to: 1) evaluate pain related outcomes of the OPMP, 2) evaluate patient satisfaction and qualitive feedback of the OPMP and 3) compare OPMP outcomes with the pre-pandemic face to face (F2F) PMP outcomes. Methods Age, gender, pain duration, occupational status, referral information and patient satisfaction data were collected. Pre- and post-treatment pain related outcomes were compared by calculating mean difference, benchmarking with effect size (Cohen's d) and determining clinically significant change (CSC) for OPMP and F2F PMP. Results Two-hundred and thirty-seven patients provided outcome data, with 60 completing the OPMP and 177 completing the F2F PMP. OPMP patients were 10 years younger than the F2F PMP (44.8 vs 53.3), more were female (6.5:1 vs 2.8:1), more were working (45% vs 27%) and fewer were retired (3% vs 17%). The OPMP showed improvements comparable to the F2F PMP. Large effect size was reported across all outcome domains including objective physical outcomes. Eighty-one percent of OPMP patients were ‘extremely likely’ to recommend the programme but just over 50% of patients felt F2F would provide greater clinical benefits. Conclusion The results support that OPMP is effective for carefully selected patients following a multidisciplinary team assessment however more complex cases still require F2F PMP.
{"title":"Moving pain management programmes into the digital age: development and evaluation of an online PMP for people with chronic pain","authors":"Katie Herron, Alison Bradshaw, Matthew Liptrot, Gina Wieringa, Kerry Mathews, John Wiles, Selina Johnson","doi":"10.3389/fpain.2024.1337734","DOIUrl":"https://doi.org/10.3389/fpain.2024.1337734","url":null,"abstract":"Introduction In response to Coronovirus Disease (COVID-19) health care restrictions, the pain management programme delivered group treatment digitally (OPMP). We aimed to: 1) evaluate pain related outcomes of the OPMP, 2) evaluate patient satisfaction and qualitive feedback of the OPMP and 3) compare OPMP outcomes with the pre-pandemic face to face (F2F) PMP outcomes. Methods Age, gender, pain duration, occupational status, referral information and patient satisfaction data were collected. Pre- and post-treatment pain related outcomes were compared by calculating mean difference, benchmarking with effect size (Cohen's d) and determining clinically significant change (CSC) for OPMP and F2F PMP. Results Two-hundred and thirty-seven patients provided outcome data, with 60 completing the OPMP and 177 completing the F2F PMP. OPMP patients were 10 years younger than the F2F PMP (44.8 vs 53.3), more were female (6.5:1 vs 2.8:1), more were working (45% vs 27%) and fewer were retired (3% vs 17%). The OPMP showed improvements comparable to the F2F PMP. Large effect size was reported across all outcome domains including objective physical outcomes. Eighty-one percent of OPMP patients were ‘extremely likely’ to recommend the programme but just over 50% of patients felt F2F would provide greater clinical benefits. Conclusion The results support that OPMP is effective for carefully selected patients following a multidisciplinary team assessment however more complex cases still require F2F PMP.","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":"12 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140744103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-03DOI: 10.3389/fpain.2024.1288758
Anne Kästner, Frank Petzke
In the endeavor to advance our understanding of interindividual differences in dealing with chronic pain, numerous motivational theories have been invoked in the past decade. As they focus on relevant, yet different aspects of the dynamic, multilevel processes involved in human voluntary action control, research findings seem fragmented and inconsistent. Here we present Personality Systems Interactions theory as an integrative meta-framework elucidating how different motivational and volitional processes work in concert under varying contextual conditions. PSI theory explains experience and behavior by the relative activation of four cognitive systems that take over different psychological functions during goal pursuit. In this way, it may complement existing content-related explanations of clinical phenomena by introducing a functional, third-person perspective on flexible goal management, pain acceptance and goal maintenance despite pain. In line with emerging evidence on the central role of emotion regulation in chronic pain, PSI theory delineates how the self-regulation of positive and negative affect impacts whether behavior is determined by rigid stimulus-response associations (i.e., habits) or by more abstract motives and values which afford more behavioral flexibility. Along with testable hypotheses, multimodal interventions expected to address intuitive emotion regulation as a central process mediating successful adaptation to chronic pain are discussed.
{"title":"Personality systems interactions theory: an integrative framework complementing the study of the motivational and volitional dynamics underlying adjustment to chronic pain","authors":"Anne Kästner, Frank Petzke","doi":"10.3389/fpain.2024.1288758","DOIUrl":"https://doi.org/10.3389/fpain.2024.1288758","url":null,"abstract":"In the endeavor to advance our understanding of interindividual differences in dealing with chronic pain, numerous motivational theories have been invoked in the past decade. As they focus on relevant, yet different aspects of the dynamic, multilevel processes involved in human voluntary action control, research findings seem fragmented and inconsistent. Here we present Personality Systems Interactions theory as an integrative meta-framework elucidating how different motivational and volitional processes work in concert under varying contextual conditions. PSI theory explains experience and behavior by the relative activation of four cognitive systems that take over different psychological functions during goal pursuit. In this way, it may complement existing content-related explanations of clinical phenomena by introducing a functional, third-person perspective on flexible goal management, pain acceptance and goal maintenance despite pain. In line with emerging evidence on the central role of emotion regulation in chronic pain, PSI theory delineates how the self-regulation of positive and negative affect impacts whether behavior is determined by rigid stimulus-response associations (i.e., habits) or by more abstract motives and values which afford more behavioral flexibility. Along with testable hypotheses, multimodal interventions expected to address intuitive emotion regulation as a central process mediating successful adaptation to chronic pain are discussed.","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":"16 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140747358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.3389/fpain.2023.1330937
J. Anastasi, B. Capili, Margaret Norton, Donald J. McMahon, Karen Marder
This paper aims to present and discuss the issues, challenges, and strategies related to recruitment and retention in clinical trials involving participants with chronic pain. The randomized controlled clinical trial (RCT) is widely regarded as the gold standard for evaluating clinical interventions. However, it is crucial to acknowledge and address the challenges associated with recruiting and retaining participants. To prioritize the experience of the study population, targeted outreach strategies and a patient-centric approach are necessary. Researchers should consider incorporating recruitment and retention strategies during the study design phase. Implementing multi-pronged recruitment methods, leveraging relationships with community providers, and involving representatives of the patient population are helpful approaches. Effective communication and maintaining a professional environment are vital for optimizing engagement and supporting the successful execution of clinical trials involving participants with chronic pain.
{"title":"Recruitment and retention of clinical trial participants: understanding motivations of patients with chronic pain and other populations","authors":"J. Anastasi, B. Capili, Margaret Norton, Donald J. McMahon, Karen Marder","doi":"10.3389/fpain.2023.1330937","DOIUrl":"https://doi.org/10.3389/fpain.2023.1330937","url":null,"abstract":"This paper aims to present and discuss the issues, challenges, and strategies related to recruitment and retention in clinical trials involving participants with chronic pain. The randomized controlled clinical trial (RCT) is widely regarded as the gold standard for evaluating clinical interventions. However, it is crucial to acknowledge and address the challenges associated with recruiting and retaining participants. To prioritize the experience of the study population, targeted outreach strategies and a patient-centric approach are necessary. Researchers should consider incorporating recruitment and retention strategies during the study design phase. Implementing multi-pronged recruitment methods, leveraging relationships with community providers, and involving representatives of the patient population are helpful approaches. Effective communication and maintaining a professional environment are vital for optimizing engagement and supporting the successful execution of clinical trials involving participants with chronic pain.","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":"41 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140371628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.3389/fpain.2024.1372814
Stefanos Gkikas, N. Tachos, Stelios Andreadis, V. Pezoulas, D. Zaridis, George Gkois, Anastasia Matonaki, Thanos G. Stavropoulos, Dimitrios I. Fotiadis
Accurate and objective pain evaluation is crucial in developing effective pain management protocols, aiming to alleviate distress and prevent patients from experiencing decreased functionality. A multimodal automatic assessment framework for acute pain utilizing video and heart rate signals is introduced in this study. The proposed framework comprises four pivotal modules: the Spatial Module, responsible for extracting embeddings from videos; the Heart Rate Encoder, tasked with mapping heart rate signals into a higher dimensional space; the AugmNet, designed to create learning-based augmentations in the latent space; and the Temporal Module, which utilizes the extracted video and heart rate embeddings for the final assessment. The Spatial-Module undergoes pre-training on a two-stage strategy: first, with a face recognition objective learning universal facial features, and second, with an emotion recognition objective in a multitask learning approach, enabling the extraction of high-quality embeddings for the automatic pain assessment. Experiments with the facial videos and heart rate extracted from electrocardiograms of the BioVid database, along with a direct comparison to 29 studies, demonstrate state-of-the-art performances in unimodal and multimodal settings, maintaining high efficiency. Within the multimodal context, 82.74% and 39.77% accuracy were achieved for the binary and multi-level pain classification task, respectively, utilizing 9.62 million parameters for the entire framework.
{"title":"Multimodal automatic assessment of acute pain through facial videos and heart rate signals utilizing transformer-based architectures","authors":"Stefanos Gkikas, N. Tachos, Stelios Andreadis, V. Pezoulas, D. Zaridis, George Gkois, Anastasia Matonaki, Thanos G. Stavropoulos, Dimitrios I. Fotiadis","doi":"10.3389/fpain.2024.1372814","DOIUrl":"https://doi.org/10.3389/fpain.2024.1372814","url":null,"abstract":"Accurate and objective pain evaluation is crucial in developing effective pain management protocols, aiming to alleviate distress and prevent patients from experiencing decreased functionality. A multimodal automatic assessment framework for acute pain utilizing video and heart rate signals is introduced in this study. The proposed framework comprises four pivotal modules: the Spatial Module, responsible for extracting embeddings from videos; the Heart Rate Encoder, tasked with mapping heart rate signals into a higher dimensional space; the AugmNet, designed to create learning-based augmentations in the latent space; and the Temporal Module, which utilizes the extracted video and heart rate embeddings for the final assessment. The Spatial-Module undergoes pre-training on a two-stage strategy: first, with a face recognition objective learning universal facial features, and second, with an emotion recognition objective in a multitask learning approach, enabling the extraction of high-quality embeddings for the automatic pain assessment. Experiments with the facial videos and heart rate extracted from electrocardiograms of the BioVid database, along with a direct comparison to 29 studies, demonstrate state-of-the-art performances in unimodal and multimodal settings, maintaining high efficiency. Within the multimodal context, 82.74% and 39.77% accuracy were achieved for the binary and multi-level pain classification task, respectively, utilizing 9.62 million parameters for the entire framework.","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":"39 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.3389/fpain.2024.1241015
Jennifer T. Anger, Laura K. Case, Andrew P. Baranowski, Ardin Berger, Rebecca M. Craft, Lyn Ann Damitz, Rodney Gabriel, Tracy Harrison, Kirsten Kaptein, Sanghee Lee, Anne Z. Murphy, Engy Said, Stacey Abigail Smith, David A. Thomas, M. V. Valdés Hernández, Victor Trasvina, Ursula Wesselmann, Tony L. Yaksh
Provide an overview of the literature addressing major areas pertinent to pain in transgender persons and to identify areas of primary relevance for future research.A team of scholars that have previously published on different areas of related research met periodically though zoom conferencing between April 2021 and February 2023 to discuss relevant literature with the goal of providing an overview on the incidence, phenotype, and mechanisms of pain in transgender patients. Review sections were written after gathering information from systematic literature searches of published or publicly available electronic literature to be compiled for publication as part of a topical series on gender and pain in the Frontiers in Pain Research.While transgender individuals represent a significant and increasingly visible component of the population, many researchers and clinicians are not well informed about the diversity in gender identity, physiology, hormonal status, and gender-affirming medical procedures utilized by transgender and other gender diverse patients. Transgender and cisgender people present with many of the same medical concerns, but research and treatment of these medical needs must reflect an appreciation of how differences in sex, gender, gender-affirming medical procedures, and minoritized status impact pain.While significant advances have occurred in our appreciation of pain, the review indicates the need to support more targeted research on treatment and prevention of pain in transgender individuals. This is particularly relevant both for gender-affirming medical interventions and related medical care. Of particular importance is the need for large long-term follow-up studies to ascertain best practices for such procedures. A multi-disciplinary approach with personalized interventions is of particular importance to move forward.
{"title":"Pain mechanisms in the transgender individual: a review","authors":"Jennifer T. Anger, Laura K. Case, Andrew P. Baranowski, Ardin Berger, Rebecca M. Craft, Lyn Ann Damitz, Rodney Gabriel, Tracy Harrison, Kirsten Kaptein, Sanghee Lee, Anne Z. Murphy, Engy Said, Stacey Abigail Smith, David A. Thomas, M. V. Valdés Hernández, Victor Trasvina, Ursula Wesselmann, Tony L. Yaksh","doi":"10.3389/fpain.2024.1241015","DOIUrl":"https://doi.org/10.3389/fpain.2024.1241015","url":null,"abstract":"Provide an overview of the literature addressing major areas pertinent to pain in transgender persons and to identify areas of primary relevance for future research.A team of scholars that have previously published on different areas of related research met periodically though zoom conferencing between April 2021 and February 2023 to discuss relevant literature with the goal of providing an overview on the incidence, phenotype, and mechanisms of pain in transgender patients. Review sections were written after gathering information from systematic literature searches of published or publicly available electronic literature to be compiled for publication as part of a topical series on gender and pain in the Frontiers in Pain Research.While transgender individuals represent a significant and increasingly visible component of the population, many researchers and clinicians are not well informed about the diversity in gender identity, physiology, hormonal status, and gender-affirming medical procedures utilized by transgender and other gender diverse patients. Transgender and cisgender people present with many of the same medical concerns, but research and treatment of these medical needs must reflect an appreciation of how differences in sex, gender, gender-affirming medical procedures, and minoritized status impact pain.While significant advances have occurred in our appreciation of pain, the review indicates the need to support more targeted research on treatment and prevention of pain in transgender individuals. This is particularly relevant both for gender-affirming medical interventions and related medical care. Of particular importance is the need for large long-term follow-up studies to ascertain best practices for such procedures. A multi-disciplinary approach with personalized interventions is of particular importance to move forward.","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-25DOI: 10.3389/fpain.2024.1376564
Elizabeth A. Ronan, Maximilian Nagel, J.J. Emrick
Somatosensory innervation of the oral cavity enables the detection of a range of environmental stimuli including minute and noxious mechanical forces. The trigeminal sensory neurons underlie sensation originating from the tooth. Prior work has provided important physiological and molecular characterization of dental pulp sensory innervation. Clinical dental experiences have informed our conception of the consequence of activating these neurons. However, the biological role of sensory innervation within the tooth is yet to be defined. Recent transcriptomic data, combined with mouse genetic tools, have the capacity to provide important cell-type resolution for the physiological and behavioral function of pulp-innervating sensory neurons. Importantly, these tools can be applied to determine the neuronal origin of acute dental pain that coincides with tooth damage as well as pain stemming from tissue inflammation (i.e., pulpitis) toward developing treatment strategies aimed at relieving these distinct forms of pain.
{"title":"The anatomy, neurophysiology, and cellular mechanisms of intradental sensation","authors":"Elizabeth A. Ronan, Maximilian Nagel, J.J. Emrick","doi":"10.3389/fpain.2024.1376564","DOIUrl":"https://doi.org/10.3389/fpain.2024.1376564","url":null,"abstract":"Somatosensory innervation of the oral cavity enables the detection of a range of environmental stimuli including minute and noxious mechanical forces. The trigeminal sensory neurons underlie sensation originating from the tooth. Prior work has provided important physiological and molecular characterization of dental pulp sensory innervation. Clinical dental experiences have informed our conception of the consequence of activating these neurons. However, the biological role of sensory innervation within the tooth is yet to be defined. Recent transcriptomic data, combined with mouse genetic tools, have the capacity to provide important cell-type resolution for the physiological and behavioral function of pulp-innervating sensory neurons. Importantly, these tools can be applied to determine the neuronal origin of acute dental pain that coincides with tooth damage as well as pain stemming from tissue inflammation (i.e., pulpitis) toward developing treatment strategies aimed at relieving these distinct forms of pain.","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140384078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.3389/fpain.2024.1301665
Kaori Horike, Masatoshi Ukezono
Chronic neck pain is common among Japanese individuals, but few receive treatment. This randomized controlled trial aimed to evaluate the efficacy of acupuncture using press needles in the self-treatment of chronic neck pain and preliminarily identify the characteristics of patients likely to benefit from this treatment.Fifty participants with chronic neck pain were allocated to receive either press needle or placebo treatment for 3 weeks. The visual analogue scale (VAS) and motion-related VAS (M-VAS) scores for neck pain, Neck Disability Index score, and pressure pain threshold were measured at baseline, after the first session, at the end of the last session, and 1 week after the last session. Changes in the outcomes were analyzed using analysis of variance, and the relationships between the variables were evaluated using structural equation modeling.Intervention results as assessed by VAS score revealed no significant differences in the ANOVA. A between-groups comparison of M-VAS scores at the end of the last session and baseline showed a significant difference (press needle: −21.64 ± 4.47, placebo: −8.09 ± 3.81, p = 0.025, d = −0.65). Structural equation modeling revealed a significant pain-reducing effect of press needle treatment (β = −0.228, p = 0.049). Severity directly affected efficacy (β = −0.881, p < 0.001). Pain duration, baseline VAS and Neck Disability Index scores were variables explaining severity, while age and occupational computer use were factors affecting severity.Self-treatment with press needles for chronic neck pain did not significantly reduce the VAS score compared to placebo but reduced the motion-related pain as assessed by M-VAS score. A direct association was observed between pain severity and the effectiveness of press needles, and the impact of age and computer were indirectly linked by pain severity.Identifier UMIN-CTR, UMIN000044078.
{"title":"Efficacy of chronic neck pain self-treatment using press needles: a randomized controlled clinical trial","authors":"Kaori Horike, Masatoshi Ukezono","doi":"10.3389/fpain.2024.1301665","DOIUrl":"https://doi.org/10.3389/fpain.2024.1301665","url":null,"abstract":"Chronic neck pain is common among Japanese individuals, but few receive treatment. This randomized controlled trial aimed to evaluate the efficacy of acupuncture using press needles in the self-treatment of chronic neck pain and preliminarily identify the characteristics of patients likely to benefit from this treatment.Fifty participants with chronic neck pain were allocated to receive either press needle or placebo treatment for 3 weeks. The visual analogue scale (VAS) and motion-related VAS (M-VAS) scores for neck pain, Neck Disability Index score, and pressure pain threshold were measured at baseline, after the first session, at the end of the last session, and 1 week after the last session. Changes in the outcomes were analyzed using analysis of variance, and the relationships between the variables were evaluated using structural equation modeling.Intervention results as assessed by VAS score revealed no significant differences in the ANOVA. A between-groups comparison of M-VAS scores at the end of the last session and baseline showed a significant difference (press needle: −21.64 ± 4.47, placebo: −8.09 ± 3.81, p = 0.025, d = −0.65). Structural equation modeling revealed a significant pain-reducing effect of press needle treatment (β = −0.228, p = 0.049). Severity directly affected efficacy (β = −0.881, p < 0.001). Pain duration, baseline VAS and Neck Disability Index scores were variables explaining severity, while age and occupational computer use were factors affecting severity.Self-treatment with press needles for chronic neck pain did not significantly reduce the VAS score compared to placebo but reduced the motion-related pain as assessed by M-VAS score. A direct association was observed between pain severity and the effectiveness of press needles, and the impact of age and computer were indirectly linked by pain severity.Identifier UMIN-CTR, UMIN000044078.","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":" 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140216959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.3389/fpain.2024.1373759
Rachel A. Reed, L. Berghaus, Rose M. Reynolds, Brittany T. Holmes, Anna M. Krikorian, Daniel M. Sakai, Yushun Ishikawa, Heather K. Knych
Understanding the pharmacokinetics and pharmacodynamics of fentanyl in horses is crucial for optimizing pain management strategies in veterinary medicine.Six adult horses were enrolled in a randomized crossover design. Treatments included: placebo, two 100 mcg/h patches (LDF), four 100 mcg/h patches (MDF), and six 100 mcg/h patches (HDF). Patches were in place for 72 h. Blood was obtained for fentanyl plasma concentration determination, thermal threshold, mechanical threshold, heart rate, respiratory rate, and rectal temperature were obtained prior patch placement and at multiple time points following patch placement for the following 96 h. Fentanyl plasma concentration was determined using LC-MS/MS. Data were analyzed using a generalized mixed effects model.Mean (range) maximum plasma concentration (Cmax), time to Cmax, and area under the curve extrapolated to infinity were 1.39 (0.82–1.82), 2.64 (1.21–4.42), 4.11 (2.78–7.12) ng/ml, 12.7 (8.0–16.0), 12.7 (8.0–16.0), 12 (8.0–16.0) h, 42.37 (27.59–55.56), 77.24 (45.62–115.06), 120.34 (100.66–150.55) h ng/ml for LDF, MDF, and HDF, respectively. There was no significant effect of treatment or time on thermal threshold, mechanical threshold, respiratory rate, or temperature (p > 0.063). There was no significant effect of treatment on heart rate (p = 0.364). There was a significant effect of time (p = 0.003) on heart rate with overall heart rates being less than baseline at 64 h.Fentanyl administered via transdermal patch is well absorbed and well tolerated but does not result in an anti-nociceptive effect as measured by thermal and mechanical threshold at the doses studied.
{"title":"The pharmacokinetics and pharmacodynamics of fentanyl administered via transdermal patch in horses","authors":"Rachel A. Reed, L. Berghaus, Rose M. Reynolds, Brittany T. Holmes, Anna M. Krikorian, Daniel M. Sakai, Yushun Ishikawa, Heather K. Knych","doi":"10.3389/fpain.2024.1373759","DOIUrl":"https://doi.org/10.3389/fpain.2024.1373759","url":null,"abstract":"Understanding the pharmacokinetics and pharmacodynamics of fentanyl in horses is crucial for optimizing pain management strategies in veterinary medicine.Six adult horses were enrolled in a randomized crossover design. Treatments included: placebo, two 100 mcg/h patches (LDF), four 100 mcg/h patches (MDF), and six 100 mcg/h patches (HDF). Patches were in place for 72 h. Blood was obtained for fentanyl plasma concentration determination, thermal threshold, mechanical threshold, heart rate, respiratory rate, and rectal temperature were obtained prior patch placement and at multiple time points following patch placement for the following 96 h. Fentanyl plasma concentration was determined using LC-MS/MS. Data were analyzed using a generalized mixed effects model.Mean (range) maximum plasma concentration (Cmax), time to Cmax, and area under the curve extrapolated to infinity were 1.39 (0.82–1.82), 2.64 (1.21–4.42), 4.11 (2.78–7.12) ng/ml, 12.7 (8.0–16.0), 12.7 (8.0–16.0), 12 (8.0–16.0) h, 42.37 (27.59–55.56), 77.24 (45.62–115.06), 120.34 (100.66–150.55) h ng/ml for LDF, MDF, and HDF, respectively. There was no significant effect of treatment or time on thermal threshold, mechanical threshold, respiratory rate, or temperature (p > 0.063). There was no significant effect of treatment on heart rate (p = 0.364). There was a significant effect of time (p = 0.003) on heart rate with overall heart rates being less than baseline at 64 h.Fentanyl administered via transdermal patch is well absorbed and well tolerated but does not result in an anti-nociceptive effect as measured by thermal and mechanical threshold at the doses studied.","PeriodicalId":12641,"journal":{"name":"Frontiers in Pain Research","volume":"105 s1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140224878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.3389/fpain.2024.1299027
Mark I. Johnson, Kerry Page, James Woodall, Kate Thompson
In this perspective article we advocate community-based system change for people living with persistent pain. Our view is that greater use of the voluntary and community sector, in partnership with the clinical sector, creates the conditions for a “whole person” approach to pain management, leading to greater personalised care for adults living with long-term pain whilst having the potential to ease some of the pressures on General Practitioners and other clinical services. We advocate pain care that is socially connected, meaningful within socio-cultural contexts and aligned with the principles of salutogenesis. We provide an example of a UK National Health Service (NHS) commissioned pain service called “Rethinking Pain” that operationalises this perspective. Led by the voluntary and community sector, Rethinking Pain works in partnership with the clinical sector to provide a central holistic pathway of care for people experiencing persistent pain. This is the first time that this model of care has been commissioned for persistent pain in this area of England. The Rethinking Pain service is underpinned by core values to work with people to manage their pain holistically. The Rethinking Pain team proactively engage with people in the community, actively approaching and engaging those who experience the biggest health inequalities. In this article we provide an overview of the context of pain services in the UK, the rationale and supporting evidence for community-based system change, and the context, pathway, values, goals, and aspirations of the Rethinking Pain service.
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