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Acupuncture in musculoskeletal pain: analysis of changes in pain perception using the NRS (Numeric Rating Scale) 针灸治疗肌肉骨骼疼痛:使用 NRS(数值评定量表)分析疼痛感觉的变化
Pub Date : 2024-01-08 DOI: 10.3389/fpain.2023.1294428
Lorenzo Fracchia, Alda Maria Olivero, Riccardo Rustichelli, Tiziana Pedrali
This study is based on data collected at the Acupuncture clinic of the Local Health Authority (ASL) in Turin from 2008 to 2022 and aims at evaluating the effectiveness of acupuncture in the treatment of musculoskeletal pain using the Numeric Rating Scale (NRS) which analyzes changes in pain perceived by patients in different body regions.The database consists of data provided by patients during the initial visit and the last session. Only patients who provided data at the beginning and end of treatment were included. The data were processed using JASP 0.17.2.1 software. The sample consisted of 932 patients with musculoskeletal conditions, excluding 254 subjects with internal medical conditions, who were treated during the same period. The selected population includes individuals aged 23–94, comprising 242 men and 690 women. Patients followed a therapeutic protocol based on the initial diagnosis and underwent an initial cycle of six weekly sessions, with the possibility of four additional sessions if needed. Acupuncture was performed by experienced medical personnel following Traditional Chinese Medicine guideline.The average NRS values were 7.49 at the beginning and 4.27 at the end, with a 43% reduction in pain. The data were analyzed using the Wilcoxon test, confirming statistical significance (p < 0.001). They were then divided by body region, showing a reduction in pain ranging from 40% to 55%. Statistical analysis among different conditions was performed using the Kruskal–Wallis test, with further comparisons using the Dunn test.The study demonstrates that acupuncture is effective in reducing musculoskeletal suffering, with a significant decrease in pain perceived by patients. The results suggest that acupuncture can be a valid treatment for a wide range of conditions, with pain reduction ranging from 40% to 55% and greater effectiveness for elbow-related conditions. However, it is important to note that sample size may influence the results, and further research is needed to confirm and expand these findings, especially for less-represented conditions by the sample.
这项研究基于都灵地方卫生局(ASL)针灸诊所从 2008 年至 2022 年收集的数据,旨在使用数字评分量表(NRS)评估针灸治疗肌肉骨骼疼痛的效果。数据库由患者在初次就诊和最后一次治疗时提供的数据组成,其中只包括在治疗开始和结束时提供数据的患者。数据使用 JASP 0.17.2.1 软件进行处理。样本包括 932 名肌肉骨骼疾病患者,不包括同期接受治疗的 254 名内科疾病患者。所选人群包括 23-94 岁的个人,其中男性 242 人,女性 690 人。患者根据初步诊断结果制定治疗方案,以每周六次为一个初始周期,必要时可增加四次疗程。针灸由经验丰富的医务人员按照中医指南进行。NRS平均值在治疗开始时为7.49,治疗结束时为4.27,疼痛减轻了43%。数据采用 Wilcoxon 检验进行分析,结果显示具有统计学意义(P < 0.001)。然后按身体部位进行划分,结果显示疼痛减轻了 40% 至 55%。研究结果表明,针灸能有效减轻肌肉骨骼疼痛,患者感觉到的疼痛明显减轻。研究结果表明,针灸可以有效治疗多种病症,疼痛减轻率在 40% 至 55% 之间,对肘部相关病症的疗效更好。然而,值得注意的是,样本量可能会影响结果,因此需要进一步研究来证实和扩大这些发现,尤其是针对样本中代表性较低的病症。
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引用次数: 0
Application of multidisciplinary team conference for neuromodulation candidates facilitates patient selection and optimization 针对神经调控候选者的多学科团队会议有助于患者的选择和优化
Pub Date : 2024-01-05 DOI: 10.3389/fpain.2023.1331883
Vafi Salmasi, Mohammad Reza Rasouli, Ming C. Kao, E. Ottestad, A. Terkawi, Garret Morris, Xiang Qian, Stephen Coleman, David C. Talavera, Heather Poupore-King, Kristen Slater, Michael S. Leong
Psychological evaluation is required by insurance companies in the United States prior to proceeding with a spinal cord stimulation or a dorsal root ganglion stimulation trial. Since January 2017, we implemented a Multidisciplinary Team Conference for Neuromodulation in our center to facilitate the collaboration between pain physicians and psychologists and to optimize screening of neuromodulation candidates. This study aims to report the impact of this team conference on improvement of neuromodulation outcome in our center.Appropriateness of neuromodulation were discussed in the team conference after initial visit with the pain specialist and psychological evaluation. For this study, we prospectively and retrospectively collected data on neuromodulation candidates who went through the team conference and those who did not as controls.We discussed 461 patients in the team conference sessions from January 2017 to July 2023. Out of these, a spinal cord stimulator or a dorsal root ganglion stimulator trial was performed in 164 patients with 80.5% (132 cases) trial success rate leading to 140 implants. Out of these implants, 26 (18.6%) explanted and 21 (15%) required revision in 41 (29.3%) patients. We performed neuraxial neuromodulation trial for 70 patients without going through the team conference from January 2016 to July 2023 with a trial success rate of 45.7% (32 cases). In this group, 7 (21.9%) and 6 (18.8%) patients underwent explant and revision. The differences between the groups were statistically significant for trial success rate (odds ratio of 4.9 with p-value of <0.01) but not for explant (odds ratio of 0.8 with p-value of 0.627) or revision (odds ratio of 0.8 with p-value of 0.595).Implementing Multidisciplinary Team Conference increased trial success rate in our center. Team conference provides therapeutic benefit for patients, and also provides the opportunity for an educational discussion for trainees.
在美国,保险公司要求在进行脊髓刺激或背根神经节刺激试验之前进行心理评估。自2017年1月起,我们在本中心实施了神经调控多学科团队会议,以促进疼痛科医生和心理医生之间的合作,并优化神经调控候选者的筛选。本研究旨在报告该团队会议对改善本中心神经调控结果的影响。在疼痛专科医生初诊和心理评估后,我们在团队会议上讨论了神经调控的适宜性。在这项研究中,我们前瞻性地和回顾性地收集了经过团队会议讨论的神经调控候选者和未经过团队会议讨论的候选者的数据作为对照。其中,164 名患者进行了脊髓刺激器或背根神经节刺激器试验,试验成功率为 80.5%(132 例),最终植入 140 个脊髓刺激器或背根神经节刺激器。在这些植入物中,有 26 个(18.6%)发生了爆炸,41 个(29.3%)患者中有 21 个(15%)需要进行翻修。从 2016 年 1 月到 2023 年 7 月,我们为 70 名患者进行了神经轴神经调控试验,没有经过团队会议,试验成功率为 45.7%(32 例)。在这组患者中,分别有 7 例(21.9%)和 6 例(18.8%)患者进行了切除和翻修。在试验成功率方面,组间差异有统计学意义(几率比为 4.9,P 值<0.01),但在切除术(几率比为 0.8,P 值为 0.627)或翻修术(几率比为 0.8,P 值为 0.595)方面,组间差异无统计学意义。团队会议为患者带来了治疗上的益处,也为受训者提供了教育讨论的机会。
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引用次数: 0
A bone to pick-cellular and molecular mechanisms of bone pain in sickle cell disease 镰状细胞病骨痛的细胞和分子机制
Pub Date : 2024-01-04 DOI: 10.3389/fpain.2023.1302014
Jahnavi Gollamudi, Kristine A. Karkoska, O. Gbotosho, Wei Zou, Hyacinth I. Hyacinth, Steven L Teitelbaum
The bone is one of the most commonly affected organs in sickle cell disease (SCD). Repeated ischemia, oxidative stress and inflammation within the bone is largely responsible for promoting bone pain. As more individuals with SCD survive into adulthood, they are likely to experience a synergistic impact of both aging and SCD on their bone health. As bone health deteriorates, bone pain will likely exacerbate. Recent mechanistic and observational studies emphasize an intricate relationship between bone remodeling and the peripheral nervous system. Under pathological conditions, abnormal bone remodeling plays a key role in the propagation of bone pain. In this review, we first summarize mechanisms and burden of select bone complications in SCD. We then discuss processes that contribute to pathological bone pain that have been described in both SCD as well as non-sickle cell animal models. We emphasize the role of bone-nervous system interactions and pitfalls when designing new therapies especially for the sickle cell population. Lastly, we also discuss future basic and translational research in addressing questions about the complex role of stress erythropoiesis and inflammation in the development of SCD bone complications, which may lead to promising therapies and reduce morbidity in this vulnerable population.
骨骼是镰状细胞病(SCD)中最常受影响的器官之一。骨骼中反复出现的缺血、氧化应激和炎症在很大程度上导致了骨痛。随着越来越多的 SCD 患者进入成年期,他们很可能会经历衰老和 SCD 对骨骼健康的协同影响。随着骨骼健康状况的恶化,骨痛很可能会加剧。最近的机理和观察研究强调了骨重塑与周围神经系统之间错综复杂的关系。在病理条件下,异常骨重塑在骨痛的传播中起着关键作用。在这篇综述中,我们首先总结了 SCD 中某些骨骼并发症的机制和负担。然后,我们讨论在 SCD 和非镰状细胞动物模型中描述的导致病理性骨痛的过程。我们强调骨神经系统相互作用的作用以及设计新疗法(尤其是针对镰状细胞人群)时的陷阱。最后,我们还讨论了未来的基础研究和转化研究,以解决有关应激性红细胞生成和炎症在 SCD 骨并发症发展过程中的复杂作用的问题,这可能会带来有前途的疗法并降低这一脆弱人群的发病率。
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引用次数: 0
Research hotspots and trends on neuropathic pain-related mood disorders: a bibliometric analysis from 2003 to 2023 神经性疼痛相关情绪障碍的研究热点和趋势:2003 至 2023 年文献计量分析
Pub Date : 2023-12-21 DOI: 10.3389/fpain.2023.1233444
Xiaohua Wang, Yueyang Zhuang, Zhigang Lin, Shuijin Chen, Lechun Chen, Hongye Huang, Hui Lin, Shiye Wu
Neuropathic Pain (NP) is often accompanied by mood disorders, which seriously affect the quality of life of patients. This study aimed to analyze the hotspots and trends in NP-related mood disorder research using bibliometric methods and to provide valuable predictions for future research in this field.Articles and review articles on NP-related mood disorders published from January 2003 to May 2023 were retrieved from the Web of Science Core Collection. We used CiteSpace to analyze publications, countries, institutions, authors, cited authors, journals, cited journals, references, cited references, and keywords. We also analyzed collaborative network maps and co-occurrence network maps.A total of 4,540 studies were collected for analysis. The number of publications concerning NP-related mood disorders every year shows an upward trend. The United States was a major contributor in this field. The University of Toronto was the most productive core institution. C GHELARDINI was the most prolific author, and RH DWORKIN was the most frequently cited author. PAIN was identified as the journal with the highest productivity and citation rate. The current research hotspots mainly included quality of life, efficacy, double-blind methodology, gabapentin, pregabalin, postherpetic neuralgia, and central sensitization. The frontiers in research mainly focused on the mechanisms associated with microglia activation, oxidative stress, neuroinflammation, and NP-related mood disorders.In conclusion, the present study provided insight into the current state and trends in NP-related mood disorder research over the past 20 years. Consequently, researchers will be able to identify new perspectives on potential collaborators and cooperative institutions, hot topics, and research frontiers in this field.
神经性疼痛(NP)常伴有情绪障碍,严重影响患者的生活质量。本研究旨在利用文献计量学方法分析NP相关情绪障碍研究的热点和趋势,并为该领域未来的研究提供有价值的预测。我们从Web of Science Core Collection中检索了2003年1月至2023年5月发表的有关NP相关情绪障碍的文章和综述文章。我们使用 CiteSpace 对出版物、国家、机构、作者、被引用作者、期刊、被引用期刊、参考文献、被引用参考文献和关键词进行了分析。我们还分析了协作网络图和共现网络图。有关NP相关情绪障碍的论文数量呈逐年上升趋势。美国是这一领域的主要贡献者。多伦多大学是最有成果的核心机构。C GHELARDINI 是最多产的作者,RH DWORKIN 是最常被引用的作者。PAIN 被认为是产量和引用率最高的期刊。当前的研究热点主要包括生活质量、疗效、双盲方法学、加巴喷丁、普瑞巴林、带状疱疹后神经痛和中枢敏化。研究前沿主要集中在与小胶质细胞激活、氧化应激、神经炎症和 NP 相关情绪障碍有关的机制上。总之,本研究深入探讨了过去 20 年 NP 相关情绪障碍研究的现状和趋势。因此,研究人员将能从新的视角发现该领域潜在的合作者和合作机构、热点话题和研究前沿。
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引用次数: 0
A preliminary study evaluating self-reported effects of cannabis and cannabinoids on neuropathic pain and pain medication use in people with spinal cord injury 一项初步研究,评估自我报告的大麻和大麻素对脊髓损伤患者神经性疼痛和止痛药使用的影响
Pub Date : 2023-12-21 DOI: 10.3389/fpain.2023.1297223
Kristiina Kinnunen, Linda E. Robayo, N. Cherup, Scott I. Frank, Eva Widerström-Noga
Approximately 60% of individuals with a spinal cord injury (SCI) experience neuropathic pain, which often persists despite the use of various pharmacological treatments. Increasingly, the potential analgesic effects of cannabis and cannabinoid products have been studied; however, little research has been conducted among those with SCI-related neuropathic pain. Therefore, the primary objective of the study was to investigate the perceived effects of cannabis and cannabinoid use on neuropathic pain among those who were currently or had previously used these approaches. Additionally, the study aimed to determine if common pain medications are being substituted by cannabis and cannabinoids. Participants (N = 342) were recruited from existing opt-in listserv sources within the United States. Of those, 227 met the inclusion criteria and were enrolled in the study. The participants took part in an anonymous online survey regarding past and current use of cannabis and their perceived effects on neuropathic pain, including the use of pain medication. Those in the sample reported average neuropathic pain intensity scores over the past week of 6.8 ± 2.1 (0 to 10 scale), reflecting a high moderate to severe level of pain. Additionally, 87.9% noted that cannabis reduced their neuropathic pain intensity by more than 30%, and 92.3% reported that cannabis helped them to better deal with their neuropathic pain symptoms. Most participants (83.3%) also reported substituting their pain medications with cannabis, with the most substituted medication categories being opioids (47.0%), gabapentinoids (42.8%) and over-the-counter pain medications (42.2%). These preliminary results suggest that cannabis and cannabinoids may be effective in reducing neuropathic pain among those with SCI and may help to limit the need for certain pain medications.
约有 60% 的脊髓损伤(SCI)患者会出现神经病理性疼痛,尽管使用了各种药物治疗,但疼痛往往持续存在。人们对大麻和大麻素产品的潜在镇痛效果进行了越来越多的研究;然而,针对 SCI 相关神经病理性疼痛患者的研究却很少。因此,本研究的主要目的是调查目前或曾经使用过大麻和大麻素的患者对神经性疼痛的感知效果。此外,该研究还旨在确定常见止痛药物是否被大麻和大麻素所替代。参与者(N = 342)是从美国现有的选择加入列表服务器来源招募的。其中,227 人符合纳入标准并被纳入研究。参与者参加了一项匿名在线调查,内容涉及过去和现在使用大麻的情况及其对神经性疼痛的感知效果,包括使用止痛药物的情况。样本中的参与者报告说,过去一周的神经性疼痛强度平均得分为 6.8 ± 2.1(0 至 10 分),反映出中度至重度疼痛的程度较高。此外,87.9% 的人指出大麻能将他们的神经性疼痛强度降低 30% 以上,92.3% 的人表示大麻能帮助他们更好地应对神经性疼痛症状。大多数参与者(83.3%)还报告说,他们用大麻替代了止痛药物,替代最多的药物类别是阿片类药物(47.0%)、加巴喷丁类药物(42.8%)和非处方止痛药物(42.2%)。这些初步结果表明,大麻和大麻素可以有效减轻 SCI 患者的神经性疼痛,并有助于限制对某些止痛药物的需求。
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引用次数: 0
Editorial: Emerging trends in pediatric pain 社论:儿科疼痛的新趋势
Pub Date : 2023-12-21 DOI: 10.3389/fpain.2023.1346075
Kenneth Craig
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引用次数: 0
Hidden family rules: perspective on a dysfunctional paternalistic system and the persistence of pain 隐性家规:透视功能失调的家长制和持续的痛苦
Pub Date : 2023-12-14 DOI: 10.3389/fpain.2023.1303853
M. Hudson, Mark I. Johnson
This article explores how paternalistic control and power reside within the family system and how this may influence pain and its persistence. Drawing upon clinical case studies and existing literature, this exploration emphasises the role of paternal dysfunction in creating emotional memory images and delves into how this may influence the chronification and treatment resistance of pain (i.e., making pain “sticky”). We argue that a dysfunctional paternalistic family system, often characterised by authoritarian dynamics, emotional neglect, and abuse, results in adverse experiences and emotional memory images that create a fertile ground for the entrenchment and propagation of psychosomatic symptoms, including pain. Further, the paper emphasizes the potential intergenerational effects of such a scenario, where inherited “Family Rules” drive maladaptive coping mechanisms, which contribute to the persistence of psychological and physiological distress across generations. Understanding these complexities offers new perspectives on treating psychological disorders and their physiological ramifications. It also highlights the urgency of addressing dysfunctional familial dynamics in psychotherapeutic interventions for both immediate and long-term psychophysiological health outcomes.
本文探讨了家长式控制和权力如何存在于家庭系统中,以及这可能如何影响疼痛及其持续性。通过临床案例研究和现有文献,本文强调了父权功能失调在创建情感记忆图像中的作用,并深入探讨了这可能如何影响疼痛的慢性化和治疗阻力(即使疼痛 "粘性")。我们认为,功能失调的父权制家庭系统通常以专制动力、情感忽视和虐待为特征,会导致不良经历和情感记忆图像,为包括疼痛在内的心身症状的巩固和传播创造肥沃的土壤。此外,本文还强调了这种情况可能产生的代际影响,即遗传的 "家庭规则 "会驱动不适应的应对机制,从而导致心理和生理困扰跨代持续存在。了解这些复杂性为治疗心理障碍及其生理影响提供了新的视角。这也凸显了在心理治疗干预中解决功能失调的家庭动力学问题的紧迫性,以获得直接和长期的心理生理健康结果。
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引用次数: 0
Pain associated with breast cancer: etiologies and therapies 与乳腺癌相关的疼痛:病因和疗法
Pub Date : 2023-12-11 DOI: 10.3389/fpain.2023.1182488
Lisa V. Doan, Jenny Yoon, Jeana Chun, Raven Perez, Jing Wang
Pain associated with breast cancer is a prevalent problem that negatively affects quality of life. Breast cancer pain is not limited to the disease course itself but is also induced by current therapeutic strategies. This, combined with the increasing number of patients living with breast cancer, make pain management for breast cancer patients an increasingly important area of research. This narrative review presents a summary of pain associated with breast cancer, including pain related to the cancer disease process itself and pain associated with current therapeutic modalities including radiation, chemotherapy, immunotherapy, and surgery. Current pain management techniques, their limitations, and novel analgesic strategies are also discussed.
与乳腺癌相关的疼痛是一个普遍存在的问题,对生活质量造成了负面影响。乳腺癌疼痛不仅限于病程本身,目前的治疗策略也会诱发疼痛。这一点,再加上乳腺癌患者人数的不断增加,使得乳腺癌患者的疼痛管理成为一个日益重要的研究领域。这篇叙述性综述总结了与乳腺癌相关的疼痛,包括与癌症疾病过程本身相关的疼痛,以及与当前治疗方式(包括放疗、化疗、免疫疗法和手术)相关的疼痛。此外,还讨论了当前的疼痛治疗技术、其局限性以及新型镇痛策略。
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引用次数: 0
The effects of upper- vs. lower-body aerobic exercise on perceived pain in individuals with chronic knee pain: a randomised crossover trial 上半身与下半身有氧运动对慢性膝关节疼痛患者疼痛感的影响:随机交叉试验
Pub Date : 2023-12-06 DOI: 10.3389/fpain.2023.1277482
Rachel Deere, Enhad A. Chowdhury, Abby Tabor, Dylan Thompson, J. Bilzon
Some patients with chronic knee pain experience an increase in knee pain following a single bout of exercise involving their knee joint, which can negatively affect exercise adherence and thus result in reduced overall health and lack of disease management. We want to determine whether a single bout of upper-body (UB) aerobic arm-ergometry exercise is effective in reducing the experience of pain in those with chronic knee pain compared with lower-body (LB) aerobic leg ergometry exercise.A total of 19 individuals (women = 11, men = 8; age = 63 ± 8 years; body mass index = 24 ± 3 kg/m2) who suffered from chronic knee pain for ≥3 months took part in this study. Arm-ergometry and cycle-ergometry exercises were performed for 30 min at a moderate intensity, separated by 7 days. Pain intensity was assessed by means of a visual analogue scale (VAS) pre- and post-exercise and for 7 days post-exercise. Pressure pain threshold (PPT) and mechanical detection threshold (MDT) were measured pre- and post-exercise at both local and distal anatomical sites. Data are presented as mean ± SD.VAS pain was significantly reduced (p = 0.035) at 1 day post-exercise following the UB exercise trial (−1.4 ± 0.8) when compared with the LB exercise trial (+0.1 ± 2.1). Both UB and LB exercises were effective in reducing local and distal PPT. MDT responses were heterogeneous, and no differences between the UB and LB exercise conditions were noted.An acute bout of upper-body aerobic arm-ergometry exercise evoked a significant decrease in the affected knee joint pain in individuals with chronic knee pain of up to 24 h/1 day post-exercise compared with lower-body aerobic exercise. While the exact mechanisms remain unclear, upper-body exercise may offer a viable, novel therapeutic treatment for patients with chronic knee pain.
一些患有慢性膝关节疼痛的患者在一次涉及膝关节的运动后,膝关节疼痛会增加,这可能会对运动的坚持产生负面影响,从而导致整体健康状况下降和缺乏疾病管理。我们想确定与下肢有氧运动相比,单次上肢有氧运动是否能有效减少慢性膝关节疼痛患者的疼痛体验。共19人(女11人,男8人;年龄= 63±8岁;体重指数= 24±3kg /m2)慢性膝关节疼痛≥3个月的患者参加本研究。进行中等强度的手臂运动和周期运动,每次30分钟,间隔7天。通过视觉模拟量表(VAS)评估运动前后和运动后7天的疼痛强度。在局部和远端解剖部位测量运动前和运动后的压力疼痛阈值(PPT)和机械检测阈值(MDT)。数据以mean±SD表示。与LB运动试验(+0.1±2.1)相比,UB运动试验后1天VAS疼痛显著减少(p = 0.035)(- 1.4±0.8)。UB和LB锻炼均可有效减少局部和远端PPT。MDT反应是异质性的,UB和LB运动条件之间没有差异。与下肢有氧运动相比,急性上肢有氧运动可显著减轻慢性膝关节疼痛患者运动后24小时/1天的膝关节疼痛。虽然确切的机制尚不清楚,但上肢运动可能为慢性膝关节疼痛患者提供一种可行的、新颖的治疗方法。
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引用次数: 0
Editorial: Novel migraine therapies: consolidating evidence from the real world 社论:新型偏头痛疗法:整合来自现实世界的证据
Pub Date : 2023-12-05 DOI: 10.3389/fpain.2023.1340268
Lanfranco Pellesi
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引用次数: 0
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Frontiers in Pain Research
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