Journal of Pain Research最新文献

Objective: To assess whether Whole Health, a system of care that emphasizes non-pharmacological approaches for chronic pain management, is associated with changes in downstream utilization of invasive pain treatment procedures.

Methods: Longitudinal retrospective cohort analysis of VHA administrative data. A total of 53,412 Veterans with chronic pain were identified between April and September 2018, with 584 initiating Whole Health and 3794 initiating a complementary and integrative health (CIH) therapy independent of Whole Health (CIH-only). Whole Health included use of coaching, personal health planning, and other services including CIH referral. CIH therapies included chiropractic care, acupuncture, massage therapy, yoga, Tai Chi/Qigong, and meditation. Propensity score matching was used to estimate expected rates of invasive pain treatment procedures 0-3, 4-12, and 13-18 months after initiating Whole Health or CIH-only compared to similar Veterans who had not engaged in either.

Results: Overall, 14% of the population were female, 11% had received prior spine injections, 3.3% had received surgery, and 0.4% had an implantable spinal stimulator. Whole Health use was associated with 42% (-61% to -17%) lower utilization of invasive pain procedures at three months compared to matched patients who did not use Whole Health. This reduction was attenuated at 18 months: 22% (-39% to -5%). CIH-only was associated with 18% (-29% to -4%) lower utilization at three months compared with matched patients, but differences were minimal at 18 months: 1% (-9% to 9%).

Discussion: Whole Health care, including CIH therapies, may help patients interrupt patterns of escalating and invasive pain care.

Purpose: Given the number of people who suffer from chronic pain and the impact on healthcare resources, it is imperative that the people with pain receive an appropriate matched treatment due and stratified care. The aim of this study was to characterize chronic non-cancer pain (CNCP) patients' states, through an unsupervised cluster analysis, to implement clinical recommendations in pain care.

Patients and methods: Real-world ambulatory CNCP cohort of patients (n = 418) completed a multidimensional patient-reported registry, as part of a routine initial evaluation, in a multidisciplinary academic pain unit. A clustering analysis was performed according to: 1) pain intensity and relief; 2) quality of life; 3) number of adverse events; and 4) emergency department visits. A retrospective study was developed (n = 120) following the stratified analysis.

Results: From a principal component analysis, cut-off points were defined to discriminate between the six clusters and three groups of different pain intervention requirements. Those patients showed a significantly different monitoring and basal clinical status. Being older than 65 years old, retired or on medical leave, under opioids and anxiolytic prescription, had a severe impact on daily quality of life without any sex-difference.

Conclusion: These clusters based on real-world clinical information might be useful for screening even more where the access to physical exploration is limited. Follow-up analyses will support the replicability of this stratified care.

Mirror therapy is among the most widely used treatments for phantom limb pain. However, discrepancies exist in the way it is conducted, and its effectiveness varies widely. The aim of this scoping review was to evaluate the application of mirror therapy across the literature and to identify treatment features unique to studies with clinically significant pain reduction outcomes. Articles published until July 2024 were identified through a systematic search of the following electronic databases: Medline (via EBSCOhost), PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, PsycINFO (via EBSCOhost), Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), Africa-Wide Information (via EBSCOhost), and Scopus. Two reviewers independently conducted the screening of titles and abstracts, review of full-text articles, and data extraction. The results were analyzed descriptively. We included 32 studies in this review, 21 of which were deemed effective for achieving clinically significant pain reduction of 50% or 2 points on a 0-10 scale. There were inconsistencies in various treatment components including treatment setting, type of pre-treatment education, treatment technique, method of exercise delivery, treatment duration, and frequency of treatment sessions. Despite identifying common treatment features across studies with clinically significant pain reduction outcomes, we found no evidence of unanimous consensus in the literature towards any specific protocol for mirror therapy. Establishing a standardized treatment protocol could enhance the reliability and reproducibility of treatment outcomes in future studies and ensure a meaningful comparison between mirror therapy and other treatments in clinical trials and meta-analyses.

Purpose: Endoscopic spine surgery has been widely performed to treat degenerative spinal diseases to mitigate the risks and complications associated with traditional open surgery. However, endoscopic procedures pose challenges, including a limited field of view and a restricted operating space, which can affect the surgeon's learning curve. This study aimed to evaluate the learning curves for unilateral biportal endoscopic spinal surgery (UBESS) and percutaneous transforaminal endoscopic surgery (PTES) by performing cumulative sum (CUSUM) analysis and to assess their efficacies in managing degenerative spinal diseases.

Patients and methods: This retrospective cohort study included 100 consecutive patients who underwent PTES and 100 consecutive patients who received UBESS. CUSUM analysis was conducted to assess the learning curve, with cutoff points used to categorize the early and late phases. These two phases were analyzed in terms of differences in operative time, hospital stay, complications, and patient-reported outcome measures (PROMs). Additionally, PROMs between the PTES and UBESS groups, which were performed by the same surgeon, were compared.

Results: CUSUM analysis revealed that the operative time for PTES and UBESS decreased after 35 and 28 cases, respectively. Both early- and late-phase cases exhibited significant improvement in all PROMs postoperatively. Furthermore, PROMs did not differ between patients who underwent PTES and those who underwent UBESS.

Conclusion: Both procedures achieved comparable clinical outcomes with low complication incidences. However, achieving proficiency in PTES required a learning curve of at least 35 cases, whereas that in UBESS required a minimum of 28 cases.

Abstract:

Introduction: Radiotherapy, administered with or without chemotherapy is the gold standard treatment for cervical cancer with both curative and palliative intent. However, the treatments often result in adverse events, mainly chronic pelvic pain and bowel morbidity, which can negatively impact quality of life.

Aim: To systematically appraise peer reviewed evidence regarding chronic pelvic pain and bowel morbidity and their impact on quality-of-life of cervical cancer patients treated with radiotherapy with or without chemoradiation therapy.

Design: A systematic review of original peer-reviewed research evidence.

Data collection methods and tools: A systematic search conducted between April and May 2021, and updated in September 2024, using PubMed, Hinari, CINAHL and Google Scholar, for peer reviewed papers published between 2008 and 2019. Data were extracted using a structured checklist designed to capture key elements about the methods and findings of the research.

Results: There were 245 articles retrieved with 29 meeting the inclusion criteria. 11 studies were conducted in Europe, eight in Asia, one in North America, three in Africa, while six were multinational/multicontinental. 13 of the papers were longitudinal, 10 cross-sectional, three literature reviews, one open randomised controlled trial, and two retrospective studies of prospectively collected data. Studies reported disruptions in nearly all domains of quality-of-life, including global, physical, emotional/psychological, financial, sexual, social, role functioning as a result of being treated with radiotherapy or radio-chemotherapy.

Conclusion: Chronic pelvic pain and bowel morbidity are common adverse events experienced by cervical cancer patients receiving, or who have received, pelvic radiotherapy or radio-chemotherapy. Symptoms occur to varying degrees and exert a negative toll on the quality-of-life of women. Clinicians should be more aware and prioritise thorough assessment and management of symptoms before, during and after treatment. There is limited population-based and longitudinal research about the topic, and on chronic pelvic pain in general, which limits generalisability. Longitudinal studies with more extended periods of follow-up are needed.

Background: The informed consent process has traditionally taken place in person. The introduction of electronic consent (eConsent) has made remote consenting processes possible. Use of eConsent has increased since the COVID-19 pandemic. It has streamlined the process of consenting patients and has been shown to benefit the research study team and participants.

Econsent in the ketamine analgesia for long-lasting pain relief after surgery kalpas study: The KALPAS study is a multicenter, double-blind, randomized controlled study investigating the effectiveness of ketamine in reducing chronic post-mastectomy pain in women undergoing mastectomy for oncologic indication. The study uses a two-part consent form consisting of a master consent with information applicable to all sites and site-specific information. All potential participants receive the full two-part consent form for review. When signing the eConsent, however, all potential participants are provided with a concise summary of the informed consent document, an approach not widely used by multicenter studies. eConsent has been noted to be beneficial to research staff when trying to gather informed consent from participants who live far away from the hospital, want to include their family and friends, and for researchers who can approach patients outside of their clinical appointments.

Conclusion: The ability to consent patients remotely has allowed for a flexible workflow within sites and a more patient-centric process that focuses on including loved ones in the discussion and scheduling time to speak to a principal investigator. Demand for eConsent will likely continue in the post-COVID era, and use of a concise summary can allow for a more efficient consenting process.

Purpose: The objective of this research is to delve into the central pathological mechanisms involved in the transformation from acute to chronic pain.

Patients and methods: This study enrolled 86 individuals with acute neck pain and 89 with chronic neck pain. Utilizing a 3.0T MR scanner, we obtained three-dimensional T1-weighted imaging (3D-T1WI) images and analyzed structural differences between the two groups with Freesurfer software to evaluate alterations in cortical thickness. Additionally, Blood Oxygen Level-Dependent functional Magnetic Resonance Imaging (BOLD-fMRI) images were acquired to assess intergroup differences in low-frequency amplitude using DPARSF software.

Results: Chronic neck pain patients exhibited increased cortical thickness in the left rostral middle frontal, left isthmus cingulate, left superior frontal, and right precuneus regions compared to those with acute neck pain. Low-frequency amplitude measures revealed decreased activity in the left dorsolateral superior frontal gyrus and left postcentral gyrus, among other areas, and increased activity in the right middle frontal gyrus and the opercular part of the right inferior frontal gyrus.

Conclusion: Our findings indicate that dysfunction and structural changes in the limbic system and prefrontal cortex may play a pivotal role in the progression from acute to chronic neck pain. These insights provide a significant new direction for understanding the central mechanisms underlying pain chronicity.

Objective: Management of postoperative pain in pediatric patients is challenging. Traditional methods of postoperative pain management may not always provide adequate relief. We aim to compare the effect of Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) on the quality of postoperative analgesia in pediatrics undergoing lower abdominal surgeries.

Methods: We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library up to August 2024 for studies that compared QLB and TAPB in the context of pediatric lower abdominal surgery. Pooled mean difference (MD), standardized mean difference (SMD), and odds ratio (OR) were calculated by a random effect model using RevMan 5.4.

Results: Nine studies met the pre-defined inclusion criteria. Pooled analysis indicated that postoperative pain measured by the FLACC score was lower in the QLB group compared to the TAPB group (MD: -0.37; 95% CI: -0.51, -0.23; P < 0.00001). QLB was also associated with lower rescue analgesic demand (OR: 0.25; 95% CI, 0.13, 0.49; P < 0.0001), higher parent satisfaction (SMD: 0.78; 95% CI: 0.53, 1.02; P < 0.00001), longer time without the need for analgesic administration (MD: 1.04; 95% CI: 0.38, 1.71; P = 0.002), and lower paracetamol consumption (SMD: -1.40; 95% CI: -2.43, -0.36; P = 0.008). However, no significant difference was found in terms of postoperative nausea, vomiting, and heart rate.

Conclusion: QLB provides superior analgesia compared to TAPB in pediatrics undergoing lower abdominal surgeries.