Pain Medicine最新文献

Objective: To assess the effectiveness of cognitive functional therapy (CFT) in reducing disability and pain compared to other interventions in chronic spinal pain patients.

Methods: Five databases were queried to October 2023 for retrieving randomized controlled trials (RCTs), including patients with chronic spinal pain and administering CFT. Primary outcomes were disability and pain. Secondary outcomes included psychological factors, quality-of-life, patient satisfaction and adverse events. Two independent reviewers performed study selection, data extraction, risk of bias assessment (Cochrane RoB 2.0), and evidence certainty (GRADE approach). Random-effect models were used for meta-analyses. Clinical relevance was assessed with the Smallest Worthwhile Effect.

Results: Eight RCTs (N = 1228) for chronic low back pain (CLBP), one (N = 72) for chronic neck pain (CNP) were included. Compared to other conservative interventions, CFT may reduce disability (MD: -9.41; 95%CI: -12.56, -6.27) and pain (MD: -1.59; 95%CI: -2.33, -0.85 for CLBP) at short-term follow-up with probable to possible clinical relevance in CLBP and with low and very low evidence certainty, respectively. Similar results, with larger effect sizes, were observed for CFT compared to any unstructured or unsupervised minimal care treatments. Efficacy persisted in longer-term follow-ups, except for comparison with other conservative interventions. The CNP study showed positive results for CFT. Evidence certainty was low to very low. Sparse evidence was found for secondary outcomes.

Conclusion: CFT may offer clinically relevant benefits for CLBP, although the evidence remains mainly of low to very low certainty. Well-conducted studies, particularly in CNP and other spinal pain conditions are needed to strengthen these findings.

Registration: PROSPERO CRD42023482667.

Introduction: Deep Brain Stimulation (DBS) and Motor Cortex stimulation (MCS) are invasive interventions in order to treat various neuropathic pain syndromes such as Central Post-Stroke Pain. While each treatment has varying degree of success, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesised.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Three databases were searched, and articles published from January 2000 October 2024 were included (last search date 25 October 2024). Meta-Analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores.

Results: Of the 478 articles identified, 32 were included in the analysis (330 patients- 139 DBS, & 191 MCS). The improvement in mean VAS score for patients that underwent DBS post-surgery was 48.6% compared to a score of 53.1% for patients that had MCS. The pooled number of patients who improved after DBS was 0.62 (95% CI, 0.51-0.71, I2=16%). The pooled number of patients who improved after MCS was 0.64 (95% CI, 0.53-0.74, I2=40%).

Conclusion: The use of neurosurgical interventions such as DBS and MCS are last-resort treatments for Central Post-Stroke Pain, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done to determine the appropriate surgical intervention in the treatment of Central Post-Stroke Pain.

Objective: Chronic pain is a global health concern and often interferes with multiple aspects of individuals' lives (eg, physical activities), diminishing a person's ability to engage in activities that promote meaning in life. However, it is not well understood how believing that one can live a meaningful life despite pain could contribute to improved function among individuals with chronic pain. The aim of the present study was to better understand the role that belief in living a meaningful life despite pain might have on adjustment to chronic pain.

Methods: Participants (n = 164) were individuals with chronic pain who completed baseline data from 2 closely related randomized clinical trials. Hierarchical regression analyses were used to examine the hypotheses that one's belief in living a meaningful life despite pain will be associated with function (pain interference and symptoms of posttraumatic stress disorder, depression, and anxiety) and that the belief in living a meaningful life despite pain would moderate the associations between pain intensity and function.

Results: Belief in living a meaningful life despite pain was significantly associated with less pain interference and less severe symptoms of posttraumatic stress disorder, anxiety, and depression, supporting the potential role of this variable in adaptive adjustment to chronic pain. However, one's belief in living a meaningful life despite pain did not moderate the associations between pain intensity and function.

Conclusions: Results provide important theoretical and clinical information about how believing that one can live a meaningful life despite pain might serve as an important process for adjustment to chronic pain.

Background: Radiofrequency ablation is a common non-opioid treatment to manage chronic knee pain. The inferior medial genicular nerve is conventionally targeted. It has been suggested that the infrapatellar branch (saphenous nerve) should also be targeted. There is controversy regarding the contribution of the infrapatellar branch to the innervation of the knee joint capsule.

Objective: (1) Identify the frequency of the branching pattern(s) of the infrapatellar branch in three-dimensional (3D); (2) Assess spatial relationships of branches of infrapatellar branch to the inferior medial genicular nerve; (3) Determine if capturing infrapatellar branch could result in additional benefit to the existing protocol.

Design: Anatomical study.

Methods: The infrapatellar branch and inferior medial genicular nerve were serially dissected, digitized, and modelled in 3D in 7 specimens (mean age 91.3 ± 6.5; 2F/5M) and their relationship documented. The spatial relationship of the nerves was used to assess the anatomical efficacy of including the infrapatellar branch in the protocol.

Results: The infrapatellar branch is most frequently a cutaneous nerve. This nerve was variable and found to be unbranched or have 2-3 branches and in all specimens was located superficial to the branches of inferior medial genicular nerve. When the infrapatellar branch (1) coursed more distally, the strip lesion would not capture the infrapatellar branch but would capture inferior medial genicular nerve consistently; (2) overlapped with the inferior medial genicular nerve, the strip lesion would capture both nerves.

Conclusions: Proposed protocol targeting the infrapatellar branch is likely to capture the inferior medial genicular consistently regardless of the anatomical variation of the infrapatellar branch.

Objective: To explore the clinical relevance and assay sensitivity of using personalized outcomes using data from a randomized clinical trial (RCT) in people with chemotherapy-induced peripheral neuropathy (CIPN).

Design: This study is a secondary analysis that leveraged data from a RCT of transcutaneous electrical stimulation for CIPN to test whether personalized outcomes could minimize potential floor effects and increase the assay sensitivity of pain clinical trials (ie, ability to detect a true treatment effect).

Setting: Participants were recruited for a RCT from community oncology clinics in the United States.

Participants: Adults with CIPN (N = 72) who reported on average ≥4 intensity (measured via a 7-day baseline diary) for at least 1 of the following pain qualities: hot/burning pain, sharp/shooting pain, and/or cramping.

Methods: Personalized outcomes were defined based on participants' unique presentation of pain qualities at baseline, measured via 0-10 numeric rating scales (NRS), or ranking of the distress caused by the pain qualities. Analysis of covariance models estimated the treatment effect as measured by personalized and non-personalized outcomes.

Results: The adjusted mean difference between groups was higher using personalized outcomes (ie, 1.21-1.25 NRS points) compared to a non-personalized outcome (ie, 0.97 NRS points), although the standardized effect sizes were similar between outcomes (0.49-0.54).

Conclusions: These results suggest that personalized pain quality outcomes could minimize floor effects, while providing similar assay sensitivity to non-personalized pain quality outcomes. Personalized outcomes better reflect an individual's unique experience, inherently providing more clinically relevant estimates of treatment effects. Personalized outcomes may be advantageous, particularly for clinical trials in populations with high inter-individual variability in pain qualities.