Pain Medicine最新文献

Objective: Neuropathic pain significantly impacts quality of life (QoL), mental health, and function. Targeted Muscle Reinnervation (TMR) is an intervention that can effectively treat and prevent neuropathic pain, but its effects on psychosocial outcomes remain underexplored. This study evaluates psychosocial outcomes following TMR surgery for neuropathic pain in both amputees (both primary pTMR and secondary sTMR) and non-amputees.

Methods: In this prospective study, 46 patients (15 sTMR, 19 pTMR, 12 non-amputees) who underwent TMR for neuropathic pain management were assessed for psychosocial outcomes. Pre- and post-operative surveys measured pain catastrophizing (PROMIS), depression (PHQ-2), anxiety (GAD-2), sleep metrics (PROMIS Sleep Disturbance, sleep duration), and QoL (WHOQOL-2). Mean follow-up was 1.5 ± 0.8 years.

Results: Pain catastrophizing significantly decreased across all groups (overall from 50.39 ± 6.24 to 42.41 ± 4.40, p < 0.001). Depression and Anxiety scores improved significantly in the non-amputee and pTMR groups, but not in sTMR patients. Sleep disturbance decreased significantly in all groups (from 59.67 ± 8.64 to 51.82 ± 8.01, p < 0.001), while sleep duration increased (from 5.32 ± 1.63 to 6.09 ± 1.29 hours, p < 0.001). QoL scores improved significantly across all groups (from 2.45 ± 0.87 to 3.43 ± 0.62, p < 0.001). Patients with psychiatric comorbidities (60.9%) showed similar improvements, despite having higher pre- and post-operative depression and anxiety scores.

Conclusions: Patients who underwent TMR for neuropathic pain management demonstrated improved psychosocial outcomes. Non-amputees and pTMR patients demonstrated greater improvements in depression and anxiety compared to sTMR patients. Sleep quality and duration improved substantially, a previously underreported benefit of TMR. Future, larger prospective studies should further validate relationship between neuropathic pain reduction through TMR and psychosocial outcomes.

Background: Refractory chronic pain conditions remain challenging to manage, and intravenous infusions of ketamine, lidocaine, or their combination have emerged as potential therapeutic options.

Objective: To evaluate the analgesic effectiveness and safety of intravenous lidocaine, ketamine, and their combination in patients with refractory chronic pain.

Methods: We conducted a retrospective analytic study of patients treated between January 2020 and November 2024 at an outpatient pain clinic. Eligible patients had persistent severe pain (numerical rating scale [NRS] > 6/10) despite ≥ 3 months of multimodal pain management and received intravenous lidocaine, ketamine, or combination infusions. The primary outcome was immediate pain reduction post-infusion. Secondary outcomes included pain relief at 1 and 3 months, quality of life assessed by EQ-5D-5L, and associations between clinical characteristics and treatment response.

Results: A total of 120 patients were included. All three groups demonstrated significant reductions in NRS scores from baseline after the first infusion, with mean differences of 3.09 (95% CI 2.56-3.62) for lidocaine, 2.30 (95% CI 1.48-3.13) for ketamine, and 3.95 (95% CI 3.33-4.57) for combination therapy. Analgesic effects persisted at 1- and 3-month follow-up. Mild, self-limiting adverse effects occurred in 7.5% of patients. The combination group showed superior pain reduction at selected time points and greater improvements in quality of life at 3 months.

Conclusions: Intravenous lidocaine, ketamine, and combination infusions provide immediate and sustained pain relief in refractory chronic pain. Combination therapy may offer additional benefit beyond monotherapy, supporting its consideration in clinical practice.

Objective: To evaluate whether baseline disability, work impairment, and job occupation predicted post pain levels of a digital care program (DCP) for chronic spinal pain.

Design: Ad-hoc analysis of a real-world clinical registry of patients undergoing a DCP.

Setting: DCP delivered remotely across the United States.

Subjects: Adults with chronic spinal pain (N = 13,330) enrolled in a DCP through employer-sponsored health plans.

Methods: Predictors included baseline disability (Oswestry Disability Index or Neck Disability Index), work impairment (Work Productivity and Activity Impairment questionnaire-WPAI), and occupation (job type group). Primary outcome was the last pain score reported during the intervention (11-point Numeric Pain Rating Scale). Structural equation modeling was used, adjusted for demographic and clinical covariates. Moderation analysis assessed whether effects varied by pain location (neck vs. low back).

Results: Baseline disability and occupation significantly predicted post-treatment pain. Greater disability was associated with higher last pain scores (β = 0.30, SE 0.02, P < 0.001). Business-related occupations were non-significantly different from trade, transportation, and utilities, but showed higher last pain score than those in goods-producing (β=-0.18, SE 0.07, P = 0.015) and healthcare/education (β=-0.14, SE 0.04, P = 0.001) jobs. WPAI Overall and WPAI Activity were not significant predictors after adjustment. Predictor effects were consistent across spinal locations. Final model explained 21.3% of variance.

Conclusions: Baseline disability and occupation were predictors of outcomes post digital rehabilitation for chronic spinal pain, while work impairment was non-significant. Integrating these factors into routine screening may enhance predictive accuracy, patient communication, and facilitate personalized care pathways. These results encourage confirmatory studies to reinforce these findings.

Trial registration: ClinicalTrials.gov, NCT05417685. Registered on June 14, 2022; https://clinicaltrials.gov/study/NCT05417685.

Objective: Strategies are needed for patients with chronic pain who are using opioids to safely and effectively wean opioids without worsening of pain. The objective was to measure associations between medical cannabis authorization (MCA) and opioid milligram equivalents (OME) in patients with chronic non-cancer pain.

Design: A longitudinal, retrospective cohort analysis from July 2016 to August 2019.

Setting: Electronic health record data were analyzed.

Subjects: Adult patients (≥18 years) seen in a university-based pain clinic.

Methods: Longitudinal multilevel modeling with maximum likelihood estimation.

Results: Average overall OME at the final time point was 33.4 mg/day (SE = 1.18) with increase over time of 0.45 mg/day per quarter (not statistically significant). Average OME in those without MCA was 32.60 mg/day (SE = 1.11) versus 38.51 mg/day (SE = 4.81) in those with MCA, not significantly different. Medical cannabis consultation predicted a nonsignificant decrease of 14.25 mg/day OME. Long-term opioid use was a significant predictor with a mean OME of 85.34 mg/day, 63 mg/day higher than the rest of the cohort at the final quarter (t = 5.77, SE = 10.93, P < 0.0001).

Conclusions: In this longitudinal study of electronic health record data, MCA was not associated with a statistically significant decrease in OME over time. However, patients with long-term opioid use diagnostic code demonstrated a significantly higher endpoint OME. Future prospective research is needed to establish whether there are opioid-sparing effects of cannabis in humans.