Pain Medicine最新文献

Objective: This study aims to evaluate the effectiveness and tolerability of a phytotherapeutic topical gel (Douloff®) compared to oral paracetamol for acute pain resulting from minor limb soft tissue injuries.

Methods: A prospective, multicenter, randomized, double-blind study conducted over 13 months in three EDs. Patients aged 18 years and older, with minor limb soft tissue injuries, were randomized into Douloff® (n = 765) and paracetamol (n = 750) groups. The primary outcome was the pain resolution rate (reduction of at least 50% of pain intensity, measured by the numeric rating scale (NRS) on active motion at day-7compared to NRS at discharge). Secondary outcomes included time to pain resolution, rescue analgesia, patient satisfaction and adverse events.

Results: The groups were comparable in terms of baseline characteristics. On day-7, resolution of pain was observed in 641 patients (83.7%) in Douloff® group versus 535 patients (71.3%) in paracetamol group (OR 1.27; 95% CI 1.015-1.6; p = 0.02). Median time to reach pain resolution was 4.5 ± 2.9 days in Douloff® group compared with 5.6 ± 3.3 days in paracetamol group (p < 0.001). Patients in Douloff® group required less rescue analgesics (48.2%) compared to paracetamol group (59.1%) (-10.9%, 95% CI -15.89 to -5.9; p < 0.001). No major adverse events were observed in either group, and 89.4% of patients in Douloff® group were satisfied, compared to 92.5% in the paracetamol group (p < 0.001).

Conclusion: Douloff®, a topical herbal paste, is superior to oral paracetamol in the management of acute pain related to soft tissue injuries. It can be considered as an alternative to conventional analgesics.

Background: The National Institutes of Health (NIH) Pain Common Data Elements (CDEs) provide a standardized framework for pain research, but their implementation and interpretation present challenges.

Objectives: To review the NIH CDE Program's selected pain domains, provide best practices for implementing required questions, and offer a checklist for appropriate CDE use in clinical trials and secondary data analysis. This work analyzed the 10 core pain research domains selected by the NIH CDE Program and discuss their limitations and considerations for use.

Results: The manuscript provides an overview of the 10 core pain research domains, including pain intensity, interference, physical function, sleep, catastrophizing, depression, anxiety, global impression of change, substance use screening, and quality of life. It offers sample scenarios for implementing required questions and presents a checklist to guide researchers in using pain CDEs effectively for clinical trials and secondary data analysis.

Conclusion: Key challenges identified include contextual variability, lack of validation across all pain conditions and populations, and potential misuse or misinterpretation of measures. This work proposes solutions such as supplementary measures, context-specific guidance, comprehensive training programs, and ongoing refinement of the CDE framework. While NIH Pain CDEs are valuable tools for standardizing pain assessment in research, addressing challenges in their implementation and interpretation is crucial for improving the consistency, validity, and interpretability of pain research data, ultimately advancing the field and enhancing patient care.

Mentorship plays a vital role in pain medicine, guiding professionals from medical training through independent practice. This article explores how mentorship fosters research, enhances clinical competence, and promotes multidisciplinary collaboration. Drawing on insights from leading institutions, we propose a structured mentorship framework tailored to different career stages. Effective mentorship cultivates research skills, expands academic networks, and provides early exposure to the field, shaping long-term career trajectories. It also strengthens clinical expertise, encourages cross-disciplinary collaboration, and advances diversity, equity, and inclusion in medicine. Structured academic mentorship models offer longitudinal guidance for sustained professional development. By aligning mentor-mentee goals and ensuring consistent support, mentorship programs maximize professional growth and ultimately improve patient outcomes. This article outlines key strategies and tools for building effective mentorship programs, emphasizing their transformative impact on the field of pain medicine.

Objectives: Despite significant medical treatment advancements, interventional treatments for intractable headache disorders are limited. This study's objective is to detail a novel percutaneous approach (the "Q2 approach") and its technical considerations for implanting peripheral neuromodulation stimulators (PNS) to the C2 dorsal root ganglion (C2-DRG) at the C2 lamina, a previously unattempted target, as a treatment for intractable headache.

Methods: In an outpatient setting, under combined ultrasound and fluoroscopic guidance, PNS electrodes were percutaneously implanted at the C2-DRG in patients under moderate sedation. The final electrode position was determined by intraoperative patient feedback to ensure optimal stimulation. Four patients were included to demonstrate technical parameters and feasibility. Follow-ups were conducted on postoperative days 10, 30, 60, and 100-120.

Results: The Q2 approach allows safe C2-DRG PNS implantations in an outpatient setting. Average operative duration was <60 minutes. All 4 patients achieved >50% pain relief during the 60-day implant period, and 3 of 4 demonstrated sustained benefit beyond the implant period. No complications (eg, lead migration, infection) were observed.

Conclusions: The present technical note demonstrates the feasibility of a novel, safe, minimally invasive approach to access the C2-DRG at the C2 lamina for the treatment of intractable headaches. The use of PNS on the C2-DRG fills an important gap in headache management, as it provides an alternative neuromodulation treatment modality to the existing destruction/denervation-based techniques.

Objective: Fibromyalgia, which is becoming increasingly common today, affects the quality of life of those affected. The aim of this study was to investigate the relationship between diet and pain, disease severity, and biochemical parameters in fibromyalgia.

Design: Cross-sectional design using validated questionnaires.

Setting: Fibroyalgia patients with Traditional and Complementary Medicine clinics.

Subject: In total, 84 patients with fibromyalgia (FM), which was diagnosed by a rheumatologist.

Methods: The cross-sectional study was conducted with 84 fibromyalgia patients in Turkey. The Dietary Inflammatory Index (DII) was calculated by a 24-hour diet recall. Self-reported pain levels and disease severity were evaluated by the Visual Analog Scale (VAS) and a Revised Fibromyalgia Impact Questionnaire (FIQR), respectively. Antropometric measures and biochemical parameters associated with inflammation were also evaluated.

Results: Linear regression analysis revealed that the VAS pain score [β (95% confidence interval [CI])=1.72 (0.90-2.55), P < .001], FIQ-R [β (95% CI)=5.62 (0.14-11.09), P < .001] and uric acid/creatinine ratio [β (95% CI)=0.21 (-0.10 to 0.52), P < .001] were positively associated with the DII after adjustments for body mass index (BMI), body fat, fat free mass, cholesterol, fiber, caroten, iron, magnesium, vitamine C reported by the patients with FM.

Conclusions: A pro-inflammatory diet was associated with higher pain, disease severity and uric acid/creatinine ratio in patients with FM.

Objective: We examined the intersection between chronic pain stigma and racial discrimination, separately among Black and White US adults with chronic low back pain.

Methods: Participants completed measures of chronic pain stigma, lifetime experiences of racial discrimination, pain severity and interference. A composite variable representing the intersectionality of stigma and discrimination was created, and Black and White participants were separately categorized into 4 groups. Black participants were categorized as: (1) high discrimination/high stigma, (2) high discrimination/low stigma, (3) low discrimination/high stigma, and (4) low discrimination/low stigma. White participants were categorized as: (1) any discrimination/high stigma, (2) any discrimination/low stigma, (3) no discrimination/high stigma, and (4) no discrimination/low stigma.

Results: Black participants reported more frequent experiences of racial discrimination than White participants (P < .05), but there was not a racial difference in chronic pain stigma (P > .05). Among Black participants, those in the high discrimination/high stigma and low discrimination/high stigma groups reported greater pain severity and interference than those in the high discrimination/low stigma and low discrimination/low stigma groups (P < .05). Among White participants, those in the any discrimination/high stigma group reported greater pain severity and interference than those in the no discrimination/low stigma group (P < .05), but there were no differences in pain severity or interference between the any discrimination/no stigma and no discrimination/high stigma groups (P > .05).

Conclusion: Our findings suggest that the relationship of intersectional chronic pain stigma and racial discrimination with pain is nuanced and differs across racial groups.

Objective: To evaluate current administrative coding practices for opioid misuse within the World Health Organization's International Classification of Diseases (ICD) framework and develop standardized documentation recommendations.

Design: Systematic scoping review following PRISMA-ScR guidelines.

Setting: Analysis of studies using administrative databases, including electronic health records, insurance claims, and national healthcare utilization databases.

Subjects: Studies published in peer-reviewed journals examining administrative codes for opioid misuse, excluding those focused solely on illicit drugs, opioid use disorder, or using only natural language processing/qualitative methods.

Methods: Comprehensive search of Embase, Medline, Google Scholar, and PubMed databases following PRISMA-S extension guidelines. Three independent reviewers screened articles and extracted data. Study quality was assessed using a modified Newcastle-Ottawa Scale.

Results: Of 9,561 initial records, 19 studies met inclusion criteria. The use of ICD-10 code F11.9* (Opioid use) emerged as the most referenced method for documenting opioid misuse, distinguishing it from opioid use disorder methods (F11.1, opioid abuse; F11.2, opioid dependence). Studies demonstrated significant heterogeneity in coding practices, resulting in code-based definitions identifying only approximately 50% of cases compared to more comprehensive clinical assessment approaches.

Conclusions: While ICD-10 code F11.9* can effectively document opioid misuse as distinct from opioid use disorder, successful implementation requires consensus on the clinical definition of opioid misuse and documentation in the form of clear clinical guidelines and operationalized through enhanced electronic health record integration. Future research should focus on validating these approaches across diverse healthcare settings.