Pain Medicine最新文献

Objective: The aim of this study was to evaluate the efficacy and safety of a single trigger point injection (TPI) of a local anesthetic for the treatment of myofascial pain syndrome (MPS) in patients with incurable cancer.

Methods: This multicenter, exploratory, open-label, randomized comparative trial was conducted in five specialized palliative care departments. Hospitalized patients with incurable cancer who had been experiencing pain related to MPS were randomized to receive either a TPI of 1% lidocaine plus conventional care (TPI group) or conventional care alone (control group). The short-term efficacy and occurrence of adverse events (AEs) were compared between groups. The primary endpoint was the percentage of patients who experienced a reduction in pain scores of ≥50%, assessed using an 11-point Numerical Rating Scale, at 3 days post-intervention. Adverse events were assessed using the Common Terminology Criteria for AEs v5.0.

Results: Fifty patients were enrolled, and the trial completion rate was 100%. The proportion of patients who experienced an improvement in Numerical Rating Scale pain scores of ≥50% was 70.8% (95% confidence interval, 52.4%-89.2%) in the TPI group and 0.0% in the control group; the difference was statistically significant (P < .001). In the TPI group, one case (4.2%) of Grade 1 nausea and 1 case (4.2%) of Grade 1 somnolence were reported.

Conclusion: A single TPI of a local anesthetic is safe and efficacious in inducing an immediate reduction in MPS-related pain in patients with incurable cancer. Clinical trials registration number: This study was registered with the Japan Registry of Clinical Trials (approval number: jRCTs051210132) on December 16, 2021. https://jrct.niph.go.jp/en-latest-detail/jRCTs051210132.Approval of the research protocol by a Certified Review Board: The present study was approved by the Wakayama Medical University (reference number: CRB5180004. Registered 26 May 2021).

Background: Endometriosis, characterized by the presence of endometrial-like tissue outside the uterus, results in chronic pelvic pain. However, lesion characteristics alone cannot fully explain the complexity of endometriosis-related pain. Pain catastrophizing, a cognitive process that influences pain perception, has traditionally been studied through cross-sectional or two-wave designs, which struggle to capture its dynamic interplay with endometriosis pain. To address these gaps, our study explores the bidirectional relationship between pain catastrophizing and pain outcomes-including intensity, frequency, and flares-over a detailed four-week period, an aggregated 30-day timeframe, and across sensory and affective dimensions.

Methods: A Latent Growth Curve Model assessed the relationship between pain catastrophizing, initial pain levels, and endometriosis pain trajectories over four weeks. Additionally, four mediator models explored how baseline pain catastrophizing affects various pain aspects, including sensory and affective dimensions, and its subsequent influence on pain catastrophizing.

Results: Results indicate that high levels of pain catastrophizing significantly escalate endometriosis pain over four weeks, affecting average pain intensity, episode frequency, and flares over 30 days. Pain catastrophizing also adversely impacts sensory and affective dimensions. These elements partially mediate baseline pain catastrophizing's effect on week five levels, revealing a bidirectional relationship. Notably, while the affective dimension amplifies subsequent pain catastrophizing, the sensory dimension exerts a contrasting negative influence.

Conclusion: The study highlights the bidirectional influence between pain catastrophizing and several aspects of endometriosis-related pain. Sensory and affective dimensions play distinct roles, with implications for personalized interventions. Limitations and clinical relevance are discussed.

Objective: This study leverages natural language processing techniques to identify specific practices older adults with chronic pain adopt to enhance well-being.

Method: We applied network topic modeling to open-ended survey responses from 683 adults (57% female) who reported experiencing chronic pain in the Midlife in the United States (MIDUS) study, analyzing responses to the question "What do you do to make your life go well?" Structural equation modeling was used to examine the relationships between identified topics and measures of pain interference and prescription pain medication use, adjusting for sociodemographics and well-being indicators.

Results: The analyses revealed twelve key topics, including avoiding stress, maintaining social connections, and practicing spirituality and faith. Notably, maintaining social connections was negatively associated with pain interference (β = -0.14, SE = 0.05, p < 0.05) and prescription pain medication use (β = -0.11, SE = 0.04, p < 0.05).

Conclusion: The findings demonstrate the utility of network topic modeling in identifying complex psychosocial dimensions influencing chronic pain management, providing insights into the distinct role of well-being practices in shaping pain outcomes.

Background: Little research has assessed the efficacy of interdisciplinary pain management programs (IPMPs) for complex regional pain syndrome (CRPS), whereas evidence shows that IPMPs are effective for low back pain (LBP) and chronic widespread pain (CWP). This study aimed to determine whether outcomes following an IPMP differ for people with CRPS compared to LBP and CWP. In addition, we determined whether it is possible to predict IPMP outcomes using baseline characteristics.

Methods: People with CRPS (N = 66) who had completed a 3-week IPMP were compared with age- and gender- matched controls with LBP (N = 66) and CWP (N = 66). Measures of pain intensity, pain interference and psychological factors were extracted for pre- and post-program, and at 1, 6 and 12 months. Latent class analysis identified recovery trajectories for pain intensity and pain interference. Chi-square analyses assessed differences between diagnostic groups in recovery trajectories. Machine learning models were implemented to predict recovery trajectories from baseline scores.

Results: Two recovery trajectories for each dependent variable (pain interference and for pain intensity) were identified: good responders and poorer responders. Following IPMPs, 37% of people belonged to a good responder recovery trajectory for pain interference, and 11% belonged to a good responder recovery trajectory for pain intensity. Recovery trajectories were equal across the three diagnostic groups (CRPS, LBP, CWP) for pain interference (χ2=1.8, p=0.4) and intensity (χ = 0.2, p=0.9). Modelling to predict outcomes correctly classified 69% of cases for pain interference and 88% of cases for pain intensity recovery trajectories using baseline scores.

Conclusion: People with CRPS, LBP, and CWP experience similar benefits following an IPMP. This supports the use of IPMPs for people with CRPS.