Pain Medicine最新文献

Objective: Shoulder pain is a prevalent musculoskeletal disorder, affecting up to 70% of adults over their lifetime. Recently radiofrequency ablation (RFA) has gained attention as a treatment for joint pain. This study aims to evaluate the efficacy of internally cooled RFA (icRFA) in alleviating shoulder pain and improving both qualitative and quantitative measures of shoulder function.

Design: Prospective cohort study.

Subjects: 35 patients with chronic shoulder pain who responded positively to diagnostic blocks of the suprascapular nerve (SSN), axillary nerve (AN), and lateral pectoral nerve (LPN).

Methods: Patients underwent icRFA targeting SSN, AN, and LPN. Treatment response was assessed using numeric rating scale (NRS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (AROM) in flexion and abduction. Outcomes were measured at baseline, and at 1, 3, and 6 months post-cRFA. Patient characteristics were compared between responder and non-responder to cRFA treatment and correlation analyses were conducted to explore the relationship between pain relief and functional improvement.

Results: NRS pain levels significant decreased at 1 month (Adj. P < 0.0001), 3 month (Adj. P < 0.0001) and 6 month (Adj. P = 0.0002) post-icRFA, respectively. ASES score improved at 1 months (Adj. P < 0.0001), 3 month (Adj. P < 0.0001), and 6 months (Adj. P < 0.0001) post-icRFA, respectively. Flexion AROM improved at 1 months (Adj. P < 0.0001), 3 months (Adj. P < 0.0001), and 6 months (Adj. P = 0.0139) post-icRFA, respectively. Abduction AROM improved at 1 months (Adj. P < 0.0001), 3 months (Adj. P < 0.0001), and 6 months (P < 0.0001) post-RFA, respectively.

Conclusion: cRFA targeting the SSN, AN, and LPN is a safe and effective intervention, providing significant improvements in pain, functional activities of daily living, and AROM of shoulder for at least 6 months.

Objective: To identify longitudinal patterns in opioid dispensing dosages for workers with low back pain within a workers' compensation setting and to explore the risk factors associated with high-dose and persistent opioid use.

Method: We included workers with accepted claims for low back pain received by insurers between 01/01/2010 and 30/06/2016, with a follow-up period of 3.5 years (data censoring on 31/12/2020) across Victoria. Trajectory modelling was used to identify different opioid dispensing patterns. Logistic regressions were utilized to compare the workers' characteristics across different opioid dispensing pattern groups.

Results: Among 14,703 accepted claims, 33.1% reported receiving opioid medications as part of their claims. Six opioid dispensing patterns were identified. Individuals in the highest socioeconomic status (SES) quintile were less likely to rapidly escalate to dispensing high-dose opioids (OR 0.58, 99% CI 0.34, 0.99) compared to other quintiles. Workers dispensed gabapentinoids and antidepressants showed an increased risk of long-term high-dose opioid use (OR: 7.96, 99% CI 5.42, 11.69; OR: 21.75, 99% CI 14.30, 33.08) relative to workers with a single opioid dispensing. Those who had surgery were also more likely to use long-term high-dose opioids compared to a non-surgery group.

Conclusion: Lower SES, having gabapentinoids or antidepressants prescriptions or having had surgery are all associated with persistent opioid use among workers with LBP. These demographic and clinical risk factors for developing persistent opioid use could help identify individuals who would benefit from early intervention, reducing the likelihood of opioid dependence for pain management and minimizing the risk of harm.

Objective: To examine the demographic and clinical characteristics of patients attending pain management services who were receiving opioid agonist treatment (ie, methadone or buprenorphine for the treatment of opioid use disorder) in comparison to those taking prescription opioid analgesics in oral morphine equivalent daily doses at low (<40 mg) and high doses (>100 mg) using a national database from the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia.

Design: A cross-sectional study.

Setting: Australian pain services.

Subjects: Adult patients referred to Australian pain service clinics between 2016 and 2021.

Methods: Multinomial and bivariate logistic regression models were conducted to compare the demographic and clinical characteristics of patients on opioid agonist treatment and those taking other prescription opioid analgesics.

Results: Among 42,182 participants, most were female (56.8%), with a mean age of 51.7 years. People on opioid agonist treatment (n = 1,016) and high-dose opioids (n = 7,122) were similar in that they both had more severe mental health symptoms and longer pain duration, compared with the low-dose group (n = 20,517). Compared to the high-dose group, people on opioid agonist treatment had reduced odds of reporting more severe pain intensity, but increased odds of having multimorbidity, more severe anxiety and pain catastrophising thoughts.

Conclusions: These findings highlight the need for mental health treatment and the necessity of tailored multidisciplinary pain management for people in opioid agonist treatment.

Objectives: The aims of this study were: 1, to determine the ability of pain thresholds to differentiate between subjects with and without tension-type headache (TTH); and 2, to determine the capability of clinical, psychological and psychophysical variables to differentiate between individuals with frequent episodic (FETTH) or chronic (CTTH) tension-type headache.

Methods: A diagnostic accuracy study was conducted. Pressure pain threshold (PPTs) over the temporalis muscle, cervical spine, second metacarpal, and tibialis anterior muscle and dynamic pain thresholds (DPT) were bilaterally assessed in 100 individuals with TTH and 50 comparable non-headache subjects. Clinical headache parameters (headache diary), headache-associated burden (HDI), anxiety and depressive levels (HADS), sleep quality (PSQI), and state (STAI-S) - trait (STAI-T) anxiety levels were also evaluated. The area under the receiver operating characteristic (ROC) curve, optimal cut-off point, sensitivity, specificity, and positive and negative likelihood ratios (LR) for each variable were calculated.

Results: Individuals with TTH exhibited lower PPTs and DPT than those without TTH. No significant differences in PPTs and DPT were found between FETTH and CTTH individuals. Overall, no clinical, psychological or psychophysical variable exhibited an acceptable ROC value (≥0.7) for identifying between TTH patients and non-headache controls or between subjects with FETTH and CTTH.

Conclusion: Although individuals with TTH exhibit widespread pressure pain hyperalgesia, neither clinical nor psychological nor psychophysical variable had proper diagnostic accuracy to discriminate between individuals with/without TTH or between those with FETTH and CTTH. Further studies should clarify the clinical relevance of these findings.

Aim: The aim of this review was to systematically identify all evidence that used conventional medical management (CMM) as a comparator in randomised controlled trials (RCTs) of spinal cord stimulation (SCS) therapy, and to conduct a meta-analysis to investigate if continued CMM provides statistical or clinically meaningful pain relief and whether CMM effects have improved over the last few decades.

Methods: Databases were searched from inception to June 2024 for RCTs that compared SCS to CMM. The primary outcome of the review was absolute change in pain intensity from baseline to the last available follow-up in the CMM group, measured using a visual analogue scale or numerical rating scale. The measure of treatment effect for absolute change and percentage change in pain intensity from baseline was mean difference (MD) and 95% confidence interval (CI). Risk of bias (RoB) was assessed by using the revised Cochrane RoB tool. The protocol for this review is registered on PROSPERO (CRD42023449215).

Results: Meta-analysis of absolute change in pain intensity from baseline to last follow-up shows that CMM is not associated with any significant reductions in pain intensity (MD -0.11; 95% CI: -0.32 to 0.11; moderate certainty). Similar results were observed for percent change in pain intensity from baseline to last follow-up (MD -3.22%; 95% CI: -12.59% to 6.14%; moderate certainty). No significant differences were observed when considering decade of publication of the RCT for absolute (p = 0.065; moderate certainty) or percent change in pain intensity (p = 0.524; moderate certainty). Meta-analysis for 6-month follow-up and sensitivity analysis shows similar numerical results.

Conclusion: Our findings show that continued CMM for a population eligible for SCS does not provide meaningful pain relief and has not considerably changed over the last few decades. The use of CMM as the control to evaluate relative SCS treatment effects should be reassessed.