Pain Medicine最新文献

This two-sample Mendelian randomization study examined causal associations of C-reactive protein (CRP) with spinal pain, the extent of multisite chronic pain, and chronic widespread musculoskeletal pain. No causal associations were found between CRP and these pain conditions.

Objective: To compare localized (primary) and widespread (secondary) hyperalgesia using pressure pain threshold (PPT) of patients with normal imaging findings, rotator cuff tear, or other pathologies.

Design: This was a cross-sectional design with data collected at a single time point.

Setting: This study was performed at two large, urban, academic medical centers.

Subjects: Participants included had chronic subacromial pain syndrome for three months or longer. Each participant was categorized into one of three imaging groups: normal imaging, rotator cuff tear, or other structural pathology.

Methods: Primary hyperalgesia was assessed with PPT at the midsection of the painful shoulder's lateral deltoid. Secondary hyperalgesia was assessed with PPT at the contralateral tibialis anterior muscle (TA). An ANOVA and ANCOVA was performed for each objective. ANCOVA covariates included age, sex, education level, and pain duration.

Results: The 103 participants included 55 males, had a median age of 55 years, median pain duration of 14.0 months, and a median composite Shoulder Pain and Disability Index (SPADI) score of 43.1%. The ANCOVA for primary hyperalgesia showed no significant difference in square-root adjusted deltoid PPT between imaging groups (F = 1.04, p = 0.3589). The ANCOVA for secondary hyperalgesia showed no significant difference in log-adjusted TA PPT between imaging groups (F = 0.24, p = 0.7900).

Conclusions: No significant difference was observed in the analysis of ipsilateral deltoid or contralateral TA PPT between patients with differing structural shoulder pathologies. These findings suggest that the three types of structural shoulder abnormalities we examined are not significantly associated with differences in one measure of hyperalgesia.

Objective: Tapering of chronic opioids has increased, with subsequent reports of exacerbated pain among patients who tapered. We aimed to evaluate the association between opioid dose tapering and subsequent pain-related healthcare utilization (ED visits, hospitalizations and primary care visits).

Design, setting and subjects: We conducted a retrospective cohort study from 2015-2019 using data from the Optum Labs Data Warehouse that contains de-identified retrospective administrative claims data for commercial and Medicare Advantage enrollees in the US. Adults aged ≥18 years who were prescribed stable doses of opioids, ≥50 morphine milligram equivalents (MME)/day, during a 12-month baseline period.

Methods: Tapering was defined as ≥ 15% relative reduction in mean daily opioid dose during one of 6 overlapping 60-day periods. Tapered patient-periods were subclassified as tapered-and-continued (MME > 0) vs. tapered-and-discontinued (MME = 0). We modeled monthly counts of visits for pain diagnoses up to 12 months after cohort entry using negative binomial regression as a function of tapering, baseline utilization, and patient level-covariates.

Results: Among 47,033 patients, 13,793 patients tapered. Compared to no taper, any taper was associated with more ED visits for pain (adjusted incidence rate ratio [aIRR] 1.21, 95% CI: 1.11-1.30), tapered then continued status was associated with more ED visits (aIRR 1.23, CI: 1.14-1.32) and hospitalizations (aIRR 1.14, CI: 1.03-1.27) for pain, and tapered-and-discontinued was associated with fewer primary care visits for pain (aIRR 0.68, CI: 0.61-0.76).

Conclusions: These associations suggest that opioid tapering may lead to increased emergency and hospital utilization for acute pain and possibly a decreased perceived need for primary care for those whose opioids were discontinued.

Objective: To identify predictors of persistent opioid use in opioid-naïve individuals undergoing total joint arthroplasty.

Design: Retrospective cohort study.

Setting: Maine Health System.

Subjects: Opioid-naïve patients who underwent at least one total joint arthroplasty (knee, hip, or shoulder) between 2015 and 2020.

Methods: Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was used to create a predictive model for persistent opioid use after surgery from a US Electronic Health Record dataset in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) format. 75% of the data was used to build the LASSO model using 10-fold cross-validation and 25% of the data was used to determine the optimal probability threshold for predicting the binary outcome.

Results: Out of 6432 patients, 12.3% (792) were identified as having persistent opioid use across combined total joint arthroplasties defined as at least one opioid prescription between 90 days and one year after surgery. Patients with persistent opioid use were more likely to be current smokers (OR 1.65), use antidepressants (OR 1.76), or have a diagnosis of post-traumatic stress disorder (OR 2.07), or a substance related disorder (OR 1.69). Other factors associated with persistent opioid use included back pain (OR 1.43), dementia (OR 1.65), and BMI over 40 (OR 2.50). The probability of persistent opioid use was not associated with age, sex, or ethnicity.

Conclusions: This predictive model for persistent opioid use after total joint arthroplasty shows promise as an evidence-based, validated, and standardized tool for identifying high-risk patients before surgery in order to target strategies and interventions to reduce the reliance on opioids for post-operative pain control.

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: 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 (%95CI)=1,72 (0,90-2,55), p < 0,001], FIQ-R [β (%95CI)=5,62 (0,14-11,09), p < 0,001] and uric acid/creatinine ratio [β (%95CI)=0,21 (-0,10-0,52), p < 0,001] were positively associated with the DII after adjustments for 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: Rapid opioid reduction or discontinuation among high-dose long-term opioid therapy patients (HD-LTOT) is associated with increased risk of heroin use, overdose, opioid use disorder, and mental health crises. We examined the association of residential segregation and healthcare access with rapid opioid reduction or discontinuation among HD-LTOT patients, and examined effect measure modification of individual-level characteristics.

Methods: Using 2006-2018 North Carolina private insurance claims data, we conducted a retrospective cohort study of 18-64 years old HD-LTOT patients (≥ 90 morphine milligram equivalents for 81/90 consecutive days), with one-year follow-up. The outcome was rapid opioid reduction or discontinuation (versus maintenance, increase, or gradual reduction/discontinuation). Individual-level characteristics included age, sex, and clinical diagnoses (post-traumatic stress disorder (PTSD), depression, anxiety, and substance use disorder). Neighborhood-level characteristics included healthcare access (measured as geographic distance to healthcare facilities) and residential segregation (operationalized using the Index of Concentration at the Extremes). We conducted bivariate linear regression to estimate one-year risk differences (RDs) and 95% confidence intervals (CIs).

Results: Of 13,375 HD-LTOT patients, 48.6% experienced rapid opioid reduction or discontinuation during one-year follow-up. Female patients and those diagnosed with PTSD who live in areas of least racial and economic privilege have higher risks of rapid opioid reduction or discontinuation compared to those living in areas with the most racial and economic privilege.

Conclusion: Healthcare providers need to address potential biases towards patients living in underserved and marginalized communities and intersectionality with mental health stigma by prioritizing training and education in delivering unbiased care during opioid tapering.