Pain Medicine最新文献

Objective: This study describes the enrollment and baseline characteristics of participants in the Lumbar Stenosis Prognostic Subgroups for Personalizing Care and Treatment Study (PROSPECTS) cohort and explores subgroups of patients presenting for nonoperative care.

Design: Cross-sectional study.

Setting and subjects: We enrolled adults ≥50 years of age initiating nonoperative care for symptomatic lumbar spinal stenosis. We excluded those with serious spinal pathology, conditions limiting ambulation, and prior or planned lumbar surgery.

Methods: We collected demographics, the Patient-Reported Outcomes Measurement Information System (PROMIS) 29, pain intensity, Oswestry Disability Index, Swiss Spinal Stenosis Questionnaire, chronicity of symptoms, pain sites, comorbidities, falls, and opioid use. We used descriptive statistics to characterize the sample and latent class analysis to derive subgroups with distinct phenotypes. The best model was selected on the basis of model fit statistics, class separation, and clinical interpretability.

Results: We enrolled 598 participants. The mean age was 67 (SD = 9), and 61% were female. Back and leg pain had been present for ≥1 year in 65% of participants. Multiple pain sites were common, with a mean of 4.3 sites (SD = 2.2), and a majority of patients had multiple comorbidities (54%). We selected a 4-class solution as the best model from the latent class analysis. These phenotypes were described as (1) "high pain impact, low psychosocial features" (n = 233; 39%), (2) "mild pain impact, low psychosocial features" (n = 218; 36%), (3) "high pain impact, complex health needs" (n = 95; 16%), and (4) "acute, intermittent, moderate-severe leg pain with high pain impact" (n = 52; 9%).

Conclusions: These phenotypes reflect distinct profiles that could inform health needs and patient-centered care. Future studies should examine longitudinal outcomes to establish their clinical utility and prognostic value.

Purpose: Chronic neck pain is challenging to treat in Veterans. Massage therapy benefit evidence for musculoskeletal pain is building and massage is now included in Veteran health benefits. This randomized control trial compared therapist-delivered massage (TT-M) versus waitlist control for Veterans with chronic neck pain.

Methods: TT-M involved twice-weekly massage therapist-delivered 60-min standardized sessions for 12-weeks. The Neck Disability Index and Brief Pain Inventory measured neck disability and pain severity at baseline, 1-, 3-, and 6-months. Linear mixed-model approach examined primary analysis at 3 months; responsiveness analysis examined clinically meaningful change, ≥5 point improvement in neck disability and ≥30% decrease in pain severity.

Results: Participants (N = 290; n = 145/group) were aged 55.8 ± 14 years, 71% White, and 15% Female. Compared to control, TT-M participants had statistically significant reductions in pain-related disability at 1-month (-2.2; P = 0.007) and 3-months (-3.1; P < 0.001) and pain severity at 1-month (-0.8; P = 0.001), 3-months (-1.3; P < 0.001), and 6-months (-0.8; P = 0.003), respectively. TT-M participants were more likely to experience clinically meaningful benefits in neck disability at 3-months (35% v 16%; P=0.003) and pain severity at 1-month (27% v 14%; P=0.021), 3-months (43% v 15%; P<0.001), and 6-months (36% v 16%; P=0.005).

Conclusion: Therapist applied massage led to greater clinical benefits and reductions in neck disability and pain severity compared to waitlist control. Less robust outcomes at 6-months may suggest longer treatment windows or booster sessions are needed to maintain benefits. Engaging Veterans with massage therapy as part of their health benefits for chronic neck pain can provide an effective, non-pharmacological approach to pain management.

Trial registration: ClinicalTrials.gov Identifier-NCT03100539.

Background: Chronic knee joint pain, resulting from osteoarthritis, post-surgical sequelae, or traumatic injuries, represents a debilitating clinical condition. Interventional approaches to manage chronic knee joint pain have been employed for decades, yielding variable outcomes in terms of pain relief, sustainability of analgesic effects, and functional restoration. The term "genicular nerves" is commonly used to refer to the primary sensory innervation of the knee joint capsule. However, recent studies have increasingly recognized the significance of additional neural structures, such as the nerve to vastus medialis.

Methods: This descriptive, prospective anatomical study involved 20 healthy volunteers. The nerve to vastus medialis was assessed using ultrasound. The following was documented: (a) confirmation of the presence of the nerve to vastus medialis; (b) number of branches/distribution patterns; (c) distance from the division of the NVM into its distal branches to the medial femoral epicondyle; and (d) positional relationship of the branches in the distal region of the knee.

Results: The presence of the nerve to vastus medialis was confirmed in all participants. The nerve exhibited considerable variability in terms of the number of branches (2 to 5). Two distinct types of branches were identified: (a) trans/intramuscular branches, which were present in varying numbers (0 to 3) in the proximal thigh likely providing motor innervation to the muscle; (b) extramuscular branches, (typically 2 or 3), located in the distal thigh, presumed to have a sensory function. The distance from the division of the NVM into its distal branches to the medial femoral epicondyle was 13.07 ± 3.40 cm. The depths of the distal branches ranged from 1.0 to 4.4 cm.

Conclusion: The findings from this study offer a standardized approach to the identification and mapping of the nerve to vastus medialis distal branches, essential for interventional treatments.

Background: Auricular vagus nerve stimulation (aVNS) has emerged as a noninvasive neuromodulatory strategy with the potential to modulate central sensitization and inflammatory pathways. However, its role in fibromyalgia (FM) remains insufficiently explored.

Objective: To investigate whether stimulation laterality (left vs. right auricular branch of the vagus nerve, ABVN) differentially influences clinical and biological outcomes in women with FM.

Methods: In this randomized, double-blind, sham-controlled trial, 51 women with FM were allocated to sham stimulation, right-sided aVNS (aVNS-R), or left-sided aVNS (aVNS-L). Participants underwent weekly sessions for four weeks and were followed for 12 weeks. Pain intensity was the primary outcome. Secondary outcomes included psychological symptoms, sleep, functional status, quality of life, and circulating biomarkers (pro- and anti-inflammatory cytokines, brain-derived neurotrophic factor [BDNF]).

Results: While no significant between-group differences were observed in pain intensity, left-sided stimulation (aVNS-L) was associated with a modest but significant reduction in global symptom severity. Importantly, aVNS-L produced consistent immunomodulatory effects, including decreased IL-1β and TNF-α levels, and increased IL-4, IL-10, and BDNF concentrations.

Conclusions: This exploratory trial suggests that stimulation laterality may shape the biological response to aVNS in FM. Although clinical pain relief was not superior to sham, left-sided stimulation promoted an anti-inflammatory profile and enhanced neuroplasticity markers. These findings support further investigation of aVNS laterality as a targeted neuromodulatory approach for FM.

Trial registration: Brazilian Clinical Trials Registry RBR-10d3crcf.