Pain Medicine最新文献

Background: Neuromodulation via transcutaneous electrical stimulation shows promise in fibromyalgia, but conventional devices have limited coverage. The EXOPULSE Mollii Suit is a full-body garment with 58 electrodes, potentially addressing widespread pain. This study evaluated repeated Mollii Suit sessions on disease impact, pain, and fibromyalgia-related symptoms.

Methods: In this double-blind, randomized, sham-controlled crossover trial (phase 1), adults with fibromyalgia received two weeks of daily active or sham stimulation (1 hour/day), followed by a ≥ 2-week washout and crossover. Participants were offered a four-week open-label extension (phase 2). The primary outcome was the Fibromyalgia Impact Questionnaire (FIQtotal). Secondary outcomes included pain, anxiety, depression, and quality of life.

Results: Twenty-two patients completed phase 1 and 20 completed phase 2. In phase 1, FIQtotal scores significantly decreased following the active intervention (66.06 ± 13.46 to 50.81 ± 23.22, Friedman's p < 0.01, Bonferroni-adjusted Dunn's p < 0.05), whereas no significant effects were observed following the sham intervention. Improvements were also observed in several secondary measures (pain catastrophizing and some quality of life domains). Phase 2 also revealed significant benefits in FIQtotal as well as several secondary outcomes. No severe adverse events occurred at any time.

Conclusions: EXOPULSE Mollii Suit led to clinically meaningful improvements in fibromyalgia impact and related outcomes. The results of this work are in line with those of previous trials and support its potential as a home-based neuromodulation therapy for fibromyalgia. Future large-scale studies would help further understand the effects of this medical device.

Objective: To investigate the influence of anxiety/depression, sleep quality and pain catastrophizing in conditioned pain modulation (CPM) in women with episodic/chronic migraine and pain-free women.

Design: A cross-sectional case-control study.

Setting: Laboratory experimental study.

Subjects: Seventy women with chronic migraine, 70 women with episodic migraine and 70 pain-free women.

Methods: Migraine features and psychological/emotional (e.g., anxiety, depression, sleep, pain catastrophizing) aspects were evaluated. Pressure pain thresholds (PPT) were assessed at the temporalis, lateral epicondyle, and tibialis anterior muscle. Heat (HPT) and cold (CPT) pain thresholds were assessed at the frontalis muscle. Thus, CPM was evaluated immediately after one minute cold-pressor test paradigm on changes in mechanical/thermal stimuli after the conditioned stimulus.

Result: Significant group*time interactions without significant effect of anxiety/depressive levels, sleep quality, or pain catastrophizing for PPTs at the temporalis muscle (Wilk's λ = 0.646, F[2,201]=55.108, p < 0.001, n2p = 0.354, 1-β=0.999), epicondyle (Wilk's λ = 0.736, F[2,201]=36.024, p < 0.001, n2p = 0.264, 1-β=0.999), and tibialis anterior (Wilk's λ = 0.798, F[2,201]=25.148, p < 0.001, n2p = 0.202, 1-β=0.999) were found: PPTs were higher in all points after the conditioned stimulus in pain-free women (increases from 10.7-16.2%) whereas PPTs in all points were lower after conditioned stimulus in women with migraine (decrease from -7.6% to -0.3%) as compared to PPT at baseline. Changes in HPT and CPT were small (<1%).

Conclusion: Women with migraine showed CPM deficits against mechanical, not thermal, stimuli compared to women without migraine. Deficits in CPM were similar between women with episodic/chronic migraine. Anxiety/depressive levels, sleep quality and pain catastrophizing did not influence CPM in women with migraine.

Introduction: Chronic low back pain (LBP) is common in older adults and can cause functional disability. It is often linked with depressive symptoms and poor sleep quality, which are factors related to each other that have bidirectional relationships with pain, forming a complex interdependent triad.

Objective: We examined whether sleep quality plays a mediating role in the association between depressive symptoms, pain, and disability in older adults with LBP.

Design: This study is an observational cohort.

Methods: A total of 171 participants aged ≥60 years were interviewed. Data on depressive symptoms (Center for Epidemiologic Studies Depression Scale), sleep quality (Pittsburgh Sleep Quality Index), pain intensity (Numeric Pain Scale), and functional disability (Roland-Morris Disability Questionnaire) were collected at different time-points (baseline, 6 months, and 12 months). Mediation analysis was used to assess whether sleep quality was a mediating factor in the relationship between pain and depressive symptoms.

Results: The results indicated that sleep quality at 6 months significantly mediated the association between baseline depressive symptoms with both pain intensity and functional disability at 12 months. The influence of baseline insomnia symptoms on outcomes at 12 months depended on sleep quality at 6 months. The indirect mediation explained 43.4% of the relationship with pain intensity and 47.9% with functional disability.

Conclusion: Sleep quality was found to mediate the relationship between depressive symptoms and pain/disability. These findings highlight the importance of assessing/improving sleep quality in older adults with LBP and depressive symptoms.

Objective: Evidence on intranasal (IN) ketamine as an alternative to opioids for acute pain is limited. We compared the efficacy and safety of IN ketamine to intravenous (IV) morphine in emergency department (ED) patients.

Methods: This triple-blinded, placebo-controlled, randomized trial included consenting adult patients with moderate-to-severe pain (≥70 mm on a visual analog scale[VAS]) who were given either 0.1 mg/kg IV morphine and IN placebo or 1 mg/kg IN ketamine and IV placebo and were monitored for vital signs, pain levels, and adverse events for 120 minutes. The primary outcome was the efficacy of intranasal ketamine compared with intravenous morphine in reducing pain, defined as achieving a ≥ 15-mm decrease in the VAS pain score. The secondary outcomes were adverse events (AEs) and overall patient's satisfaction.

Results: Sixty-eight participants (mean age 43.5 ± 12.2 years, 48 male) were randomized equally. Groups were similar at baseline in mean age, sex, and pre-treatment median pain levels. There were no significant differences between IV morphine and IN- ketamine groups in the median [Intra quartile range (IQR)] values of time to onset of significant pain reduction (10.0 [5.0-20.0] vs. 10.0 [5.0-15.0) minutes, P =0.92), maximal pain reduction (30.0 [10.0- 57.0] vs. 20.5 [4.2- 39.5] mm VAS, P =0.18) and time to maximal pain reduction (105.0 [63.7-120.0] vs. 90.0 [45.0-120.0] minutes, P = 0.35). There were no significant differences in frequency of adverse effects at 0, 60, and 120 minutes.

Conclusions: This study did not demonstrate a statistically significant difference in efficacy or safety between IN ketamine and IV morphine for the management of acute pain in the emergency department (ED). Moreover, the findings indicate that IN ketamine may be a viable, and potentially superior, alternative to IV morphine.

Background: The impact of disease-modifying therapies (DMT) on chronic pain in multiple sclerosis (MS) is poorly understood. Preclinical research suggests that modulation of sphingosine-1-phosphate pathways involved in inflammation and central sensitization could exert analgesic effects alongside MS relapse prevention, but more clinical data is needed.

Objective: To compare pain phenotypes, severity, and treatment regimens in persons living with MS (PwMS) using S1PR modulators versus other DMTs.

Methods: We conducted a secondary analysis of cross-sectional data from a nationwide MS survey. Univariate analyses were used to (t- and chi-square tests) examine associations between DMT class, demographics, disability severity, MS duration, pain outcomes, including pain phenotype (painDETECT Questionnaire for neuropathic pain and American College of Rheumatology Fibromyalgia survey for nociplastic pain), intensity and interference (PROMIS scales), analgesics and comorbidities (PROMIS measures).

Results: Among 731 participants, 82 used S1PR modulators. S1PR users were younger (48.02 vs. 52.51), but other characteristics were similar. After adjusting for age, pain types were similar in both groups. Among those with nociplastic pain, S1PR patients reported lower pain intensity than those on other DMTs (p = 0.02).

Conclusions: Compared to other DMTs, S1PR modulators are associated with lower pain intensity in MS patients with nociplastic pain.