Pain Medicine最新文献

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.

Background: Minimally invasive pain relief treatments targeting articular nerves have emerged as treatment options for chronic joint pain, bridging the gap between conservative management and surgical intervention. These procedures have not been developed for the elbow joint due to insufficient anatomical knowledge of the articular branches innervating the elbow joint.

Objective: To determine origin, course, frequency, landmarks and capsular distribution of the articular branches supplying the anterior elbow joint.

Design: Anatomical dissection study.

Methods: 6 upper extremity specimens were meticulously dissected. Articular branches were traced from their origin on the brachial plexus to their termination. Origin, course, termination, and landmarks of each branch were documented and photographed in high-resolution. A frequency map was generated to visualize the capsular areas supplied by each articular branch.

Results: The musculocutaneous and/or median nerve gave rise to an extramuscular branch supplying the capsule deep to brachialis (83%). The median nerve supplied the medial capsule via a direct articular branch (17%), branches to flexor digitorum superficialis (100%), and a branch to pronator teres (67%). The anterior interosseus nerve supplied the capsule over the proximal radioulnar joint (67%). The radial nerve provided articular innervation to the lateral capsule via a radial branch to brachialis (83%), branches to extensor carpi radialis longus (100%), and branches to supinator (100%).

Conclusions: Detailed anatomical knowledge of the articular branches supplying the anterior elbow joint is essential for identifying potential targets for therapeutic intervention and exploring selective blockade of articular nerves to alleviate pain originating from specific capsular areas.

Objective: Fluoroscopy-guided radiofrequency rhizotomy for trigeminal neuralgia relies on biplanar fluoroscopic imaging and surface landmarks. However, anatomical variations and imaging limitations often necessitate multiple attempts, leading to patient discomfort and increased procedural risks. This study evaluated the procedural outcomes of radiofrequency rhizotomy using preplanned trajectories and intraoperative computed tomography with neuronavigation.

Design: Retrospective study.

Setting: Single-center study conducted in a neurosurgical department.

Participants: Forty-six patients with trigeminal neuralgia who underwent radiofrequency rhizotomy between September 2019 and December 2024 were recruited in this study.

Intervention: Cannulation of the foramen ovale was performed using navigation-guided trajectories, with intraoperative computed tomography used to adjust the trajectory if initial attempts failed. Success rates and the distances between the landmark-based and neuronavigation-guided entry points were measured.

Results: Among the 46 procedures, the entry points were adjusted from the landmark-based entry points in 22 patients (47.8%) to achieve successful foramen ovale cannulation. Adjustments involved inferolateral displacement in 17 cases and inferomedial displacement in 5 cases. The mean lateral displacement was 3.75 ± 5.40 mm, and the mean inferior displacement was 14.65 ± 6.91 mm. Foramen ovale cannulation was successfully achieved in all the patients without complications.

Conclusions: Intraoperative computed tomography and navigation-guided radiofrequency rhizotomy are safe and effective techniques for treating trigeminal neuralgia. The conventional entry point designated by surface landmarks was not optimal in 47.8% cases, who required an inferior shift to accommodate anatomical variations.

Objective: Fibromyalgia is the prototypic nociplastic chronic pain syndrome, characterized by widespread pain, nonrestorative sleep, and fatigue. We evaluated efficacy and safety of bedtime TNX-102 SL (sublingual cyclobenzaprine) 5.6 mg for treatment of fibromyalgia.

Methods: This phase 3, double-blind, multicenter, placebo-controlled trial randomized patients 1:1 to once-nightly TNX-102 SL 2.8 mg for 2 weeks, followed by 5.6 mg for 12 weeks, or to matching placebo (NCT05273749). The primary endpoint was change from baseline at week 14 in weekly average of daily diary pain intensity scores. Secondary endpoints included Patient Global Impression of Change, Fibromyalgia Impact Questionnaire (Revised) Symptoms and Function domains, Patient-Reported Outcomes Measurement Information System instruments for Sleep Disturbance and Fatigue, and daily diary sleep quality scores.

Results: Overall, 81.0% (n = 187/231) and 79.6% (n = 179/225) of patients receiving TNX-102 SL and placebo completed the trial, respectively. Treatment with TNX-102 SL vs placebo was associated with significantly greater reductions in the primary pain endpoint (P < .001; mean [SE], -1.8 [0.12] vs -1.2 [0.12]) and in each of the 6 secondary endpoints (P ≤ .001; all). The most common systemic treatment-emergent adverse events (TEAEs) with TNX-102 SL and placebo were COVID-19 (4.3% vs 3.1%, respectively), headache (3.0% vs 1.8%), and somnolence (3.0% vs 1.3%); the most common TEAEs overall were local administration-site reactions including oral hypoesthesia (23.4% vs 0.4%), product taste abnormal (11.3% vs 0.9%), and oral paresthesia (6.9% vs 0.9%), which were transient and self-limited.

Conclusion: Bedtime TNX-102 SL treatment was associated with significant improvements in fibromyalgia symptoms and function and was well tolerated.

Clinical trial registration: ClinicalTrials.gov/study/NCT05273749, first patient screened March 21, 2022.

Importance: Labor epidural placement can cause significant procedural anxiety for patients. Behavioral interventions, such as mindful meditation, can effectively reduce anxiety, including during pregnancy.

Objective: This study aimed to assess the impact of a 10-minute mindful meditation session on anxiety and pain during labor epidural placement.

Design, setting, participants, intervention, and outcome measures: Pregnant women were recruited and randomized into 2 groups: A 10-minute guided mindful meditation, or a neutral content recording, both delivered via headphones before the epidural procedure as a recording. After the procedure, participants reported their levels of anxiety, pain, and satisfaction. Linear regression analyses were used to evaluate the main effects of the intervention on anxiety, pain, and satisfaction. Additionally, an exploratory post hoc moderation analysis assessed the role of baseline pain catastrophizing and its interaction with the intervention.

Results: A total of 100 participants were included (50 per group). There were no overall main effect of mindful meditation on primary outcomes of anxiety and pain, or secondary outcome of procedural satisfaction, compared to the neutral content recording (P's > .05). Exploratory post hoc analysis indicated a moderation of treatment effect, such that participants with higher baseline pain catastrophizing experienced greater benefits from mindful meditation compared to neutral content on anxiety (b = -0.18, P = .01) and pain (b = -0.14, P = .03).

Conclusions and relevance: While no overall group-level effects of mindful meditation were found, exploratory analysis suggested that the intervention may be more beneficial for participants with high baseline pain catastrophizing. Future studies enrolling a larger sample, or enriching for patients with these characteristics are needed to confirm these results.

Clinical trial number and registry url: ClinicalTrials.gov Identifier: NCT04687085 (https://clinicaltrials.gov/ct2/show/NCT04687085).