Pain Medicine最新文献

Objective: Numerous risk factors for persistent pain severity and pain related interference have been identified but opioid use characteristics associated with pain trajectories are understudied. We determined if opioid dose and frequency of use were associated with non-cancer chronic pain trajectories.

Methods: Participants starting a new period of prescription opioid use lasting 30-90 days were recruited from two health care systems that deliver care in Michigan, Illinois, Missouri, Oklahoma and Wisconsin. Participants completed structured surveys at baseline and completed up to twelve monthly surveys for PEG-assessed pain severity and interference. Growth mixture modeling was used to compute trajectories. Multinomial, logistic regression models estimated the association between patient opioid use characteristics and trajectory membership, after adjusting for covariates.

Results: The sample (n = 842) was, on average, 53.8 ± 11.8 years of age, 68.8% female and 29.0% non-white race. The best fitting model was a 3-class solution with trajectories characterized as "mild-improving," "severe-improving," and "stable-severe". Opioid dose ≥50 morphine milligram equivalent and daily vs. non-daily opioid use were not associated with these trajectories. More pain sites was significantly associated with severe improving and stable-severe vs. the mild-improving trajectory. Higher income and ability to participate in social roles were inversely associated with membership in the -stable-severe trajectory.

Conclusions: In this sample with 30-90 days of opioid use at baseline, we identified three pain trajectories. Relatively few patient characteristics were associated with pain severity and interference trajectories. Opioid dose and frequency of use were not predictors of the course of non-cancer pain.

Background and objective: Pregabalin (PGB) and duloxetine (DLX) are commonly used first-line medications in the clinical management of painful diabetic neuropathy (PDN), yet high-quality comparative evidence is limited. This meta-analysis evaluates the comparative efficacy and safety of PGB versus DLX, focusing on efficacy outcomes such as pain reduction and mental health, and safety outcomes including adverse events in PDN patients.

Method: We searched electronic databases for relevant studies assessing the efficacy and safety of PGB and DLX in PDN. The primary outcomes were the mean change of the visual analog scale (VAS) and the improvement ratio for patients achieving ≥ 50% pain reduction. Secondary outcomes, including the numeric rating scale (NRS) for pain, the short form 12 health survey (SF-12), and related adverse events. A random-effects meta-analysis was performed to evaluate these outcomes.

Results: We analyzed 19 studies involving 4,483 patients. PGB significantly reduced VAS scores at 24 weeks (MD = -0.38; 95% CI [-0.45, -0.31], P < 0.0001) and decreased the mental component of SF-12 compared to DLX (MD = -3.36; 95% CI [-6.64, -0.07], P = 0.05) and lower rates of achieving >50% pain reduction (RR = 0.88; 95% CI [0.79, 0.98], P = 0.03). Regarding safety, PGB showed a lower incidence of several adverse events, including anorexia, decreased appetite, diarrhea, nausea, and vomiting. However, no significant differences in VAS scores were observed between PGB and DLX at 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks, and 12 weeks, with similar results observed in NRS.

Conclusion: We found that PGB and DLX showed similar efficacy in relieving PDN. Ultimately, the two drugs' similar effectiveness and different safety profiles highlight the importance of considering patient-specific factors when choosing the appropriate treatment.

Objective: People with migraine have a higher prevalence and severity of insomnia. We examined the relationship between insomnia severity and migraine-related disability (MIDAS) and migraine-specific quality of life (MSQv2.1).

Methods: We conducted a post-hoc analysis of a pilot randomized controlled study assessing the RELAXaHEAD application in those with insomnia and comorbid migraine. Descriptive statistics were used to summarize demographic and clinical characteristics. Linear mixed model analysis was conducted to evaluate Insomnia Severity Index (ISI) as a predictor of each MSQv2.1 domain and MIDAS.

Results: Forty-two participants completed baseline and at least one follow-up survey. Mean age was 43.8 years (SD 12.6) and the majority (85.7%) were female. Most participants (81.0%) had severe migraine-related disability (median baseline MIDAS, 32 (IQR 52)). Over half (54.8%) of participants had moderate clinical insomnia (mean baseline ISI, 18.5 (SD 4.6)). Baseline median MSQv2.1 scores were 44.3 (IQR 31.4) for Role Function-Restrictive (RFR), 65.0 (IQR 45.0) for Role Function-Preventive (RFP), and 46.7 (IQR 46.7) for Emotional Function (EF). The effect of ISI on MIDAS was statistically significant (rate ratio (RR)=1.10, p < 0.05, 95%CI [1.028, 1.171], meaning each one-point increase in ISI was associated with a 10% higher MIDAS score). Additionally, a 1-point increase in ISI was associated with a decrease of 1.2 points in MSQ-RFR (B=-1.205, p = 0.001),1.0 point in MSQ-RFP (B=-0.981, p = 0.020), and 1.4 points in MSQ-EF (B=-1.66, p = 0.001).

Conclusions: Our study revealed significant associations between insomnia severity and migraine-related disability and quality of life, highlighting the importance of prevention and sleep intervention for patients with migraine.

Objective: Describe long-term treatment outcomes of nervus femoralis radiofrequency ablation (NF-RFA) for recalcitrant greater trochanteric pain syndrome (GTPS).

Design: Cross-sectional study.

Methods: Chart review of consecutive patients who underwent NF-RFA from 2022-2023 was performed. A standardized telephone survey was utilized to capture current Numeric Pain Rating Scale (NPRS) and Patient Global Impression of Change (PGIC) scores. The primary outcome was ≥50% NPRS score reduction at follow-up. A secondary analysis was completed on free text responses asking patients to describe post-procedural changes in pain and function in their own words.

Results: Outcomes were collected from 25 patients (aged 71.7 ± 9.3 years; 80.0% female; BMI 29.3 ± 6.8 kg/m2) for 27 NF-RFA procedures at a minimum follow-up time of six months post-procedure. Average follow-up time was 13.1 ± 4.9 months. ≥50% NPRS reduction from baseline was reported by 55.6% (n =15/27; 95% CI: 37.3-72.4) of patients. A ≥ 2-point NPRS score reduction from baseline was reported by 70.4% (n =19/27; 95% CI: 51.5-84.2) of patients, and 51.9% (n =14/27; 95% CI: 34.0-69.3) reported a PGIC score consistent with "much improved" or "very much improved".

Conclusion: In this cohort, over 55% of patients who received NF-RFA as treatment for refractory GTPS reported at least 50% improvement in hip pain at an average follow-up of approximately 13 months. The majority of free text responses from patients indicated that they would recommend NF-RFA, while approximately 25% reported ongoing pain and disability from low back pain or a return of index hip pain symptoms post-procedure.

Objective: We introduce a novel intervention for posterolateral knee pain termed the biceps femoris short head (BiFeS) Block, which targets the articular branches innervating the posterolateral aspect of the joint. We describe a two-part proof-of-concept study to validate the BiFeS block: A cadaveric study evaluating injectate spread and a retrospective case series assessing analgesic efficacy.

Design: A cadaveric and retrospective study.

Setting: Multicenter study conducted in anatomy and anesthesiology departments.

Subjects: Three adults cadavers and five patients.

Methods: In the cadaveric study, 25 mL of dye solution was applied at the interface between the BiFeS and the lateral supracondylar line of the femur following bone contact. For the retrospective cases, we present five patients with posterolateral knee pain following total knee arthroplasty (TKA) who underwent a BiFeS block with 25 mL of 0.25% bupivacaine.

Results: In all cadaveric specimens, a distinct dye spread was observed deep to the BiFeS, extending both medial and lateral to the lateral supracondylar line and along the facies poplitea. In all specimens, the superior lateral genicular nerve and the lateral branch of the nerve to the vastus intermedius were stained. The anterior branch of the common fibular nerve was stained in 2 out of 6 specimens where it could be identified. In the clinical cases, the median(IQR) NRS score decreased from 6.5(6-7) pre-block to 3(2-3) post-intervention.

Conclusion: Our preliminary data demonstrate that the BiFeS block achieves complete blockage of the posterolateral knee capsule. This technique may serve as a complementary, motor-sparing regional anesthesia method, particularly for postoperative pain management following TKA. Advantages include a low risk of complications, avoidance of vascular and neural structures, feasibility in the supine position.

Objective: To identify and quantify the factors associated with shoulder dysfunction in patients with subacromial pain syndrome (SAPS).

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

Setting: Two large, urban, academic medical centers in the United States.

Subjects: Participants included patients who had had chronic SAPS for 3 months or longer.

Methods: Shoulder function was evaluated with both the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) and the Shoulder Pain and Disability Index-Disability (SPADI-D). First, 12 demographic and clinical variables were independently assessed for an association with FIT-HaNSA and SPADI-D score. Next, 2 separate multivariable linear regression analyses, one for each outcome measure, were created to examine the association of each with all variables.

Results: The 113 participants had a median age of 55 years, a median pain duration of 14 months, and a median composite SPADI score of 43.85%. In univariate analysis, 4 variables were associated with FIT-HaNSA, and 5 were associated with SPADI-D. The FIT-HaNSA multivariable linear regression model (F = 4.01, P < .0001) had an overall R2 of 38.27% (n = 98). This identified the worst pain in the past week (F = 10.86, P = .0014) and the deltoid pressure pain threshold (F = 14.94, P = .0002), with significant associations. The SPADI-D model (F = 4.20, P < .0001) had an overall R2 of 39.38% (n = 98). This identified the worst pain in the past week (F = 21.04, P > .001) and the Pain Catastrophizing Scale score (F = 5.32, P = .235), with significant associations.

Conclusions: Six variables were associated with shoulder function in univariate analyses, and 3 were associated in a multivariable analysis. Future research is necessary to determine whether these variables are appropriate targets for clinical intervention to improve shoulder function and to identify the other factors explaining the remaining outcome measure variability.

Importance: Transcranial magnetic stimulation (TMS) is a recognized therapy for treatment-resistant depression and has been studied for its potential in managing chronic pain. Knowing the intrinsic relationship between pain and depressive symptomatology, it is essential to study effective treatments that can address both conditions.

Objective: To assess the impact of TMS on depressive symptomatology in patients with chronic pain through a systematic review of the literature.

Design: Systematic review.

Setting: Electronic databases were systematically searched for eligible studies published up to November 2023.

Participants: A total of 1339 unique patients with chronic pain who underwent TMS treatment and were evaluated for both pain and depressive symptoms.

Intervention(s) or exposure(s): Transcranial magnetic stimulation (TMS) applied using various protocols in chronic pain populations.

Main outcome(s) and measure(s): Changes in depressive symptomatology following TMS treatment. Secondary consideration was given to TMS safety and tolerability.

Results: The results showed heterogeneous protocols with widely different results in depressive symptomatology across the studies, precluding meta-analysis. TMS was considered a safe treatment option with minor side effects.

Conclusions and relevance: The impact of TMS on depressive symptomatology among patients with chronic pain is a complex subject. Considering the diversity of the protocols and results encountered, future research should prioritize the establishment of standardized TMS protocols to clarify their efficacy in managing depressive symptoms among these patients. This systematic review highlights the need for further investigation of TMS as a dual therapeutic approach for chronic pain and depressive symptomatology, emphasizing the necessity of improving the protocols to enhance clinical outcomes.