Pain Medicine最新文献

Objective: To evaluate the effectiveness of genicular nerve radiofrequency ablation (GnRFA) for chronic knee pain using a systematic review and Bayesian network meta-analysis (BNMA).

Methods:

Results: The search identified 1,740 records, with 358 full texts reviewed and 29 studies included (13 randomized controlled trials and 16 observational studies, totaling 2,285 participants) GnRFA was most likely to be the highest ranked treatment for chronic knee treatment at 1 month (86.3%), 3 month (75.3%), 6 month (74.3%), and 12 months (75.0%) when compared to sham, intra-articular joint injections, and chemical neurolysis.

Conclusions: GnRFA serves as an effective treatment for chronic knee pain from either OA or PPSP for at least 12 months. Additionally, it was found to be more effective than sham for at least 6 months.

Objective: One in nine Americans will undergo a surgical procedure during their lifetime and, for some, the treatment of post-operative pain represents their first prolonged exposure to an opioid. New persistent opioid use (NPOU) refers to continued opioid use beyond the typical surgical recovery period (3 months) in opioid-naïve patients and has been linked to increased morbidity, mortality and opioid-related complications. This systematic review with meta-analysis synthesized the recent evidence on patient-related risk factors for NPOU among opioid-naïve postsurgical adults in the US to derive a pooled effect size for evaluable factors using a random-effects model (PROSPERO: CRD420250651059).

Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and checklist. The level of evidence and methodological quality were assessed using the Joanna Briggs Institute checklist. Estimates of associations and confidence intervals were extracted. Risk factors were categorized as either sociodemographic, clinical, or opioid exposure factors using a narrative synthesis. A random effects meta-analysis of estimates of association was performed.

Results: A comprehensive literature search resulted in 27 articles; all were retrospective cohort studies and 89% were deemed of good quality. Among the various risk factors identified through narrative synthesis, mood disorders, anxiety, Medicaid enrollment, and preoperative benzodiazepine use were the most predictive of NPOU. The pooled odds ratios for these risk factors from meta-analysis were 1.24(95% confidence intervals: 1.17-1.32), 1.17(1.11-1.23), 1.77(1.46-2.15), and 1.77(1.53-2.05) respectively.

Conclusion: Opioid-naïve persons insured by Medicaid or with pre-operative anxiety, depression, or benzodiazepine use, are associated with a higher risk for NPOU.

Objective: Chronic whiplash-associated disorders (WAD) may involve complex interactions between physical symptoms and psychological factors, and long-term effects of exercise programs are of interest. This study aimed to evaluate the effects of a predominantly internet-based neck-specific exercise program (NSEIT) compared with the same exercises (NSE) performed at a physiotherapy clinic on psychological outcomes in chronic WAD, including cognitive-behavioral factors (pain catastrophizing, fear-avoidance beliefs, self-efficacy), emotional distress (symptoms of depression, anxiety), and cognitive functioning. A further objective was to assess whether psychological factors moderated treatment effects on the primary outcome, neck-specific disability.

Methods: This secondary analysis was based on a randomized multicenter trial. Participants (n = 140) were randomized to NSEIT or NSE. Outcomes were assessed at baseline, 3-months, and 15-months. Psychological outcomes were analyzed using mixed design analysis of variance. Moderation effects were tested by adding interaction terms (psychological factor x group) in linear regression models of neck-specific disability.

Results: No significant group differences or group x time interactions were found for psychological outcomes. However, there were significant main effects of time for cognitive-behavioral factors and emotional distress in both groups (all P < 0.01), with small to intermediate effect sizes. Psychological factors did not moderate the treatment effects on neck-specific disability.

Conclusion: The internet-based format (NSEIT), involving fewer clinical visits, did not differ from the more comprehensive physiotherapist-led program (NSE) regarding psychological outcomes. Improvements in cognitive-behavioral factors and emotional distress occurred over time in both groups. The internet-based format might be suitable regardless of psychological characteristics at baseline.

Background: Cancer-related pain management remains challenging, particularly for spinal metastases, in which pain arises from multiple pathological mechanisms. Despite the increasing use of epidural steroid injections (ESI) in clinical practice as part of multimodal pain management, the evidence of their effectiveness in these patients remains limited.

Design: A retrospective cohort study.

Setting: Three university-affiliated tertiary hospital in South Korea.

Subjects: A total of 123 patients with cancer and radiologically confirmed spinal metastases who underwent ESI between January 2020 and December 2022. Patients were categorized as effective (Group E, ≥50% pain reduction at 1 month, n = 73) or non-effective (Group N, n = 50).

Methods: Pain intensity, opioid use, patient satisfaction, repeat procedures, and survival were evaluated at baseline and one and three months after ESI. In addition, factors influencing the effectiveness of ESI were analyzed.

Results: A better performance status (ECOG-PS 1) and lower baseline opioid requirements predicted a favorable ESI response. The group E maintained pain relief at three months with a minimal increase in opioid use, reported higher satisfaction (94.5% vs. 6.5%), needed fewer repeat injections (64.4% vs. 86.6%), and demonstrated better six-month survival (78.1% vs. 34.0%) than group N.

Conclusion: ESI may be beneficial in reducing pain and attenuating opioid escalation in patients with spinal metastases, especially when the performance status is relatively preserved, and before the initiation of high-dose opioid therapy. These results support early integration of ESI into multimodal cancer pain management strategies.

Objective: To characterise the sensory signs of nociceptive and neuropathic mixed pain (NP) subtypes, in a paediatric-onset spinal cord injury (SCI) cohort.

Design: Exploratory cross-sectional observational study.

Setting: Monographic SCI Rehabilitation Hospital.

Subjects: Fifty-one individuals (12.8 ± 3.4 years; 52.9% females) with paediatric-onset SCI (8.1 ± 4.8 years).

Methods: Standardized bedside and quantitative sensory testing (BST/QST), and a novel dynamic QST method to test cold hyperaesthesia above, at and below the SCI.

Results: BST performed to evaluate differences sensory function at or below the level of SCI revealed no differences with dynamic light touch (Brush), pinprick, cold or heat thermoroller stimuli, except for hypoaesthesia to dynamic light touch (Q-tip) in youth with nociceptive pain only. Dynamic QST assessment detected a high level of perceived tonic cold intensity above the level of SCI that was characteristic of probable NP, whereas standardized QST identified elevated at- and below-level cold pain thresholds that were typical of nociceptive pain. In the nociceptive pain cohort, SCI evolution time correlated positively with both at-level and above-level tonic cold intensity. Finally in youth with nociceptive pain at-level tonic cold intensity correlated with below-level tonic cold intensity.

Conclusions: Assessment of change in cold sensory function, above, at or below the SCI, highlights the presence of pathophysiological mechanisms throughout the neuroaxis after SCI in the paediatric cohort. Further understanding of cold hyperaesthesia and chronic nociceptive and neuropathic pain subtypes, in a larger statistically powered confirmatory study may lead to an improved prognosis of SCI pain in the pediatric population.

Objective: To map literature on racial-ethnic differences in the management of individuals with co-occurring chronic non-cancer pain (CNCP) and opioid use disorder (OUD), and to scope clinician, system, and patient factors that may contribute to these differences.

Methods: Scoping review of five databases through 05/01/2025, following PRISMA-ScR guidelines. CNCP was defined as pain lasting ≥3 months unrelated to malignancy; OUD was identified through diagnostic codes, clinician assessments, or validated proxies. Eligible studies included adults with both conditions and reported outcomes stratified by participant race or ethnicity. Data were extracted and appraised using the Mixed Methods Appraisal Tool. Findings were synthesized inductively across four themes: Prevalence and predictors, treatment differences, provider decision-making, and patient-reported experiences.

Results: 21 studies were included, encompassing prospective, retrospective, cross-sectional, and qualitative designs. Among patients with CNCP and OUD, Black and Hispanic groups were less likely to receive non-pharmacologic pain treatments, pain specialist referrals, or buprenorphine for OUD. Conversely, opioid prescribing rates and OUD diagnoses were higher among White patients. Patients reported experiences of differential treatment and stigma, a finding reinforced by clinician interviews that described greater reluctance to prescribe opioids to non-White racial and ethnic groups. None of the reviewed studies found that non-White individuals faced a higher risk of opioid misuse or OUD; instead, key predictors included pain-related distress and treatment access barriers.

Conclusions: Differences in CNCP and OUD care may relate to access-related factors and stigma. Comprehensive research and improvements in treatment access are necessary to ensure accessible and integrated care.

Objective: To assess the effectiveness of ultrasound-guided percutaneous electrolysis and peripheral nerve stimulation in reducing pain, improving functional capacity, and modifying mechanosensitivity responses in patients with carpal tunnel syndrome compared to a sham intervention.

Design: A multicenter, randomized controlled clinical trial.

Settings: Double center pain clinic.

Subjects: In brief, 46 patients diagnosed, with carpal tunnel syndrome, assigned to an intervention group or a sham group.

Methods: Both groups received 3 sessions over 4 weeks. Primary outcomes included mean and worst pain intensity. Secondary outcomes assessed functional status and symptoms severity; Boston Carpal Tunnel Questionnaire, Upper Limb Neurodynamic Test 1, grip and pinch strength, two-point discrimination, sensory thresholds, pressure pain threshold and Global Rating of Change Scale. Follow-ups were conducted at 4, 12, and 24 weeks.

Results: Statistically significant intergroup differences were observed for all evaluated variables across follow-ups, except for grip and pinch strength. The intervention group demonstrated significantly greater improvements in pain intensity, functional disability, sensory thresholds, and neural mobility, with large effect sizes ranging from 0.64 to 2.09. Notably, the improvements in pain and function were sustained at 6 months.

Conclusions: Ultrasound-guided percutaneous electrolysis and peripheral nerve stimulation significantly reduce pain and improve function in carpal tunnel syndrome, offering a promising minimally invasive alternative to standard care.

Clinical trial registration number: Effectiveness of an Invasive Physical Therapy Protocol in Carpal Tunnel Syndrome: Randomized Controlled Clinical Trial. Registration number: NCT05527743. Link to full trial record: https://clinicaltrials.gov/ct2/show/NCT05527743 Patient enrollment began on: April 1, 2023.