Pain Medicine最新文献

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.

Objectives: The current study sought to evaluate the psychometric properties of a newly developed Knee OsteoArthritis Pain Index (KOAPI), derived from the Brief Pain Inventory (BPI), among individuals with knee osteoarthritis (KOA).

Methods: This study consisted of secondary data analysis of two clinical trials. In study 1, 241 individuals with KOA were evaluated before total knee arthroplasty and six months post-surgery. In study 2, 37 individuals with KOA participated in a randomized, double-blind, placebo controlled, two-way crossover study in which they received either a COX-2 inhibitor followed by a placebo or a placebo followed by a COX-2 inhibitor. The KOAPI was derived from the BPI and included three BPI pain severity items (worst, average, current) and the BPI pain interference item related to pain when walking.

Results: The KOAPI showed excellent model fit (CFI = 0.99; TFI: 0.98-0.99; RMSEA: 0.08-0.001), good reliability (Cronbach's alpha: 0.84-0.87) and high convergent validity with the Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.66; 95% CI: 0.44, 0.81) and the Pain Catastrophizing Scale (r = 0.50; 95% CI: 0.39, 0.60).

Conclusions: Overall, the psychometric properties of the KOAPI were comparable or better than those produced by the original BPI pain severity subscale. The KOAPI may be a helpful screening and outcome measure for individuals with KOA that more closely captures symptoms which drive patients to seek clinical care.