Pain Medicine最新文献

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.

Background: Acute musculoskeletal pain in emergency department (ED) patients is challenging to treat with medications alone, but adding acupuncture may improve pain outcomes.

Methods: In this pragmatic randomized controlled trial, acupuncture was delivered by licensed acupuncturists in the ED and twice a week in follow-up clinic for 1 month. From February 10, 2020 to April 19, 2023, 2781 adult patients at an academic ED with acute (≤7 days) musculoskeletal pain in neck, back and/or extremities were screened, and 599 were enrolled and randomized to usual care only (n = 189, 31.6%) or acupuncture plus usual care (n = 410, 68.4%).

Results: Acupuncture and control arms had similar demographics (mean age 45.2, SD 15.8; 57.7% female) and baseline pain scores (control 7.1, SD 2.2; acupuncture 7.1, SD 2.3). At 1 month, pain scores were similar between arms (control 3.8, SD 3.2; acupuncture 3.2, SD 3.0). However, 178 (43.4%) participants in the acupuncture arm were unable to attend acupuncture clinic and reported time and financial constraints. Exploratory analysis of pain score by number of clinic sessions attended showed that patients attending 6 or more acupuncture sessions (n = 121, 20.2%) experienced significant pain improvements compared to those with fewer sessions (n = 478, 79.8%).

Conclusion: Improving access and availability of acupuncture in outpatient settings may be needed for more effective pain management.

Background: Magnetic resonance imaging (MRI) safety with implanted neuromodulation devices presents a critical challenge in modern medicine. While spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) devices are increasingly utilized for pain management, the scattered nature of manufacturer-specific MRI safety information creates substantial challenges for healthcare providers in making informed clinical decisions. Furthermore, despite the public availability of this information, a comprehensive review of the literature reveals no centralized repository of data regarding SCS and PNS.

Objective: To synthesize comprehensive MRI safety data from multiple manufacturers of SCS and PNS devices into a centralized resource for clinicians, thereby streamlining the decision-making process for MRI scanning in patients with implanted neuromodulation devices.

Methods: We collected MRI safety data for devices from 10 major neurostimulation companies (Abbott, Biotronik, Boston Scientific, Curonix, Mainstay, Medtronic, Nalu, Nevro, Saluda, and SPR Therapeutics) through December 2024. Data collection involved direct communication with manufacturers and analysis of technical documentation to extract specific MRI-related parameters.

Results: Full-body MRI safety at 1.5 T is standard across most SCS systems, with select devices permitting 3.0 T imaging. Specific limitations vary by manufacturer, including restrictions on spatial gradient magnetic fields (1000-4000 Gauss/cm), specific absorption rates, and active scan times (15-60 minutes). PNS systems show similar safety patterns.

Conclusions: This manuscript addresses the urgent need for centralized safety information. As device technology continues to evolve, this resource will require ongoing updates to maintain its utility in supporting informed clinical decision making and patient care.

Purpose: Sacroiliac joint (SIJ) pain, a frequent contributor to low back pain, is commonly treated with minimally invasive SIJ fusion. A large body of evidence supports the safety and effectiveness of lateral transiliac SIJ fusion. Traditionally performed by surgeons, this procedure is increasing in utilization by non-surgeon interventionalists. Herein, we present early safety results from a single-arm clinical trial of participants who underwent lateral SIJ fusion using threaded titanium implants placed by interventional pain management physicians.

Methods: STACI (NCT05870488) is a 2-year prospective study conducted at 15 US interventional pain management sites. The primary endpoint is change in SIJ pain from baseline to 6 months. Secondary endpoints include changes in function (Oswestry Disability Index), quality of life (PROMIS-29), device- or procedure-related adverse events, and evidence of fusion on CT scan at 2 years.

Results: A total of 110 patients were enrolled. Mean (SD) participant age is 64 (14) years and 68% are female. Mean (SD) operative time was 44 minutes (16) and estimated blood loss was 14 cc (15). No serious or device-related adverse events have occurred. Reported perioperative adverse events include one surgical site infection and one hematoma. At 1-month follow-up, ODI improved by 18 points (P < .0001) and SIJ pain (NRS) decreased by 4 points (P < .0001) from baseline.

Conclusion: Early results from this prospective multicenter study support the relative safety and early effectiveness of LTI SIJ fusion using a threaded implant when performed by interventional pain management physicians. The data are consistent with published literature with a low adverse event rate and early improvements in pain and function.