Pain Medicine最新文献

Background: Despite treatment advances, the majority of adults with cystic fibrosis (CF) experience chronic pain, negatively impacting quality of life. CF Foundation guidelines call for a multi-modal approach to pain management. While non-pharmacologic behavioral interventions are an effective and safe component of such an approach, there are no existing behavioral interventions that have been designed specifically for adults with CF who experience chronic pain.

Objective: We created a novel cognitive-behavioral and mind-body intervention tailored to the needs, preferences, and experiences of adults with CF and chronic pain.

Methods: Individual qualitative interviews were conducted with 14 adults with CF and chronic pain. A hybrid inductive-deductive thematic analysis was conducted to identify themes regarding needs and preferences to inform intervention development.

Results: We identified the following themes: 1) the importance of addressing mental health, 2) need for an individualized/tailored program, 3) preference for CF care team delivery, 4) CF-specific modifications of proposed content, 5) barriers and facilitators of patient engagement with a mind-body pain management intervention in CF.

Discussion: Adults with CF provided vital feedback on the structure and substance of a cognitive-behavioral and mind-body intervention for chronic pain, which was utilized to create the Pain Acknowledgement, Coping, and Empowerment (PACE CF), a program to be delivered as part of routine care in CF centers.

Objective: Chronic migraine is a condition marked by highly frequent, intense, and disabling headaches. However, less commonly examined symptoms, such as persistent fatigue, widespread non-cephalic pain, and post-traumatic stress disorder, may also play a key role in migraine-relevant clinical outcomes.

Methods: The current study utilized retrospective clinical registry data from 704 treatment-seeking patients with chronic migraine to examine longitudinal trajectories of pain intensity and pain-related life interference using linear growth modeling.

Results: High levels of co-occurring non-cephalic pain (71.9% of patients) were noted in this sample. Patients endorsing more widespread pain reported higher average levels of pain intensity over time (β = 0.189 [0.103, 0.275], p < 0.001) and less improvement in pain interference over time (β = 0.328 [0.131, 0.525], p = 0.001). Additional findings included greater reductions in pain interference among patients with higher baseline levels of pain intensity (β = -0.185 [-0.351, -0.020], p = 0.028) and fatigue (β = -0.280 [-0.493, -0.067], p = 0.010) and non-significant associations between post-traumatic stress symptoms and pain intensity and pain interference in all models.

Conclusions: The current findings suggest that clinical factors sometimes overlooked in headache research, such as co-occurring non-cephalic pain and fatigue, may contribute to trajectories of treatment response and psychosocial function in chronic migraine. Future research may benefit from examining these factors in headache-specific treatment settings and in the context of examining the effects of multidisciplinary care on patients with complex symptom presentations.

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.