Pain Medicine最新文献

Objective: To investigate the predictive value of thoracic sympathetic ganglion block (TSGB) in response to ketamine infusion therapy (KIT) and spinal-cord stimulation (SCS) in patients with chronic upper-extremity pain including complex regional pain syndrome (CRPS).

Design: Retrospective.

Setting: Tertiary hospital single-center.

Subjects: Patients who underwent TSGB receiving KIT or SCS within a 3-year window.

Methods: Positive TSGB outcomes were defined as ≥2 0-10 Numerical Rating Scale (NRS) score reduction at 2 weeks post-procedure. Positive KIT and SCS outcomes were determined by ≥2 NRS score reduction at 2-4 weeks post-KIT and ≥4 NRS score reduction at 2-4 weeks post-SCS implantation, respectively.

Results: Among 207 patients who underwent TSGB, 38 received KIT and 34 underwent SCS implantation within 3 years post-TSGB; 33 patients receiving KIT and 32 patients receiving SCS were included. Among 33 patients who received KIT, 60.6% (n = 20) reported a ≥ 2 0-10 NRS pain-score reduction. Positive response to TSGB occurred in 70.0% (n = 14) KIT responders, significantly higher than that in 30.8% (n = 4) KIT non-responders. Multivariable analysis revealed a positive association between positive responses to TSGB and KIT (OR 7.004, 95% CI 1.26-39.02). Among 32 patients who underwent SCS implantation, 68.8% (n = 22) experienced short-term effectiveness. Positive response to TSGB was significantly higher in SCS responders (45.5%, n = 10) than in non-responders (0.0%). However, there were no associations between pain reduction post-TSGB and that post-KIT or post-SCS.

Conclusions: A positive response to TSGB is a potential predictor for positive KIT and SCS outcomes among patients with chronic upper-extremity pain, including CRPS.

The field of pain medicine mourns the passing of Professor Michael J. Cousins, a towering figure who reshaped the landscape of pain management for anesthetists and pain specialists globally. Professor Cousins was not merely a luminary in the field; he was a visionary whose contributions have profoundly shaped the understanding and treatment of pain.

Introduction: Pain is a prevalent side-effect seen in breast cancer survivors (BCS). Psychological factors are known role-players in pain mechanisms. Both pain and psychological factors contribute to or interact with healthcare use (HCU). However, the association between psychological factors and HCU has never been investigated in BCS with pain, which is aimed in this study.

Methods: Belgian BCS with pain (n = 122) were assessed by the Medical Consumption Questionnaire, Injustice Experienced Questionnaire, Pain Catastrophizing Scale, Pain Vigilance and Awareness Questionnaire, Brief Illness Perceptions Questionnaire, and the Depression, Anxiety and Stress Scale. Associations were analyzed using logistic and Poisson regressions.

Results: Opioid use was related to more catastrophizing and less psychological distress. Psychotropic drug was related to more psychological distress. Endocrine therapy related to less vigilance and awareness. Psychological distress related to all types of healthcare provider (HCP), with psychological distress negatively related to physiotherapy, psychology, and other primary HCP visits, and positively with visiting a general practitioner and secondary HCP. Catastrophizing related to more visiting behavior in primary HCP, except to a general practitioner. Perceived injustice related to more general practitioner and other primary HCP visits, but to fewer psychology visits. Illness perceptions are only related to visiting other primary HCP. Vigilance and awareness was related to more psychologist and secondary HCP visits.

Conclusion: Our findings underscore the complex interplay between HCU and psychological factors in BCS with pain. Psychological distress was overall the most important psychological factor related to HCU, whether catastrophizing and perceived injustice were the most relevant related to HCP visits.

Background: It is well established that catastrophic thinking about pain modulates clinical pain severity, but it may also relate to interindividual differences in the pain experience during procedures. This mixed-methods study investigated the relationship between ratings of situational pain catastrophizing and reported pain sensitivity in the context of receiving a nerve block without sedation, and explored participants' experiences.

Methods: Healthy volunteers (n = 42) completed baseline psychosocial questionnaires, underwent quantitative sensory testing, and received a lower extremity nerve block, followed by further psychosocial assessment and interviews. Associations of catastrophizing scores with pain sensitivity and procedural site pain were assessed using Spearman's correlations. Interviews were reviewed using an immersion/crystallization approach to identify emergent themes.

Results: Greater situational catastrophizing scores were associated with higher pain sensitivity, measured as lower pain threshold and tolerance. Although females exhibited greater pain sensitivity generally, moderation analysis revealed a significant association between situational catastrophizing scores and pain sensitivity only among male participants. Qualitative interviews revealed the importance of participants' emotional responses to pain, and a mismatch of expectation and experience with procedural pain. Males also reported more negative comments about procedural pain.

Discussion: Examination of the variable subjective experience while receiving a nerve block in this experimental lab-based study revealed an important relationship between situational pain catastrophizing scores and pain sensitivity, which was more prominent among male participants. These findings reinforce how insight into individual expectations, emotions, and thought processes may impact pain sensitivity during procedures, and may inform strategies to personalize care, improving patient satisfaction and procedural acceptance.

Objective: To examine the predictors of persistent opioid use ('persistence') in people initiating opioids for non-cancer pain in Australian primary care.

Design: A retrospective cohort study.

Setting: Australian primary care.

Subjects: People prescribed opioid analgesics between 2018-2022, identified through the Population Level Analysis and Reporting (POLAR) database.

Methods: Persistence was defined as receiving opioid prescriptions for at least 90 days with a gap of less than 60 days between subsequent prescriptions. Multivariable logistic regression was used to examine the predictors of persistent opioid use.

Results: The sample consisted of 343,023 people initiating opioids for non-cancer pain; of these, 16,527 (4.8%) developed persistent opioid use. Predictors of persistence included older age (≥75 vs 15-44 years: Adjusted odds ratio: 1.67, 95% CI: 1.58-1.78), concessional beneficiary status (1.78, 1.71-1.86), diagnosis of substance use disorder (1.44, 1.22-1.71) and chronic pain (2.05, 1.85-2.27), initiation of opioid therapy with buprenorphine (1.95, 1.73-2.20) and long-acting opioids (2.07, 1.90-2.25), provision of higher quantity of opioids prescribed at initiation (total OME of ≥ 750mg vs < 100mg: 7.75, 6.89-8.72), provision of repeat/refill opioid prescriptions at initiation (2.94, 2.77-3.12), and prescription of gabapentinoids (1.59, 1.50-1.68), benzodiazepines (1.43, 1.38-1.50) and z-drugs (e.g., zopiclone, zolpidem; 1.61, 1.46-1.78).

Conclusions: These findings add to the limited evidence of individual-level factors associated with persistent opioid use. Further research is needed to understand the clinical outcomes of persistent opioid use in people with these risk factors to support the safe and effective prescribing of opioids.

Background: This randomised controlled trial evaluated the effect of radiofrequency ablation (RFA) of genicular nerve on muscle strength in osteoarthritis knee patients with chronic pain.

Methodology: Fifty-four patients with chronic knee osteoarthritis, experiencing significant pain (VNRS > 50) and moderate to severe disease (KL grade ≥ 2) were enrolled. Group 1 received RFA of genicular nerves of the affected knee while Group 2 received a sham procedure. The primary outcome was change in knee muscle strength evaluated using isokinetic peak torque(IPT) using IsoforceTM isokinetic dynamometer at 3 months. Secondary outcomes included changes in pain scores, function, perceived effect of the treatment and compliance to physiotherapy.

Results: At 3 months, significant difference was observed between IPT of flexor muscle at 60 and 180 degrees between the treatment and the Sham control (p-value = 0.01). No significant difference was observed in the extensor muscle strength. Within-group analysis revealed a significant increase in the IPT values for both extension and flexion at 60 and 180 degrees/sec evident across various time intervals. Group1 consistently reported lower VNRS scores at all time points. WOMAC scores of both groups were significantly different at all timepoints, with higher scores indicating reduced functionality in Group2. The GPE and compliance to physiotherapy were higher in Group1 patients at all times of follow up albeit decreasing trend in later periods.

Conclusion: Application of RFA to genicular nerves in chronic OA knee patients resulted in better pain relief, improved functionality and increased muscle strength at extension and flexion at 3 months follow-up.

Objective: Fibromyalgia is a chronic and disabling condition that presents management challenges for both patients and healthcare providers. The objective of this systematic review was to summarize current evidence on the effectiveness and safety of mind-body therapies in the treatment and/or management of fibromyalgia.

Methods: We searched MEDLINE, EMBASE, PsycINFO, AMED, and CINAHL databases from their inception to December 2023. Eligible articles included adults diagnosed with fibromyalgia participating in a mind-body therapy intervention and were published from the beginning of 2012 onwards. We assessed the quality of the studies using the Joanna Briggs Institute Critical Appraisal Checklists.

Results: Of 3866 records screened, 27 studies (30 articles) met our inclusion criteria, in which 22 were randomized controlled trials and 5 were quasi-experimental studies. Mind-body therapies included guided imagery (n = 5), mindfulness-based stress reduction (n = 5), qi gong (n = 5), tai chi (n = 5), biofeedback (n = 3), yoga (n = 2), mindfulness awareness training (n = 1), and progressive muscle relaxation (n = 1). With the exception of mindfulness-based stress reduction, all therapies had at least one study showing significant improvements in pain at the end of treatment. Multiple studies on guided imagery, qi gong, and tai chi observed significant improvements in pain, fatigue, multidimensional function, and sleep. Approximately one-third of the studies reported on adverse events.

Conclusions: This review suggests that mind-body therapies are potentially beneficial for adults with fibromyalgia. Further research is necessary to determine if the positive effects observed post-intervention are sustained.

Study registration: Open Science Framework (https://osf.io) (September 12, 2023; https://doi.org/10.17605/osf.io/6w7ac).