Pain physician最新文献

Background: Surgical site infections (SSIs) are common and preventable postoperative complications that contribute to increased morbidity, mortality, and health care costs. Diabetes mellitus (DM) is a known risk factor for SSIs across multiple surgical specialties, with poor perioperative glycemic control linked to higher infection rates. While neuromodulation procedures carry infection risks, optimal glycemic targets for these procedures remain unclear. Identifying an optimal glycemic threshold could improve infection rates and patient outcomes within this growing field of neuromodulation.

Objectives: To examine and compare the effects of Type 1 and Type 2 DM as well as those of hemoglobin A1c (HbA1c), perioperative glucose levels, DM status, and insulin use in association with neuromodulation pain management procedures.

Study design: A single-center retrospective chart review.

Setting: This study was conducted at the University of Texas MD Anderson Cancer Center.

Methods: This retrospective study examined neuromodulation surgical cases between October 2019 to July 2024 to ascertain the postoperative infection factors. Among the variables studied were demographics, clinical factors, and surgical outcomes. After reviewing the charts of patients who had received qualifying procedures, the researchers investigated any infections that developed in those individuals.

Results: From the 297 surgical cases analyzed, 9 (3%) yielded SSIs. The rate of SSI was significantly higher in patients with Type 1 DM (P = 0.0102), HbA1c levels > 7 (P = 0.0026), perioperative glucose > 200 mg/dl (P = 0.0088), presence of DM (P = 0.0111), and insulin use (P = 0.0244). Data specifically showed a 6.23-fold increase in the odds of developing postoperative infections for DM patients, an 8.72-fold increase in the odds for those with type 1 DM in particular, and an 8.56-fold increase in the odds for patients with HbA1c > 7 over those with an HbA1c < 7.

Limitations: Due to the retrospective design of this study, the data eligible for collection were limited to what could be found within the charts available in the electronic medical record. Therefore, the data might have been susceptible to potential confounding and bias.

Conclusions: Patients with type 1 diabetes, HbA1c > 7, perioperative glucose > 200 mg/dl, presence of DM, and a history of insulin use demonstrated a significantly higher risk of developing postoperative infections after neuromodulation procedures. Identifying the variables that contribute to postoperative infection is important to further reduce surgical complications. Future research goals include establishing glycemic targets for patients who inquire about undergoing neuromodulation procedures to improve those patients' outcomes.

Background: Spinal pain, particularly low back pain, poses a significant health and economic burden, contributing to widespread disability and economic costs. Emerging evidence suggests a connection between spinal pain and metabolic conditions, such as insulin resistance and obesity. When combined with obesity metrics, the triglyceride-glucose (TyG) index, a reliable marker for insulin resistance, may provide enhanced predictive value for metabolic syndrome and related health outcomes. However, the association of the TyG index with spinal pain remains underexplored.

Objectives: This study explores the connection of the TyG and TyG-obesity metrics (TyG-WC, TyG-WHtR, and TyG-BMI) to spinal pain. The analysis relies on data collected through the National Health and Nutrition Examination Survey from 1999 to 2004.

Study design: A cross-sectional study was conducted on 31,126 NHANES participants aged ≥20 years.

Methods: Weighted multivariable logistic regression models were utilized to evaluate the associations of the TyG index and TyG-obesity metrics with spinal pain outcomes. Restricted cubic spline analysis was employed to assess dose-response relationships, and receiver operating characteristic (ROC) analysis quantified the predictive accuracy of these indicators.

Results: Higher levels of the TyG index and TyG-obesity metrics (TyG-WC, TyG-WHtR, and TyG-BMI) were strongly linked to a greater occurrence of spinal pain and associated functional impairments (P trend < 0.001). Among these indicators, TyG-WC demonstrated the greatest predictive value for spinal pain (OR 1.70; 95% CI 1.53-1.89), whereas TyG-WHtR showed the most effective diagnostic performance across various spinal pain outcomes (AUC: 0.647; 95% CI 0.635-0.659). The associations demonstrated both linear and nonlinear trends, emphasizing the complex interplay between metabolic factors and spinal pain.

Limitations: This study's cross-sectional design means that temporal relationships cannot be established, thus limiting causal inference. Additionally, self-reported data may introduce bias, and residual confounding cannot be fully excluded.

Conclusions: This research work highlights the potential of the TyG and TyG-obesity metrics as valuable tools for predicting and diagnosing spinal pain and associated functional limitations. Incorporating these metabolic markers into clinical assessments could enhance early detection and intervention strategies for individuals at risk of spinal pain.

Background: Ketamine helps in the management of complex regional pain syndrome (CRPS) by blocking N-methyl-D-Aspartate receptors, reducing inflammation, relieving pain, and offering antidepressant effects.

Objectives: To investigate how 3 sub-anesthetic doses of ketamine infusions aid pain reduction in CRPS patients.

Study design: A randomized prospective comparative study.

Methods: This study was carried out on 75 men and women over 21 years of age who were diagnosed with CRPS and categorized as I or II according to the physical status classification system used by the American Society of Anesthesiologists. Patients were divided into 3 groups and given ketamine infusions over a period of 6 hours at doses ranging from 0.1 to 0.35 mg/kg/h, with a maximum dose of 24 mg/h. Three days of treatment were given to Group A, 5 days to Group B, and 7 days to Group C.

Results: The scores on the Brief Pain Inventory-Short Form and on the numerical rating scale were significantly lower in groups B and C than in group A (P < 0.05) at the first, second, and third months. Nevertheless, no significant differences were observed between group B and group C at the same intervals. Side effects associated with ketamine infusion were significantly lower in group A than groups B and C. Similarly, the side effects were also significantly lower in group B than group C (P < 0.05).

Limitations: The study had no control group and was performed in a single center with a short period of follow-up.

Conclusions: A 5-day regimen of ketamine infusion was associated with the best outcome for pain control and minimal side effects. Meanwhile, the 7-day regimen of ketamine infusion had the greatest number of side effects. The 3-day period of infusion had the lowest number of side effects and offered the least pain control.

Background: Herpes zoster (HZ) presents as painful blisters caused by the reactivation of the varicella-zoster virus. Postherpetic neuralgia (PHN) is a challenging complication of HZ. Oxidative stress, implicated in various skin diseases, may play a role in PHN, motivating the investigation of blood antioxidants as potential predictors of the complication. Only a limited amount of research has explored the connection between serum antioxidants and HZ outcomes.

Objectives: To examine the impact of specific serum antioxidants on the development of PHN.

Study design: A retrospective, observational study.

Setting: The study was carried out in the Pain Department of the First Hospital Affiliated to Jiaxing College in Jiaxing, China.

Methods: A total of 305 patients were included in the study, with 149 classified into the PHN group and 156 into the non-PHN group. Demographic information such as gender, age, disease duration, hospitalization, affected site, number of segments involved, complications, and treatment details were gathered. Moreover, common hematological data, including patients' levels of albumin (ALB), total bilirubin (TBIL), uric acid (UA), homocysteine (Hcy), and C-reactive protein (CRP) upon admission were recorded. Factors influencing prognosis were analyzed through both univariate and multivariate logistic regression analyses. Furthermore, a receiver operating characteristic (ROC) curve was constructed to evaluate the predictive potential of ALB and TBIL for prognosis.

Results: In the univariate analysis, age (odds ratio [OR] = 2.386, P = 0.000), disease duration (OR = 2.182, P = 0.001) and levels of albumin (OR = 0.284, P = 0.000), and TBIL (OR= 0.224, P = 0.000) were found to be correlated with PHN. Multifactorial logistic regression analysis revealed that an age exceeding 60 years (OR = 1.979, P = 0.012), ALB levels >= 44 g/L (OR = 0.278, P = 0.000), and TBIL levels >= 9.2 mu-mol/L (OR = 0.302, P = 0.000) were independent factors associated with PHN. The ROC curve demonstrated high predictive values for PHN with ALB and TBIL.

Conclusions: This study highlights the significant association between serum antioxidants, specifically ALB and TBIL, and the prognosis of PHN in patients with HZ.

Limitations: The nonrandomized, single-center, and retrospective design are major limitations of this study.

Background: Oxidative stress plays a critical role in the pathogenesis of low back pain. Higher serum levels of lutein and zeaxanthin are associated with reduced susceptibility to this disease due to their potent antioxidant properties.

Objectives: Our study aimed to assess the correlation between serum lutein and zeaxanthin levels and low back pain.

Study design: This is a cross-sectional study based on publicly available data from the National Health and Nutrition Examination Survey.

Setting: The National Health and Nutrition Examination Survey employs a complex, multistage probability sampling design in order to select a nationally representative sample.

Methods: In our study, information was gathered from individuals who were 20 years old or older who took part in the National Health and Nutrition Examination Survey from 2001 through 2004. Detailed information was collected on low back pain, serum lutein and zeaxanthin levels, and various other crucial factors. Multivariable logistic regression and restricted cubic spline regression analyses were performed in order to investigate the relationship between serum lutein and zeaxanthin levels and the occurrence of low back pain.

Results: In our study 7,026 participants were included, of whom 38.21% (2,685 of 7,026) had low back pain. There was a nonlinear relationship (P < 0.001) between serum lutein and zeaxanthin levels and low back pain, depicted as a U-shaped curve in the restricted cubic spline. The occurrence rate for individuals with serum lutein and zeaxanthin levels below 25.3 nmol/dL was 0.975 (95% CI, 0.960-0.990; P < 0.001). In comparison, the occurrence rate for individuals with serum lutein and zeaxanthin levels exceeding 25.3 nmol/dL was 1.006 (95% CI, 1.000-1.013; P = 0.043).

Limitations: This is a cross-sectional study; therefore causality cannot be established.

Conclusion: A nonlinear association between serum lutein and zeaxanthin levels and the risk of low back pain was observed in US adults. The ideal serum lutein and zeaxanthin level that corresponds to the lowest risk of low back pain is approximately 25.3 nmol/dL.

Background: Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Recent studies show increasing evidence for the implication of a multimodal treatment approach for CLBP, including education, exercise therapy, and physical activity.

Objective: This study aimed to analyze the trends in the biopsychosocial approach to CLBP through bibliometric analysis and to explore the main topics and provide recommendations for researchers and clinicians.

Study design: In this bibliometric analysis, a 2-phase literature screening was performed to generate clusters and thus explore the main topics of the years 2012-2023.

Methods: Literature was derived from Web of Science for the years 2012-2023. Two researchers independently conducted double-blind title and abstract screening in accordance with PRISMA guidelines. VOSViewer and CiteSpace software were used to analyze authors, countries, institutions, journals, keywords, and references. The clusters of co-cited references generated by the CiteSpace software were analyzed, and the largest clusters related to the biopsychosocial approach were narratively reviewed in detail.

Results: A total of 2,070 studies were included in the analysis. The most influential country, institution, and author were the United States of America, the University of Sydney, and Leonardo Oliveira Pena Costa, respectively. BMC Musculoskeletal Disorders was the journal with the greatest number of publications. Exercise therapy, cognitive-functional therapy, pain neuroscience education, manual therapy, mobile applications, and psychologically informed physical therapy stood out in the reference analysis.

Limitations: This study has several limitations, such as the restriction to studies indexed in the WOS database. Only English-language studies were included, and to maintain focus, we chose to discuss only those relevant to the biopsychosocial approach within the top 10 clusters.

Conclusions: This bibliometric analysis highlighted the evolving trends and main contributors in this field. The study mapped the complex knowledge network in the field, highlighting various interventions as focal points of scientific interest, particularly exercise therapy, cognitive-functional therapy, pain neuroscience education, manual therapy, mobile application, and psychologically informed physical therapy. Standardization in research methodologies and more high-quality studies are needed to solidify the efficacy of these interventions and inform clinical practice more effectively.

Background: Thoracic outlet syndrome (TOS) encompasses a range of symptoms originating from the compression of neurovascular structures, often leading to significant morbidity. Neurogenic thoracic outlet syndrome (N-TOS) frequently manifests as brachial plexus neuropathy, with a subset of patients experiencing refractory pain that does not respond to conservative treatments.

Objectives: This review aims to consolidate current evidence to evaluate the efficacy of available ultrasound (US)-guided injection techniques, including muscle injections, hydrodissection, regenerative therapies, and nerve blocks, in managing refractory pain associated with N-TOS. Additionally, this study aims to provide clinical guidance for pain management in refractory TOS through current treatment strategies, offering structured guides that physicians can use as practical tools.

Methods: A literature search was conducted across various academic databases to identify studies addressing US-guided interventions for refractory N-TOS. Relevant data regarding treatment efficacy, patient outcomes, and procedural details were extracted and synthesized narratively, as well as using structured tables and frameworks to aid in clinical decision-making.

Results: US-guided injection techniques have demonstrated effectiveness in managing refractory pain that occurs after TOS surgery. Muscle injections, particularly botulinum toxin and local anesthetics, target muscle spasms, while hydrodissection alleviates nerve entrapment. Additionally, nerve blocks, such as epidurals and stellate ganglion blocks, provide targeted pain relief by addressing specific nerve pathways. However, although regenerative therapies, including dextrose prolotherapy and platelet-rich plasma (PRP), show great potential for tissue healing, they remain under research and available data on them are limited.

Limitations: The effectiveness of these interventions may vary based on individual patient factors, practitioner experience, and the complexity of TOS presentations. Furthermore, while US-guided injections are well-established, the role of regenerative therapies requires further investigation due to a lack of standardized protocols and robust clinical trials, calling for future research.

Conclusion: US-guided injection techniques represent a promising approach for managing refractory pain in N-TOS, offering tailored pain relief strategies. However, ongoing research is essential to clarify the efficacy of regenerative therapies and to optimize treatment protocols, ultimately enhancing patient outcomes and quality of life.

Background: The U.S. health care system faces escalating costs and inefficiencies, with Medicare projected to reach insolvency by 2036. Despite this, Medicare Advantage (MA) plans continue to receive preferential funding, resulting in overpayments, rising patient out-of-pocket expenses and limited accountability, instead of being a tool to achieve lower spending and increase quality. Physicians endure payment cuts, sequestration, and denied services, threatening access to care.

Objective: To analyze MA plans' growth, costs, and policy implications and assess their impact on Medicare solvency, physician reimbursement, and patient care quality.

Study design: A comprehensive policy and financial analysis using data from Medicare Payment Advisory Commission, Centers for Medicare and Medicaid Services, Congressional Budget Office, peer-reviewed literature, and federal reports from 1997-2025.

Methods: We reviewed legislative history, financial trends, and quality metrics of Medicare and MA programs. Specific focus was placed on benchmarks, rebates, risk adjustments, favorable selection, coding intensity, and patient access barriers. Data on enrollment trends, geographic variation, and out-of-pocket costs were analyzed.

Results: MA enrollment grew from 6.9 million (16% of Medicare beneficiaries) in 2014 to 33.6 million (54%) in 2024. Payments to MA plans exceed fee-for-service (FFS) Medicare by 22%, translating to $84 billion annually, plus $15 billion in quality bonuses. Out-of-pocket maximums surged 859% since 1999, and inappropriate care denials affect 13%-18% of cases. Risk adjustment and coding practices inflate payments, undermining program sustainability.

Limitations: The present investigation relies on secondary data from government agencies and published literature; real-time administrative and clinical data from MA plans were unavailable due to reporting gaps.

Conclusion: Originally intended to reduce costs, MA plans have driven higher expenditures, limited access, and increased patient burdens. Policy reforms-including alignment of MA payments with FFS Medicare, elimination of favorable selection and upcoding incentives, and enforcement of coverage requirements-are critical to preserving Medicare solvency and ensuring equitable patient care.