Pain and Therapy最新文献

Introduction: Menstrual migraine (MM) is a common subtype of migraine that greatly affects a woman's quality of life. A number of different drugs are used to treat menstrual migraine, but it is not known which is more effective.

Methods: In this study, we searched all randomized controlled trials that satisfied the inclusion and exclusion criteria up to December 2023 on PubMed, Embase and Cochrane Library using a suitable search strategy. We constructed a suitable network model for analysis after evaluating the heterogeneity among the included direct, indirect and pooled evidence. Odds ratio (OR) and corresponding 95% confidence intervals (CI) were used as valid indicators for this network meta-analysis.

Results: In the Bayesian network model we constructed, we found that lasmiditan (vs. placebo OR, 14; 95% CI 3.1-100) was better than rizatriptan (vs. placebo OR, 1.9; 95% CI 1.2-3.3) in terms of the rate of sustained freedom from pain. There was no statistically significant difference between lasmiditan and different triptans in terms of the rate of being pain-free at 2 h (2-h pain-free) and the rate of pain relief at 2 h (2-h pain relief). Regarding safety, the probability of adverse events was significantly higher for rizatriptan (OR, 2.7; 95% CI 1.1-7.3) than for placebo.

Conclusion: In terms of treatment efficacy for MM, lasmiditan was not worse than different triptans and was even better than some of the triptans in the rate of sustained freedom from pain. As an emerging treatment, lasmiditan is promising for the treatment of MM. However, more research needs to be carried out because of the lack of safety analysis for lasmiditan.

Introduction: The specific headache phenotype, accompanying symptoms and psychological impact that lead to admission of patients with cluster headache are not yet known. The aim of this study was therefore to analyze the characteristics of patients who were admitted to a tertiary headache center in 2018, 2019 and 2020 due to cluster headache.

Methods: A total of 207 patients with cluster headache were examined, who were admitted to the Kiel Headache Center, a tertiary headache center in Germany, in the years 2018, 2019, and 2020. A retrospective cohort study was conducted to analyze the phenotype and psychosocial impact of cluster headaches in a standardized manner. The data were collected based on information from the standardized Kiel Headache Questionnaire, the Migraine Disability Assessment (MIDAS) questionnaire, and the World Health Organization (WHO) Disability Assessment Schedule (WHODAS 2.0).

Results: Most of the patients had a chronic course of disease over many years, and 71.5% had had the disease for more than 5 years. Cluster headache attacks occurred in 98.6% of the patients, with strong to very strong pain intensity, and more than 78% of the patients experienced three or more attacks per day. Nighttime occurrence led to severe sleep disturbances with exhaustion, a lack of energy, and an inability to work. In 31.4% of the patients, persistent pain in the area also contributed to the inability to work. A total of 94.7% of the patients had a MIDAS score of grade 4. The analysis of the WHODAS 2.0 score revealed that 92.7% of the patients with cluster headaches experienced severe limitations in their health and functionality. These individuals were particularly severely affected by the accompanying psychological symptoms and the psychosocial impact of cluster headaches. The highly stressful complications of cluster headaches were particularly evident in the high frequency of suicidal ideation in more than 40% of the patients examined. Severe illness affected almost all areas of professional, social, and family life and caused a very high level of suffering.

Conclusions: The results revealed a pronounced, severe symptom complex in patients with cluster headaches that went far beyond the purely diagnostic criteria. The psychosocial impact of cluster headaches should be given close attention in the care of these patients.

Introduction: Postoperative analgesia in thoracoscopic lung resection is crucial, with several nerve block techniques-including thoracic epidural anesthesia (TEA), paravertebral block (PVB), erector spinae plane block (ESPB), intercostal nerve block (INB), and serratus anterior plane block (SAPB)-commonly employed. However, there remains ongoing debate regarding the optimal technique.

Methods: To evaluate and compare the effectiveness of these analgesia methods, a systematic review was conducted across multiple databases, including PubMed, Embase, Web of Science, and the Cochrane Library, identifying relevant randomized clinical trials (RCTs). A Bayesian network meta-analysis was performed to assess postoperative pain management, with subgroup analyses and meta-regression conducted to examine key factors influencing outcomes, such as the risk of bias, continuous catheter analgesia, and patient-controlled analgesia (PCA).

Results: The results revealed that for 12-h resting visual analog scale (VAS) scores, the surface under the cumulative ranking curve (SUCRA) ranking was TEA > PVB > ESPB > control > INB > SAPB, whereas at 24 h, it shifted to PVB > TEA > ESPB > INB > control > SAPB. For 12-h coughing VAS scores, TEA ranked highest, followed by PVB, SAPB, ESPB, and control. At 24 h, PVB ranked highest, followed by TEA, ESPB, SAPB, INB, and control. The inconsistency test showed good consistency, with minimal publication bias, and meta-regression revealed that neither study quality nor local anesthetic infiltration at the incision site significantly impacted the outcomes. Excluding studies without PCA did not change the SUCRA rankings. PVB consistently ranked highest for 24-h resting and coughing VAS scores. Clustered ranking plots indicated that PVB and ESPB were the most suitable techniques for postoperative analgesia.

Conclusion: PVB and ESPB emerged as the most suitable analgesic techniques for thoracoscopic lung resection. While PVB showed superior analgesic efficacy, ESPB offered fewer side effects, providing a safety advantage. TEA was considered less suitable due to its excessive side effects.

Introduction: Various acupuncture techniques are widely applied in clinics for pain control and dysfunction relief in patients with knee osteoarthritis (KOA). The purpose of this trial was to investigate whether the different acupuncture techniques were more effective in treating joint pain and dysfunction than were sham acupuncture or drug treatment in patients with KOA and to determine the differences in efficacy among them.

Methods: In this multi-center, single-blind, randomized, controlled trial, participants were randomly assigned to the manual acupuncture (MA), electroacupuncture (EA), warm-needling acupuncture (WA), mild moxibustion (MM), sham acupuncture (SA), or drug treatment (Celebrex) groups. Each participant in the above groups received individual treatments for 4 consecutive weeks. The primary outcome measures included the visual analog scale score (VAS) and the physical function score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results: Compared with the SA group, the acupuncture technique groups (MA, EA, WA, and MM) had markedly lower patient VAS scores (- 0.61; 95% CI - 1.09 to - 0.13; P = 0.01) and lower WOMAC physical function scores (- 13.84; 95% CI - 21.14 to - 6.54; P < 0.01). Compared with Celebrex, EA had a significant advantage in reducing the VAS score (1.14; 95% CI 0.55 to 1.72; P < 0.01) and WOMAC physical function score (14.81; 95% CI 5.69 to 23.93; P < 0.01).

Conclusions: The observed acupuncture techniques effectively relieve pain and ameliorate knee joint dysfunction in patients with KOA. EA is the most effective method of alleviating pain intensity in treating KOA.

Trial registration: The trial was registered on ClinicalTrials.gov (NCT03563690).

Introduction: Strategies to reduce pharmacologic use for pain are needed. Pulsed electromagnetic field (PEMF) therapy is a noninvasive, nonpharmacologic treatment for pain that modifies nitric oxide signaling to improve healing. This study examined whether PEMF decreased pain and pharmacologic use vs. standard-of-care (SOC) treatment for joint and soft tissue pain.

Methods: This prospective, randomized controlled trial enrolled 120 patients presenting with joint or soft tissue pain at five orthopedic clinic sites. The PEMF group self-administered daily therapy from a commercially available device and the SOC group received standard treatment daily as prescribed by the clinician. Patients recorded their pain level, pharmacologic usage, and adverse events daily for 14 days. After 14 days, patients in the SOC group were given the option to crossover to PEMF therapy and continue for 16 days. The study was overseen by an independent clinical research organization. It was hypothesized that PEMF would be superior to SOC for pain management.

Results: PEMF treatment provided significant analgesic benefits compared to SOC. Complete data was collected for 91 patients, 48 from the PEMF group and 43 from the SOC group. The least squares mean pain score change from baseline was - 1.8 (a 36% reduction) for the PEMF group, significantly surpassing - 0.46 (a 10% reduction) for the SOC group (p < 0.0001). Pharmacologic usage decreased from 40 to 18% for the PEMF group (a 55% reduction), while the SOC group decreased from 40 to 35% (a 12% reduction). In the crossover subgroup, patients experienced an additional 18% decrease in pain score and 63% decrease in pharmacologic use after switching from SOC to PEMF treatment.

Conclusions: PEMF was significantly more effective than SOC at managing pain and reducing pharmacologic use. PEMF therapy should be considered for noninvasive, nonpharmacologic management of joint and soft tissue pain.

Trial registration: ClinicalTrials.gov ID NCT05244187.

Introduction: Patient satisfaction is important in pain management. Satisfaction with prescribed pain relievers and continued use of these drugs may be affected by a patient's understanding of their efficacy and safety. We investigated the association between patients' satisfaction and understanding of their prescribed medication for three oral pain relievers (lasmiditan, mirogabalin, and tramadol) that recently became available in Japan.

Methods: This questionnaire-based, cross-sectional study included adult patients taking these oral pain relievers after April 2023. The primary endpoint was overall satisfaction (five-point rating) and the secondary endpoint was overall understanding (five-point rating) of the oral pain relievers.

Results: In total, 328 patients (lasmiditan, 36.9%; mirogabalin, 55.5%, tramadol, 8.8%; four patients had been prescribed more than one medication) were included, and 71.6% of patients reported high satisfaction (score 4, 5) with their oral pain relievers (lasmiditan, 62.0%; mirogabalin, 76.1%; tramadol, 85.2%). The proportion of patients in the total population who reported a high understanding (score 4, 5) of their oral pain relievers was 68.0% (lasmiditan, 77.7%; mirogabalin, 63.3%; tramadol, 55.6%). In the total population and the lasmiditan and mirogabalin subgroups, the patient satisfaction level was significantly associated with scores on medication understanding (Cochran-Armitage test, p < 0.0001 for all). Discontinuation rates were higher in patients who were unsatisfied with their treatment than those who were satisfied (38.7% and 9.8%, respectively).

Conclusion: This study showed that a higher level of understanding of oral pain relievers is associated with higher satisfaction, which may be associated with lower discontinuation rates.

Clinical trial registration: UMIN000052629.

Chronic pain in the diabetic foot (DF) is a common complication of diabetes, bringing a significant burden to patients, their families, and even society. There is no very effective treatment for it, traditional treatments such as medication, lumbar sympathetic nerve block, and alternative therapies are often not very effective and have more adverse effects. The emergence of neuromodulation technology has brought new hope for the treatment of DF, among which spinal cord stimulation (SCS) is a hotspot in current research and has achieved remarkable efficacy in the study of DF treatment by blocking pain signaling and improving circulation and other mechanisms. This article reviews the SCS technique and clinical trails of SCS for chronic DF pain, and describes the prospects and current challenges of SCS.