Pain and Therapy最新文献

Introduction: Epidural steroid injections (ESIs) are commonly used to manage chronic spinal pain. However, variations in ESI practices remain prevalent among interventional pain physicians. This study evaluates current practice patterns and perceptions of ESI efficacy to identify areas for potential standardization in clinical application.

Methods: A structured survey was distributed to interventional pain physicians via email and social media outlets, collecting data on several aspects of ESI practice: (1) the importance of precise injectate placement, (2) perceived effectiveness for axial versus limb pain, and (3) preference for fixed versus variable injectate volume based on contrast pattern spread. Responses were collected and analyzed to understand prevailing practice trends. The survey included a diverse group of pain management physicians representing different primary specialties and practice settings.

Results: Of the 94 respondents, 77.7% (73/94) selected that precise injectate placement is crucial for optimal outcomes, while 22.3% (21/94) did not view it as essential. Regarding pain type, 61.7% (58/94) selected that ESIs help with axial and limb pain, while 36.2% (34/94) found ESIs primarily effective for limb pain. Only 1.1% (1/94) selected that ESIs were beneficial solely for axial back pain, with one respondent selecting ineffectiveness for either pain type. For injectate volume, 69.2% (65/94) selected that they use a fixed volume for injection, while 30.9% (29/94) adjusted injectate volume based on contrast spread.

Conclusion: This survey highlights practice patterns among interventional pain physicians regarding ESIs, underscoring the value placed on targeted injectate placement and the perceived broad efficacy of ESIs for axial and limb pain. However, the variability in volume administration suggests a need for further research to explore the impact of fixed versus variable injectate volumes on clinical outcomes. These findings may influence future standardization efforts in ESI practice.

Introduction: Schroth therapy improves outcomes in mild degenerative scoliosis but may be insufficient for patients with vertebrogenic pain linked to vertebral endplate changes. Basivertebral nerve ablation (BVNA) is a novel intervention that may provide additional benefit in these cases.

Methods: This retrospective, propensity score-matched cohort study included adults aged ≥ 18 years with idiopathic or degenerative scoliosis (Cobb angle ≥ 20°) and vertebrogenic pain, treated between January 1, 2020 and January 31, 2024, across two major healthcare systems. A subset received BVNA between December 5, 2022 and December 5, 2024. Propensity score matching was performed 1:1 for age, sex, body mass index, baseline disability and pain scores, and prior therapy sessions, yielding 44 matched patients (22 per group). The primary outcome was ≥ 15-point improvement in Oswestry Disability Index (ODI) at 12 months. Secondary outcomes included ≥ 3-point pain reduction, opioid and health-resource utilization, and complications.

Results: Among 76 patients (mean [standard deviation] age 68.8 [14.8] years; 82.9% female), 44 were included in the matched analysis. At 12 months, patients receiving Schroth therapy plus BVNA achieved greater ODI improvement (mean change - 22.3 vs - 15.1; P = 0.03) and were more likely to reach ≥ 15-point ODI improvement (81.8% vs 59.1%; OR 2.58 [95% CI 1.01-6.60]; P = 0.048). Opioid use declined more in the BVNA group (- 37% vs - 14%, P = 0.037), with progressive MEDD reduction (19 → 10 mg) compared with stable use in the Schroth-only group (17 → 17 mg; group × time P = 0.003). Rates of subsequent pain procedures (81.8% vs 13.6%, P < .001) and ER visits for chronic back pain (63.6% vs 9.1%, P = 0.0004) were higher for Schroth-only patients. No complications were reported.

Conclusion: In adults with scoliosis and vertebrogenic pain, combining BVNA with Schroth therapy was associated with superior outcomes at 12 months compared with Schroth therapy alone.

Introduction: Despite expert recommendations against using opioids for migraine treatment, their use remains common in the USA. We aimed to evaluate the use of opioids among people with active migraine using data from the Observational Survey of the Epidemiology, Treatment, and Care of Migraine (OVERCOME) (US) study.

Methods: This observational, longitudinal, web-based survey study included a demographically representative sample of adults with migraine in the USA (2018-2020). Participants with migraine (International Classification of Headache Disorders, third edition [ICHD-3]) and ≥ 1 headache in the previous 12 months were identified via a questionnaire and/or self-reported diagnosis. Information on opioid use for acute migraine treatment was collected. Demographics, clinical, and migraine-related characteristics among those with current opioid use and those with non-use were evaluated in the cross-sectional analysis using standardized mean difference (SMD). Multivariable analysis was conducted using machine learning (least absolute shrinkage and selection operator regression, random forest) and logistic regression models to assess factors associated with current opioid use.

Results: Of 61,932 respondents with active migraine, 13,331 (21.5%) reported currently using opioids to treat migraine. Among those using opioids, 68.0% were female, 64.3% identified as White, and 13.7% identified as Hispanic. Those currently using opioids differed from those not using opioids in various characteristics, including higher tobacco/marijuana use, more comorbidities, higher migraine-related disability, and higher interictal burden (all SMD > 0.2). The factors most associated with current opioid use were "currently taking recommended acute medications for migraine" (odds ratio [OR], 10.1; confidence interval [CI], 9.47, 10.78), "currently taking barbiturates for migraine" (OR, 2.2; CI, 2.03, 2.34), and "sought care at an Emergency Department/Urgent Care for migraine in the previous 12 months" (OR, 1.7; CI, 1.67, 1.85).

Conclusions: This study shows that opioid use for migraine is associated with using recommended acute medications, barbiturates, and emergency department care for migraine. Understanding how to limit these factors is key to developing interventions to reduce opioid use in migraine.

Introduction: Acute and chronic pain affects patients' overall health status and well-being, and the assessment and treatment of these patients can be challenging. Unfortunately, many patients fail to respond to the available multimodal treatment options, with some even failing advanced interventions including surgery. Therefore, alternative approaches to pain treatment represent an unmet medical need. Haptic vibrotactile trigger technology (VTT) is designed to target nociceptive pathways and is theorized to disrupt the neuromatrix of pain. The aim of this study was to evaluate the analgesic effects of a wearable VTT haptic patch in adults diagnosed with mild-to-moderate acute or chronic pain.

Methods: This was a prospective, randomized, controlled, double-blind study. A total of 118 research participants (58 male, 60 female) met the inclusion criteria and were enrolled in the study. Participants were randomly assigned to either a treatment group receiving the active patch (N = 64) or a control group which used a similar-appearing vehicle/placebo patch (N = 54). Assessments were performed at baseline (day 0), day 7, and day 14. Reduction in pain severity and interference was assessed using the validated Brief Pain Inventory (BPI), and range of motion/flexibility assessment was performed using the Schober (only for low back pain), goniometer, and bubble inclinometer tests. Data for the active patch user group and the control group were aggregated and compared over the 14-day time frame of the study.

Results: The active patch user group had significantly greater improvement in pain severity and reduction in pain interference; in addition, the active patch group showed greater objective improvement in range of motion (ROM)/flexibility than the control group at day 7 and day 14.

Conclusion: These findings suggest that this non-pharmacological, noninvasive, topical VTT haptic patch (FREEDOM Super Patch with VTT) can reduce pain severity and increase ROM/flexibility. Considering the multitude of serious adverse effects associated with standard pharmacological pain treatments, clinicians should consider this readily available, over-the-counter VTT patch as a potential first-line or adjunct therapy to treat pain.

Trial registration: ClinicalTrials.gov identifier, NCT06505005.

Introduction: Long-term use (≥ 3 months) of opioids for chronic noncancer pain (CNCP) shows limited benefit and often leads to dependence, especially when tapered too quickly. Standard opioid discontinuation typically involves gradual dose reduction, yet many patients fail to complete it. Meta-analyses show buprenorphine reduces withdrawal severity, increases treatment retention and completion rates, and facilitates analgesia and smoother transitions in patients with chronic pain, with low adverse effects and high initiation success.

Methods: This single-center, prospective, nonrandomized proof-of-concept study assessed the efficacy of an outpatient buprenorphine-based discontinuation strategy in patients with CNCP and opioid dependence who had failed standard tapering. Participants first attempted gradual tapering; those unsuccessful transitioned to buprenorphine: 4-8 mg/day for 1 month, followed by tapering over up to 9 months. Success was defined as complete opioid cessation at 9 months, confirmed by urine analysis (including buprenorphine). The primary outcome was the success rate of the buprenorphine strategy, with ≥ 60% considered effective. A secondary outcome compared success rates between strategies.

Results: Of 20 patients, six (30.0%) successfully withdrew using standard tapering. Fourteen failed; 11 of them transitioned to buprenorphine. Of these, seven (63.6%) achieved full discontinuation. While not statistically significant, the buprenorphine group showed a higher success rate than standard tapering (p = 0.076; OR = 4.08 [0.90-21.23]).

Conclusions: Buprenorphine substitution appears at least as effective as conventional tapering and may benefit patients unable to succeed with tapering alone. These preliminary results support further investigation in larger trials.

Trial registration: ClinicalTrials. gov identifier, NCT03156907.

Introduction: Acute pain associated with headaches and migraines in children and adolescents may be managed with over-the-counter (OTC) treatments (e.g., paracetamol and ibuprofen); however, there are few studies on their safety and effectiveness in these patients. This narrative review evaluates the use of OTC treatments in children and adolescents with headaches and migraines.

Methods: A literature search of Embase, MEDLINE, ToxFile, and Derwent Drug File was performed for reviews of clinical studies and meta-analyses (January 2010-October 2023) related to the acute treatment of headaches and migraines in children (1 month-11 years) and adolescents (12-18 years) with OTC analgesics (paracetamol, ibuprofen, aspirin, and naproxen). The results of the literature search were interpreted alongside expert recommendations per real-world clinical experience.

Results: Twenty-eight articles were identified, of which half included recommendations that either paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs; typically, ibuprofen) were appropriate first-line OTC treatments for headache and/or migraine in children and adolescents. The remaining studies recommended ibuprofen and/or other NSAIDs (particularly naproxen) exclusively or preferentially over paracetamol. Four studies noted that aspirin was appropriate for adolescent patients > 16 years of age. An overall lack of clinical evidence on children and adolescents was noted, particularly regarding combinations of paracetamol and NSAIDs, and adjuvants such as caffeine.

Conclusion: Paracetamol appears to be effective for treating headaches and migraines in children and adolescents; however, evidence is inconclusive regarding the equivalence or superiority of NSAIDs for the same indication. Clinical judgment and patient or caregiver preferences should guide medication selection.

Introduction: Cluster headache (CH) causes brief but extremely severe head pain, yet we still do not fully understand the molecules that trigger these attacks. Many studies have looked at changes in neurotransmitters and neuropeptides, but their results do not always agree. This systematic review brings together all the available data on neurochemical changes in CH, with the goal of clarifying current knowledge gaps and highlighting promising targets for future research.

Methods: We searched PubMed, Embase (Ovid), and Scopus for studies reporting quantitative measurements of neurotransmitters in human biological samples from individuals with CH, as well as provocation studies in which neurotransmitters or neurotransmitter-related compounds were administered to trigger attacks. Thirty-eight eligible studies were identified. For each, we extracted information on design, participant characteristics, sampling matrix (e.g., plasma, saliva, cerebrospinal fluid, platelets), and the neuromodulators assayed, and then synthesized the findings narratively.

Results: Altered levels of histamine and sensory neuropeptides such as calcitonin gene-related peptide (CGRP) and substance P were documented, especially during active headache attacks. Conflicting data were reported for serotonin, whereas nitric oxide (NO), pituitary adenylate cyclase-activating peptide (PACAP), and vasoactive intestinal peptide (VIP) provoked CH attacks in experimental studies. Data on orexins and their receptors were inconclusive.

Conclusions: The evidence emphasize several potential therapeutic targets, including CGRP, substance P, histamine, VIP, and PACAP. However, interpretation is hampered by heterogeneity across studies and methodological limitations, particularly the large variance and uncertainties of CGRP assays, which make cross-study comparisons difficult. Further research is needed to elucidate the exact molecular mechanisms driving CH and to identify effective therapeutic interventions.

Introduction: Chronic pain is a leading global cause of disability in aging populations, yet pain distribution patterns among middle-aged and older adults in China remain uncharacterized. Using latent class analysis (LCA), this study identified distinct pain location patterns and their associations with cognitive impairment, depressive symptoms, and functional limitations.

Methods: A cross-sectional analysis of 9544 participants from the CHARLS 2020 database was conducted. LCA categorized pain patterns, and multivariate logistic regression examined influencing factors and associations with cognitive impairment, depressive symptoms, and activities of daily living (ADL) impairment. Model fit was optimized via AIC/BIC and entropy/posterior probabilities (> 0.8).

Results: Four distinct categories were identified: the broad pain group (n = 935, 9.8%), the shoulder-low back pain group (n = 2426, 25.4%), the lower limb pain group (n = 2568, 26.9%), and the head-neck-stomach pain group (n = 3615, 37.9%). The analysis revealed significant associations between pain location patterns and variables such as sex, income, and the presence of multiple comorbidities, including dyslipidemia, stomach disease, cancer, asthma, chronic lung disease, stroke, kidney disease, arthritis, mood disorders, Parkinson's disease, and memory-related diseases. In addition, the broad pain group showed stronger associations with cognitive impairment, depressive symptoms, and ADL difficulties (including BADL difficulties and IADL difficulties), and the lower limb pain group was associated with a significantly higher likelihood of ADL impairment than the head-neck-stomach pain group.

Conclusions: Pain patterns in Chinese adults ≥ 45 years reflect distinct phenotypes with differential health risks. The broad pain group warrants comprehensive intervention targeting pain, cognition, mood, and function. Lower limb pain requires prioritized mobility preservation strategies. Findings support phenotype-specific pain management to reduce disability burden.

Introduction: Despite growing interest in non-pharmacological analgesia, clinical evidence supporting transauricular vagus nerve stimulation (taVNS) for postoperative pain management following arthroscopic shoulder surgery remains limited. This study aimed to evaluate the efficacy and safety of taVNS in postoperative analgesia after shoulder arthroscopy.

Methods: Seventy patients scheduled for arthroscopic shoulder surgery were randomly assigned to two groups on the basis fo computer-generated concealed allocation sequences. The intervention group received taVNS once on the day of surgery and once daily for the following two consecutive days, with each session lasting 2 h. The control group received sham stimulation following an identical schedule. The primary outcome was total sufentanil consumption within 24 h postoperatively.

Results: Postoperative sufentanil consumption at 24 and 48 h, resting Numeric Rating Scale (NRS) scores at 4, 6, 12, 24, and 48 h, and the requirement for rescue analgesia were all significantly lower in the taVNS group compared with the sham stimulation group (all P < 0.05). In addition, quality of recovery-15 (QoR-15) scores at 24, 48, and 72 h post surgery were significantly higher in the taVNS group (all P < 0.05). No significant intergroup differences were observed in hemodynamic parameters (all P > 0.05). The incidences of nausea, vomiting, constipation, and gastrointestinal dysmotility were lower in the taVNS group, while other adverse events did not differ significantly between groups.

Conclusions: TaVNS demonstrates both safety and efficacy in the management of postoperative pain following shoulder arthroscopy. Its application is associated with a reduction in analgesic requirements and contributes to an improved quality of recovery during the early postoperative period.

Trial registration: ClinicalTrials.gov identifier no. ChiCTR2400094087.