Pain and Therapy最新文献

Compared with conventional sternotomy, minimally invasive cardiac surgery (MICS) is associated with significant advantages such as reduced tissue trauma, faster recovery, and shorter hospital stay. However, the management of postoperative pain caused by intercostal nerve injury, pleural irritation, and tissue retraction remains a major challenge. Despite the less invasive nature of MICS, patients often report experiencing pain similar to that experienced following conventional cardiac surgery, particularly during the acute postoperative period. Effective pain management is essential for optimizing recovery, reducing the consumption of opioids, and preventing the transition to chronic postsurgical pain. Regional anesthesia techniques play a key role in multimodal analgesia for MICS. Thoracic epidural analgesia exhibits strong analgesic efficacy; nevertheless, it remains underutilized owing to concerns regarding anticoagulation-related complications and hemodynamic instability. The thoracic paravertebral block is a safer alternative that provides comparable pain relief with fewer side effects. Similarly, ultrasound-guided fascial plane blocks, such as serratus anterior, parasternal intercostal, interpectoral + pectoserratus, and erector spinae plane blocks, have gained popularity owing to their safety and feasibility; however, the effectiveness of these blocks varies according to the surgical approach and type of incision. Systemic analgesia is an integral component of multimodal pain management in MICS. Despite the efficacy of opioids, a shift toward opioid-sparing strategies has been observed given the significant adverse effects associated with the use of opioids. Intravenous adjuncts such as dexmedetomidine, ketamine, and non-steroidal anti-inflammatory drugs can reduce opioid consumption and improve postoperative pain control. Despite advances in pain management, a single approach that can provide comprehensive analgesia for MICS remains to be established. A multimodal strategy that combines systemic and regional techniques must be developed to optimize pain management and long-term outcomes.

Ibuprofen arginine (IBA) combines well-established analgesic and anti-inflammatory properties with enhanced pharmacokinetics. The addition of arginine significantly improves solubility and absorption, leading to a faster onset of action compared to conventional ibuprofen. Clinical studies consistently demonstrate that IBA achieves meaningful pain relief within a shorter timeframe while maintaining a favorable safety profile. IBA's rapid action is particularly valuable in managing acute exacerbations of chronic pain and preventing central sensitization, thus improving patient comfort, adherence, and overall quality of life. By addressing both the inflammatory and nociceptive components of pain, IBA offers an effective and well-tolerated alternative in multimodal pain management strategies. This review explores the clinical benefits of IBA in pain management among various clinical settings.

Musculoskeletal ultrasound has gained increasing attention as a noninvasive imaging modality in pain clinics. Its advantages include the lack of radiation exposure, cost-effectiveness, and efficiency, allowing for rapid provision of dynamic examination results. Notably, it has demonstrated significant effectiveness in diagnosing common joint injuries. This review synthesizes the advancements in the application of musculoskeletal ultrasound across various domains, including muscles, joints, bones, tendons, ligaments, and bursae. It explores the critical role of ultrasound in pain management, highlighting both its importance and limitations. Moreover, the review analyzes the latest research findings and the potential for clinical applications, underscoring the evolving landscape of musculoskeletal ultrasound in enhancing diagnostic accuracy in pain management.

Regional anesthesia (RA) has become an integral part of modern anesthesia practice and acute pain management strategies. It provides effective pain relief, reduces opioid consumption, and facilitates enhanced recovery after surgery. However, like any medical intervention, RA is not without risks. RA is associated with potential complications, including neurological deficits which can range from mild and transient to severe and permanent. These neurological deficits may result from non-adherence to established standards of care and deviations from the clinical practice guidelines. An online database search was conducted across multiple websites to identify the relevant articles. The inclusion criteria were articles in English, published between January 2010 and July 2024. The search included various study types, such as case series, observational studies, cross-sectional analyses, cohort studies, longitudinal studies, systematic reviews, and practice guidelines. A total of 38 articles met the inclusion criteria and were included in this comprehensive review which examines the neurological complications associated with regional anesthesia and pain interventions, with a particular focus on how deviations from the standards of care contribute to adverse neurological outcomes. Furthermore, it highlights preventive strategies aimed at minimizing the risks of these complications and improving patient safety.

Introduction: Although global opioid consumption is decreasing, high-income populations are experiencing an increase. Data on specific opioid-prescribed and at-risk patient groups in Austria are lacking.

Methods: We performed a retrospective observational population-based study analysing health insurance data between January 2016 and December 2021. The dataset included demographic information; hospital data, including coded primary and secondary discharge diagnoses; and prescription data for all legally available opioids and nonopioid analgesics. The primary objective was to describe trends in opioid and nonopioid analgesic prescriptions. Logistic regression analysis was conducted to identify potential risk factors for receiving an opioid prescription.

Results: The study cohort included 7,274,651 individuals. During the observation period, the percentage of individuals receiving an opioid prescription decreased by 14.69% (4.22-3.60%). The number of individuals receiving an opioid prescription was consistently greatest for tramadol. A particularly strong positive correlation was observed between opioid prescriptions and the concurrent use of benzodiazepines (odds ratio [OR], 1.45 [95% confidence interval {CI}, 1.43-1.47]). Furthermore, a history of persistent somatoform pain disorder (OR, 1.28 [95% CI, 1.21-1.36]) and a diagnosis of pain disorder (OR, 1.26 [95% CI, 1.25-1.28]) were identified as significant risk factors. In 2021, general practitioners were the predominant initial opioid prescribers, issuing 82.17% of the prescriptions, followed by hospital staff and orthopaedic specialists.

Conclusion: Prescription opioid use decreased from 2016 to 2021, with tramadol representing the most prevalent opioid. The study revealed a strong link between opioid and benzodiazepine prescriptions and an association with persistent somatoform pain disorder, where opioid use is typically not recommended. Interactive map available for this article.

Introduction: There are few studies of pharmacotherapy of neuropathic pain in cervical spondylotic radiculopathy (CSR). Miro-Cens aimed to examine the efficacy and safety of mirogabalin for treating pain in patients with CSR on non-steroidal anti-inflammatory drugs (NSAIDs), compared with NSAIDs alone.

Methods: Miro-Cens was a 12-week, multicenter, randomized, controlled, open-label, interventional study in Japan. Eligible patients with CSR having upper limb pain (visual analog scale score ≥ 40 mm) were randomly assigned in a 1:1 ratio to the mirogabalin add-on to NSAIDs group and the NSAIDs alone group. The primary endpoint was the change in the weekly average numerical rating scale (NRS) score for upper limb pain from baseline at Week 12.

Results: The mirogabalin add-on group and NSAIDs alone group included 72 and 70 patients, respectively. The mirogabalin add-on group had a significantly greater reduction in the NRS score for upper limb pain than the NSAIDs alone group: estimated changes from baseline at Week 12, - 2.63 [95% confidence interval (CI) - 3.14, - 2.11] in the mirogabalin add-on group; - 1.07 (- 1.62, - 0.53) in the NSAIDs alone group; intergroup difference, - 1.55 (- 2.31, - 0.80; p < 0.001). The responder rate on the NRS score at Week 12 was significantly higher in the mirogabalin add-on group than in the NSAIDs alone group: ≥ 30% improvement, 71.7% vs. 39.6%; ≥ 50% improvement, 58.3% vs. 22.6% (both p < 0.001). The frequent treatment-emergent adverse drug reactions in the mirogabalin add-on group were the known ones (somnolence and dizziness), with most being mild or moderate in severity.

Conclusion: In patients with CSR, combination therapy with mirogabalin and NSAIDs significantly improved neuropathic pain compared with NSAID monotherapy. No new safety concerns were identified, although caution should be exercised regarding somnolence and dizziness. These findings suggest that concomitant use of mirogabalin with NSAIDs could be tolerable and a novel treatment option for CSR patients with insufficient analgesic effects on NSAIDs.

Trial registration number: jRCTs031210629.

Introduction: Low back pain (LBP) is the primary factor contributing to years lived with disability. In view of the close correlation between the functions of the body, which cannot be examined piecemeal but as an integrated system, a holistic approach allows for a comprehensive assessment of the patient. The main objective of this study is to evaluate the impact of face-to-face or remote rehabilitation treatment on the psychosocial aspects of patients with chronic low back pain (CLBP) examining all possible related dimensions: cognitive function, anxiety and depression, pain perception, treatment adherence, the sexual sphere, family dynamics, social support, dysfunctional communication, quality of life (QoL), while also considering attribution of causes.

Methods: This prospective, randomized, controlled trial with blinded outcome assessors evaluates the psychosocial functioning of 86 patients with chronic LBP. Participants divided into two groups to compare tele-rehabilitation with face-to-face rehabilitation with a 1:1 randomization based on a web-based system will all undergo neuropsychological, psychological, and associated clinical condition assessment through standardized tests and ad hoc questionnaires at enrollment (T0), after 1 month (T1), 2 months (T2), and 6 months (T3). The analysis involves descriptive statistics, ANOVA, and correlation tests to evaluate treatment effects and psychosocial outcomes at multiple time points.

Planned outcomes: We expect this study to provide a comprehensive, in-depth, and integrated understanding of the patient, shedding light on the challenges they may face in managing chronic LBP (CLBP). Repeated administration of the questionnaires will allow us to monitor the patient over time, assess any changes in their health status, and structure an intervention tailored to their needs. By emphasizing these often neglected areas through a comprehensive, multi-step assessment, it will be possible to quantify and analyze how these risk factors can affect patients' wellbeing and hinder the treatment process and recovery.

Trial registration: Registered on Clinicaltrials.gov (ID: NCT06895317).

Introduction: This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit.

Methods: Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information regarding opioids, and route of administration, prescribed prior to admission, during admission, and at time of discharge was recorded. Opioids, doses, and routes were changed according to the clinical need to obtain the maximum benefit, individualizing the treatment. The opioid escalation index was calculated in milligrams (OEImg) and as a percentage (OEI%).

Results: A total of 113 patients were assessed. The mean pain intensity at admission and at time of discharge was 6.4 (SD 1.8) and 2.3 (SD 1.4), respectively (P < 0.0005). The mean opioid dose expressed as oral morphine equivalent (OME) by patients who were receiving opioids before admission was 128 mg/day (SD 120). There was no statistical difference in OME between admission and discharge time. Sixty-one and 20 patients were prescribed a second and a third opioid/route, respectively. Mean OEI% and OEImg were 9.3% (SD = 22.5) and 4.0 mg/day (SD = 24.1), respectively. Only a minority of patients had a breakthrough pain prescription at admission. Intravenous morphine was more frequently prescribed at beginning, then replaced by oral morphine and fentanyl preparations at discharge.

Conclusions: An intensive and careful use of opioids in the APCU allows for the achievement of adequate analgesia in all examined patients within a short time, without increasing OME. These findings should encourage further studies in APCUs as well as in other palliative care settings.

This systematic review aims to reassess the expanding role of the cerebellum in pain perception, challenging its traditional and simplistic association with the motor domain. Pain perception is a complex experience shaped by sensory, emotional, and cognitive factors, with recent findings underlining the cerebellum's influence over these systems. This paper evaluates findings from 24 relevant studies to elucidate key findings with regard to pain and their potential clinical applications. The cerebellum's role in pain processing is assessed through its interaction with nociceptive pathways, pain anticipation, and the intonation of pain-related emotional responses. Key cerebellar regions such as Crus I, lobules VI and VIII, and the vermis, are persistently activated during pain perception and anticipation. These regions are linked to sensory-discriminative and affective-motivational elements of pain. Studies on patients with migraines, chronic low back pain, and irritable bowel syndrome (IBS) demonstrated increased cerebellar activation, suggesting its role in chronic pain conditions. Non-invasive neurostimulation techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), administered onto these cerebellar regions, show potential in modulation of pain and clinical application. Future research should aim to standardise methodologies, explore the cerebellum's role in acute pain, and investigate long-term effects of cerebellar-targeted treatments. Understanding the cerebellum's multifaceted role in pain perception can advance diagnostic and therapeutic strategies, offering a more comprehensive approach to pain management. This review underscores the need for further investigation into cerebellar mechanisms and their clinical applications, potentially transforming pain treatment paradigms.