Pain Research & Management最新文献

Objective: To evaluate and compare the safety and efficacy of two treatments for cervical spondylosis. One treatment involves the use of electronic wrist-ankle acupuncture, in combination with Tuina, while the other treatment involves using traditional wrist-ankle acupuncture, along with Tuina. The objective was to provide evidence-based support for the treatment of cervical spondylosis using innovative medical device E-WAA combined with Tuina and provide a better treatment option for patients with cervical spondylosis.

Method: A total of 164 patients with cervical spondylosis from June 2021 to December 2022 were randomly assigned to a control group and an experimental group. The control group received traditional wrist-ankle acupuncture combined with Tuina, while the experimental group received the electronic wrist-ankle acupuncture combined with Tuina. Both groups underwent treatment twice a week for a total of 3 weeks. The primary outcome measure was the improvement rate of visual analog scale score, while the secondary outcome measures were the Neck Disability Index score and cervical range of motion. Safety measures included the recording of adverse reactions during treatment and subjective evaluation of the treatment methods by the patients. Clinical data were analyzed from January to March 2023.

Result: Both treatment modalities demonstrated improvements in pain and cervical function. There was no significant difference in the VAS improvement rate between the two groups (p = 0.593). However, the electronic wrist-ankle acupuncture combined with Tuina showed an additional benefit in reducing the NDI scores compared to the control group (p = 0.017). During the study, no adverse reaction was reported, and 83.75% of patients considered the electronic wrist-ankle acupuncture device to be safe.

Conclusion: Both the electronic wrist-ankle acupuncture combined with Tuina and the traditional wrist-ankle acupuncture combined with Tuina showed significant therapeutic effects on cervical spondylosis. In comparison with the traditional wrist-ankle acupuncture, the electronic wrist-ankle acupuncture offers advantages such as noninvasiveness, controllability, and autonomous operation.

Significance: These findings suggest that the electronic wrist-ankle acupuncture can serve as an adjunctive therapeutic approach for patients with cervical spondylosis, providing a more convenient treatment option.

Trial registration: Clinical Trial Registry: ChiCTR2200056394.

Aim: To explore the self-efficacy and self-management practises of people with low back pain (LBP), including associations between participant characteristics, self-efficacy and self-management. The secondary aim was to describe the characteristics of people with LBP who use smartphone apps for self-management, including app preferences.

Methods: Prospective cross-sectional online survey of Australian adults with current or previous LBP. Descriptive statistics were completed for all variables. Associations between participant characteristics, self-efficacy and self-management were explored through linear regression. Alpha was 0.05.

Results: A total of 136 survey responses were included (55.5 ± 14.5 years, 74% female). Most participants (93%) had LBP at the time of the survey and reported constant or daily (58%) pain of moderate severity. Nearly all participants managed their LBP on their own (91%), with the most frequently used self-management options including exercise (47%), advice from health professionals (38%) and pharmacological management (37%). Most self-managed either moderately (35%) or fairly (32%) well, with a mean self-management score of 11.9 ± 4.0 out of 20 and a mean self-efficacy score of 3.6 (±0.8), well above mid-range of 2.5. Lower socioeconomic status and higher scores in personality traits were associated with higher self-efficacy (p < 0.05). Longer duration and increased recurrence of LBP were associated with lower self-efficacy (p < 0.05). Participants with higher self-management scores were female, older, with higher scores in personality traits aside from agreeableness and lower severity of LBP (p < 0.05). Seventeen participants (13%) used apps.

Conclusion: Most adults with LBP self-managed well and had above-average self-efficacy. Smartphone app use was limited, with lack of knowledge a perceived barrier (59%, n = 73).

Background: Frailty represents a geriatric syndrome characterized by diminished physiological reserves and increased vulnerability to adverse health outcomes. While chronic diseases are established frailty risk factors, the relationship between migraine-a prevalent neurological condition affecting millions globally-and frailty development remains unexplored, representing a critical knowledge gap in geriatric neurology.

Methods: We conducted a cross-sectional analysis using baseline data (2011-2015) from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative cohort. Frailty was assessed using a validated 32-item Frailty Index based on deficit accumulation theory. Multivariable logistic regression models examined migraine-frailty associations, with sequential adjustment for sociodemographic factors, lifestyle behaviors, and comorbid conditions. Subgroup analyses evaluated effect modification across key demographic and clinical variables.

Results: Among 13,798 participants (mean age 57.6 ± 9.1 years; 49.6% female), 598 (4.3%) reported migraine and 1,315 (9.5%) met frailty criteria. Migraine participants demonstrated a 4.5-fold higher frailty prevalence (37.0% vs. 8.3%, p < 0.001) and significantly elevated median frailty scores (20.0 vs. 7.8, p < 0.001). A multivariable analysis revealed a robust independent association (OR = 5.61, 95% CI: 4.51-6.99, p < 0.001). Smoking status significantly modified this relationship (P-interaction = 0.025), with the strongest associations in ever-smokers (OR = 8.78, 95% CI: 4.36-17.69) and current smokers (OR = 7.30, 95% CI: 4.87-10.96).

Conclusion: This study establishes migraine as a novel independent risk factor for frailty in Chinese middle-aged and older adults. The pronounced smoking interaction suggests targeted tobacco cessation interventions may benefit frailty prevention in migraine patients.

Postoperative pain remains a significant challenge in surgical services, which necessitates improving analgesic strategies to enhance patient outcomes. Botulinum neurotoxin (BoNT), which was primarily approved for the treatment of strabismus and blepharospasm, has demonstrated a promising impact on pain reduction through mechanisms such as neurotransmitter inhibition, receptor modulation, glial activity suppression, and interactions with opioidergic and GABAergic systems. A number of studies have investigated BoNT's impact on postsurgical pain. However, there is a lack of evaluation of its efficacy, safety, and optimal administration protocols across different surgical settings. This study aims to provide a comprehensive overview of the existing literature on the efficacy and complications of intra- and postoperative BoNT injections in managing postsurgical pain across various surgical procedures, including orthopedic and head and neck surgeries, mastectomy, hemorrhoidectomy, and fissurectomy.

Background: Multisite musculoskeletal pain is a common condition among young adults, and identifying risk factors for the experience of pain is of particular interest. During the transition from adolescence to adulthood, individuals become less physically active. The aim of this study was to investigate the long-term association between physical inactivity during adolescence and young adulthood and multisite musculoskeletal pain or discomfort later in young adulthood, with analyses conducted separately for males and females.

Methods: Data on self-reported levels of physical activity at Ages 15, 18, and 21 and multisite musculoskeletal pain or discomfort at Age 28 from The West Jutland Cohort Study (n = 1833) were used. The levels of physical activity were dichotomized into low level (< 4 h per week) and high level (> 4 h per week) of physical activity. Logistic regression analysis was conducted, stratified by sex and adjusted for depressive symptoms, smoking, parental and own educational level, equivalized childhood income, and pain status at Age 15. Results were presented as odds ratios with corresponding 95% confidence intervals.

Results: The prevalence of multisite musculoskeletal pain or discomfort was 32%, and more females reported experiencing multisite pain (37%) than males (26%). The adjusted results showed that adolescents and young adults who were physically inactive were more likely to experience multisite musculoskeletal pain or discomfort later in life than those adolescents and young adults who were physically active (OR 1.9 (1.3-2.9)).

Conclusion: Physical inactivity during adolescence and young adulthood is a risk factor for experiencing multisite musculoskeletal pain or discomfort at Age 28. This emphasizes the importance of physical activity during adolescence and young adulthood for later physical health.

Objective: Pain is one of the most common and long-lasting symptoms after lung cancer surgery, potentially impairing physical functioning. This study aims to investigate to what extent pain mediates the association between the different surgical approaches (single-port VATS versus multiport VATS or thoracotomy) and postoperative functional recovery after lung cancer surgery, with the goal of establishing clinically actionable pain score thresholds.

Methods: In a prospective cohort study including 1381 patients, pain and functional status (activity limitation and walking difficulty) were assessed daily in hospital with the Perioperative Symptom Assessment for Lung Surgery (PSA-Lung). The structural equation model (SEM) was used to investigate the mediation effect of pain in the surgery-pain-functioning pathway. The pain thresholds on postoperative day (POD) 1, 2, and 3 for optimal functional recovery were identified, corresponding to the cutoff points of pain categorization that demonstrated the largest indirect effects in the models.

Results: The surgical approach had a significant indirect effect on activity limitation and walking difficulty through pain severity (p < 0.001), with a standardized effect value of 0.039 and 0.037, respectively. According to the largest mediation effects of pain categories generated from the each day SEM, the optimal pain score cutoffs are 5 on POD1, 4 on POD2, and 3 on POD3, for both activity limitation and walking difficulty.

Conclusion: Our study quantified the partial mediating effects of pain between surgical approaches and postoperative functional status in patients with lung cancer surgery. The mediation effect-based pain thresholds support precise strategies for postoperative functional rehabilitation, which is considered the major goal of enhanced recovery after surgery. Trial Registration: Chinese Clinical Trials Registry: ChiCTR2000033016.

Pain management apps are gaining popularity for providing timely, accessible care. However, digital health intervention research is still in its infancy, with a limited understanding of how users experience and make meaning of these tools. This study explores users' experiences with the Curable app, considering its impact and the influence of contextual factors. Semi-structured interviews were conducted online with 12 Curable app users for chronic pain. Transcripts were analysed using reflexive thematic analysis through a critical realist lens. Five themes were conceptualised: (1) The space between, participants navigate a paradoxical space where trust coexists with scepticism and desperation with hope in a delicate balance. (2) Tin Man and the Invisible Women, follows the participants' journeys towards the Curable app, navigating systemic biases and cultural norms. (3) It Takes a Village, highlights the 'village' of people, resources and modalities participants needed for effective pain care, beyond a solely biomedical approach. (4) Enjoy Being in the Process of Becoming, follows participants' interoceptive journey as they reconnect with the present moment, finding peace with their pain. (5) Fiend to Friend; a story of neuroplasticity, illustrates a shift in participants' fearful and combative relationship with pain towards a more conscious and compassionate companionship. The Curable app helped to fill gaps in existing care, illustrating the potential of digital tools when woven into broader ecosystems of support. However, as with all qualitative inquiry, these findings are situated and partial, reflecting the perspectives of well-educated, cisgender, English-speaking participants who chose to engage with this research.

Objectives: This study aimed to investigate the prevalence and risk factors of mechanical pain in patients with advanced knee osteoarthritis (KOA), providing insights for targeted treatment approaches.

Methods: We conducted a cross-sectional study involving 920 patients with KOA. The sample size was determined using the formula n=(Z ²∗P∗(1 - P))/E ², assuming a 95% confidence interval (CI) and a 5% margin of error. Data on demographics and affected knee parameters, including age, sex, body mass index (BMI), affected side, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, range of motion, degree of varus, and numeric rating scale (NRS) were collected. Pain was categorized using the painDETECT questionnaire and WOMAC scores to differentiate between simple mechanical pain, mixed mechanical pain, and probable neuropathic pain (NP).

Results: Among participants, 43.48% experienced simple mechanical pain, 33.48% had mixed mechanical pain, and 23.04% reported probable NP. Significant differences were observed in the total WOMAC scores, range of motion (bend), and NRS across the three groups. Gender distribution varied significantly, with a higher proportion of female patients in each pain category. Notably, NRS on the affected side was moderately correlated with the total WOMAC pain score (r = 0.500, ^∗ p < 0.05). Moreover, female patients exhibited significantly higher WOMAC pain scores (6.28) compared with males (6.08), and women with a WOMAC pain score > 4 had an odds ratio (OR) of 2.462 (95% CI: 1.766-3.433, ^∗ p < 0.05) compared with those with a score ≤ 4.

Conclusions: Mechanical pain is highly prevalent in patients with advanced KOA. Identifying the specific type of mechanical pain and associated risk factors, such as female gender and higher NRS score, can facilitate personalized pain management.

Objectives: Opioid-free anesthesia (OFA) is a promising alternative to traditional opioid-based anesthesia. Research indicates that OFA reduces postoperative opioid consumption and related adverse effects while maintaining effective pain control and patient safety. Despite these benefits, clinical adoption of OFA remains limited, possible due to gaps in evidence. To bridge this knowledge gap, a web-based survey was used to assess Swedish healthcare professionals' (HCPs') knowledge, attitudes, and practices regarding OFA, aiming to identify barriers and facilitators for its broader integration into routine anesthesia care.

Methods: A web-based survey was sent to anesthesiology department heads at all university hospitals in Sweden and three randomly selected smaller hospitals. The department heads distributed the survey to anesthesiologists, nurse anesthetists, critical care nurses, and registered nurses involved in intraoperative care. The questionnaire had four sections: demographic data, general questions regarding intraoperative care, specific questions on OFA usage, and an open-ended question.

Results: A total of 309 HCPs responded to the survey, corresponding to a response rate of 35%. The majority of respondents (77%) had seven or more years of perioperative experience, 63% were female, and 82% worked at university hospitals. Knowledge about OFA was generally low, with 62% reporting insufficient knowledge, and 14% actively applied OFA. Self-report data demonstrated that anesthesiologists had significantly lower knowledge levels on applying OFA compared to nurse anesthetists and critical care nurses (p < 0.01). However, 85% of all HCPs expressed interest in acquiring additional theoretical knowledge about OFA. Additionally, 87% reported either absent guidelines or uncertainty about their existence, while most (57%) agreed that guidelines supporting the practice of OFA should be introduced at their clinic.

Conclusion: This survey indicated interest in OFA among Swedish perioperative HCPs while revealing key barriers to implementation, including knowledge gaps and limited guidelines. Addressing these challenges through targeted education and institutional support may facilitate broader OFA adoption, enhancing patient safety and multimodal perioperative pain management.

Introduction: Exercise-induced pain (EIP) is a transient pain phenomenon that emerges during physical exertion and resolves soon after exercise cessation. Despite being recognized as a performance-limiting variable in endurance sports, the mechanisms driving its interindividual variability remain poorly defined. We aimed to determine whether sex remains a significant predictor of EIP intensity after adjustment for performance and pain sensitivity.

Materials and methods: This cross-sectional study enrolled 122 recreational athletes (61 males and 61 females), including 48 trail runners and 74 hikers. Participants provided self-reported data on demographics and training habits. Performance was evaluated using both external and internal load metrics: external load was represented by activity duration and effort-adjusted speed, while internal load was assessed using the rating of perceived exertion (RPE). Maximum and average EIP was rated on a numeric rating scale and combined into a pain composite score (PCS). Pain threshold and tolerance were measured using the cold pressor test. Associations between variables and pain outcomes were analyzed using generalized linear models.

Results: No significant differences were observed in maximum or average EIP intensity, pain threshold, or pain tolerance between male and female athletes. Sex was not a significant predictor of the PCS after adjusting for external and internal exercise load. Neither pain threshold nor tolerance significantly predicted PCS, and these associations did not vary by gender.

Conclusion: In recreational endurance athletes, sex had no significant impact on EIP intensity when accounting for performance and pain sensitivity. These findings challenged traditional assumptions about sex-related pain differences.