Pain Research & Management最新文献

Background: Nonpharmacological interventions are necessary tools for managing chronic pain to reduce dependence on prescribed analgesic medications. myoActivation® is an innovative systematic nonpharmacological assessment and needling process to help reduce chronic pain related to myofascial dysfunction (MFD). Aim: Analyze quantitative data collected during a longitudinal mixed methods observational pilot study in patients living with social and health inequities undergoing myoActivation as part of routine clinical care to determine the impact of this treatment approach on pain intensity, enjoyment of life, general activity, and unregulated drug use. Methods: Following ethics approval, we conducted a prospective observational study of patients receiving sequential myoActivation for chronic pain. Data were collected at baseline (Week 1) and subsequently at 4, 12, and 24 weeks using validated tools, including the PEG (Pain, Enjoyment of Life, General Activity) scale as well as self-reports of substance and analgesic use. Results: There were 35 participants with a median (interquartile range) baseline PEG score of 7.7/10 (6.7-8.7/10). PEG scores improved at each follow-up, with a mean difference from baseline of -2.5 (95% CI -3.4 to -1.5, p < 0.001) at Week 24, which corresponds to a clinically significant (> 30%) and lasting improvement. At 24 weeks, 9/27 (33%) participants reported less unregulated drug use, and 8/27 (30%) reported less analgesic medication use. Discussion: This study suggests that myoActivation pain care can be an effective tool, with a lasting positive impact, to manage MFD and chronic pain in a population living with social and health inequities. Further studies are needed to examine the impact of myoActivation in the primary care setting. Trial Registration: ClinicalTrials.gov identifier: NCT04261959.

Objective: Diabetic peripheral neuropathy (DN) is a common complication of diabetes, characterized by symptoms that are milder during the day and worsen at night. This study aims to uncover the role of circadian NRF2 expression in dorsal root ganglia (DRG) in regulating pain sensitivity and explores its disruption on neuropathic pain. Method: Male BKS.Cg-Lepr^db/db/J (db/db) type 2 diabetic mice (T2DM) were used as a model for DN. Diurnal pain sensitivity in the mice was evaluated through force withdrawal threshold (FWT) and thermal withdrawal latency (TWL) at Zeitgeber Time (ZT) 2 and ZT14 from 8 to 16 weeks of age. Sciatic nerve conduction velocity (SNCV) and oxidative stress levels in DRG were evaluated. Oxidative stress levels and antioxidant activity were assessed using fluorescent probe staining. NRF2 expression was evaluated through molecular and histological methodologies. The circadian regulatory genes (Clock, Bmal1), inflammatory factors (IL-6 and IL-10), and NRF2 target gene HO-1 were all detected by qRT-PCR. To directly investigate NRF2's role, AAV-mediated intrathecal injection was used to knock down NRF2 in DRG, disrupting its circadian rhythmicity. Results: A significant diurnal variation in neuropathic pain sensitivity was observed in db/db mice, with increased pain sensitivity at ZT2 compared to ZT14. Elevated ROS levels were detected in the DRG of db/db mice, especially at ZT2. In db/+ mice, NRF2 showed diurnal rhythms with higher expression at ZT2, a pattern disrupted in db/db mice, accompanied by elevated ROS levels and inflammation in the DRG. NRF2 knockdown yielded distinct effects: in db/db mice, it further elevated ROS levels at ZT14, impaired antioxidant capacity, and imbalance between pro-inflammatory and anti-inflammatory factors without significantly altering pain sensitivity, whereas in db/+ mice, it reduced pain thresholds and induced diurnal variations in pain sensitivity. Conclusion: The circadian rhythmicity of NRF2 in nondiabetic (db/+) mice is essential for maintaining the balance between anti- and pro-ROS, as well as inflammation, thereby preventing pain exacerbation and diurnal variations. Its disruption increases oxidative stress and inflammation, associated with induced diurnal pain sensitivity. In diabetic (db/db) mice, the loss of NRF2 rhythmicity exacerbates oxidative stress but minimally affects pain sensitivity, indicating a ceiling effect in pain sensitivity. These findings highlight NRF2 rhythmicity as a potential chronotherapeutic target for managing diabetic neuropathy.

Objective: To investigate whether the tip of the spinal needle was accurately positioned within the trigeminal cistern (TC) in patients with idiopathic trigeminal neuralgia undergoing percutaneous treatments through the foramen ovale. Methods: Transovale trigeminal cisternography (TOTC) was performed to ascertain the location of the spinal needle tip within the TC in 35 patients who underwent percutaneous retrogasserian glycerol rhizotomy (PRGR) procedures and 112 patients who underwent percutaneous controlled radiofrequency trigeminal rhizotomy (PCRF-TR) where the preganglionic trigeminal rootlets (PGTRs) could not be stimulated by radiofrequency. When TOTC revealed that the needle tip was in the subtemporal subarachnoid compartments, the needle insertion site at the foramen ovale was adjusted and redirected toward the dorsum sellae under intraoperative fluoroscopy guidance. Results: In 17 (15%) patients who underwent PCRF-TR, PGTR stimulation was unsuccessful, and TOTC revealed the needle tip within the subtemporal subarachnoid space. In five (14%) patients who underwent PRGR, the needle tip was inside the subtemporal subarachnoid space, according to the TOTC evaluation. Conclusion: The findings of this study underscore the significance of TOTC in both PRGR and PCRF-TR procedures, particularly when PGTRs cannot be stimulated by the radiofrequency electrode.

Background: Opioids are a class of potent analgesics extensively utilized for the management of moderate to severe pain. They are integral to postoperative analgesia, effectively mitigating pain following surgical interventions. The present study aims to undertake a comprehensive bibliometric analysis to evaluate research trends and focal areas within the domain of opioid use and postoperative analgesia. Methods: A bibliometric analysis was conducted using the Web of Science Core Collection to gather literature from 2014 to 2024. Analysis of publication trends, research hotspots, and collaboration networks was conducted using VOSviewer, CiteSpace, and the R package "bibliometrix." Results: The search yielded 5383 relevant articles, indicating a consistent upward trend in research volume, with a significant increase commencing in 2019. The USA emerged as the leading contributor, with Harvard University identified as the foremost institution. The journal Anesthesia and Analgesia was recognized as the most prominent publication in this field, while the influential author was Meissner Winfried. Analyses of keyword identified four clusters, such as complications management, nonopioid analgesics, clinical validation of opioid-free anesthesia (OFA) and pharmacokinetics of opioids. Keywords burst analysis showed emerging interests in "enhanced recovery after surgery," "prescription," and "erector spinae plane block." Conclusion: This bibliometric analysis mapped the scientific landscape of opioids in postoperative analgesia. The research hotspots included importance of complications management, nonopioid analgesics, clinical validation of OFA, and pharmacokinetics of opioids. Future studies should improve patient outcomes through individual-based multimodal analgesia with more efficacy and safety.

Introduction: The multifactorial nature of pain complicates assessment of the validity of presenting symptoms and behaviours in people with chronic pain. Recently, the Personal Problems Questionnaire (PPQ) was developed to assess genuine and noncredible cognitive, emotional and physical complaints. Here, the PPQ was used to investigate the extent to which patients with chronic pain report noncredible complaints and the relationship with pain severity and measures of cognitive performance validity and symptom over-reporting. Materials and Methods: Seventy-five participants with chronic pain recruited from outpatient and pain management programme clinics completed the clinical and validity scales of the PPQ, the short-form McGill Pain Questionnaire (SF-MPQ) subscales and the Medical Symptom Validity Test (MSVT), and a subsample (n = 27) completed the Personality Assessment Inventory (PAI). Results: Significant mean (T-score±SD) elevations were observed across the PPQ cognitive (64.5 ± 13.1), emotional (65.1 ± 13.2) and physical (77.4 ± 11.0) clinical domains. Endorsement of implausible complaints on the PPQ was common; 35.6% of patients endorsed noncredible pain/physical complaints, while 19.2% and 33.3%, respectively, reported implausible cognitive and emotional difficulties. Multivariate analyses indicated that the odds of likely noncredible responding significantly increased in cognitive (34%) and emotional domains (26%) and in the physical domain (12%) for every point increase on the SF-MPQ affective and sensory pain subscales, respectively. Noncredible symptom reporting was elevated in those receiving disability benefits/involved in litigation (n = 27), but not significantly after controlling for pain severity. Negative impression management on the PAI was associated with implausible cognitive and emotional symptom endorsement, but there was a limited relationship between PPQ validity scales and MSVT underperformance. Conclusion: The PPQ is a potentially useful tool in the assessment of chronic pain patients, with implausible symptom endorsement found in a significant proportion, although this may not reflect intentional exaggeration.

Background: This study investigated the role of impulsivity as a personality variable predisposing to prescription opioid misuse. Pain catastrophizing, as well as anxiety, depression, and pain intensity, were postulated as potential serial mediators in this relationship. Methods: The sample comprised 366 individuals with chronic pain. We conducted correlational and serial mediation analyses to investigate the relationships between the study variables. Results: The results showed that pain catastrophizing partially mediated the relationship between impulsivity and prescription opioid misuse. Depression and anxiety also partially mediated the relationship between pain catastrophizing and prescription opioid misuse, although pain intensity did not mediate this relationship. Impulsivity was also indirectly associated with prescription opioid misuse through pain catastrophizing, anxiety, and depression. Conclusions: Our findings highlight the key role of impulsivity in prescription opioid misuse and contribute to understanding its mechanisms of action. Based on these results, clinical interventions could target emotion-related impulsivity and cognitive control deficits to reduce rumination. Future research could investigate the relationships identified in this study using the specific dimensions of impulsivity.

Objective: This study aimed to develop and validate a German version of the Treatment Expectations in Chronic Pain Scale (TEC) with the goal to provide a reliable instrument for the assessment of treatment expectations in chronic pain patients within the German healthcare context. Methods: A total of 153 chronic pain patients participated in the study. Participants were recruited from the outpatient and day clinics of the University Hospital Jena, which specialize in chronic pain treatment. The TEC scale was translated into German following the International Test Commission Guidelines. Psychometric evaluation was conducted using Mokken Scale Analysis, focusing on unidimensionality, scalability, and local independence. For construct validity, correlations were examined with optimism for convergent validity and with depression and anxiety for discriminant validity. Results: Unidimensionality was supported for the TEC scale overall, but local independence violations were observed for two item pairs on the Ideal Expectations subscale. Furthermore, strong ceiling effects were found in the Ideal Expectations subscale, limiting its discriminatory capacity. Scalability was higher for the Predicted subscale (H = 0.475) than for the Ideal subscale (H = 0.371). Reliability measures supported the internal consistency. No significant correlations with optimism were found for either subscale, contrary to previous findings. Discussion: The German TEC displayed a unidimensional structure and is appropriate for group-level analyses of treatment expectations. For individual comparisons, the Predicted subscale offers sufficient precision. Future studies with larger, more diverse samples should confirm these results and clarify how expectations shape adherence and outcomes. Trial Registration: German Clinical Trials Register (DRKS): DRKS00027071.

Objectives: Longus colli tendinitis (LCT) is a rare, self-limiting disease primarily characterized by neck pain. This study is to investigate and analyze the imaging and clinical features of LCT and to develop a predictive model for pain risk in LCT based on these features. Methods: This study included 35 patients with LCT enrolled between January 2017 and December 2024. Radiological features, laboratory indicators, and clinical profiles were systematically analyzed. We stratified LCT patients into high-risk (n = 20) and low-risk (n = 15) groups based on pain intensity and duration. Nomograms were developed using logistic regression models, with feature selection performed via the least absolute shrinkage and selection operator method. Model performance was evaluated through discrimination (Harrell's C-index) and calibration (calibration plots), with internal validation conducted via bootstrapping. A clinical impact curve was used to assess the model's clinical usefulness. Results: MRI features of LCT included average lesion width of 6.13 mm, length of 64.00 mm, circumference of 134.52 mm, and area of 230.64 mm². Clinically, LCT patients exhibited elevated white blood cell counts, neutrophil counts, hsCRP levels, and IL-6 levels. Feature selection revealed that the lesion area could predict pain risk in LCT patients, which was used to construct a predictive model. The model demonstrated a C-index of 0.93 (95% CI 0.84-0.99). Internal validation confirmed the model's robust performance, with a C-index of 0.93 (95% CI 0.83-0.99). Conclusion: LCT possesses distinct imaging and clinical features. Utilizing these features enables effective prediction of pain risk, thereby assisting clinical decision-making.

Background: Chronic neuropathic pain, a debilitating health condition, significantly deteriorates the quality of life. Available treatment options, mostly focusing on pain management, do not target underlying cause, resulting in suboptimal and temporary outcomes. Therefore, therapeutic targeting of the cause of neuropathic pain is necessary. This study was undertaken to assess the antineuropathic potential of the herbomineral formulation, Peedanil Gold (PN-G), which has earlier been proven effective against osteoarthritis and associated inflammatory pathophysiology. Methods: Unilateral sciatic nerve chronic constriction injury (CCI) rat model was used to assess the analgesic and anti-inflammatory potential of PN-G in managing chronic neuropathy and associated pain hypersensitivities, by monitoring cold and tactile allodynia and thermal hyperalgesia. The mRNA expression levels of various pain receptors, TRPV1, TRPV4, TRPA1, and TRPM8, and inflammatory factors, p38 MAP kinase and interleukin-6 receptor (IL-6R), were evaluated through RT-qPCR. Results: Compared to untreated study animals with CCI, PN-G treatment significantly alleviated pain hypersensitivities for cold and tactile allodynia and thermal hyperalgesia to an extent comparable to that of the reference drug, gabapentin. PN-G treatment also significantly reduced the mRNA levels of pain receptors in dorsal root ganglia, implicating a strong modulation of the pain perception. Additionally, PN-G-treated animals also exhibited noticeably reduced expressions of p38 MAP kinase and IL-6R, the crucial factors in the neuropathy-associated inflammation. Conclusions: Altogether, the outcomes from the current study prove that PN-G is an effective antineuropathic agent with potential to manage pain as well as eliminate the underlying cause of neuroinflammation behind the chronicity of neuropathic pain.

Objective: This study aimed to compare postoperative pain following the single-visit retreatment procedures of asymptomatic and symptomatic teeth using two different nickel-titanium file systems. Materials and Methods: Eighty patients were divided into symptomatic and asymptomatic groups, each further subdivided based on the use of rotary or reciprocating files. Retreatment involved removal of filling material with one flare and MicroMega REMOVER files, followed by shaping with one curve mini (rotary) or One RECI (reciprocating) files. Postoperative pain was recorded using a visual analogue scale (VAS) at 24 h, 48 h, 72 h, 7 days, and 14 days. Data were analyzed using Shapiro-Wilk, Mann-Whitney U, Kruskal-Wallis, Dunn-Bonferroni, and Pearson chi-square tests (p < 0.05). Results: No significant differences in postoperative pain were found among the four groups. Pain levels were not associated with sex, age, or tooth position. Analgesic use significantly decreased over time in all groups except the asymptomatic rotary group. Patients requiring analgesics reported higher pain scores within the first 48 h (p < 0.05). Conclusions: Postoperative pain was low and comparable across all groups. File kinematics (rotary vs. reciprocating) did not influence pain outcomes. Single-visit retreatment is a viable alternative to multivisit procedures for both symptomatic and asymptomatic cases. Clinical Relevance: This study supports the clinical feasibility of single-visit root canal retreatment, potentially improving patient comfort and reducing chair time. Trial Registration: ClinicalTrials.gov identifier: NCT06357481.