Pain Research & Management最新文献

Objective: Patient adherence to treatment recommendations is less than optimal within chronic pain management. Behaviour change techniques (BCTs) and frameworks can be used to maximise engagement with desired behaviours but are also underused. This study sought the perceptions of nurses to explore the perceived barriers and facilitators to utilising BCTs in clinical practice in chronic pain settings. Methods: Eight qualified nurses participated in semi-structured interviews. Reflexive thematic analysis was conducted to understand barriers and facilitators to the use of BCTs in practice. Results: Three themes were identified (1) behaviour change embedded in current practice, (2) complexities in chronic pain as barriers in implementing behaviour change and (3) from experience to expertise: training and supervision needs. Findings suggest that nurses engage in some BCTs (17 were discussed across all interviews), without explicit knowledge of specific BCTs and how to use them. The use of BCTs is restricted by patients' medical complexities, including mental health comorbidities, unhelpful biomedical beliefs about pain and opioid reliance. Furthermore, the opportunity to effectively utilise BCTs is impeded by a lack of training and clinical supervision. Conclusions: Improving nurses' capabilities by enhancing BCT training and clinical supervision is required. Furthermore, organisational change is recommended to create the opportunity for nurses to effectively utilise BCTs. Specifically, organisations should devote necessary resources, backed by effective implementation strategies, to enhance such engagement.

Background: Peripheral sensitization mediated by the Transient Receptor Potential Vanilloid 4-Calcium/calmodulin-dependent protein kinase II (TRPV4-CaMKII) signaling pathway plays a fundamental role in the generation and maintenance of neuropathic pain (NP). Tuina, a safe and effective therapy in traditional Chinese medicine, shows analgesic effects; however, the underlying mechanisms remain unclear. We aimed to investigate whether Tuina alleviates pain by modulating the TRPV4-CaMKII/CREB/NLRP3 signaling pathway. Methods: The Chronic Constriction Injury (CCI) model of the sciatic nerve was used to simulate clinical NP. Tuina was applied to the Yinmen (BL37), Yanglingquan (GB34), and Chengshan (BL57) acupoints once daily for 14 days. Mechanical Withdrawal Threshold (MWT) and Thermal Withdrawal Latency (TWL) were assessed to evaluate the analgesic effect of Tuina. Its protective effects on dorsal root ganglion (DRG) neurons were evaluated using Nissl staining. The whole-cell patch clamp technique recorded excitability changes in DRG neurons and assess the effects of Tuina on peripheral sensitization. Western blot (WB), immunofluorescence (IF), and enzyme-linked immunosorbent assay (ELISA) helped detect changes in the TRPV4-CaMKII/CREB/NLRP3 pathway and expression of inflammation-related cytokines in DRG neurons. Results: Tuina significantly alleviated mechanical allodynia and thermal hyperalgesia in CCI rats and exerted a protective effect on DRG neurons. Patch clamp recordings showed that Tuina inhibited hyperexcitability in DRG neurons. Mechanistically, Tuina downregulated the expression of the TRPV4-CaMKII/CREB/NLRP3 signaling pathway and reduced the secretion of TNF-α, IL-1β, and IL-18. Conclusion: The analgesic effect of Tuina in CCI rats is associated with reduced peripheral sensitization via modulation of the TRPV4-calcium signaling cascade.

Background: Spinal cord stimulation (SCS) serves as a treatment option for neuropathic pain conditions. Despite its widespread use and technological advancements over the last decade, the long-term efficacy of SCS remains a topic of debate. Consequently, there is an increasing demand for real-world, long-term data regarding its effectiveness. Material and Methods: In 2018, the Belgian government launched a nationwide platform to monitor all SCS therapies. Five and a half years after its start, a full data extraction was conducted. In the present study, we update the findings of Bernaerts et al. (2024) from the 3-week trial period and the long-term follow-up of patients with persistent spinal pain syndrome and focus on the completion rates of the follow-ups and the battery lifetime of the implantable pulse generators (IPGs). Results: Findings indicate that "yellow flags" or psychological variables can be confirmed as significant predictors of recovery and satisfaction following the trial. Additionally, these yellow flags were able to predict long-term disability. Analysis revealed that patients who completed the follow-up module displayed more active and less passive coping strategies for their pain, along with lower levels of illness anxiety prior to the trial's start, better physical and psychological functioning, and greater recovery and satisfaction with the trial's outcomes. However, adherence to the chronic follow-up module declined over time. Moreover, we investigated the battery life of both rechargeable and nonrechargeable batteries across various indication types. The real-world dataset indicated no significant differences in battery lifetime between rechargeable and nonrechargeable IPGs for each indication type. Conclusions: The long-term outcomes of neuromodulation are intricate and influenced by various factors. Data extracted from the Neuro-Pain® registry increasingly enable us to identify confounding factors and predictors of treatment success with greater precision. Trial Registration: ClinicalTrials.gov identifier: NCT06835868.

Background: The quadratus lumborum block (QLB) and erector spinae plane (ESP) block are relatively new regional analgesic techniques that provide analgesia to the abdominal wall and reduce postoperative opioid consumption. We compared the effectiveness of ultrasound-guided bilateral ESP block versus bilateral QLB in patients undergoing laparoscopic kidney surgery. Methods: Adult patients who underwent laparoscopic nephrectomy or nephron-sparing surgery (NSS) within the study period were included. Patients were randomly assigned to one of two groups: group I received an ultrasound-guided ESP block with 30 mL of 0.35% ropivacaine on each side and group II received an ultrasound-guided QLB 1 with 30 mL of 0.35% ropivacaine on each side. Results: A total of 84 patients were included, with 45 patients in the ESP block group and 39 in the QLB group. The mean dosage of oxycodone in the ESP block group was 22.66 mg and in the QLB group was 22.66 mg. There was no difference in oxycodone consumption within the first 24 h after surgery between the groups (p=0.77). Conclusion: The effect of ultrasound-guided bilateral QLB and ESP blocks in patients undergoing laparoscopic kidney surgery was found to be similar in terms of postoperative pain and opioid consumption. There were no significant differences between the blocks in opioid consumption or pain scores. Both techniques appear to be effective and safe components of multimodal analgesia strategy for laparoscopic nephrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT05446727.

Background: A supportive healthcare experience that implements a biopsychosocial model of care can empower a person with chronic pain to make informed decisions and engage in self-management behaviours. Despite the positive influence of supportive healthcare, little is known about the presence of healthcare support in under-resourced chronic pain services. This idiographic study explores the lived experience of service users and providers participating in chronic pain services with a specific focus on autonomy support and self-management skills. Methods: Semistructured interviews were conducted on service users (n = 7) self-reporting a diagnosis of chronic pain (pain > 3 months) and service providers (n = 5), defined as healthcare professionals with > 3 years of experience in clinical healthcare settings managing pain conditions. All interviews took place online (mean 47 ± 11 min). Interview transcripts were analysed using interpretative phenomenological analysis. Results: Analyses generated four themes: 'biomedical model leads care'; 'lost in a system'; 'I need support' and 'the essentials of self-management'. Both service users and providers described regular experiences of invalidation and biomedical approaches to pain management. Long waitlists, a lack of multidisciplinary services, short appointment times and a lack of educational resources all impacted the development of self-management skills in service users. Conclusion: Despite clinical guidelines recommending a biopsychosocial model of care, the biomedical model remains the dominant approach in chronic pain management, reflecting a persistent gap between evidence and practice. Service users and providers desire access to multidisciplinary services that support a biopsychosocial model of care. Healthcare professionals cannot deliver what service users expect due to macro-, meso- and microlevel factors. Future research is needed to explore practical solutions to deliver pain services that optimise the development of self-management skills where existing infrastructure and resources negatively impact service delivery. Suggested approaches include enhancing autonomy-supportive communication by healthcare providers and ensuring early access to high-quality educational materials.

Background: Nurses play a crucial role in pain management through adherence to protocols, accurate pain assessment, and personalized pain relief strategies. However, a gap exists between nurses' ability to perceive pain and patients' actual needs. In Ethiopia, postoperative pain management practices are inadequate, and there is limited research on nurses' pain cognition. Aim: To evaluate the knowledge, attitudes, practices, and associated factors regarding postoperative pain management among nurses at Wolaita Sodo Comprehensive Specialized Hospital in Ethiopia. Methods: A cross-sectional study design involving 124 nurses was utilized. Data were collected using the Knowledge Attitude Survey regarding pain and the Nurses Carrying Behaviors Checklist. Statistical analysis was conducted using SPSS Version 28, employing descriptive statistics, one-way ANOVA, independent sample t-tests, and Pearson correlation coefficients. Multiple linear regressions were used to identify factors associated with pain management practices, with statistical significance set at a p value below 0.05. Results: The mean knowledge, attitude, and practice scores were 49.51 ± 9.51, 43.04 ± 14.72, and 71.05 ± 10.53, respectively. Positive correlations were found between knowledge and practices (r = 0.348, p < 0.001) and between attitudes and practices (r = 0.247, p=0.006). Training on pain, pain experience, work experience, and marital status were independent influencing factors for practice toward postoperative pain management. Conclusion: The study highlights critical gaps in nurses' knowledge and practices regarding postoperative pain management, particularly in opioid safety, dose conversion, and withdrawal symptoms. Over half of the nurses had inadequate knowledge, and most exhibited poor practices. Although negative attitudes were prevalent, training, experience, and personal pain exposure contributed to improved practices. Enhancing structured education, clinical mentoring, and institutional support is essential to improve postoperative pain care.

Background: Trigeminal neuralgia (TN) is a prevalent neurological disorder characterized by recurrent acute pain localized within the distribution area of the trigeminal nerve. This condition places a severe psychological and emotional burden on patients. Although lipids are associated with many diseases, their relationship with TN remains unclear. This study aims to investigate the causal association between plasma lipidome and TN using a bidirectional two-sample Mendelian randomization (MR) approach, with the ultimate goal of informing potential therapeutic strategies for TN management. Methods: We conducted a bidirectional two-sample MR analysis to systematically assess the causal relationship between plasma lipidome and TN. Genome-wide association study (GWAS) summary statistics for plasma lipidome and TN were obtained from publicly available datasets. The primary causal inference was performed using inverse variance weighted (IVW) regression, with complementary analyses including MR-Egger regression, weighted mode, simple mode, weighted median, and MR pleiotropy residuals and outliers (MR-PRESSO) to test for and adjust potential pleiotropy. Comprehensive sensitivity analyses were implemented to verify the robustness of our findings, including heterogeneity testing, leave-one-out analysis, and examination of directional pleiotropy. This multianalytical approach provides a rigorous framework for elucidating the potential role of plasma lipidome dysregulation in TN pathogenesis. Results: Our forward MR analysis results demonstrated that genetically predicted glycerophospholipids (GP) and glycerolipid family (GL) exert significant causal effects on TN risk. More specifically, phosphatidylinositol (PI) in the GP, as well as diacylglycerol and triacylglycerol in the GL, were significantly associated with reduced TN risk (p < 0.05, OR < 1). However, distinct molecular configurations of phosphatidylcholine (PC) and phosphatidylethanolamine (PE) within the GP class exhibited differential impacts on TN susceptibility. The reverse MR analysis identified eight configurations of PC reduced TN risk (p < 0.05, OR < 1), with PC (18:0_18:2) showing a particularly notable bidirectional causal relationship with TN. Rigorous sensitivity analyses confirmed the absence of both heterogeneity (Cochran's Qp > 0.05) and horizontal pleiotropy (MR-Egger intercept p > 0.05) across all examined lipid species, supporting the robustness of these findings. Conclusions: This MR study establishes causal links between specific plasma lipidomes and TN risk, identifying protective lipid species and revealing a bidirectional relationship for PC, offering potential therapeutic targets for TN management.

Background: Dysmenorrhea is a common gynecological symptom among reproductive-aged women, associated with substantial pain and decreased quality of life. Previous studies have suggested that inflammatory and hormonal fluctuations linked to dysmenorrhea may influence endometrial cancer (EC) risk though causality remains uncertain. This study aimed to investigate potential causal relationships between dysmenorrhea (including pain severity, analgesic use, endometriosis, and related pelvic pain) and EC risk using a Mendelian randomization (MR) approach. Methods: A two-sample MR analysis was conducted using genome-wide association study (GWAS) data, selecting single nucleotide polymorphisms (SNPs) significantly associated with dysmenorrhea to assess EC risk. Primary analysis was performed with the inverse-variance weighted (IVW) method, while weighted median and MR-Egger analyses were conducted to enhance robustness. Results: The IVW analysis showed a significant inverse association between dysmenorrhea and EC risk (OR = 0.883; 95% CI: 0.794-0.983; and p=0.023), which remained significant after adjusting for confounders (OR = 0.868; 95% CI: 0.775-0.971; and p=0.0136). Sensitivity analyses supported this protective association. Other factors, including pain severity, analgesic use, endometriosis, and related pelvic pain, showed no significant association with EC. Conclusion: This study indicates a potential inverse relationship between dysmenorrhea and EC risk. These findings provide novel causal evidence for understanding complex associations in female reproductive health, underscoring the need for further research on dysmenorrhea in EC prevention.

Background: Paracetamol is one of the most commonly used analgesic and antipyretic drug, available as a single or a combined formulation. Caffeine is an adjuvant analgesic to several drugs such as paracetamol. The goal of combining paracetamol with caffeine is to achieve a higher analgesic efficacy of paracetamol while lowering its dose and thus reducing side effects. Objective: This narrative literature review aims to provide an overview of the cumulative analgesic effects of this combination and the mechanisms underlying the potentiation by caffeine of the antinociceptive effect of paracetamol. Methods: The search was conducted in PubMed, MEDLINE, ClinicalTrials.gov, and Cochrane Database. For the clinical efficacy and safety, only randomized controlled trials and meta-analysis assessing paracetamol 1000 mg in combination with caffeine 130 mg were considered. Results: As emphasized by the data presented in this review, there is a potentiation of paracetamol-induced analgesia by caffeine with synergistic interactions observed in preclinical and clinical studies. Caffeine enhances the antinociceptive effect of paracetamol and accelerates the absorption of associated paracetamol, which explains the significant faster analgesics' effect with the combination. In clinical trials in patients with mild to moderate acute pain, the combination demonstrates a higher pain relief compared with paracetamol alone with a significant improvement of pain relief in patients with primary headaches without added safety issues. Conclusions: This combination is effective and safe in the treatment of acute mild and moderate pain. Prescribing physicians might consider using paracetamol and caffeine combination among other options in treating these types of pain.

Objective: Mental imagery involves forming internal sensory representations, while osteoarthritis is a degenerative joint disease characterized by cartilage loss. This study explores how mental imagery can modulate pain perception and enhance visual processing in individuals with knee osteoarthritis. Methods: Forty-eight participants were randomly assigned to a mental imagery group or a treatment group. The treatment group received conventional physiotherapy interventions, including ultrasound, transcutaneous electrical nerve stimulation, hot pack application, and isometric knee exercises, while the mental imagery group mentally imagined the same treatments. Both groups underwent interventions for 10 days, with assessments before and after. Pain intensity was measured using the visual analog scale (VAS), and visual processing was assessed through the digital pareidolia test. Results: Both groups exhibited significant reductions in VAS scores, with the mental imagery group demonstrating a more substantial decrease. Notably, the mental imagery group had faster reaction times to face pareidolia images, indicating improved visual processing. In contrast, the treatment group's reaction times to face pareidolia images remained unchanged. Conclusion: These findings highlight that mental imagery could serve as an alternative approach to pain management and cognitive enhancement, potentially influencing top-down mechanisms in facial pattern recognition. This highlights the potential for mental imagery to be integrated into therapeutic strategies for pain-related conditions, promoting personalized, innovative treatments.