Pain Research & Management最新文献

Background: Postoperative pain in thoracic surgery often requires opioids, yet can be poorly managed with short-acting anesthetics. Liposomal bupivacaine (LB) offers prolonged analgesia, potentially improving pain control and reducing opioid use. This study evaluates LB's effectiveness and safety in thoracic postoperative pain management, aiming to provide an alternative to current practices. Methods: In this single-center, double-blind, prospective, randomized controlled trial, patients undergoing uniportal lobectomy, segmentectomy, or wedge resection from November 2023 to May 2024 were enrolled. Participants were randomly assigned in a 1:1 ratio to receive either 0.375% ropivacaine (control group, n = 57) or LB (LB group, n = 56) for intercostal nerve blocks (ICNBs). Postoperative visual analog scale (VAS) scores, opioid consumption, overall benefit of analgesia score (OBAS), chest tube duration, length of hospital stay, and adverse events (AEs) were recorded and analyzed. Results: Data from 57 patients in the control group and 56 patients in the LB group were included in the analysis, with no significant demographic differences between the groups. The LB group demonstrated lower VAS scores at rest and during activity (p > 0.05), reduced opioid consumption (p=0.021), and higher OBAS (p < 0.01) compared with the control group. No significant differences were observed in chest tube duration, length of hospital stay, or AEs between the groups. Conclusion: LB is safe and effective for ICNB, providing significant postoperative pain relief for patients undergoing uniportal thoracoscopic surgery. Trial Registration: Chinese Registry of Clinical Trials: chiCTR2300075463.

The American Migraine Foundation estimates that over 39 million Americans and over 1 billion people worldwide suffer from some form of migraine. Treatment of migraine generally falls into two categories: treatment of attacks once they have begun, and prophylactic prevention, including lifestyle changes. The use of phytocannabinoids to reduce both the frequency and severity of migraine is widely documented in scientific, grey, and popular literature. This review provides descriptions of both preclinical and clinical studies involving the treatment of migraines with phytocannabinoids as well as the involvement of endocannabinoids and endocannabinoid-like compounds in migraine pathology, including the receptors and associated mechanisms. Currently unanswered questions and areas for further exploration are discussed.

Background: Self-declared chronic pain has not been compared to existing definitions. Our objective was to evaluate the agreement between self-declared chronic pain and different chronic pain definitions, three months after an emergency department (ED) visit. Methods: In this planned substudy of a prospective multicenter cohort study, we included consecutive patients aged ≥ 18 years with an acute pain condition discharged from the ED with an opioid prescription. Three months after their ED visit, participants were asked about their pain intensity, pain frequency, pain disability, and self-declared chronic pain. Agreement between self-declared chronic pain and five other definitions were calculated with kappas. Results: A total of 1411 participants were included; mean age was 52 (±16) years, and 53% were female. Prevalence of self-declared chronic pain was 23.0% and varied from 16.9% to 45.3% for other definitions. Agreement of self-declared chronic pain was moderate (0.57-0.60) with most definitions but lower with the pain intensity ≥ 1 definition (0.47). The proportion of chronic pain participants using opioids ( ⁓20%) or other analgesics (⁓80%) was similar with all definitions except for the pain intensity ≥ 1 definition which was associated with a lower proportion of analgesic use (11%, 64%). Conclusion: In summary, self-declared chronic pain displayed moderate agreement with other chronic pain definitions and similar analgesic consumption but lower with the pain intensity ≥ 1 definition. Nonetheless, chronic pain prevalence varied greatly depending on how it was defined. Self-declared chronic pain might be a more patient-centered outcome and could be easily applied to standardize chronic pain definition. Trial Registration: ClinicalTrials.gov identifier: NCT03953534.

Chronic pain is a prevalent and debilitating condition that imposes substantial personal and societal burdens. Despite its significance, the neural mechanisms underlying individual susceptibility to chronic pain remain inadequately understood. In this study, we examined the prospective associations between 1325 brain structural imaging phenotypes and the future risk of developing chronic pain in a UK Biobank cohort of 5754-5756 participants. These phenotypes encompassed regional and tissue volume, cortical surface area and thickness. General linear models (GLMs) were employed to identify brain structural variations associated with the risk of developing chronic pain, and then Mendelian randomization (MR) was employed to explore potential causal relationships between brain structure and chronic pain development. GLMs identified three significant associations between imaging phenotypes and the future development of chronic pain. All three imaging phenotypes pertained to the cortical surface area of the frontal operculum, albeit derived from three different brain atlases. Specifically, reduced cortical surface area in the frontal operculum was significantly associated with an increased risk of developing chronic pain: BA atlas area 44 (T=-4.10, p=4.24 × 10^-5), Desikan atlas pars opercularis (T=-4.21, p=2.55 × 10^-5), and DKT atlas pars opercularis (T=-3.96, p=7.47 × 10^-5). Subsequent MR analysis further demonstrated a causally protective effect of larger cortical area in the prefrontal operculum against the risk of developing chronic pain (OR = 0.91, p=1.91 × 10^-2). These results indicate a critical role of the surface area of frontal operculum in individual chronic pain susceptibility and provide a potential risk predictor for chronic pain development.

Objective: This study aimed to investigate differences in depression, anxiety and somatosensory amplification between fibromyalgia (FM) patients with and without type D personality (TDP) and healthy controls and to examine the mediating role of somatosensory amplification in the relationship between TDP and FM severity. Methods: A total of 159 participants were included in the cross-sectional case-control study and divided into three groups: FM patients with TDP (n = 56, mean age = 45.93 ± 11.01), FM patients without TDP (n = 48, mean age = 49.17 ± 11.18) and healthy controls (n = 55, mean age = 46.1 ± 9.64). Participants were assessed with the Fibromyalgia Impact Questionnaire (FIQ; administered only to FM patients), TDP Scale, Beck Depression Inventory, Beck Anxiety Inventory and Somatosensory Amplification Scale. Mediation analysis was performed to determine the mediating role of somatosensory amplification. Results: FM patients with TDP had significantly higher levels of depression, anxiety and somatosensory amplification compared to both FM patients without TDP and healthy controls (p < 0.001). Correlation analyses showed strong positive associations between TDP and anxiety (r = 0.729, p < 0.001) and depression (r = 0.794, p < 0.001). Somatosensory amplification was found to have a significant mediating role in the relationship between TDP and FM severity (b = 0.084, 95% CI = 0.018-0.172, p < 0.05). Conclusion: These results highlight TDP as an important psychological risk factor associated with increased depression, anxiety, and somatosensory amplification in FM patients. The apparent mediating role of somatosensory amplification suggests that addressing this mechanism and psychological stress with targeted psychosocial interventions may improve the efficacy of FM treatment.

Radiosynovectomy (RSV) represents an advanced therapeutic modality in nuclear medicine, designed to treat chronic inflammatory joint disorders that are unresponsive to conventional therapies. This targeted approach involves the intra-articular administration of radioactive microparticles containing a β^--emitting radionuclide, selectively eradicating the inflamed synovial membrane while preserving surrounding tissues. As a minimally invasive, nonsurgical procedure routinely performed in outpatient settings, RSV offers a compelling alternative to more invasive interventions. Over time, RSV has evolved significantly, transitioning from the empirical use of radiocolloids to the development of specialized agents tailored for different joint types. Advancements in this field continue to explore a variety of β^--emitting radionuclides with unique emission characteristics, integrated into novel microparticles to improve both specificity and therapeutic efficacy. The selection of an optimal radionuclide hinges on critical nuclear and chemical properties, ensuring effective binding to microparticles and delivering favorable clinical outcomes. This review examines the evolution of RSV in joint disorder management, detailing its mechanisms of action, key factors influencing radionuclide and microparticle selection, and the methodologies involved in their development and production. Additionally, it provides an overview of commonly used radionuclides and microparticles, evaluating their effectiveness within the ever-evolving landscape of RSV.

Objectives: To develop effective, individualized pain science education for people with chronic (primary) pain, underlying pain concepts, defined as the understanding of what pain is, what function it serves, and what processes are thought to underpin it, are essential. Pain concepts and misconcepts of chronic pain can influence its development and maintenance. This study explores whether profiles of healthy adults' biopsychosocial pain concepts can be identified using a newly developed tool, the biopsychosocial pain concept matrix (BiPS matrix), and if adults assigned to the profiles differ regarding sociodemographic and pain-related variables. Methods: N = 229 healthy adults (75% female, M = 22.66 years, SD = 3.61) participated in an online survey. The BiPS matrix assesses biopsychosocial pain concepts through 40 items on the biological, psychological, and social domains combined with the five content dimensions of the common-sense model of self-regulation. Results: A latent profile analysis (LPA) revealed a five-profile solution with distinct patterns of biopsychosocial pain concepts. Participants assigned to Profile 1 demonstrated strongly developed biopsychosocial pain concepts, Profile 2 showed weakly developed concepts, and Profiles 3 to 5 showed different levels of pain concepts. General and neurophysiological pain knowledge differed between profiles, with higher scores being associated with Profile 1 and lower scores with Profile 5. There were no differences in sociodemographic variables in adults assigned to the different profiles. Discussion: Results provide preliminary evidence for distinct profiles of biopsychosocial pain concepts among healthy adults. Further research should replicate these findings in clinical samples to better understand biopsychosocial pain concepts and their use for individualized pain science education.

Objectives: To observe the clinical efficacy of Tiaokou acupoint-penetrating Chengshan combined with conventional therapy for C5 nerve root palsy after posterior cervical decompression surgery. Methods: A total of 52 patients undergoing posterior cervical decompression surgery at Tianjin Union Medical Center from March 2020 to March 2023 were grouped using computer-generated random numbers. Group A (n = 26) received the treatment of acupuncture combined with conventional therapy. Group B (n = 26) received only conventional therapy. Results: The VAS scores of the two groups after treatment were significantly lower than scores before treatment (p < 0.01). The JOA scores, Lovett muscle strength grade, and shoulder ROM of the two groups after treatment were significantly higher than those before treatment (p < 0.01). After treatment, the VAS scores of Group A were significantly lower than those in Group B (p < 0.01) while the JOA scores, Lovett muscle strength grade, and shoulder ROM were significantly higher than those in Group B (p < 0.01). There were significant differences in VAS difference (p < 0.01) and JOA difference (p < 0.01) after 2 weeks of intervention treatment in Group A compared to Group B. There was a significant difference in the improvement of shoulder ROM in Group A after 2 weeks of intervention compared to Group B. Conclusions: The acupuncture method of Tiaokou acupoint-penetrating Chengshan combined with conventional nutritional support therapy was more effective in patients with C5 nerve root palsy after posterior cervical decompression surgery compared to conventional nutritional support therapy. Trial Registration: Clinical Trial Registry identifier: ChiCTR2300073583.

Purpose: Acute postoperative pain is a typical complaint following cesarean delivery (CD). The current standard for postcesarean pain management is the use of a multimodal analgesia regimen which is beneficial for many but may be inadequate for some patients. This study aimed to determine if combining patients' response to a pain rating questionnaire, their pain score during local anesthetic infiltration (LAI) preceding spinal anesthesia for CD, and an anesthesiologist's prediction of postcesarean pain severity can predict the intensity of postcesarean pain. Methods: This was a prospective study of ninety women undergoing scheduled CD under spinal anesthesia. Patients completed a pain rating questionnaire preoperatively and rated pain on LAI before spinal injection, and an anesthesiologist predicted the severity of postcesarean pain. Postoperative pain scores were assessed at rest and with movement at 6, 24, and 48 h after surgery. Results: The patient's expected postoperative pain (β = 0.39, p=0.0011), perceived analgesic requirements (β = 0.34, p=0.0002), pain on LAI (β = 0.22, p=0.004), and anesthesiologist's predicted postoperative pain severity (β = 0.22, p=0.01) were associated with mean postoperative pain after CD. The multivariate model analysis found that the pain rating questionnaire and the an anesthesiologist's prediction of postcesarean pain severity contributed to postoperative pain modeling (R ² = 0.27). Conclusion: Combining a preoperative pain rating questionnaire with an anesthesiologist's prediction of postcesarean pain severity accounted for 27% of the variance in mean postoperative pain with movement and may be a useful tool in predicting postcesarean pain. Implications: This study highlights the potential of a combined preoperative pain rating questionnaire and anesthesiologist's predictions to improve postcesarean pain management. By accounting for 27% of the variance in mean postcesarean pain with movement, this approach could enhance pain management outcomes for CD patients.