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Persistent opioid use after hospital admission due to trauma: a population-based cohort study. 因外伤入院后持续使用阿片类药物:一项基于人群的队列研究。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-03 DOI: 10.1097/j.pain.0000000000003329
Jiayi Gong, Kebede Beyene, Amy Hai Yan Chan, Chris Frampton, Peter Jones

Abstract: Persistent opioid use (POU) is a common marker of harm related to opioid use after trauma. This study determined the incidence and risk factors for POU after hospitalisation due to trauma in New Zealand, among opioid-naïve patients. This was a population-based, retrospective cohort study, using linked data, involving all trauma patients of any age admitted to all NZ hospitals between 2007 and 2019. We included all patients who received opioids after discharge and were considered opioid naïve, defined as not having received opioids or not having a prior diagnosis of opioid-use disorder up to 365 days preceding the discharge date. The primary outcome was the incidence of POU defined as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify independent risk factors for POU. A total of 177,200 patients were included in this study. Of these, 15.3% (n = 27,060) developed POU based on criteria used for the primary analysis, with sensitivity analyses showing POU incidence ranging from 14.3% to 0.8%. The opioid exposure risk factors associated with POU included switching between different opioids (adjusted odds ratio [aOR] 2.62; 95% confidence interval [CI] 2.51-2.73), prescribed multiple opioids (vs codeine, aOR 1.44; 95% CI 1.37-1.53), slow-release opioid formulations (aOR 1.32; 95% CI 1.26-1.39), and dispensed higher total doses of on the initial discharge prescription (aOR 1.26; 95% CI 1.20-1.33). Overall, 1 in 7 opioid-naïve patients who were exposed to opioids after trauma developed POU. Our findings highlight clinicians should be aware of these factors when continuing opioids on discharge.

摘要:持续使用阿片类药物(POU)是创伤后使用阿片类药物造成伤害的常见标志。本研究确定了新西兰因外伤住院的阿片类药物无效患者中持续使用阿片类药物的发生率和风险因素。这是一项基于人群的回顾性队列研究,使用的是关联数据,涉及 2007 年至 2019 年期间新西兰所有医院收治的所有年龄段的外伤患者。我们纳入了出院后接受阿片类药物治疗的所有患者,这些患者被认为是阿片类药物新患者,即在出院前365天内未接受过阿片类药物治疗或之前未被诊断出患有阿片类药物使用障碍。主要结果是 POU 的发生率,定义为出院后 91 天至 365 天内阿片类药物的使用情况。我们使用多变量逻辑回归来确定 POU 的独立风险因素。本研究共纳入了 177200 名患者。根据主要分析使用的标准,其中 15.3% 的患者(n = 27,060 人)出现了 POU,而敏感性分析显示 POU 的发生率在 14.3% 到 0.8% 之间。与 POU 相关的阿片类药物暴露风险因素包括:在不同阿片类药物之间转换(调整后比值比 [aOR] 2.62;95% 置信区间 [CI] 2.51-2.73)、开具多种阿片类药物处方(与可待因相比,aOR 1.44;95% CI 1.37-1.53)、使用缓释阿片类药物制剂(aOR 1.32;95% CI 1.26-1.39),以及首次出院处方总剂量较高(aOR 1.26;95% CI 1.20-1.33)。总体而言,在创伤后接触过阿片类药物的阿片类药物无效患者中,每7人中就有1人出现POU。我们的研究结果表明,临床医生在出院后继续使用阿片类药物时应注意这些因素。
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引用次数: 0
Refining lidocaine studies for inflammatory arthritis. 改进利多卡因治疗炎症性关节炎的研究。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-15 DOI: 10.1097/j.pain.0000000000003429
Rongrui Zhao, Weixia Sun, Sijia Zheng, Hong You
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引用次数: 0
The 50th anniversary of PAIN: a celebration and introducing Pain Essays. PAIN 50 周年纪念:庆祝活动并介绍《疼痛论文集》。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-11-05 DOI: 10.1097/j.pain.0000000000003438
Karen Deborah Davis, Jane Carol Ballantyne
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引用次数: 0
Understanding what it is like to experience pain as you grow up: a poetic meta-ethnography. 了解成长过程中的痛苦体验:诗意的元民族志。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-18 DOI: 10.1097/j.pain.0000000000003420
Francine Toye, Erin Hannink, Amy Woolverton, Karen L Barker

Abstract: A recent Lancet Commission raised concerns about the management of child and adolescent pain. We aimed to undertake a comprehensive review of qualitative research to understand children and adolescent pain experiences across contexts. We used the 7 stages of meta-ethnography to synthesise findings. We combined the strengths of arts-based methods, translating themes into poems in a range of languages. We screened 7471 titles, 464 abstracts, and 302 full texts, including 189 reports (177 unique samples) incorporating 5875 young people. Age range across studies was 2 to 38 years, with 93% including those between the age of 11 and 20 years old. Studies spanned 30 years (1993-2023) with 121 (64%) published in the last 10 years. Almost all (93%) were set-in high-income countries. We report 6 themes focusing on transition to adulthood: (1) I want to stay within the safety of home; (2) don't exclude me from my own care; (3) it might hurt but it's for my own good; (4) I rely on others but I want some independence; (5) I am no longer a child but I am not an adult yet; and (6) I wasn't prepared for the transfer to adult health care. Our findings focus on the complex transition into adulthood and the importance of creating a genuine healthcare partnership with young people by acknowledging their perspectives, creating a safe and supportive environment, and preparing them for the transition to adult pain care. Arts-based methods have the potential to make findings from qualitative evidence syntheses accessible and impactful for compassionate health care.

摘要:最近的柳叶刀委员会对儿童和青少年疼痛的管理提出了担忧。我们旨在对定性研究进行全面回顾,以了解儿童和青少年在不同情况下的疼痛体验。我们采用元民族志的 7 个阶段来综合研究结果。我们结合了以艺术为基础的方法的优势,将主题转化为各种语言的诗歌。我们筛选了 7471 篇标题、464 篇摘要和 302 篇全文,其中包括 189 篇报告(177 个独特样本),涉及 5875 名青少年。各项研究的年龄范围为 2 到 38 岁,其中 93% 的研究对象年龄在 11 到 20 岁之间。研究时间跨度为 30 年(1993-2023 年),其中 121 项(64%)是在最近 10 年内发表的。几乎所有的研究(93%)都是在高收入国家进行的。我们报告了 6 个关于向成年过渡的主题:(1)我想呆在安全的家里;(2)不要把我排除在自己的护理之外;(3)这可能会伤害我,但这是为了我好;(4)我依赖他人,但我想要一些独立;(5)我不再是个孩子,但我还不是个成年人;以及(6)我没有为转入成人医疗保健做好准备。我们的研究结果集中反映了向成人过渡的复杂性,以及与年轻人建立真正的医疗保健伙伴关系的重要性,即承认他们的观点,创造一个安全和支持性的环境,并让他们为过渡到成人疼痛护理做好准备。以艺术为基础的方法有可能使定性证据综述中的发现变得易于理解,并对富有同情心的医疗保健产生影响。
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引用次数: 0
Characterizing phenotypes and clinical and health utilization associations of young people with chronic pain: latent class analysis using the electronic Persistent Pain Outcomes Collaboration database. 表征年轻人慢性疼痛的表型、临床和健康利用关联:使用电子持续性疼痛结局协作数据库进行潜在分类分析
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-09 DOI: 10.1097/j.pain.0000000000003326
Helen Slater, Robert Waller, Andrew M Briggs, Susan M Lord, Anne J Smith

Abstract: Using the Australiasian electronic Persistent Pain Outcomes Collaboration, a binational pain registry collecting standardized clinical data from paediatric ePPOC (PaedsePPOC) and adult pain services (AdultePPOC), we explored and characterized nationally representative chronic pain phenotypes and associations with clinical and sociodemographic factors, health care utilization, and medicine use of young people. Young people ≥15.0 and <25.0 years captured in PaedePPOC and AdultePPOC Australian data registry were included. Data from 68 adult and 12 paediatric pain services for a 5-year period January 2018 to December 2022 (first episode, including treatment information) were analysed. Unsupervised latent class analysis was applied to explore the existence of distinct pain phenotypes, with separate models for both services. A 3-phenotype model was selected from both paediatric and adult ePPOC data, with 693 and 3518 young people included, respectively (at least one valid indicator variable). Indicator variables for paediatric models were as follows: pain severity, functional disability (quasisurrogate "pain interference"), pain count, pain duration, pain-related worry (quasisurrogate "catastrophizing"), and emotional functioning; and, for adult models: pain severity, pain interference, pain catastrophizing, emotional functioning, and pain self-efficacy. From both services, 3 similar phenotypes emerged ("low," "moderate," "high"), characterized by an increasing symptom-severity gradient in multidimensional pain-related variables, showing meaningful differences across clinical and sociodemographic factors, health service utilization, and medicines use. Derived phenotypes point to the need for novel care models that differentially respond to the needs of distinct groups of young people, providing timely, targeted, age-appropriate care. To effectively scale such care, digital technologies can be leveraged to augment phenotype-informed clinical care.

摘要:利用澳大利亚电子持续疼痛结局协作,一个收集来自儿科ePPOC (PaedsePPOC)和成人疼痛服务(AdultePPOC)标准化临床数据的两国疼痛登记,我们探索和表征了具有全国代表性的慢性疼痛表型及其与临床和社会人口统计学因素、医疗保健利用和年轻人用药的关系。年轻人≥15.0岁
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引用次数: 0
Application of the grading system for "nociplastic pain" in chronic primary and chronic secondary pain conditions: a field study. 慢性原发性和慢性继发性疼痛中 "非痉挛性疼痛 "分级系统的应用:一项实地研究。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-26 DOI: 10.1097/j.pain.0000000000003355
Hannah Schmidt, Armin Drusko, Malika Pia Renz, Lea Schlömp, Heike Tost, Sigrid Schuh-Hofer, Jonas Tesarz, Andreas Meyer-Lindenberg, Rolf-Detlef Treede

Abstract: The concept "nociplastic pain" has been developed for patients with features of nociceptive system sensitization that are not explained as nociceptive or neuropathic. Here, we tested how well the recently published grading system differentiates between chronic primary and secondary pain conditions. We recruited patients with fibromyalgia (FMS, n = 41), complex regional pain syndrome (CRPS, n = 11), osteoarthritis (OA, n = 21), or peripheral nerve injury (PNI, n = 8). We used clinical history, pain drawings, quantitative sensory testing (QST), and questionnaires to classify their pains as possibly or probably "nociplastic." All patients with chronic primary pain exhibited widespread/regional pain not explainable by either nociceptive or neuropathic mechanisms. Widespread pain occurred in 12 patients with OA but was identified as nociceptive in 11 of 12. Regional pain occurred in 4 patients with PNI but was identified as neuropathic in 3 of 4. At this step, the grading system had 100% sensitivity and 93% specificity. Clinical evidence for pain hypersensitivity by QST, and history of hypersensitivity and mental comorbidities did not differentiate between chronic primary pain (QST: 36/52 = 69%, history: 43/52 = 83%) and secondary pain conditions (QST: 20/29 = 69%, history: 24/29 83%). Based on these data, specificity remained excellent (93%), but sensitivity dropped substantially (60%) due to lacking evidence for pain hypersensitivity in many patients with FMS. This low sensitivity suggests that the published grading system is not suitable for screening purposes. We suggest structural and content modifications to improve sensitivity, including placement of patient history before clinical examination and addition of a high tender point count as evidence for widespread pain hypersensitivity.

摘要:"非可塑性疼痛 "这一概念是针对具有痛觉系统敏感化特征但无法解释为痛觉性或神经病理性的患者而提出的。在此,我们测试了最近公布的分级系统在区分慢性原发性疼痛和继发性疼痛方面的效果。我们招募了纤维肌痛(FMS,n = 41)、复杂区域疼痛综合征(CRPS,n = 11)、骨关节炎(OA,n = 21)或周围神经损伤(PNI,n = 8)患者。我们通过临床病史、疼痛图谱、定量感觉测试(QST)和问卷调查,将他们的疼痛分为可能是 "非痉挛性 "疼痛或可能是 "非痉挛性 "疼痛。所有慢性原发性疼痛患者都表现出广泛性/区域性疼痛,无法用痛觉或神经病理性机制来解释。12 名 OA 患者出现了广泛性疼痛,但其中 11 人被确定为痛觉性疼痛。在这一阶段,分级系统的敏感性为 100%,特异性为 93%。临床证据表明,QST、痛觉过敏史和精神合并症并不能区分慢性原发性疼痛(QST:36/52 = 69%,病史:43/52 = 83%)和继发性疼痛(QST:20/29 = 69%,病史:24/29 = 83%)。根据这些数据,特异性仍然很好(93%),但敏感性大幅下降(60%),原因是缺乏证据表明许多 FMS 患者存在痛觉过敏。这种低灵敏度表明,已公布的分级系统不适合用于筛查。我们建议在结构上和内容上进行修改,以提高敏感性,包括将患者病史置于临床检查之前,以及增加高触痛点计数作为广泛痛觉过敏的证据。
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引用次数: 0
Reply to Zhao et al. 对 Zhao 等人的答复
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-15 DOI: 10.1097/j.pain.0000000000003430
Zoe Rutter-Locher, Sam Norton, Franziska Denk, Stephen McMahon, Leonie S Taams, Bruce Kirkham, Kirsty Bannister
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引用次数: 0
Central nervous system active medication use in Medicare enrollees receiving home health care: association with chronic pain and anxiety level. 接受家庭医疗护理的医疗保险参保者中枢神经系统活性药物的使用情况:与慢性疼痛和焦虑程度的关系。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-10 DOI: 10.1097/j.pain.0000000000003331
Mukaila A Raji, Rohan Shah, Jordan R Westra, Yong-Fang Kuo

Abstract: No comparative effectiveness data exist on nonopioid analgesics and nonbenzodiazepine anxiolytics to treat pain with anxiety. We examined the relationship between drug class and central nervous system (CNS) active drug polypharmacy on pain and anxiety levels in Medicare enrollees receiving home health (HH) care. This retrospective cohort study included enrollees with diagnoses and 2+ assessments of pain and anxiety between HH admission and discharge. Three sets of linear regression difference-in-reduction analyses assessed the association of pain or anxiety reduction with number of drugs; drug type; and drug combinations in those with daily pain and daily anxiety. Logistic regression analysis assessed the effect of medication number and class on less-than-daily pain or anxiety at HH discharge. A sensitivity analysis using multinomial regression was conducted with a three-level improvement to further determine clinical significance. Of 85,403 HH patients, 43% received opioids, 27% benzodiazepines, 26% gabapentinoids, 32% selective serotonin reuptake inhibitors, and 8% serotonin and norepinephrine reuptake inhibitors (SNRI). Furthermore, 75% had depression, 40% had substance use disorder diagnoses, and 6.9% had PTSD diagnoses. At HH admission, 83%, 35%, and 30% of patients reported daily pain, daily anxiety, and both, respectively. Central nervous system polypharmacy was associated with worse pain control and had no significant effect on anxiety. For patients with daily pain plus anxiety, pain was best reduced with one medication or any drug combination without opioid/benzodiazepine; anxiety was best reduced with combinations other than opiate/benzodiazepine. Gabapentinoids or SNRI achieved clinically meaningful pain control. Selective serotonin reuptake inhibitors provided clinically meaningful anxiety relief.

摘要:目前还没有关于非阿片类镇痛药和非苯二氮卓类抗焦虑药治疗疼痛伴焦虑的比较效果数据。我们研究了在接受家庭医疗(HH)护理的医疗保险参保者中,药物类别和中枢神经系统(CNS)活性药物的多重药理作用与疼痛和焦虑水平之间的关系。这项回顾性队列研究纳入了在入院和出院期间诊断出疼痛和焦虑并进行过 2 次以上评估的参保者。三组线性回归差异减少分析评估了每日疼痛和每日焦虑患者的疼痛或焦虑减少与药物数量、药物类型和药物组合的关系。逻辑回归分析评估了药物数量和类别对 HH 出院时疼痛或焦虑少于每日次数的影响。为了进一步确定临床意义,我们使用多项式回归进行了三级改进的敏感性分析。在 85,403 名 HH 患者中,43% 接受了阿片类药物治疗,27% 接受了苯二氮卓类药物治疗,26% 接受了加巴喷丁类药物治疗,32% 接受了选择性血清素再摄取抑制剂治疗,8% 接受了血清素和去甲肾上腺素再摄取抑制剂 (SNRI)治疗。此外,75%的人患有抑郁症,40%的人被诊断患有药物使用障碍,6.9%的人被诊断患有创伤后应激障碍。入院时,分别有83%、35%和30%的患者报告有日常疼痛、日常焦虑和两者兼有的情况。中枢神经系统多药治疗与疼痛控制较差有关,但对焦虑没有显著影响。对于每日疼痛并伴有焦虑的患者,使用一种药物或任何不含阿片类/苯二氮卓类药物的联合用药减轻疼痛的效果最好;使用阿片类/苯二氮卓类药物以外的联合用药减轻焦虑的效果最好。加巴喷丁类药物或 SNRI 可实现有临床意义的疼痛控制。选择性血清素再摄取抑制剂可在临床上有效缓解焦虑。
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引用次数: 0
Expectations and transcranial direct current stimulation-induced brain modulation: independent and additive effects on experimental pain. 期望和经颅直流电刺激诱导的大脑调节:对实验性疼痛的独立和叠加效应。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-15 DOI: 10.1097/j.pain.0000000000003339
Nandini Raghuraman, Luana Colloca
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引用次数: 0
Independent effects of transcranial direct current stimulation and social influence on pain. 经颅直流电刺激和社会影响对疼痛的独立影响。
IF 5.9 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-07-12 DOI: 10.1097/j.pain.0000000000003338
Amin Dehghani, Carmen Bango, Ethan K Murphy, Ryan J Halter, Tor D Wager

Abstract: Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulatory technique with the potential to provide pain relief. However, tDCS effects on pain are variable across existing studies, possibly related to differences in stimulation protocols and expectancy effects. We investigated the independent and joint effects of contralateral motor cortex tDCS (anodal vs cathodal) and socially induced expectations (analgesia vs hyperalgesia) about tDCS on thermal pain. We employed a double-blind, randomized 2 × 2 factorial cross-over design, with 5 sessions per participant on separate days. After calibration in Session 1, Sessions 2 to 5 crossed anodal or cathodal tDCS (20 minutes 2 mA) with socially induced analgesic or hyperalgesic expectations, with 6 to 7 days between the sessions. The social manipulation involved videos of previous "participants" (confederates) describing tDCS as inducing a low-pain state ("analgesic expectancy") or hypersensitivity to sensation ("hyperalgesic expectancy"). Anodal tDCS reduced pain compared with cathodal stimulation (F(1,19.9) = 19.53, P < 0.001, Cohen d = 0.86) and analgesic expectancy reduced pain compared with hyperalgesic expectancy (F(1,19.8) = 5.62, P = 0.027, Cohen d = 0.56). There was no significant interaction between tDCS and social expectations. Effects of social suggestions were related to expectations, whereas tDCS effects were unrelated to expectancies. The observed additive effects provide novel evidence that tDCS and socially induced expectations operate through independent processes. They extend clinical tDCS studies by showing tDCS effects on controlled nociceptive pain independent of expectancy effects. In addition, they show that social suggestions about neurostimulation effects can elicit potent placebo effects.

摘要:经颅直流电刺激(tDCS)是一种非侵入性神经调节技术,具有缓解疼痛的潜力。然而,在现有研究中,tDCS 对疼痛的影响各不相同,这可能与刺激方案和预期效应的差异有关。我们研究了对侧运动皮层 tDCS(阳极与阴极)和社会诱导的对 tDCS 的预期(镇痛与镇痛过度)对热痛的独立和联合影响。我们采用了双盲、随机 2 × 2 因式交叉设计,每位受试者在不同的日子里接受了 5 次治疗。在第 1 节校准后,第 2 至第 5 节将阳极或阴极 tDCS(20 分钟,2 毫安)与社会诱导的镇痛或超痛觉期望交叉进行,每节之间间隔 6 至 7 天。社交操纵包括播放以前的 "参与者"(同伴)描述 tDCS 可诱导低痛状态("镇痛预期")或感觉过敏("高痛预期")的视频。与阴极刺激相比,阳极 tDCS 可减少疼痛(F(1,19.9) = 19.53,P < 0.001,Cohen d = 0.86);与超痛预期相比,镇痛预期可减少疼痛(F(1,19.8) = 5.62,P = 0.027,Cohen d = 0.56)。tDCS 与社会期望之间没有明显的交互作用。社交建议的效果与期望有关,而 tDCS 的效果与期望无关。观察到的叠加效应提供了新的证据,证明 tDCS 和社会诱导期望是通过独立的过程运作的。他们扩展了临床 tDCS 研究,表明 tDCS 对控制性痛觉疼痛的影响与期望效应无关。此外,他们还表明,关于神经刺激效应的社会建议可以引发强烈的安慰剂效应。
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