PAIN®最新文献

Abstract: There are no nationally representative studies examining both the frequency and correlates of "undiagnosed pain"-pain without a formal diagnosis. To identify the magnitude of this healthcare gap, we performed cross-sectional secondary analyses of the Medical Expenditure Panel Survey (MEPS), 2016-2019 data. The primary study outcome is "being undiagnosed": the absence of diagnoses for pain-related conditions among participants reporting pain-related interference (PRI). Pain-related interference was established using the SF36 pain question embedded in MEPS, with 10,954 individuals reporting any PRI within 4 weeks of the interview and 4,902 individuals reporting at least moderate PRI. Participants with PRI were assigned as "being undiagnosed" if the following conditions were met: (1) the participant did not have medical records for any pain-related conditions in both the previous and current year of the interview and (2) did not report having any pain-related priority conditions from a list provided during the MEPS interviews. Among those reporting any PRI, about 21.1 million people (9.3%; 95% confidence interval [CI], 8.6%-10.0%) were without diagnoses for either primary pain conditions identified using MEPS clinical classification codes or conditions where pain would be a secondary symptom (eg, hypertension and immunity disorders). From multivariable logistic regression modeling, we determined that younger and middle-aged adults, males, racial and ethnic minority groups, foreign-born populations, people without insurance, and people with better perceived health are more likely to have their pain undiagnosed. Our findings underscore the need for improved access to care and better patient-provider communications in those suffering from underdiagnosed pain.

Abstract: Widespread misuse of prescription opioids has resulted in large numbers of opioid-related overdose deaths. It is critical to have a better understanding of the temporal patterns of opioid prescribing practices and associated clinical scenarios. We examined opioid prescription trends over 7 years in a large medical system using electronic health record data. Between 2017 and 2023, we identified 1,019,706 patients from 13 hospitals within a large health system in the northeastern United States, who had at least 1 opioid prescription. In total, there were 3,877,281 associated encounters with 18,225 prescribers. We examined the overall monthly opioid prescription rates and observed an average decrease during the 84 months of study period and discovered 4 distinct stages. A decrease was seen between January 2017 and January 2020 (monthly rate change: -0.70%, 95% CI: -0.89% to -0.41%), followed by a sharp decrease and a fast rebound between February 2020, April 2020, and July 2020 (monthly rate change: -10.60%, 95% CI: -14.73% to -2.52%; 13.06%, 95% CI: 3.42%-18.47%), then back to a gradual decrease from August 2020 to December 2023 (monthly rate change: -0.46%, 95% CI: -0.67% to -0.29%). When prescriptions were further classified by prescribing setting, patient demographics, and patient visit encounter types, we observed variations among these subgroups. We also identified significant associations between patient characteristics and provider specialty with high morphine milligram equivalent dose prescriptions. These results highlight the complexity of opioid prescription practice trends indicating that all these issues need to be considered in developing prescription guidance.

Abstract: Self-initiated actions often generate sensory signals perceived to be less intense than identical signals generated externally. This phenomenon, known as sensory attenuation, is particularly robust for nonpainful tactile sensations. For pain, however, even if the stimulation is self-generated and predictable, it remains painful, albeit sometimes slightly less intense. This difference may reflect the functional divergence between pain and nonpainful sensations, with the sense of agency playing a central role in this distinction. Across 2 experiments involving 61 pain-free adults, we investigated the attenuation of self-induced pain and nonpainful sensations across different stimulation modalities, contexts, and agency levels. We found that self-induced attenuation depended on stimulation modality rather than intensity, with significant reductions for modalities involving strong motoric components and high spatiotemporal alignment (eg, mechanical pressure), in line with the internal forward model. Individuals' trait agency played a pivotal role, with stronger agency associated with enhanced attenuation of nonpainful sensations and mild pain, but reduced attenuation of intense pain. Sex differences also emerged with stronger attenuation effects in men, who also reported higher levels of agency. This study is the first to show that trait-level agency differentially modulates attenuation for painful and nonpainful sensations and the first to explore sex differences. By comparing pain with nonpainful touch, we proposed that self-induced sensations are not attenuated uniformly but shaped by evolutionary priorities such that socially or playfully mediated sensations are more readily suppressed, while high-threat sensations like pain resist qualitative suppression to preserve their protective function.

Abstract: Animal models of disease are frequently used to test the safety and efficacy of new treatments and to explore mechanistic insights. The most useful models are those that accurately predict therapeutic success in humans of both pharmacologic and nonpharmacologic interventions. Here, we tested the predictive validity of the Dahl salt-sensitive (SS) rat strain as a model of fibromyalgia syndrome (FMS), a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and mood disorders. Using the Fibromyalgia Analog Model (FAM) index, a multivariate statistical tool that quantifies the magnitude of fibromyalgia traits in an animal, we assessed the effectiveness of both established and investigational pharmacologic and nonpharmacologic therapies in SS rats. FAM scores were higher in female SS rats than males (P < 0.0001), indicating more robust fibromyalgia-like traits, matching the higher prevalence of FMS in women. When compared to controls, treatments with the FDA-approved drugs for FMS milnacipran and pregabalin (both P < 0.0001, in males and females), as well as the investigational therapies metformin (P < 0.0001) and green light exposure (P = 0.0034 and P = 0.0002 for males and females, respectively) effectively decreased the FAM scores, showing reduction of FMS-like symptoms in SS rats. In contrast, indomethacin and the mu-opioid agonist DAMGO displayed limited efficacy (P = 0.0239 and P = 0.0523, respectively), matching the relative effectiveness of these treatments in humans, justifying why they are not usually prescribed for patients with FMS. The results validate the SS rat as a predictive model in testing pharmacologic and nonpharmacologic therapies for FMS treatment, illustrating the utility of the FAM index in assessing treatment outcomes.