Pain Practice最新文献

Background: Chronic pain is associated with functional disability and reduced work participation. This study aimed to evaluate the long-term effects of a multidisciplinary chronic pain management program adapted to the Japanese healthcare system on work-related status, pain-related assessments, and physical function in patients with chronic pain classified under ICD-11.

Methods: One hundred patients participated in a 5-week program comprising exercise therapy, cognitive behavioral therapy (CBT), pain education, and nature-based activities. The program was delivered in a mixed inpatient-outpatient format, with all participants completing both components as part of an integrated program, allowing participants to practice and apply pain coping skills in their daily lives between sessions. Outcomes were assessed at baseline, post-treatment, 3, and 12 months. Self-reported assessments included pain severity (NRS), self-efficacy (PSEQ), catastrophizing (PCS), disability (PDAS), quality of life (EQ-5D-3L), anxiety/depression (HADS), and sleep quality (PSQI). Physical function was assessed through standardized tests. Missing data were addressed using multiple imputations, and repeated-measures ANOVA with Bonferroni correction was used to examine changes over time. Effect sizes (Cohen's d) were calculated.

Results: All self-reported assessments improved significantly post-treatment and were sustained at 3 and 12 months (p < 0.05, Bonferroni-corrected). Effect sizes ranged from small to large, with particularly large effects observed for self-efficacy, catastrophizing, and several physical functions. Among those not working at baseline, 66% had returned to work at 3 months and 81% at 12 months. No significant group × time interaction was observed between chronic primary and secondary pain groups, although baseline anxiety levels (HADS-A) were higher in the chronic primary group.

Conclusions: Our multidisciplinary chronic pain management program demonstrated significant effectiveness in enhancing long-term outcomes and facilitating return-to-work in patients with refractory chronic pain, including chronic primary pain.

Background: We evaluated the immediate and long-term therapeutic efficacy of transcranial direct current stimulation (tDCS) using two distinct montages of anodal and cathodal electrical stimulation over the primary visual cortex compared with a sham tDCS in patients with chronic migraines.

Methods: In this randomized, double-blind, controlled trial, 72 eligible patients with resistant chronic migraine were randomly assigned to one of three groups, receiving anodal or cathodal (2 mA for 20 min), or sham tDCS (0.5 mA for 30 s), over the pain-dominant side of the primary visual cortex. Clinical features including the number of migraine attacks per month, attack duration, pain intensity, and frequency of painkiller use at baseline, 2 months after starting and ending tDCS therapy were recorded using a personal questionnaire.

Results: Both anodal and cathodal real tDCS protocols resulted in a significant reduction in the number of attacks, pain intensity, attack duration, and frequency of painkiller use during the treatment period compared to baseline. There was no significant difference between the two treatment groups regarding the therapeutic efficacy. However, only anodal tDCS significantly maintained the beneficial therapeutic effects on the number of migraine attacks and painkiller use at the follow-up phase. The sham protocol did not produce any significant clinical utility in this population.

Conclusions: The study supports the analgesic effects of the proposed real tDCS approaches in patients with resistant chronic migraine. Anodal tDCS may offer superior benefits to cathodal tDCS, likely by stabilizing therapeutic outcomes through reorganizing the thalamocortical pathway.

Background: Sacroiliac joint (SIJ) pain accounts for a large portion of low back pain within the population. Management for this SIJ pain consists of many non-invasive treatments including physical therapy, nerve ablation, intra-articular SIJ injections, bracing, and manipulative therapy. Pain that proves to be resistant to these modalities has previously been considered for surgical stabilization through a transiliac approach, which involves placement of screws.

Aims: To describe the anterior extrusion of a SIJ implant following arthrodesis, which is a unique complication of a minimally invasive SIJ fusion via the posterior approach.

Materials and methods: A 52 year old female with a past medical history of psoriatic arthritis and alanto-axial instability presented with a year-long history of bilateral lower back and right-sided posterior thigh and buttock pain. Evaluation included lumbar MRI and pelvic CT. Based on these findings, she underwent minimally invasive posterior SIJ fusion using the LinQ allograft. Her symptoms and response to treatment were documented throughout her clinic follow-ups.

Results: Imaging revealed degenerative SIJ changes. She subsequently underwent several rounds of SIJ steroid injections. Due to continued pain, she opted to have a minimally invasive SIJ fusion via the posterior approach, first on the right side and then on the left side. After several months of persistent, reaggravated SIJ pain, a repeat pelvic CT showed anterior extrusion of the right SIJ allograft.

Discussion: More recently, multiple minimally invasive techniques for SIJ fusions have been developed, one of them being posterior insertion of an orthobiologic implant. Minimally invasive SIJ fusion has been shown to provide pain relief and decrease disability. Posterior implant insertion to partially fuse the SIJ carries minimal risk of complications, one of which is posterior dislodgment of the implant. However, anterior extrusion of the implant has not, to our knowledge, been described or reported.

Background: tDCS has demonstrated hypoalgesic effects on Parkinson's disease (PD)-related pain applied in the On state but not in the Off state. We aimed to determine the effect of tDCS in the Off state followed by dopaminergic medication on PD-related pain.

Methods: This randomized controlled crossover trial included 15 patients (age range 39-81, 5 male) with PD-related pain in the Off state. All participants received both an active and sham tDCS sessions of 20 min over the M1 contralateral to pain at 2 mA intensity in two separate days while in Off state. Following tDCS they took its dopaminergic medication. Outcome measures were assessed at baseline, post-tDCS and post-medication intake. The Numeric Pain Rating Scale (NPRS), Global Rating Of Change (GROC), Conditioned Pain Modulation (CPM), Pain Pressure Thresholds (PPT) and Widespread Mechanical Hyperalgesia (WMH) were evaluated.

Results: No significant differences were found after active tDCS in NPRS, GROC, CPM, PPT's or WMH when compared to sham at post-medication intake measure. However, examining exclusive effects of tDCS in the Off state for NPRS, active tDCS was superior to sham tDCS (p = 0.037). No meaningful changes between stimulation conditions were found in GROC, CPM, PPT's and WMH at post-tDCS measure.

Conclusions: One session of tDCS over the M1 alleviates pain perception in PD patients in the Off state. However, tDCS followed by dopaminergic medication intake does not yield additional benefits in pain processing suggesting pathways different to dopaminergic ones in pain regulation in PD patients. These findings are exploratory and carry high risk of type-II error.

Trial registration: clinicaltrials.gov identifier: NCT06214377.