Pain Practice最新文献

Background: Smoking is known to increase the risk of numerous postoperative complications, including increased rates of infection, cardiovascular events, and pulmonary complications. In addition, there may be an effect of smoking on pain in the perioperative period. Through this meta-analysis, we sought to investigate what is known about the relationship between smoking and acute postoperative pain.

Methods: Articles published between January 2003 and December 2023 that compared smokers to nonsmokers and utilized pain scores and/or measured postoperative opioid consumption were selected for review. 95% confidence intervals were utilized to determine statistical significance in standardized mean differences for each outcome between smokers and nonsmokers.

Results: The meta-analysis included five studies that assessed postoperative pain scores and opioid requirements in smokers and nonsmokers. In the analysis of pain scores, smokers consistently had higher pain scores overall on all postoperative days (POD) 0 (0.46 [95% CI: 0.26-0.66]), POD1 (0.32 [0.17-0.46]), and POD2 (0.38 [0.24-0.52]). Smokers also demonstrated higher opioid requirements compared to nonsmokers on POD0 (0.62 [0.43-0.80]), POD1 (0.49 [0.36-0.62]), and POD2 (0.70 [0.56-0.84]). Four additional studies were included in our systematic review, which further revealed an association between smoking history and postoperative pain.

Conclusions: Smokers demonstrate increased postoperative pain, as assessed by pain scores and opioid requirements. The ability to anticipate increased postoperative pain in this population has the potential to improve postoperative outcomes for patients with a smoking history.

Objectives: Neck pain presents a multifactorial challenge with substantial personal and societal impact. Traditional classification approaches often overlook the variability among patients. This study aims to systematically collect and analyze data using a mobile health (m-health) application to explore the anatomical distribution of pain in neck pain patients, with particular attention to pain duration and socio-demographic characteristics. The aim of this study is to assess whether an m-health application can provide relevant insights into the anatomical pain distribution in neck pain patients based on pain duration and socio-demographic variables.

Methods: The retrospective cross-sectional study adhered to ethical guidelines, analyzing data from medicalmotion app users reporting neck pain between October 2018 and September 2022. Collected data encompassed movement frequency, work position, pain duration, quality, and intensity (NRS, 0-10). Statistical analyses investigated pain variations based on different pain durations and lifestyles.

Results: This study examined data from 1359 participants (mean age 42.7, 70.1% females). Chronic pain (70.7%) had an average intensity of 6.2 (1.7). Participants reported 3.9 pain areas on average, with 'pulling' (63.2%) and 'pressing' (36.8%) as primary descriptors. The chronic pain group reported more pain areas (4.3) compared to subacute (3) and acute (2.4) groups. Logistic regression revealed significant anatomical differences, consistently distinguishing chronic pain from subacute and acute groups.

Conclusion: This study emphasizes notable differences in other painful areas of the body in people with chronic, subacute, and acute neck pain, underscoring the importance of considering pain duration. The moderate effect size and significant anatomical differences, identified through logistic regression, reveal the complexity of pain experiences in different neck pain groups. Accounting for confounding factors like age, sex, and sports frequency is crucial, aligning with research indicating an increased risk of persistent widespread neck pain in women.

Trial registration: https://doi.org/10.17605/OSF.IO/7XW23 (13.02.2023 via OSF Registries).

Introduction: Sacroiliac joint (SIJ) dysfunction is a significant contributor to chronic low back pain. Between 70% and 85% of people will suffer from low back pain (LBP) at some stage in their lives, and 15%-30% of these individuals will experience pain associated with the SIJ. With the limitations of conservative treatments in addressing the underlying pain and dysfunction, minimally invasive sacroiliac joint fusion has emerged as a promising intervention. Robust studies targeted towards examining complications associated with posterior approach SIJ fusions are rare; thus, this study aims to assess the incidence of adverse events (AEs) associated with posterior approach SIJ fusions using a cadaveric graft joint stabilization system in a clinical setting.

Methods: A retrospective single-site study was conducted reviewing 260 patients with chronic SIJ dysfunction refractory to conservative management. Patients underwent SIJ fusion using the almond-shaped bone allograft with bone window (LinQ system, Painteq, and Tampa Florida) and were monitored for AEs up to 6 months post procedure. Descriptive statistics and hierarchical generalized linear models were used to analyze the data.

Results: The cohort primarily consisted of females (70.27%) with a mean age of 65.21 years. The incidence of AEs was low, with 2.3% at 3 months and 1.9% at 6 months post intervention. No major serious adverse events occurred related to the surgery. Minor adverse events included superficial infection and limited hematoma. All events resolved without permanent harm. There were no device-related events.

Conclusion: The posterior approach to minimally invasive SIJ fusion using a human bone allograft demonstrates a favorable safety profile with a low incidence of adverse events.

Purpose: To compare the efficacy and safety of a once-daily prolonged release (PR) pregabalin formulation to pregabalin immediate release (IR) in patients with diabetic peripheral neuropathy (DPN).

Patients and methods: This was a non-inferiority, randomized, double-blind, double-dummy, multiple-dose, multicenter, active and placebo controlled, three-arm, parallel study. Patients were randomly assigned in a 1:1:1 ratio to receive pregabalin PR tablet, pregabalin IR hard capsule (Lyrica) or placebo at an optimized dose based on individual subject's response and tolerability for 13 weeks. The primary efficacy outcome was the change in the mean weekly pain score from baseline to end of treatment.

Results: Overall, 453 patients were randomized. In the per protocol (PP) analysis set, the least square mean (LSM) difference between test and reference treatment for the change in weekly pain score from baseline to end of treatment was 0.06 (95% CI: -0.28, 0.41, p = 0.7121), indicating that pregabalin PR was non-inferior to pregabalin IR. In the Full Analysis Set (FAS), the LSM of change in mean weekly pain score from baseline to end of treatment for test, reference, and placebo groups were -3.43, -3.49, and -3.04, respectively. Test and reference products were superior to placebo (p = 0.0158 and 0.0047, respectively).

Conclusion: The efficacy and safety of pregabalin PR was comparable to pregabalin IR for the treatment of pain in patients with DPN.

Background: Diagnosing cLBP is complex due to its heterogeneity, lack of definitive biomarkers, and the subjective nature of pain. This study aims to analyze cLBP patients comprehensively, characterizing demographic and clinical profiles of patients and evaluating the types and effectiveness of previous treatments.

Methods: From January 2022 to April 2024, we recruited 1262 participants aged between 18 and 72 years from the general population by advertisements and word-of-mouth propaganda. Collected data included a detailed medical history, standardized questionnaires (e.g., Von Korff) and a clinical examination.

Results: Our population included 471 (38%) with chronic back pain, 335 (27%) without back pain, and an additional group in between of 327 (26%) with intermittent back pain. The majority of participants experienced multifocal back pain, which was further subdivided based on the predominant pain localization. In patients with localized cLBP (median: 5 years, IQR: 1-10 years), the pain persisted for a shorter time than in the group with predominant back pain other than the lower back (median: 10 years, IQR: 5-15 years). The majority of participants did either use no pain medication at all (cLBP: 32%; iLBP: 37%; no-BP(2): 55%) or on-demand medication (cLBP: 56%; iLBP: 56%; no-BP(2): 39%).

Conclusion: Our data show considerable heterogeneity underlying the widespread diagnosis "chronic back pain." Quantitative differentiation is difficult due to the low pain intensity on the day of the examination, and adequate treatment recommendations are challenging. To better understand chronic back pain, there is a strong need for a subclassification.

Trial registration: German Clinical Trial Register: DRKS-ID: DRKS00027907.

The Numerical Pain Rating Scale (NPRS) is routinely used to assess pain severity. A recently developed NPRS integrated the pain scale with an eye tracker (NPRS_ETI). As part of this study, we explored the NPRS_ETI's utility to detect feigned pain, an ongoing challenge facing clinicians. To achieve this aim, chronic pain outpatients were randomly assigned to a simulation (i.e., requested to exaggerate their pain; n = 34) or a control condition (i.e., requested to genuinely report their pain severity; n = 35). They then rated their pain using the NPRS_ETI. Eye movement analyses indicated that simulators spent more time gazing at the higher NPRS_ETI pain ratings before providing their pain ratings and less time at the leftward ("No pain") anchor afterward. The discrimination capacities of these measures, however, were poor. In contrast, pain ratings using the NPRS_ETI showed excellent discriminative capacity, with a pain rating of 10 associated with 94.3% specificity and 26.5% sensitivity. Overall, the study's findings further indicate the feasibility of incorporating an eye tracker to evaluate the severity of pain. Though the findings at present do not support the utility of NPRS_ETI-based eye movement measures as validity indicators, pain ratings showed promise as a simple screen of feigned pain. The preliminary nature of the findings, however, calls for further research. Such research may aid in further developing effective indicators of feigned pain and hopefully clarify cognitive processes (e.g., experienced cognitive load) involved in pain deception. PERSPECTIVE: The NPRS_ETI enables pain ratings by patients with severe motor and speech impairments. While eye movements were not adequate in detecting feigned pain, participants' pain ratings showed initial promise. As this is a preliminary study, further research is recommended.

Background: Ablative techniques, such as radiofrequency (RF) and cryoneurolysis (CN), are emerging as minimally invasive options for knee osteoarthritis (OA) pain management. However, inconsistencies in efficacy, technique variations, and a lack of standardized protocols limit their clinical application. This study addresses these gaps through a comprehensive meta-analysis.

Objectives: This systematic review and meta-analysis aimed to evaluate the efficacy of ablative techniques in improving (1) pain, measured by the Visual Analog Scale (VAS), (2) functionality, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and (3) quality of life and patient perception/satisfaction at 4, 12, and 24 weeks after treatment in patients with OA.

Methods: A meta-analysis of randomized controlled trials (RCTs) was conducted using PubMed, Embase, Scopus, and the Cochrane Database up to October 2024. Studies were included evaluating genicular or saphenous nerve ablation in adults with OA-associated pain. Outcomes of interest comprised pain reduction (VAS), functional improvement (WOMAC), patient perception, and quality of life. The risk of bias was evaluated using the RoB 2 tool, and data were analyzed using fixed- or random-effects models based on the degree of heterogeneity.

Results: Seven studies involving a total of 437 patients were included. The meta-analysis demonstrated a significant reduction in pain in the ablation group at 4 weeks (MD = -1.60; 95% CI = -2.79 to -0.41), 12 weeks (MD = -1.97; 95% CI = -2.54 to -0.80), and 24 weeks (MD = -0.82; 95% CI = -1.41 to -0.23). CN consistently reduced pain (MD = -2.25 at 4 weeks, -1.12 at 12 weeks, and -1.28 at 24 weeks). Additionally, most evaluations did not show significant differences in patient perception and quality of life measures.

Conclusion: Ablative techniques, particularly CN, show promise in reducing pain and enhancing function in patients with OA, offering a minimally invasive alternative for those with an inadequate response to conservative treatments. However, the observed outcome variability underscores the need for further research to standardize protocols and confirm long-term safety and efficacy.

Introduction: Chronic back pain is a significant global healthcare challenge, with a lifetime incidence affecting approximately 80% of people worldwide. Most patients respond positively to nonsurgical management, while a substantial proportion of the remainder obtain relief from surgical therapy. For the minority of patients with chronic back pain who do not respond to conventional medical management (CMM) and are not candidates for spine surgery, spinal cord stimulation (SCS) may be a viable treatment option. This Delphi consensus focused on identifying the thoughts and opinions of pain management and referral specialties on the use of SCS in patients with chronic back pain who are not suitable for spine surgery.

Methods: A steering group of US healthcare professionals specialized in spine surgery and chronic back pain management generated 35 statements across six main domains. Using a four-point Likert scale, the survey was created and shared with a wider panel of specialists. Results were analyzed to produce an aggregated agreement level for each statement. The consensus threshold was set at 75% agreement, which is defined as strong consensus, and ≥ 90% agreement was considered powerful consensus.

Results: A total of 211 responses were received from the following specialties: pain physician (18%; n = 38), physical therapist (18%; n = 38), orthopedic surgeon (18%; n = 37), neurosurgeon (17%; n = 36), primary care physician (15%; n = 32), and musculoskeletal radiologist (14%; n = 30). Of the 35 consensus statements developed for broader testing, 30/35 (86%) achieved consensus; 18 (51%) of which achieved ≥ 90% agreement. The remaining five (15%) statements failed to achieve consensus among the wider panel.

Conclusion: Based on the agreement scores, the steering group agreed on seven key findings to consider for pain management in patients with chronic back pain who are not candidates for spine surgery. These findings are opinion-based and are meant to be a starting point to help identify appropriate patients who may benefit from SCS therapy and when an evaluation for SCS candidacy should be considered.