Pain Practice最新文献

Introduction: Cluster headache is a rare primary headache disorder characterized by excruciating unilateral pain around the eye, lasting between 15 and 180 min, accompanied by ipsilateral cranial autonomic symptoms. Cluster headache is classified into two forms: episodic and chronic, with chronic cluster headache defined by pain-free intervals of less than 3 months between bouts. Both drug-based and invasive treatments are available for abortive and preventive purposes. Treatment selection depends on individual efficacy and tolerance, with invasive options considered when pharmacological treatments prove ineffective.

Methods: This narrative review summarizes the literature on common practice and the evidence in the treatment of cluster headache.

Results: Oxygen therapy and subcutaneous sumatriptan are the most effective abortive treatments for cluster headache. Oral corticosteroid tapering regimens can be used as bridging therapy. Verapamil, lithium, topiramate, and CGRP antagonists are potential preventive medication options. Greater occipital nerve (GON) injections and radiofrequency (RF) therapy can be used as preventive treatments, though their effects are often temporary. For refractory chronic cluster headache, occipital nerve stimulation (ONS) has proven to be effective. Deep brain stimulation (DBS) may also be considered if all other treatments have failed.

Conclusions: The management of cluster headache is complex due to the variable efficacy of treatments across different patients and limited evidence.

Background: Post-traumatic stress disorder (PTSD) is a significant psychiatric comorbidity in individuals with chronic pain. To date, the link between PTSD and chronic pain has mostly been described using the outdated DSM-IV PTSD criteria. Stronger evidence utilizing the updated DSM-5 criteria is needed to ensure comparability with earlier prevalence rates.

Methods: This observational study reported the percentage of individuals who had experienced at least one traumatic event and fulfilled the DSM-5 PTSD criteria, based on self-report, at a tertiary pain clinic in Sweden. The study also investigated the associations between PTSD symptom severity and sociodemographic characteristics, trauma-related factors, and pain-related factors, using regression analysis in the trauma-affected subsample.

Results: A large proportion of the sample (76.8%) reported having experienced at least one traumatic event, with the prevalence of self-reported PTSD being 23.0% for the sample. Female sex, being born outside of Sweden, anxiety, and multiple traumatic events were identified as significant predictors of more severe PTSD symptoms. The most common trauma types were accidents, life-threatening illness or injury, sudden accidental or violent death, and multiple traumas.

Conclusions: Based on the results from this study, it seems important to integrate PTSD assessment in clinical settings focused on chronic pain. The findings align with the broader literature on the impact of sex, migration, and cumulative traumas as predictors of PTSD symptomatology. Furthermore, the results highlight the complex interconnection between PTSD and chronic pain, underscoring the importance of considering sociodemographic and trauma-related factors in the clinical assessment and treatment of chronic pain populations.

Background: The development of liposomal bupivacaine (LB) as an anesthetic was widely lauded due to the potential benefits this drug claimed to carry. This systematic review and meta-analysis aimed to assess the efficacy of LB versus standard bupivacaine (SB) in improving postoperative outcomes, including pain scores and morphine use.

Methods: PubMed, Cochrane CENTRAL, Web of Science, and MedLine databases were searched until April 2024. All trials evaluating the efficacy of LB versus SB in abdominal surgeries like colorectal procedures, bariatric surgeries, and hemorrhoidectomy were included. Data analysis was conducted in Review Manager employing a random-effects model.

Results: Eight clinical trials with 810 patients were included. No statistically or clinically significant result was obtained on using LB over SB in reducing postoperative pain score on postoperative day 0 (POD0) (mean difference (MD) = -0.19, [95% confidence interval (CI): -0.91, 0.53]; p = 0.60), POD1 (MD = -0.11 [95% CI: -1.12, 0.91]; p = 0.84), POD2 (MD = -0.18 [95% CI: -0.57, 0.22]; p = 0.22), and POD3 (MD = 0.01 [95% CI: -0.55, 0.22]; p = 0.57). Additionally, there was no reduction in morphine use in PODs 0-3, time to ambulation, hours to postoperative flatus, or length of hospital stay between the groups.

Conclusion: Our findings showed that LB is not superior to SB in the surgical plane for individuals undergoing abdominal procedures.

Background: The relationship between chronic musculoskeletal pain and cognitive function in older adults remains unclear. This study aimed to investigate whether the cognitive function of older adults with chronic musculoskeletal pain differs from asymptomatic older adults.

Methods: Four databases (PubMed, Science Direct, Web of Science, and Scopus) were searched. Two researchers independently reviewed the references against the eligibility criteria and performed the quality assessment of included studies using The National Institutes of Health (NIH) - Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: A total of 8484 references were found and ten articles, published between 2006 and 2021, were included. Only one study was classified as being of good quality, the remaining were of fair quality. Independent meta-analysis were performed for global cognition and specific cognitive domains (language, attention/orientation, executive function, memory, processing speed, and visuospatial skills). Differences between older adults with and without chronic musculoskeletal pain were found for the domains of general cognition (k = 10; d = -0.20; 95% CI = -0.38, -0.03; z = -2.25, p = 0.03) and language (k = 8; d =  -0.16; 95% CI = -0.28, -0.05; z = -2.72, p = 0.006), with very low certainty of evidence.

Conclusion: Overall, and considering the very low certainty of evidence for both global cognition and specific cognitive domains, we are uncertain about whether cognitive function differs between older adults with and without chronic musculoskeletal pain. Further research is needed comparing cognitive performance between older adults with and without chronic musculoskeletal pain, on the long-term impact of pain on cognitive functioning, and on the mechanisms underlying this potential relationship.

Background: Patients with lower extremity wounds often experience neuropathic pain; however, there is no validated assessment tool to specifically measure wound-related neuropathic pain. The study aimed to assess the prevalence of neuropathic pain in lower extremity wounds using different assessment tools and to identify factors associated with neuropathic pain.

Methods: A cross-sectional study of 130 patients with lower extremity wounds of different etiologies assessed neuropathic pain through clinical examinations, the Short Form McGill Pain Questionnaire-2 (SF-MPQ-2), and the Douleur Neuropathique 4 Questions (DN4). Pain intensity was measured using the Visual Analog Scale (VAS).

Results: In total, 38 (29%) experienced neuropathic pain (DN4 score ≥ 4), and 75% (n = 97) described pain using one or more neuropathic pain descriptors on the SF-MPQ-2. The frequently reported descriptors on the neuropathic sub-scale were "pain caused by light touch" (59%) and "tingling or pins and needles" (49%). There was a positive correlation between DN4 and the neuropathic sub-scale of SF-MPQ-2, and the major difference between the tools is the design and time consumption. Univariate analysis revealed that younger age, arterial wound type, infection, and morphine consumption were associated with neuropathic pain (DN4 score ≥ 4). In multivariate analysis, arterial wound type increased the risk of neuropathic pain five-fold. Younger age and morphine consumption were also significantly associated with neuropathic pain, whereas infection was not.

Conclusion: Neuropathic wound pain is frequent, and the prevalence relies on the applied assessment tool. Arterial wound type, younger age, and morphine consumption are associated with neuropathic wound pain.

Background: Chronic pelvic pain syndrome (CPPS) is pain in the region of the lower pelvis for three months or longer. Which is often accompanied by complaints of organ systems in the lower abdomen. CPPS is often a subjective diagnosis where electrodiagnostic tests are recommended as a supplement in defining a diagnosis.

Objective: Synthesize the clinical studies that describe electrodiagnostic testing in humans with a clinical diagnosis of CPPS.

Evidence review: Registered in PROSPERO (CRD42024510404). A systematic search in Medline/PubMed, Embase, CINAHL, and Web of science, from inception till February 2024, complemented with reference examining. Two reviewers independently reviewed titles, abstracts, and full-text papers, and performed data extraction. Reviews were excluded, and papers were included if patients were clinically diagnosed with CPPS and underwent EMG and/or SSEP. The QUADAS-2 tool was used to assess the quality of studies.

Findings: Fourteen papers were included concerning EMG and/or SSEP, nine papers reported on EMG and five on SSEP. In total, 432 patients clinically diagnosed with CPPS underwent electrodiagnostic testing. 152/277 patients showed abnormalities on EMG and 102/155 patients had abnormal findings on SSEP. Due to the lack of quantitative data, no meta-analysis could be performed.

Conclusions: Abnormalities on electrodiagnostic testing are seen in half of the patients with CPPS, and therefore not recommended as a substitute in the diagnostic process. The low number of patients enrolled in this review needs to be taken into consideration when interpreting the results. Further research on the sensitivity of EMG and/or SSEP in PN is recommended.

Aim: To assess the influence of contrast material distribution patterns on treatment success in patients with chronic coccygodynia undergoing ganglion impar block (GIB).

Methods: An evaluation was conducted on 58 patients who underwent GIB from August 2021 to August 2023 at a university hospital's interventional pain management center. Numeric rating scale (NRS) scores were recorded before the procedure and at 1-month post-procedure. The patients were categorized into two groups based on treatment success, defined as at least a 50% reduction in the NRS score at 1 month.

Results: There were no significant differences between the two groups regarding age, gender, BMI, symptom duration, comorbidities, coccyx curvature type, presence of anterior/posterior subluxation, presence of posterior spicule, type of approach, contrast distribution direction, and contrast dye level. Patients with coccygodynia experienced statistically significant benefits from GIB treatment at the 1-month follow-up (p < 0.001).

Conclusion: Although the use of contrast material in fluoroscopic procedures is the gold standard to prevent possible complications, the distribution pattern of contrast does not significantly affect the success of GIB treatment in patients with coccygodynia. Further prospective and long-term follow-up studies are required to validate these findings.

Background: Pain from musculoskeletal pain conditions is often persistent, bothersome, and negatively impacts physical function. Individuals with musculoskeletal pain report difficulty with walking and regular activities. For some, this may be related to overly negative pain cognitions, such as pain catastrophizing and kinesiophobia. In a geographically and racially diverse sample, we examined relationships between pain catastrophizing, kinesiophobia, and multimodal physical function (i.e., self-report, performance-based, objective).

Methods: Participants were sedentary adults with ≥3 months of chronic musculoskeletal pain. Participants completed self-report measures of pain catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale of Kinesiophobia), and physical function (World Health Organization Disability Assessment Scale 2.0). Performance-based physical function was assessed in-clinic with the Six-Minute Walk Test (6MWT). Physical function was objectively measured with ≥4 days of ActiGraph wear outside the clinic. We conducted descriptive, correlation, and linear regression statistics in SPSS.

Results: Higher levels of pain catastrophizing (β = 0.42) and kinesiophobia (β = 0.25) were significantly associated with worse self-reported physical function. Neither pain catastrophizing nor kinesiophobia were related to performance-based or objectively measured physical function. The direction and significance of relationships between pain catastrophizing, kinesiophobia, and physical function measures were consistent in unadjusted and adjusted regression models.

Conclusions: Pain catastrophizing and kinesiophobia are associated with an individual's perceived physical functioning. Behavioral interventions designed to enhance physical function may benefit from including cognitive restructuring to challenge catastrophic thoughts about pain, as well as thoughts about injuring oneself or worsening pain with movement. More work is needed to understand why neither pain catastrophizing nor kinesiophobia were significantly associated with performance-based or objective assessment of physical function. It is possible that other pain-related cognitions, for example self-efficacy for pain control, or variables (e.g., in vivo pain catastrophizing, mood, stress, sleep) assessed closer in time to performance-based or objective measures of physical function are more relevant.

Objective: The current approval for all available spinal cord stimulation (SCS) devices set several limitations for magnetic resonance imaging (MRI). As a result, most of the necessary examinations are not possible within the scope of the restrictive approvals and, if legally permitted, must be carried out off-label. This retrospective subgroup analysis investigates if the currently extended MRI approval of one specific device allows more MRI scans to be conducted within the manufacturer's recommendations.

Materials and methods: Technical MRI data (saved in the DICOM headers) and medical treatment data for all MRI examinations on patients with Proclaim® implantable pulse generators (IPG; Proclaim® spinal cord stimulation systems, Abbott Laboratories, Plano, TX, USA) were examined. Due to a major change in our standard operating procedures for MRI scans in 2019, the two time periods (before and after 2019) were separately analyzed.

Results: We identified 62 MRI scans with the IPG. The entire implanted system was approved for MRI examinations in just over 50% of the cases, regardless of old and new approval. Options for lead placement were expanded in the new approval; however, this did not significantly improve the number of MR conditional devices. By contrast, for a higher specific absorption rate, significantly more scans within the recommendations are possible in Period 2 (p = 0.011). However, the number of possible scans did not reach statistical significance in Period 1 (p = 0.078). No device-related adverse events were noted.

Conclusion: The new MRI approval is suitable for performing more scans within the manufacturer's specifications. Cervical leads remain problematic because longer leads are required, and the lower impedances inhibit the MRI mode.