Pain Practice最新文献

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.

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.

Background: Cluster headache (CH) is a rare but severe primary headache disorder characterized by recurrent attacks of unilateral, typically periocular pain lasting 15 min to 3 h, accompanied by ipsilateral autonomic symptoms and restlessness or agitation. Attacks may occur multiple times daily and present in clusters lasting weeks to months, interspersed with remission periods in episodic CH, or without remission in chronic CH.

Methods: This review summarizes the clinical evidence supporting the use of transcutaneous cervical vagus nerve stimulation (tcVNS) for both the acute and preventive treatment of CH. Relevant clinical trials, real-world studies, and guideline recommendations are discussed.

Results: Pharmacological therapy for CH includes triptans and high-flow oxygen for acute management, and verapamil, corticosteroids, or galcanezumab for prevention. For patients with inadequate response or intolerance to these options, neuromodulation may be required. TcVNS has emerged as a noninvasive, safe, and effective alternative to invasive neuromodulation. Clinical trials have demonstrated significant reductions in attack frequency and intensity, leading to U.S. Food and Drug Administration (FDA) clearance and UK National Institute for Health and Care Excellence (NICE) approval for both acute and preventive treatment of CH.

Conclusions: TcVNS represents a well-tolerated, noninvasive neuromodulatory option for patients with cluster headache, offering both acute and preventive benefits. This paper provides an overview of the current evidence, mechanisms of action, and practical guidelines for incorporating tcVNS into clinical management.

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.