Pain management最新文献

The aim of this systematic review and meta-analysis was to determine the therapeutic efficacy of transcutaneous electrical nerve stimulation (TENS) in women with primary dysmenorrhea. We searched PubMed, Embase, EBSCOhost, and Ovid MEDLINE for randomized controlled trials from inception to 18 December 2024. The risk ratio (RR) or standardized mean difference (SMD) with a 95% confidence interval (CI) was calculated. Heterogeneity was assessed using the I² statistic. Of 139 identified records, 9 articles met inclusion criteria, encompassing 530 women with primary dysmenorrhea. Moderate-quality evidence indicated that significantly fewer women required pain medication following TENS compared with placebo (RR: 0.43; 95% CI: 0.30 to 0.63; p < 0.0001; I² = 37.22%). Analgesia duration was significantly longer after TENS than placebo (MD: 8.07; 95% CI: 8.05 to 8.09; p < 0.001). No significant differences were observed in pooled menstrual pain intensity (SMD: -4.50; 95% CI: -9.90 to 0.91; p = 0.1) or in the number of women reporting adverse effects (RR: 2.89; 95% CI: 0.40 to 20.88; p = 0.29; I² = 0%) between TENS and placebo groups. This meta-analysis should be interpreted cautiously due to limited evidence quality and the small number of included studies.Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD420251000666.

Objectives: To estimate the prevalence and intensity of concomitant opioid and psychotropic medication use in Mississippi Medicaid members.

Methods: This cross-sectional study used Mississippi Medicaid claims from 2016 to 2021 and examined members who filled at least one opioid prescription in a given year. The prevalence and intensity of concomitant opioid-psychotropic use, along with demographic characteristics, chronic non-cancer pain (CNCP) diagnoses, mental health diagnoses, and long-term opioid therapy (LTOT) among members were estimated annually.

Results: The eligible sample declined from 82,550 in 2016 to 51,583 in 2021, with CNCP diagnoses at 21% to 24% and LTOT use at 16% to 9%. Concomitant use prevalence was 33.3% in 2016 and 33.8% in 2021, with antidepressants (range: 14.46%-17.04%) and muscle relaxants (range: 13.92%-15.49%) being the most commonly used concomitant medications. Concomitant benzodiazepine use decreased over time (from 9.42% to 3.04%). Concomitant use intensity increased from 76.7% in 2016 to 84.3% in 2021, with mean increases for all studied medications.

Conclusions: Despite reductions in opioid use, the stable prevalence and rising intensity of psychotropic medication overlap highlight a growing reliance on multimodal pharmacologic approaches. These findings underscore the importance of coordinated prescribing, ongoing monitoring, and targeted interventions to mitigate risks in vulnerable populations.

Introduction: Of the 11.9 million Americans living with cancer, 44% experience cancer-related pain. High-dose opioids remain the mainstay of treatment but often reduce quality-of-life (QoL) due to side effect burden, and 40% of patients do not achieve adequate analgesia. Intranasal ketamine offers analgesia without the dose-limiting gastrointestinal or respiratory effects of opioids. It's intranasal formulation allows easier self-administration. This case series highlights the adverse effects of self-administered intranasal ketamine.

Objectives: Describe the impact of self-administered intranasal racemic ketamine on adverse effects, pain intensity, and perceived QoL in patients with cancer-related pain.

Methods: Three patients followed by palliative care and pain medicine services at a tertiary academic center were prescribed intranasal racemic ketamine. Pain scores, opioid consumption (oral morphine equivalents (OME), and adverse effect burden were summarized from clinical encounters.

Results: All three patients reported analgesic benefit, including reductions in OME up to 90%. Despite this, each patient developed adverse effects: fatigue, cognitive slowing, and dissociation warranting termination of therapy. Treatment duration ranged from 1 to 8 months with dosing from 50 mg TID to 100 mg QID.

Conclusion: Intranasal ketamine may reduce opioid requirements in cancer-related pain, but adverse effects can limit tolerability. Future research should identify high-risk patients and develop risk mitigation strategies.

Background: Chronic pain affects nearly one-third of older Australians and is often under-recognised and undertreated, frequently dismissed as normal ageing. Lifestyle and social factors (e.g., inactivity, higher BMI, disadvantage) may intensify pain but are poorly characterised in community samples.

Objective: To estimate chronic pain prevalence, impact, and management in Australian adults and examine associations with personal, lifestyle, and socioeconomic factors.

Methods: Thirty-nine adults (19-70 years) completed an online survey on pain features, management, and daily impact. Measures included pain severity, BMI, exercise frequency, and area-level socioeconomic indices (SEIFA). Open-ended survey responses and focus groups were analysed thematically.

Results: Seventy-nine percent reported current pain, affecting activity (59%), mental health (51%), and sleep (41%). Lower BMI and more frequent exercise were associated with lower pain. Socioeconomic indices were not significantly related to pain intensity, although lower-SES participants more often sought formal treatment. Four themes emerged: normalisation of pain, emotional/social burden, self-management, and barriers to care.

Conclusion: Chronic pain was common and linked to modifiable lifestyle patterns, particularly exercise and BMI, but these factors do not fully explain pain experiences. Socioeconomic influences appeared subtle yet may shape care-seeking. Findings support integrated, lifestyle-oriented, multidisciplinary approaches and improved access to early community-based support.

Greater trochanteric pain syndrome (GTPS), a common cause of hip pain, is typically managed with conservative treatments such as physical therapy and corticosteroid injections. However, some cases do not respond to these conservative treatments, so alternative therapeutic options become necessary. Peripheral nerve stimulation (PNS) is a promising modality for chronic pain management and may be effective for GTPS. A 71-year-old female with a BMI of 30 kg/m² and chronic left hip pain for over a year, unresponsive to conservative treatments, underwent temporary PNS lead placement targeting the trochanteric branch of the femoral nerve. Within one week, she reported a 90% reduction in pain, improving to 95% at two months. She regained independent mobility and improved quality of life. Leads were removed at two months, with benefits sustained at 24 months. This is the first reported case of successful PNS (SPRINT PNS System, SPR Therapeutics, Cleveland, Ohio, US) targeting the trochanteric branch of the femoral nerve for treating GTPS.

Background: Pain management is critical to reduce mortality and morbidity.

Objective: In this research, the injection of two drugs, Apotel and Ketorolac, as well as the amount of narcotic consumption 24 hours after the operation, were compared to reduce pain after abdominal surgery.

Methods: In this double-blind, randomized trial, 128 patients candidates for abdominal surgery were divided into two groups of 64 people, receiving either Apotel or Ketorolac. The intensity of pain (visual analog scale) and the amount of narcotic intake were evaluated in patients after surgery, 6, 12 and 24 hours later. The data was analyzed by SPSS version 26.

Results: Patients who received Apotel reported significantly lower pain scores at 6 hours (p < 0.001) and 24 hours (p < 0.001) after surgery compared to the ketorolac group. The mean 24-hour pain scores were 3.6 in the group receiving Apotel and 4.3 in the group receiving ketorolac. The mean intake of narcotics was also in the group receiving Apotel (51.1 mg) and in the ketorolac group (62.8 mg, p = 0.009).

Conclusion: The administration of Apotel before surgery was associated with more pain relief and less narcotic consumption in patients, and it seems that the use of this drug combination is more effective than the administration of Ketorolac in patients who are candidates for abdominal surgery for postoperative control.Clinical trial registration: Iranian Registry of Clinical Trials identifier is IRCT20230911059408N1.

Lumbosacral radicular pain (LRP) is a condition characterized by debilitating pain and functional impairment. Epidural steroid injections (ESIs) are frequently used to relieve symptoms of LRP; there are currently no FDA-approved corticosteroid products specifically indicated for this condition. Moreover, existing products carry safety warnings against epidural administration, which have been linked to the off-label use of formulations. SP-102 (10 mg dexamethasone in a 2 ml viscous gel) is a proposed product that is formulated to provide rapid onset of action while prolonging the duration of effect, potentially resulting in extended pain relief and an improved safety profile for dexamethasone. Phase I and phase II studies have demonstrated SP-102 to be safe and well-tolerated. In phase III, SP-102 demonstrated greater pain relief compared to placebo; SP-102 reduced leg pain scores by an average of 1.1 points more than placebo over four weeks (p < 0.001) and extended the median time before repeat injection to 84 days compared with 58 days for placebo. SP-102 also produced an average 8.9-point reduction in the Oswestry Disability Index (ODI) from baseline versus 5.5 points with placebo (p = 0.015). Importantly, no serious adverse events related to the injection of SP-102 were reported.

Aims: To examine multilevel factors associated with nonpharmacological treatment (NPT) use during opioid tapering among older adults with chronic low back pain (cLBP).

Methods: A cohort study was conducted using 2012-2020 5% national Medicare data. Older adults ≥65 with cLBP who initiated long-term opioid therapy and experienced subsequent tapering were included. The primary outcome was the receipt of NPT within 90 days of tapering. Guided by the social ecological model, predictors were assessed across individual, interpersonal, community, and organizational levels. Multivariable logistic regression was used to evaluate associations with NPT use.

Results: A total of 10,811 eligible beneficiaries were identified. NPT use was more likely among Asian and female individuals, while those receiving partial low-income subsidies had lower odds. Residing in counties with more mental health providers and social associations was linked to higher NPT use. Prior NPT use, higher baseline opioid dose, rapid tapering, mental health conditions, substance use disorders, additional pain diagnoses, and higher comorbidity burden were associated with increased odds of NPT use.

Conclusion: This study identified key factors affecting NPT use during opioid tapering among older adults with cLBP. Findings underscore the importance of targeted clinical and policy strategies to reduce disparities in NPT access.

Chronic pain is one of the main health problems in the world. But managing chronic pain poses special challenges for healthcare. While interventional pain management - especially when focused on zygapophysial joint pain - have been shown to be able to improve health-related quality of life in a cost-effective manner, many European countries have focused on the bio-psychosocial model and pain rehabilitation programs where the general practitioners in primary care gets a subordinate role instead of the leading role they should have. Based on the experience from pain management during the last two decades in Sweden, a program is suggested based on primary care and controlled by the general practitioners and where interventional pain management is integrated early in the process.

Background: This study aimed to identify the most frequently searched keywords and questions related to the Achilles, knee, shoulder, and elbow tendons in Italy. It further aimed to evaluate the credibility, readability, and content of the most visited web pages.

Methods: Semrush Inc. (2008) machine learning models were used for data mining in December 2024. Credibility and readability of the most visited web pages were assessed through the QUality Evaluation Scoring Tool (QUEST) and Gulpease index, respectively. A content analysis of web pages was used to determine alignment with evidence-based literature.

Results: The most searched question was "How to treat foot tendonitis?" (2,750 searches). Only two web pages (2.2%) were rated as providing unbiased information using the QUEST, with credibility values ranging from 4.0 (±1.6) to 11.4 (±4.0) across all searches. Gulpease indices ranged from 34.0 (±2.1) to 42.8 (±2.9) across all web pages. Notably, content analysis revealed only a small percentage of web pages that aligned to best available evidence.

Conclusion: Credibility, readability, and overall quality of online content on tendons were poor. Healthcare professionals may play a role in promoting accurate terminology and supporting the production of high-quality, evidence-based web page content to improve public health literacy.