Pain management最新文献

Background: We compared referrals to pain management specialists between rural and urban primary care clinics within a single academic healthcare network (integrating hospital and outpatient services) in the Southeastern United States.

Materials & methods: We retrospectively queried primary care visits in 2022 with chronic pain-associated diagnosis codes, stratified by rural vs. urban clinic location. Referrals (pain clinic, orthopedics, neurology, rheumatology, or any of the above) were tracked through June 2024 and analyzed using Cox proportional hazard models. While some patients were referred to multiple specialists, each model included one observation per patient.

Results: Of 777 patients with a chronic pain visit, 468 met eligibility criteria (pain occurring for greater than 3 months, without pain specialist visits in the last 12 months), among whom 17% were referred to a pain clinic, 26% to orthopedics, 6% to neurology, and 3% to rheumatology. Patients initially visiting rural (vs. urban) primary care clinics were less likely to be referred to a pain specialist (hazard ratio [HR]:0.51; p = 0.004) or rheumatology (HR:0.29; p = 0.027), but more likely to be referred to orthopedics (HR:1.54; p = 0.046).

Conclusions: Referral patterns for chronic pain differ between rural and urban primary care clinics, potentially influencing subsequent chronic pain management.

Aim: The pain experienced during and after the injection may cause discomfort and lead individuals to develop a negative perception toward future injections. This study aimed to evaluate the impact of vibration stimulation on pain induced by subcutaneous injections and patient satisfaction.

Methods: This was a prospective, randomized, single-blind, crossover study design. Data were collected from 85 patients. Vibration and non-vibration subcutaneous anticoagulant injections were administered randomly by the same investigator following a standardized procedure. Pain and satisfaction were evaluated by a study-blind investigator using the Visual Analogue Scale immediately after the injection. Data were analyzed using descriptive statistics, the Student's t-test, paired sample test, and a generalized linear mixed model.

Results: A total of 175 injections were analyzed. It was found that the pain level of patients was lower when vibration was applied (4.06 ± 1.68 vs. 5.32 ± 2.19, p = 0.004). Additionally, patient satisfaction was higher when vibration was used (7.17 ± 1.71vs. 5.97 ± 2.46, p = 0.011).

Conclusion: The results of this study demonstrated that vibration was effective in reducing the pain associated with subcutaneous anticoagulant injections and in increasing patient satisfaction. Vibration can be used as a method to alleviate pain from subcutaneous anticoagulant injections and enhance patient satisfaction. Clinically, this suggests that incorporating vibration during subcutaneous injections can be a simple, non-pharmacological strategy to improve patient comfort and adherence to therapy.

Aims: This review aims to analyze the safety and efficacy of trigeminal nerve nucleotractotomy in cases of cancer facial pain suggestive of trigeminal neuralgia, considering the high risks associated with damage to important anatomical structures during the procedure, which may result in sensory and motor function loss, cardiorespiratory arrest, and death.

Method: A systematic literature review was conducted based on 160 articles selected from PubMed and screened using the PRISMA method, of which 7 articles were included. This is not a registered review.

Results: Based on the 7 articles selected following the PRISMA methodology, a sample of 147 patients was included. However, data discrimination allowed for the analysis of only 45 patients and there was a significant pain management between them.

Conclusion: In oncological patients, who naturally have a shorter life expectancy due to their condition, studies have indicated that nucleotractotomy results in satisfactory improvements in pain relief and quality of life, but the available data is limited. This review was not registered.

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.

Slipping rib syndrome (SRS) is an underdiagnosed condition causing chronic debilitating thoracic wall pain due to hypermobility of costal cartilage and irritation of intercostal nerves. Conservative management includes analgesics and intercostal nerve blocks. When these measures fail, surgical rib fixation is considered. This case is the first reported successful use of intercostal nerve radiofrequency ablation (RFA) as a preoperative bridge in the management of SRS. We report a case of a 25-year-old woman with hypermobile Ehlers-Danlos Syndrome and slipping rib syndrome who developed recurrent rib fractures and chronic chest wall pain. After limited relief with opioids and intercostal nerve blocks, she underwent bilateral T7-T10 intercostal nerve RFA, resulting in complete pain resolution and opioid tapering. She later proceeded with bilateral rib fixation and remained pain-free postoperatively. Intercostal nerve RFA offers a promising minimally invasive treatment for patients with chronic intercostal neuralgia due to SRS, particularly in high-risk surgical patients. This case also supports the potential value of interdisciplinary collaboration between pain specialists and thoracic surgeons to optimize care for patients undergoing thoracic surgeries.

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and disabling complication of several chemotherapeutic agents. Peripheral nerve stimulation (PNS) has emerged as a potential neuromodulatory treatment, but its effectiveness in CIPN remains unclear. This study evaluates whether optimizing PNS lead placement improves clinical outcomes.

Methods: Four adults with moderate to severe CIPN (Numerical Rating Scale [NRS] ≥ 4) underwent PNS implantation. Lead placements were categorized as proximal (L5/S1), intermediate (femoral or sciatic at the subgluteal region), or distal (saphenous or popliteal nerves at the midthigh). Pain was assessed using the NRS, and neuropathy symptoms using the Treatment-Induced Neuropathy Assessment Scale (TNAS) at baseline and at 1, 2, and 3 months.

Results: Distal lead placement resulted in the greatest improvement, with 30-40% pain reduction and measurable decrease in TNAS scores. Proximal and intermediate placements demonstrated relatively minimal benefit. Two patients with distal placement also reduced their opioid use. No major adverse events occurred.

Conclusion: Preliminary findings suggest that PNS lead placement closer to the symptomatic region may improve CIPN-related pain and neuropathic symptoms. These results validate the importance of optimizing lead positioning and support further prospective evaluation.

Genicular artery embolization (GAE) is an emerging, minimally invasive procedure for treating knee osteoarthritis (OA) that targets pain-producing neovessels and inflammation. Over the last decade, interest in GAE has grown rapidly. This descriptive review synthesizes key evidence regarding GAE's proposed mechanisms of effect, procedural techniques, effectiveness and safety. Single-arm studies and meta-analyses consistently report significant improvements in pain and function following GAE, however these are limited by the absence of comparison groups. Three placebo-controlled randomized trials have yielded mixed results, with two studies suggesting strong nonspecific effects. Effectiveness appears greater in early-stage OA, with diminishing effects in advanced disease. Animal studies and preliminary human imaging data support anti-inflammatory effects, although causal links in humans remain unconfirmed. Procedural variables such as embolic agent type and number of arteries treated appear to influence outcomes and adverse events. Biodegradable agents may offer improved safety profiles compared to permanent materials, though conclusive comparative data are lacking. Most complications reported to date have been minor and self-limiting, including transient skin ischemia and procedural pain. Looking ahead, carefully designed, large-scale trials with standardized protocols, biomarkers, and longer follow-up are needed to define GAE's role in OA management and to determine whether it provides benefits beyond placebo.