Pain management最新文献

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.

Uncontrolled cancer pain remains one of the most common reasons for unscheduled medical care in the UK, yet primary and community care services often lack standardized approaches to management. This scoping review explored existing evidence on cancer pain management within primary and community care settings, focusing on integration strategies, barriers to access, and facilitators of equitable pain management, particularly in underserved populations. Six electronic databases were searched for studies published between 2000 and 2025. Thirty-two articles were included, encompassing systematic reviews, qualitative and quantitative studies, randomized controlled trials, and mixed-methods research. Findings were synthesized narratively under broad thematic headings. Considerable variability in pain management practices, limited GP training, workforce constraints, and fragmented communication between generalist and specialist services were identified. Digital technologies and patient education promoted better access, empowerment, and self-management, although adoption remained inconsistent. Socioeconomic inequities and digital exclusion continue to impede equitable pain control. Cancer pain management in primary care is hindered by systemic, educational, and structural barriers. Integration of pain and palliative care services, standardized assessment protocols, and targeted digital and educational interventions could enhance equity and effectiveness. Future research should evaluate integrated care models and the role of digital health in supporting community-based pain management.

Background: Chronic pain affects up to 20% of the population, impacting quality of life and generating substantial costs. However, the relationship between pain management strategies, their associated costs, and related factors remains poorly understood. This study aimed to explore these aspects through a survey in Spain.

Methods: A cross-sectional online survey was conducted among 511 people with chronic pain. The survey assessed pain characteristics, pain management strategies, satisfaction, costs, and willingness to pay. Data were analyzed using descriptive statistics, univariate analyses, and OLS regression models.

Results: Participants, predominantly women (89%) with an average age of 51, reported low back (84%) and neck pain (75%) as common pain sites. On average, 18 pain management strategies were used per person, with resting (99.8%) and prescribed medication (98%) being the most common. Higher pain intensity, longer duration, female gender, and higher education were associated with using more strategies. The average annual cost was approximately €1563, increasing with the number of strategies, income, younger age, and female gender.

Conclusions: Passive strategies were widely used, potentially perpetuating pain. Despite frequent use of active strategies, promoting healthier lifestyles could improve outcomes. The high economic burden highlights the need for more effective, cost-efficient pain management approaches.

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: Radiating chronic low back pain (CLBP-r) is linked to more pain, more disability, and a lower quality of life than non-radiating chronic low back pain (CLBP-nr). Female patients experience higher pain intensity and greater incidence of pain-related conditions compared to males. The objectives are to compare clinical manifestations potentially associated with human assumed central sensitization (HACS) between: (1) patients with CLBP-r and CLBP-nr and (2) female and male patients.

Methods: In this cross-sectional observational study, 142 patients with CLBP underwent quantitative sensory testing (QST), including mechanical detection thresholds, mechanical pain thresholds, pressure pain thresholds, wind-up ratio, conditioned pain modulation, and the central sensitization inventory (CSI) to assess HACS.

Results: Patients with CLBP-r based on radiculopathy, radicular pain, or segmental pain showed a higher mechanical detection threshold (8.0 [2.0-16.0] vs. 4.0 [1.0-8.0]; p < 0.001) and mechanical pain threshold (64.0 [16.0-128.0] vs.16 [8.0-64.0]; p = 0.001) and lower CSI score (34.2 ± 13.7 vs. 40.6 ± 12.4; p = 0.005) compared to patients with CLBP-nr. Female patients showed lower mechanical pain threshold (32.0 [8.0-64.0]) vs. (96.0 [32.0-128.0]; p < 0.001) and pressure pain threshold (36.0 [24.5-51.8] vs. 65.5 [40.2-83.0]; p < 0.001) than males.

Discussion: Radiating pain and sex appears to influence clinical expressions attributed to HACS. Patients with CLBP-r showed higher mechanical thresholds and female patients presented lower mechanical and pressure pain thresholds. Interpretation should consider the cross-sectional design, the use of two data sets and unresolved clinical relevance.

Clinical trial registration: https://trialsearch.who.int/ identifiers are NL-OMON24108 and NL-OMON24502.

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.

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.

Introduction: Effects of Spinal Cord Stimulation (SCS) on physical activity and self-efficacy remain unexplored.

Purpose: To evaluate effects of SCS on pain intensity, physical activity, health-related quality of life (HRQL), and self-efficacy among chronic neuropathic pain patients.

Methods: Randomized controlled trial, the first phase of a 3-part intervention study. Patients >18 years of age underwent SCS implantation after a test trial and were randomized 1:1 to active SCS or conventional medical management (CMM) with the SCS switched off. Data were collected at baseline and 3 months after implantation regarding pain (Numeric Rating Scale; NRS), physical activity (accelerometer), HRQL, and self-efficacy.

Results: Participants implanted with SCS (n=42) were randomized to active SCS (n=21) or CMM (n=21). Nineteen participants crossed over from CMM to active SCS due to lack of pain relief. Neuropathic pain intensity decreased significantly from baseline to 3 months (NRS 6.7 to 4.5; p <0.001) in patients with active SCS. Moderate-to-vigorous physical activity increased by 26 minutes/week (87%), although not statistically significant. Patients reported significant improvements in HRQL and self-efficacy.

Conclusion: SCS seems to reduce neuropathic pain intensity which might contribute to improvements in HRQL and self-efficacy. Low physical activity levels in this population should prompt targeted rehabilitation interventions.

Clinical trial registration: The https://clinicaltrials.gov/ identifier is NCT03740763 and the Västra Götaland Region (VGR) registry (https://www.researchweb.org/is/vgr/) identifier is 216271.

Background: Persistent post-traumatic headache (PTH) is a frequent and disabling sequela of mild traumatic brain injury. This proof-of-concept study investigated whether a one-year multidisciplinary intervention could reduce PTH and other post-concussion symptoms in patients treated at the Danish Headache Center and the Headache Center in Southwest Jutland.

Methods: This prospective, non-randomized cohort study included consultations with a doctor, nurse, physiotherapist, and psychologist, and offered pharmacological treatment with candesartan, amitriptyline, or gabapentin. Data were collected before and after the intervention using medical records and electronic questionnaires, including the Rivermead Post-Concussion Symptoms Questionnaire, Hospital Anxiety and Depression Scale (HADS), and Insomnia Severity Index (ISI).

Results: Fifty-eight patients with PTH (mean duration 36 months) were enrolled between August 2021 and February 2023. Headache frequency decreased by 1.7 days per month (p = 0.044). There were no significant changes in acute medication use (p = 0.965), Rivermead score (p = 0.169), HADS-anxiety (p = 0.792), HADS-depression (p = 0.898), ISI (p = 0.138), physical activity (p = 0.071), or self-rated health (p = 0.598). Candesartan, amitriptyline, and gabapentin were reported effective by 28%, 6.5%, and 22% of users, respectively.

Conclusion: A comprehensive multidisciplinary program did not produce clinically meaningful improvement in headache or associated symptoms, although patient satisfaction remained high. Further research is needed to improve treatment strategies.Clinical trial registration: The ClinicalTrials.gov identifier is NCT05328635.