Pain management最新文献

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.

Background: To evaluate efficacy and safety of ultrasound (US)-guided lumbar transforaminal epidural injection (TFEI) for relieving zoster-associated pain (ZAP) in lumbosacral nerves.

Methods: A retrospective observational cohort study was performed with 1:1 propensity matching to control cohort. Patients undergoing TFEI were included as a US cohort using US guidance and control cohort under fluoroscopy (FL) guidance. Primary endpoint was visual analog scale (VAS) pain scores at 1 month after the procedure with a non-inferiority margin of 10 mm. Secondary outcomes included sensory blockade, procedure time, radiation exposure, adverse events, rescue analgesics, post-herpetic neuralgia (PHN) incidence, and EuroQoL Five-dimension (EQ-5D) scores.

Results: US cohort reported a mean VAS score of 33.52 ± 14.30 mm at 1 month, which was non-inferior to control cohort. PHN occurred in 12.5% of US cohort and 11.1% of FL cohort at 3 months after rash onset (p = 0.796). Trends in EQ-5D scores improved similarly between cohorts over time (all p > 0.05). US approach was associated with wider anesthetic dermatomes (p = 0.031), shorter procedure times (p < 0.001) and lower radiation exposure (p < 0.001). No serious adverse events were observed in either cohort.

Conclusions: US-guided lumbar TFEI was non-inferior to FL procedures. Its unique benefits supported its use in clinical routine practice.

Background: Chronic nonspecific neck pain is a significant cause of disability among Hausa-speaking populations in northern Nigeria. While pain neuroscience education (PNE) is effective, previous local studies were limited.

Aim: This study aims to compare the effectiveness of translated standard PNE versus a culturally adapted PNE version for this population.

Methods: A single-blind randomized controlled trial will enroll 69 adults with chronic neck pain into three groups. All participants will receive 8 weeks of structured neck exercises (SNE), a standard physiotherapy regimen for chronic neck pain in the region focusing on range of motion, strengthening, and postural correction. Two groups will receive additional weekly sessions of either Standard Translated PNE or Culturally Adapted PNE, while the third group will receive Structured Neck Exercises only. Primary (neck-related disability) and secondary outcomes (pain intensity, pain comprehension, psychological factors, fear-avoidance beliefs and quality of life) will be measured at baseline, 4, 8, and 12 weeks.

Discussion: It is hypothesized that the culturally adapted PNE will yield superior outcomes due to its enhanced relevance and comprehension. The findings are expected to inform the development of effective, culturally tailored pain management strategies in sub-Saharan Africa, thereby advancing musculoskeletal care in the region.

Clinical trial registration: The Pan African Clinical Trial Registry (https://pactr.samrc.ac.za/) identifier is PACTR202503884900037.