Pain management最新文献

Background: Complex regional pain syndrome (CRPS) is classified into two subtypes based on clinical presentation: warm or cold.Methods: We examined the distribution of warm and cold subtypes in CRPS patients before they received lumbar sympathetic block. We retrospectively analyzed 81 prelumbar sympathetic block Forward Looking InfraRed images obtained from 30 patients to study temperature asymmetry between affected and unaffected limbs.Results: In 23 of the 30 patients (77%), the temperature difference between the affected and affected limbs was within the normal range (<0.6°C difference). Of the remaining seven cases, six (20%) were diagnosed with cold-CRPS and one (3%) with warm-CRPS. During subsequent interventions, 74% of the patients maintained a temperature difference within the normal range (<0.6°C difference).Conclusion: Retrospective analysis of Forward Looking InfraRed thermal camera images in CRPS patients showed that 77% of patients did not exhibit significant temperature asymmetry (<0.6°C difference) between affected and unaffected limbs.

Aim: Diabetic peripheral neuropathy (DPN) induces chronic neuropathic pain in diabetic patients. Current treatments like pregabalin and duloxetine offer limited efficacy. This study evaluates combining pregabalin and duloxetine versus pregabalin alone for DPN pain relief, and explores gene modulation (PPARγ and Akt) to understand neuropathic pain's molecular basis.Materials & methods: Diabetic patients with DPN were randomized into groups receiving combination therapy or pregabalin alone for 4 weeks. Pain intensity, gene expression and quality of life were assessed.Results: Combination therapy significantly reduced pain, improved quality of life and upregulated PPARγ and Akt genes compared with monotherapy.Conclusion: Pregabalin and duloxetine combination therapy in DPN led to PPARγ mRNA upregulation and negative correlation of Akt gene expression with pain scores. This combination therapy effectively reduced pain and improved quality of life.Clinical Trial Registration: CTRI/2021/02/031068.

Aim: To describe the successful treatment of atypical occipital neuralgia (ON) using a unilateral dual-lead occipital nerve stimulator.Setting: Outpatient clinic/operating room.Patient: A 53-year-old male with atypical ON.Case description: Patient was previously diagnosed with treatment-refractory left-sided trigeminal neuralgia with atypical occipital distribution. On presentation, his symptoms were consistent with ON with distribution to the left fronto-orbital area. He received a left-sided nerve stimulator implant targeting both the greater and lesser occipital nerves.Results: Patient reported pain relief from a numerical rating scale 10/10 to 3-4/10.Conclusion: ON with referred ipsilateral trigeminal distribution should be considered when patients present with simultaneous facial and occipital pain. Further, a dual-lead unilateral stimulator approach may be a viable treatment.

The treatment of pain remains a critical, unmet public health challenge. According to the CDC, in 2021, an estimated 20.9% of US adults (51.6 million people) endured chronic pain, and 6.9% (17.1 million people) endured high-impact chronic pain. Additionally, the impact of the social determinants of health on pain treatment are beginning to emerge. Treating pain addresses its control and relief, enhancing patient outcomes and quality of life. However, current treatment options have limitations, creating a significant need for innovative solutions. This raises the role of innovation in identifying new pain medicines. Thus, the clinical development of novel pain medicines is an unmet need to address public health worldwide.

Aim: We aimed to investigate the association between social determinants of health and chronic opioid therapy.Materials & methods: We conducted a retrospective analysis of electronic health records from five family medicine and internal medicine clinics in Oregon in 2020 and 2021. Our outcome variable was whether a patient was receiving chronic opioid therapy for chronic non-cancer pain. Our variables of interest included financial difficulty, insurance types, transportation barriers, currently married or living with a partner and organizations participation.Results: Our results showed that patients with financial difficulty were more likely to have chronic opioid therapy (OR: 2.69; 95% CI: 1.14, 6.33).Conclusion: Addressing patients' social determinants of health disadvantages is important for optimizing pain management.

Aim: Despite the growing evidence supporting the use of peripheral nerve stimulation (PNS) for cancer pain in adults, it is underutilized in the pediatric oncology population.Method: We describe the use of temporary, percutaneous PNS for pain management in pediatric patients suffering from cancer related pain.Results: Two adolescent patients underwent an ultrasound-guided suprascapular nerve PNS placement utilizing the percutaneous 60-day therapy system. Both patients reported approximately 60% pain relief during the therapy, as well as up to 90 days post lead removal.Conclusion: PNS may play a crucial role in the pediatric oncology population. Further studies are warranted to investigate the efficacy and safety of PNS for various cancer-related pain conditions in pediatric populations.

Aim: Traditional radiofrequency ablation (TRFA) effectively treats facet joint-related pain, while water-cooled radiofrequency ablation (CRFA) may offer benefits like larger lesions and easier nerve access. Our goal is to assess the effectiveness of TRFA and CRFA for facet joint-related pain.Materials & methods: This retrospective study included an evaluation of 346 RFA interventions performed on 190 patients suffering from long-term low-back pain. The primary outcome was defined as a decrease of ≥50% of the mean numeric rating scale.Results: The primary outcome was achieved at the first follow-up (FU) for both TRFA and CRFA, with pain relief of 55.2 and 60.5%, respectively. At the second FU, the primary outcome was achieved only in the CRFA group (54.1%), although the TRFA group also showed a good improvement (48.6%). In both groups, pain relief was under 50% during the third FU.Conclusion: Our study indicates that both CRFA and TRFA modalities are effective and safe treatments.

Aim: Hip fracture management is challenging when surgical risks outweigh benefits. Inadequate analgesia from conservative treatments prompted new procedures targeting hip capsule denervation. This study evaluates the efficacy and safety of single injection chemical hip neurolysis in the pericapsular nerve group plane.Materials & methods: In eligible patients, an ultrasound-guided diagnostic block was performed using 5 ml of 2% lidocaine in the pericapsular nerve group plane. If positive, 6 ml of 99.9% alcohol was administered.Results: From May 2022 to May 2023, five patients underwent hip neurolysis. None reported pain at day 5 or during follow-up. There were no adverse effects.Conclusion: Chemical neurolysis seems to provide effective and safe conservative treatment for hip fractures, offering reliable analgesia for nonsurgical candidates.

Bertolotti's syndrome, also known as lumbosacral transitional vertebrae, is a relatively rare spinal condition characterized by an anatomical variation in the lower spine. Conservative approaches such as physical therapy, anti-inflammatory medications and lifestyle modifications may be recommended for mild cases. In more severe cases or when conservative measures fail to provide relief, injections such as may be considered to alleviate pain. This case is unique in that we document a challenging technique of ipsilateral transforaminal epidural steroid injection in a patient with Bertolotti's syndrome.