Pain management最新文献

Aims: This open-label non-placebo clinical trial was designed as an explorative test of a recent hypothesis suggesting a causative relation between neck muscle dyssynergia and pain in patients with chronic tension-type headache (TTH) and common whiplash (WL). A Dopamine agonist was used as test-treatment. The primary aim was to improve neck muscle dyssynergia and second to observe the effect on pain.

Patients & methods: Fifteen patients, comprising 8 tension-type headache and 7 common whiplash patients, all with significant neck muscle tenderness, were started on a standard Pramipexole treatment by 0.18 mg Pramipexole daily and increased by 0.18 mg weekly to 0.18 mg × 3 daily for maintenance. Weekly visits with measurements of head laser tracking (HLT) as indicator of neck muscle dyssynergia, total neck muscle tenderness score, and self-reported daily average headache and neck pain. Head laser tracking was compared to a control group of 8 untreated healthy persons.

Results: HLT normalized during treatment and clinical parameters of pain significantly improved.

Conclusion: This result provides preliminary support of the hypothesis of a pathogenetic relation between the dyssynergic neck muscle innervation and pain in TTH and common WL.

Clinical trial registration: EudraCT 2021-003574-31.

Objectives: To provide a comprehensive overview of qualitative studies on three key perspectives of patients with nonspecific back and neck pain - pain beliefs, treatment expectations, treatment experiences, and their interaction.

Methods: Literature search was conducted in PubMed and CINAHL and included articles from inception to 1 October 2025. Two reviewers screened the records for eligibility in a two-step process. Data were charted and synthesized narratively.

Results: Twenty-four studies involving a total of 666 participants were included. Most patients held biomedical pain beliefs and sought a specific diagnosis for their condition. Such a diagnosis influenced treatment expectations, which were in turn linked to previous treatment experiences. A need for pain validation, often expected to be confirmed through diagnostic imaging, emerged as an overarching theme. This need can be addressed by the health professionals' empathy and genuine interest in participatory engagement, their perceived competence, e.g. reflected by a thorough physical examination, and their guidance toward patient self-management considering individual barriers.

Conclusions: Patients' beliefs, expectations, and experiences were connected by an underlying need for validation of their pain experience. Incorporating empathetic, individually tailored pain validation, distinct from solicitousness and mere reassurance, into spinal management might improve treatment satisfaction and outcomes.

Tendinopathy of the conjoint tendon (CjT), comprising the short head of the biceps brachii and coracobrachialis, represents an uncommon etiology of anterior shoulder pain. To our knowledge, this is the first documented case in which leukocyte-rich platelet-rich plasma (LR-PRP) was employed for its treatment. A 54-year-old male weightlifter presented with right shoulder pain that was refractory to conventional conservative management. Although magnetic resonance imaging revealed mild rotator cuff tendinopathy and acromioclavicular osteoarthritis, point-of-care ultrasound (POCUS) identified a hypoechoic lesion within the CjT accompanied by enthesopathy. An ultrasound-guided injection of LR-PRP resulted in complete symptom resolution within 1 month, with sustained improvement observed at the 12-month follow-up. Adverse effects were limited to mild, transient deep injection-site soreness noted on the first post-procedure day. Furthermore, ultrasound evaluation at 6 months demonstrated notable improvement in tendon morphology. This case underscores the importance of considering CjT tendinopathy in the differential diagnosis of anterior shoulder pain and highlights the critical role of POCUS in enhancing diagnostic accuracy and guiding targeted therapeutic interventions. LR-PRP may serve as a regenerative alternative to corticosteroid therapy, promoting tendon healing while avoiding corticosteroids side-effects. As a single case report, generalizability is limited, and conclusions should be interpreted with caution.

Objectives: This study aimed to evaluate the effect of preoperative nursing education on postoperative pain levels and complication development in patients undergoing tympanoplasty.

Material and methods: The study included 56 patients scheduled for tympanoplasty at Department of ENT (Ear, Nose and Throat) Hacettepe University Adult Hospital. Participants were randomized into two groups: 28 in the control and 28 in the intervention group. The intervention group received preoperative nursing education on ear care, while the control group received routine care. Pain levels were measured using the Visual Analog Scale (VAS), and vital signs, complications, and psychological status were monitored through structured forms.

Results: The groups were demographically homogeneous. Regarding the primary outcome, VAS scores on postoperative days 0, 1, and 6 decreased significantly over time in both groups, but no intergroup difference was found (p > 0.05). Male patients and primary school graduate patients had lower VAS scores. However, these differences were not statistically significant. The intervention group demonstrated significantly lower pulse rates (p = 0.043) and fewer psychological problems. Early postoperative nausea and vomiting were more frequent in the control group (p = 0.043).

Conclusion: Preoperative nursing education did not directly reduce postoperative pain, but it is associated with decreased complications and psychological stress, supporting improved recovery after tympanoplasty.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT06717217.

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: 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.