Pain management最新文献

Aim: To determine the efficacy of transdermal anti-inflammatory patches in the treatment of acute and chronic musculoskeletal pain.Methods: A comprehensive search of: Cochrane Central register of controlled trials, EMBASE, MEDLINE, CINAHL and PubMed, for studies using transdermal anti-inflammatory patches vs placebo for management of musculoskeletal pain, e.g. soft tissue injuries or tendonitis (last search January 2024). Cochrane Risk of Bias Tools v1 was used for quality assessment and GRADE determined certainty of evidence. Meta-analysis was performed.Results: Twenty-three randomized placebo-controlled trials (n = 4729) were included. There was low-certainty evidence that transdermal patches provided statistically and clinically significant pain relief on movement at long-term follow-up for chronic musculoskeletal pain (effect size -2-69 (95% CI: -4.14, -1.24) and at short-term follow-up which was non-clinically significant, (-1.24: 95% CI: -1.78, -0.69).Conclusion: Several types of transdermal anti-inflammatory patches may offer short-term and long-term pain relief for acute and chronic musculoskeletal conditions. However, the clinical significance of this effect for the long-term pain relief was based on low-certainty evidence of transdermal anti-inflammatory patches versus placebo; for short-term pain there was an overall non-clinically significant improvement. Performing a meta-analysis for all outcomes was not possible due to insufficiency in the evidence-base.Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42020185944.

Cluster headache (CH), a highly disabling condition, lacks disease-specific, mechanism-based prophylactic treatment. Galganezumab, a monoclonal antibody targeting the calcitonin gene-related peptide, reduced the weekly attacks of CH in one randomized, placebo-controlled trial for the prevention of episodic CH (eCH), but this effect was not detected in people with chronic CH (cCH). In this case series, we systematically monitored the efficacy and safety outcomes of adjunctive therapy in 11 people with refractory CH (failure of ≥ 3 prophylactic treatments; eCH n = 5, cCH, n = 6) who received galcanezumab (120-360 mg monthly) for 3 consecutive months. All participants received intermediate treatment with oral steroids or a great occipital nerve block ≥ 2 months before starting galcanezumab treatment. After galcanezumab treatment, the average number of weekly CH attacks and weekly days with any symptomatic treatment for CH decreased significantly from 16.0 ± 9.4 and 6.50 ± 3.59 before treatment to 1.8 ± 1.32 (p = 0.002) and 1.8 ± 3.36 (p = 0.001) at month 3 of treatment, respectively. Two participants with cCH showed no change in the number of attacks with galcanezumab. No serious adverse events were recorded. These data, along with those of previous real-world reports, suggest that galcanezumab may help people with refractory CH as an add-on treatment.

What is this summary about?: This is a summary of two research studies (known as clinical trials) called LIBERTY 1 and LIBERTY 2. These studies compared how well a medicine called relugolix combination therapy and placebo worked in reducing heavy menstrual bleeding (periods) in women with uterine fibroids (published in a separate article referenced in the section: Where can readers find more information on these studies?). Researchers also looked at whether women with moderate to severe pain from uterine fibroids saw improvement in their worst pain symptoms after 24 weeks of treatment (results described in the present summary).

What are the key takeaways?: Women with moderate to severe pain from uterine fibroids (menstrual or nonmenstrual pain) took either relugolix combination therapy or placebo (once daily by mouth) for 24 weeks. During the last 5 weeks of treatment, 65% of women taking relugolix combination therapy and 19% of women taking placebo reported having minimal or no menstrual pain. Similarly, 45% of women taking relugolix combination therapy and 22% of women taking placebo reported having minimal or no non-menstrual pain. During the same time period, 71% of the women taking relugolix combination therapy and 40% of women taking placebo reported their worst pain was reduced by about one third compared with the start of the study.

What were the main conclusions reported by the researchers?: Women with moderate to severe pain from uterine fibroids taking relugolix combination therapy were more likely to have minimal or no pain from uterine fibroids after treatment compared with women taking placebo.Clinical Trial Registration: NCT03049735 (LIBERTY 1), NCT03103087 (LIBERTY 2) (ClinicalTrials.gov).

Acute pain management requires balancing analgesia with adverse effects risk. The voltage-gated sodium channel NaV1.8 plays an important role in pain physiology, and its inhibition was shown to have analgesic effects. VX-548 is a new oral NaV1.8-specific inhibitor that received United States Food and Drug Administration Fast Track and Breakthrough Therapy designations. Its efficacy was demonstrated in two Phase II trials of patients who underwent abdominoplasty and bunionectomy. These showed that VX-548, when given as an oral loading dose of 100 mg followed by 50 mg 12-hly, significantly decreased pain scores compared with placebo. Similarly, two Phase III trials of patients who underwent abdominoplasty and bunionectomy comparing VX-548 with hydrocodone bitartrate-acetaminophen and placebo reported significantly reduced pain scores compared with placebo, but no improvement compared with hydrocodone bitartrate-acetaminophen. Evidence from Phase II and III trials suggest that VX-548 is well-tolerated, with headache, nausea, constipation and dizziness being the most common adverse effects. However, the safety of prolonged VX-548 administration is uncertain; a Phase II trial of patients with diabetic neuropathy who received high-dose VX-548 over 12 weeks reported decreased creatinine clearance. Data pertaining to VX-548 safety and efficacy within the context of multimodal analgesia and pregnancy are also needed.

Lead migration is a common complication of spinal cord stimulation, although anterior migration is rare. While early studies suggested that anterior stimulation may produce analgesic effects, it is thought to be poorly tolerated due to abnormal paresthesia and muscle contractions due to its proximity to the corticospinal tract. This case report presents a unique case of sustained pain relief despite anterior lead migration, which suggests that anterior column stimulation may hold clinical significance for pain management. Further studies are needed to explore its analgesic mechanisms and potential therapeutic application. Strategies to prevent lead migration, particularly in the early postoperative period, are also crucial for optimizing outcomes.

Aim: To examine the range of services pharmacists provide and their impact on patient outcomes, harm reduction, and appropriate opioid use.Methods: Six databases were searched (MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL and Cochrane Methodology Register) from inception to March 2023. The protocol was registered in PROSPERO (CRD42023401895).Results: Twenty-nine studies identified five key areas of pharmacist interventions in opioid management-naloxone programs and opioid de-escalation, patient and primary healthcare providers' education and motivational interview, prescription monitoring and opioid risk screening, clinical pharmacy interventions (pharmacotherapy, medication review, prescribing, adherence monitoring), and collaborative healthcare approaches to promote optimal opioid use. Outcomes assessment indicated harm reduction, improved safety, increased non-opioid analgesic use, decreased opioid consumption, and enhanced pain management.Conclusion: This review underscores pharmacists' vital role in tackling opioid misuse, overuse and abuse, providing a foundation for evidence-based policies to minimize harm and promote optimal opioid use.

Aim: Polmacoxib, a new COX-2 inhibitor with carbonic anhydrase (CA) inhibitory action, is expected to help minimize the adverse effects associated with other NSAIDs, like GI (gastrointestinal) and CV (cardiovascular) system- related issues. The comparative efficacy and safety of polmacoxib 2 mg (manufactured by Hetero Labs Limited) versus celecoxib 200 mg (manufactured by Hetero Labs Limited) were assessed in this randomized, double-anonymous, clinical study in Indian adult patients diagnosed with idiopathic osteoarthritis (OA) of the.

Patients & methodology: 18 years and older patients of either sex, clinically and radiographically diagnosed idiopathic knee or hip OA were randomized to receive either polmacoxib or celecoxib in a 1:1 ratio. All patients were assessed with various pain measuring scales and recorded the scores at the end of weeks 3 and 6.

Conclusion: The data for all the pain assessment scores were analyzed, and polmacoxib was found to be a non-inferior therapeutic agent compared to celecoxib in terms of safety and efficacy.(https://ctri.nic.in/CTRI/2022/05/042923).

Aim: The study compared responders and nonresponders to transcranial direct current stimulation (tDCS) regarding clinical pain outcomes in knee osteoarthritis (OA) patients.

Patients and methods/materials: Sixty participants received home-based active tDCS, and clinical pain outcomes were compared between responders and nonresponders.

Results: Latent class growth analyses classified 41 participants as responders and 19 as nonresponders. Responders showed significantly greater decreases in pain intensity from baseline to post intervention than nonresponders (p < .001). Participants with higher BMI (p = .02) and weight (p = .005) were more likely to respond, while no significant sociodemographic differences were found.

Conclusions: Identifying characteristics of nonresponsive tDCS subgroups can tailor treatments for each group.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT04016272.

Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.