Pain management最新文献

Chronic pain is one of the main health problems in the world. But managing chronic pain poses special challenges for healthcare. While interventional pain management - especially when focused on zygapophysial joint pain - have been shown to be able to improve health-related quality of life in a cost-effective manner, many European countries have focused on the bio-psychosocial model and pain rehabilitation programs where the general practitioners in primary care gets a subordinate role instead of the leading role they should have. Based on the experience from pain management during the last two decades in Sweden, a program is suggested based on primary care and controlled by the general practitioners and where interventional pain management is integrated early in the process.

Aims: To examine multilevel factors associated with nonpharmacological treatment (NPT) use during opioid tapering among older adults with chronic low back pain (cLBP).

Methods: A cohort study was conducted using 2012-2020 5% national Medicare data. Older adults ≥65 with cLBP who initiated long-term opioid therapy and experienced subsequent tapering were included. The primary outcome was the receipt of NPT within 90 days of tapering. Guided by the social ecological model, predictors were assessed across individual, interpersonal, community, and organizational levels. Multivariable logistic regression was used to evaluate associations with NPT use.

Results: A total of 10,811 eligible beneficiaries were identified. NPT use was more likely among Asian and female individuals, while those receiving partial low-income subsidies had lower odds. Residing in counties with more mental health providers and social associations was linked to higher NPT use. Prior NPT use, higher baseline opioid dose, rapid tapering, mental health conditions, substance use disorders, additional pain diagnoses, and higher comorbidity burden were associated with increased odds of NPT use.

Conclusion: This study identified key factors affecting NPT use during opioid tapering among older adults with cLBP. Findings underscore the importance of targeted clinical and policy strategies to reduce disparities in NPT access.

Background: This study aimed to identify the most frequently searched keywords and questions related to the Achilles, knee, shoulder, and elbow tendons in Italy. It further aimed to evaluate the credibility, readability, and content of the most visited web pages.

Methods: Semrush Inc. (2008) machine learning models were used for data mining in December 2024. Credibility and readability of the most visited web pages were assessed through the QUality Evaluation Scoring Tool (QUEST) and Gulpease index, respectively. A content analysis of web pages was used to determine alignment with evidence-based literature.

Results: The most searched question was "How to treat foot tendonitis?" (2,750 searches). Only two web pages (2.2%) were rated as providing unbiased information using the QUEST, with credibility values ranging from 4.0 (±1.6) to 11.4 (±4.0) across all searches. Gulpease indices ranged from 34.0 (±2.1) to 42.8 (±2.9) across all web pages. Notably, content analysis revealed only a small percentage of web pages that aligned to best available evidence.

Conclusion: Credibility, readability, and overall quality of online content on tendons were poor. Healthcare professionals may play a role in promoting accurate terminology and supporting the production of high-quality, evidence-based web page content to improve public health literacy.

Chronic pain presents a complex challenge in general practice, often leading to cycles of over investigation, overprescribing, and underutilization of holistic support. This article explores how GPs can be better supported to identify chronic pain early, make clinically appropriate decisions without overmedicalizing, and confidently signpost patients to non-medical pain support at the right time. Drawing on the example of Rethinking Pain in Bradford, England - a cross-sector initiative that invests in GP education and provides demedicalised, culturally informed, person-centered pain support - we argue for a shift in the primary care paradigm. Importantly, this approach recognizes the valuable and needed role of GPs in chronic pain care - one that does not necessarily require more time, but rather a shift in mindset and confidence. By enabling GPs to intervene more effectively and holistically, this model has the potential to reduce repeated consultations and break the cycle of high-frequency GP use among people living with chronic pain. Empowering GPs with the tools, training, and networks to navigate chronic pain holistically can reduce harm, improve outcomes, and align care with national strategies for sustainable pain management.

The direct-to-implant (DTI) approach to spinal cord stimulation (SCS) represents an emerging paradigm in the treatment of chronic neuropathic pain. Unlike the conventional two-stage models, which include a preliminary trial phase, the DTI strategy involves immediate permanent implantation in carefully selected patients. This article explores the rationale, clinical outcomes, and practical implications of adopting a single-stage implantation model. Drawing on recent evidence from randomized trials, real-world studies, health economic analyses, and patient preference data, this perspective highlights how the DTI approach may achieve comparable long-term pain relief and functional improvement while minimizing procedural burden, infection risk, and healthcare costs. It also discusses the essential role of rigorous patient selection and intraoperative assessment in ensuring safe and effective use of this model. The literature discussed was identified through non-systematic searches of PubMed, Scopus, and Google Scholar (January 2010-May 2025). By focusing on the clinical and economic value of DTI, this article challenges the assumption that a trial phase is universally necessary and proposes a more flexible, evidence-informed strategy for SCS implantation. As healthcare systems increasingly emphasize patient-centered and cost-effective care, the DTI strategy emerges as a practical and efficient option for managing chronic pain in carefully selected patients.

Intro: Individuals with chronic musculoskeletal pain (CMP) and high pain catastrophizing demonstrate functional and structural brain changes via functional magnetic resonance imaging that may serve as useful neural correlates. Yet, few studies take advantage of electroencephalography (EEG), a more cost effective and accessible tool. Utilizing EEG to further establish clinical characteristics of pain catastrophizing may assist in developing novel interventions that modulate brain activity and expand the depth at which CMP is treated.

Methods: Search strings were entered into PubMed, ProQuest Central, and Scopus and included keywords such as pain catastrophizing and electroencephalography. Articles retrieved underwent blinded review by two independent reviewers.

Results: Seven studies identified significant relationships between EEG measures and pain catastrophizing while five studies found no relationship. Increased pain catastrophizing was found to be correlated with decreased P2 amplitudes, lower signal attenuation following sensory stimuli, increased lagged coherence connectivity, and lower frontal apply asymmetries.

Conclusion: Low-quality evidence demonstrates that neurophysiological relationships may exist between pain catastrophizing and brain regions commonly associated with pain processing. These relationships highlight potential targets for novel interventions aiming to modulate those brain regions to promote recovery of CMP. Further research is needed to better understand the relationship between pain catastrophizing and EEG measures.

Objective: Chronic musculoskeletal pain is common and lacks effective long-term therapies. Transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) offer noninvasive alternatives, but conventional devices are limited by static protocols and poor adherence. The NXTSTIM EcoAI platform integrates TENS/EMS with artificial intelligence to deliver personalized, adaptive therapy. This study examined 24-month real-world outcomes of EcoAI, focusing on usage and subgroup-level efficacy.

Methods: A retrospective analysis was conducted using de-identified data from 2,050 adults using EcoAI at home. The primary endpoint was change in pain intensity (0-10 numeric rating scale). Secondary endpoints included functional status, session engagement, and qualitative pain self-efficacy.

Results: Across ~185,000 sessions, users reported significant pain reduction. Mean pain decreased by 2.4 points (p < 0.001), exceeding 30% improvement, with benefits sustained at 12 and 24 months. Functional interference and mood improved significantly (p < 0.01). Older adults (≥60 years) achieved comparable or greater relief despite slightly lower usage. No serious adverse events occurred. Findings aligned with prior EcoAI analyses showing optimal outcomes with 2-4 daily sessions of 20-59 minutes.

Conclusion: EcoAI provided clinically meaningful, durable pain relief with improved function and mood, supporting personalized home-based neuromodulation as a safe, effective adjunct for chronic musculoskeletal pain.

Aims: Healthcare professionals' attitudes toward chronic pain patients can contribute to stigma, affecting care and patient outcomes. This study examined whether psychological flexibility moderates the relationship between stigma vulnerability (i.e. patient characteristics that invite stigma) and enacted stigma (i.e. discriminatory behaviors) among healthcare professionals.

Participants & methods: A cross-sectional study recruited 239 National Health Service (NHS) staff from six UK NHS Trusts. Participants were randomly assigned one of four vignettes manipulating patient stigma vulnerability (high vs. low) and gender. Enacted stigma outcomes (e.g. perceived deception, pain attribution) were assessed via Likert scales. Psychological flexibility and inflexibility were measured using the Acceptance and Action Questionnaire - Stigma (AAQ-S). Robust ANOVA tested main effects and moderation.

Results: Psychological flexibility did not significantly moderate the stigma vulnerability - enacted stigma relationship (p >0.05). However, higher psychological inflexibility was associated with greater enacted stigma, U  = 3133, p  = .017 suggesting its role in stigma-related behaviors. The AAQ-S flexibility and inflexibility subscales showed distinct associations with stigma outcomes.

Conclusions: Psychological inflexibility plays a role in stigma-related behaviors and may be a target for interventions to reduce healthcare provider bias in chronic pain care. Further research is needed to examine these mechanisms and their implications.

Clinical data reveals that people living with chronic pain often report suboptimal nutrition and eating behaviors. Nutrition may significantly affect the occurrence, development, and prognosis of chronic pain. The International Association for the Study of Pain (IASP) encourages clinicians to include nutrition care in pain management. A potential approach is to integrate nutrition care into interdisciplinary pain rehabilitation, alongside routine lifestyle interventions such as physical activity, sleep habits, and stress management. This discussion paper explores the practical implementation of nutrition care in tertiary pain rehabilitation settings, highlighting key adaptations, challenges, and successful strategies drawn from clinical experience. These reflections on adapting practical tips in day-to-day practice may help strengthen the integration of nutrition care in pain rehabilitation and inspire new investigations in this field.

Aims: This observational study aimed to explore the prevalence and severity of chronic pain in menopausal-aged females.

Materials & methods: We identified participants in the NIH-sponsored All of Us database with a diagnosis of chronic pain. We examined the severity of pain based on numeric rating scale score (NRS). Among those with chronic pain, we generated four sub-cohorts: females ≥ 51 years old who were menopausal, females 18-50 years who were considered pre-menopausal, and age matched male cohorts.

Results: The 53,289 participants were separated into four cohorts by age and sex: females 18-50 (10,269), females ≥ 51 (20,182), males 18-50 (4,989), and males ≥ 51 (17,849). Both older females and older males had lower pain levels than the sex-matched 18-50 group (p < 0.001). Findings were consistent in White, Black, and non-Hispanic cohorts. When comparing older adults, females ≥ 51 had higher pain levels than males ≥ 51 (p < 0.001).

Conclusions: We found that independent of sex, NRS scores were lower in older adults compared to younger cohorts. Older women however had more pain than their male counterparts. These findings have implications for the design of patient-tailored therapeutic treatments and warrant further exploration of physiological and psychosocial causes.