Pain management最新文献

Introduction: Genicular radiofrequency ablation (RFA) is a minimally invasive treatment for knee pain with variable outcomes reported. This study aimed to evaluate genicular RFA in reducing pain and identify predictors of treatment success.

Methods:  This retrospective study included 34 patients who underwent genicular RFA between April 2022 and December 2023. Data on demographics, pre- and post-procedure pain levels, and clinical variables were collected through chart reviews and follow-up surveys. The primary outcome was pain reduction at postoperative follow up. Statistical analyses were conducted to identify predictors of pain outcomes.

Results: RFA led to pain reduction in 24 patients (71%), though only 9 (26%) achieved >50% relief according to IMMPACT criteria. The mean pre-procedure pain score was 7.1 ± 1.4, which decreased to 5.2 ± 2.0 post-procedure. Lower pre-procedure Numeric Rating Score (NRS) was the strongest predictor of success (P < 0.001), while age, BMI, gender, and arthritis severity did not significantly impact outcomes.

Conclusion: While genicular RFA led to pain reduction in a majority of patients, only a subset experienced clinically significant improvement. Pre-procedure pain score was a key predictor of outcomes, suggesting the need for more refined patient selection criteria and further research into optimizing treatment targets.

Long acting (or extended release) injectable buprenorphine formulations for the treatment of opioid dependence have been introduced in a number of countries in recent years. One such product, Buvidal, available as Weekly or Monthly subcutaneous injections, has been increasingly used in many European countries and Australia for several years, and has recently been registered under the brand name Brixadi in the United States. This review provides an overview of opioid dependence, examines the rationale for the development of Buvidal, its pharmacological properties, evidence of efficacy and safety, and key principles of clinical care in the treatment of opioid dependence. Particular attention is given to issues of pain management, pregnancy, and treatment in custodial settings. This long-acting injectable buprenorphine product is an important addition to the available options for the treatment of opioid dependence, providing a safe and effective alternative to treatment with medications requiring daily dosing.

Aim: evaluate the immediate results of short-wave diathermy (SWD) in individuals with chronic low back pain (CLBP).

Materials and methods: individuals with CLBP, aged between 18 and 80, of both sexes, were selected for a double-blind, 3-arm, randomized, and controlled trial. The outcomes assessed were: pain by Numeric Rating Scale for pain (NRS), McGill Pain Questionnaire (MPQ), and Pressure Pain Threshold (PPT); disability; strength and power of lower limbs and flexibility of spine and lower limbs. The participants were randomized into three groups: continuous SWD (cSWD, n = 50), pulsed SWD (pSWD, n = 50), and placebo group (PG, n = 50). All groups received a single application of SWD for 30 mins and underwent assessment at three stages: pre-intervention, post-intervention, and follow-up.

Results: we found a significant difference between cSWD and PG in NRS (p < 0.05). Only pSWD showed a significant intergroup difference with PG in sensory and total MPQ index (p < 0.05). There were improvements in intra-group disability in pSWD and PG, in flexibility only in cSWD, and the power of lower limb post-intervention only in pSWD.

Conclusions: SWD endowed an immediate analgesic effect in individuals with CLBP.

Clinical trial registration: The www.ensaiosclinicos.gov.br/rg/RBR-2k58f5h/ identifier is RBR- 2k58f5h.

Aim: To review the relationship between drug concentrations of perioperative intravenous lidocaine and their analgesic effects.

Methods: We systematically searched SCOPUS, Medline, EMBASE, CENTRAL, and Web of Science (inception to March 2024) for randomized controlled trials comparing intraoperative lidocaine to placebo or control in adults undergoing non-cardiac surgery. Studies reported pain outcomes and plasma lidocaine concentrations. Bias was assessed using the Cochrane risk-of-bias tool, and data was analyzed with a random-effects model to determine mean difference (MD) and 95% confidence intervals (CI).

Results: Fifteen studies (445 lidocaine, 453 control patients) were included. Lidocaine lowered post-anesthetic care unit (PACU) opioid use (8 studies, MD: -3.00, 95% CI [-5.00, -1.01], p = 0.0092, I² = 57%), with meta-regression indicating greater reduction at higher plasma concentrations (regression coefficient: -3.05, 95% CI [-4.48, -1.61], p = 0.002). However, 11 studies found no significant difference in 24-hour postoperative opioid consumption or pain scores. Nausea and vomiting incidence were similar between groups, and a few patients experienced lidocaine-related adverse events.

Conclusion: Perioperative lidocaine infusion reduces PACU opioid consumption, with greater effects at higher concentrations, although significant heterogeneity was noted. Further research is needed to identify optimal concentrations for clinically significant analgesic benefits.

Protocol registration: International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) ID: INPLASY202180046, DOI: 10.37766/inplasy2021.8.0046.

Objective: TNX-102 SL is a new sublingual tablet formulation of cyclobenzaprine (CBP) for rapid transmucosal absorption. We aimed to evaluate the efficacy and safety of TNX-102 SL in improving pain and sleep quality in patients with fibromyalgia (FM).

Methods: Searches were conducted in Embase, PubMed, Cochrane Library, and Web of Science databases. The primary endpoint was the reduction in daily diary pain score. Secondary outcomes included Fibromyalgia Impact Questionnaire (FIQ-R) Function and Symptoms, daily diary sleep score, and adverse effects. Four studies met eligibility criteria and a random-effect meta-analysis was performed to combine data.

Results: The analyses of 1,993 patients yielded statistically significant differences in the TNX-102 SL group versus the control group on daily diary pain intensity (SMD = -0.25; 95% CI [-0.34, -0.16]; p < 0.001), FIQ-R Function (SMD = -0.18; 95% CI [-0.35, -0.02]; p = 0.028), FIQ-R Symptoms (SMD = -0.23; 95% CI [-0.33, -0.13]; p < 0.001) and sleep daily diary (SMD = -0.21; 95% CI [-0.32, -0.11]; p < 0.001). Sedation, oral hypoaesthesia, and paresthesia were TNX102-SL's most common adverse effects.

Conclusions: Pooled data show TNX-102 SL significantly reduces pain, improves sleep quality, and enhances quality of life in FM patients.

Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42024588069.

Clinicaltrial registration: www.clinicaltrials.gov identifier is NCT06743802.

Aims: To examine whether eye-tracking (ET) enables reliable self-report of pain in intubated patients with spinal cord injury (SCI) and to explore associations between pain and psychological self-appraisals.

Methods: In this prospective observational study, 75 mechanically ventilated ICU patients (46 SCI, 29 non-SCI) completed pain assessments using a Tobii Dynavox ET device. Pain was measured via the Numeric Rating Scale (NRS) and the EQ-5D-5L pain dimension. Self-esteem, anxiety, and depression were measured with the Visual Analogue Self-Esteem Scale (VASES).

Results: NRS and EQ-5D pain ratings showed strong correlation (r = 0.78, p < 0.001). Pain intensity did not differ significantly between SCI and non-SCI groups. No significant associations were observed between pain and self-esteem, anxiety, or depression. A Bland - Altman plot confirmed agreement between NRS and EQ-5D pain scores.

Conclusions: ET enables reliable pain self-report in intubated ICU patients with severely limited communication. Pain ratings were independent of psychological self-appraisals, suggesting ET offers a feasible, patient-centered tool for assessing pain in this population.

Introduction: Managing osteoarthritis aims to relieve pain, improve joint function and quality of life. Current guidelines recommend combining non-drug and pharmacological approaches. A non-medication solution integrating an endorphin-stimulating millimeter wave device, mobile application, and coaching program was evaluated.

Methods: This combined approach is evaluated in a real-world evidence study over three months in patients with osteoarthritis-related pain. The primary endpoint was patient-perceived change at three months using the Patient Global Impression of Change (PGIC). Secondary outcomes, assessed at baseline and three months, included pain intensity (mean and maximum), frequency of pain crises, quality of life, sleep, mental health, and medication use.

Results: Among 156 participants completing follow-up, 80.1% reported improvement (PGIC > 4). Quality of life improved by 29.8%, while sleep and mental health improved by 13.1% and 13.5%, respectively. Mean and maximum pain intensity decreased by 33.9% and 33.1%. Pain crises became less frequent, and patients reported reduced medication use.

Conclusion: These results align with recent randomized controlled trial findings, supporting millimeter wave neuromodulation as an innovative, non-drug strategy targeting both nociceptive and nociplastic pain mechanisms to improve quality of life in osteoarthritis patients.