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[Influence of health care crises on the treatment of cancer pain: a presentation using the example of the COVID-19 pandemic from the provider's perspective]. [医疗危机对癌痛治疗的影响:以 COVID-19 大流行为例,从提供者的角度进行介绍]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-05 DOI: 10.1007/s00482-024-00826-w
Frederik Dombrowski, Stefan Wirz, Hannes Hofbauer, Pascal Kowark, Joachim Erlenwein, Ulrike Stamer, Kristin Kieselbach

Background: The COVID-19 pandemic led to significantly restricted access to pain medicine services. Patients with cancer-related pain are considered a vulnerable group in terms of care deficits. A questionnaire among providers providing treatment to this group was used to assess limitations and solutions in this critical situation.

Materials and methods: The online survey, developed by the 'Tumour Pain Working Group' of the German Pain Society using the Delphi method, included questions on site structure, pandemic-related care problems, and burdens experienced by those treating patients. It was distributed several times via the mailing lists of the German Pain Society and the 'Palliative Medicine Working Group' of the German Society of Anaesthesiology and Intensive Care Medicine.

Results: In all, 175 fully completed questionnaires were analysed. Over 75% of participants reported pandemic-related staff shortages and closures of pain medicine facilities, with 32% of facilities temporarily not treating elective pain patients and 13% not treating any emergencies. Care was hampered by numerous logistical problems such as very frequent pandemic-related cancellations by patients or in the transmission of prescriptions. Alternative forms of consultation by telephone or telemedicine, rarely used before the pandemic, were reported by 79 and 31% of respondents respectively, but deficiencies were noted. In addition, 52.1% of respondents complained of severe and 26.8% of moderate psychological stress due to the pandemic, and 74.1% evaluated working conditions as moderately to severely difficult. Medical training was still possible for 86% through format changes.

Conclusion: The COVID-19 pandemic revealed numerous deficits in the care of patients with cancer-related pain, as well as burdens on healthcare providers. The development of new concepts could help to ensure better care in future crisis situations.

背景:COVID-19 大流行导致疼痛医疗服务受到极大限制。癌症相关疼痛患者被认为是在护理方面处于弱势的群体。在为这一群体提供治疗的医疗机构中开展了一项问卷调查,以评估在这一危急情况下的局限性和解决方案:该在线调查由德国疼痛学会的 "肿瘤疼痛工作组 "采用德尔菲法编制而成,其中包括有关医疗机构结构、与大流行病相关的护理问题以及治疗患者所承受的负担等问题。该问卷通过德国疼痛学会和德国麻醉学与重症监护医学学会 "姑息医学工作组 "的邮件列表进行了多次分发:共对 175 份填写完整的问卷进行了分析。超过 75% 的参与者报告了与大流行病相关的人员短缺和疼痛医学机构关闭的情况,其中 32% 的机构暂时不收治选择性疼痛患者,13% 的机构不收治任何急诊患者。许多后勤问题阻碍了医疗服务,例如病人经常因大流行而取消就诊,或在传送处方时出现问题。分别有 79% 和 31% 的受访者报告了大流行前很少使用的电话或远程医疗等替代咨询方式,但也指出了不足之处。此外,52.1% 的受访者抱怨大流行造成了严重的心理压力,26.8% 的受访者抱怨有中等程度的心理压力,74.1% 的受访者将工作条件评价为中等至严重困难。86%的受访者仍可通过改变形式接受医疗培训:COVID-19大流行揭示了癌症相关疼痛患者护理中的诸多不足,以及医疗服务提供者的负担。新概念的开发有助于确保在未来的危机情况下提供更好的护理。
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引用次数: 0
Wir gestalten Zukunft : Abstracts des Deutschen Schmerzkongresses 2024: 16.–19. Oktober 2024 im CC Rosengarten, Mannheim. 我们塑造未来:2024 年德国疼痛大会摘要:2024 年 10 月 16-19 日,曼海姆罗森加滕 CC 会议中心。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 DOI: 10.1007/s00482-024-00827-9
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引用次数: 0
[Conservative combination therapy of sciatica due to lumbar disc herniation with mechanical physiotherapy (McKenzie), gabapentin, and transforaminal epidural injections]. [腰椎间盘突出症引起的坐骨神经痛的保守综合疗法:机械理疗(McKenzie)、加巴喷丁和经椎间孔硬膜外注射]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-12 DOI: 10.1007/s00482-024-00824-y
Manuela Jäntsch-Rieckert, Oliver Rommel, Verena Kästner, Lotte Maercklin-Rommel, Georg Jäger

Background: Treatment of sciatica due to lumbar disc herniation can be surgical or conservative. Conservative management has been described to be effective in 90% of patients; however, in most studies no consistent treatment concept was used.

Objectives: In the present study, we evaluated the effect of a combined nonsurgical management (McKenzie physiotherapy, gabapentin, and periradicular injections) in 40 patients during a 10-day inpatient treatment.

Methods: In addition to the neuro-orthopedic examination, pain severity at rest and after walking were assessed. The Oswestry pain disability scale, the pain severity scale, and the painDETECT scale were examined to assess neuropathic pain components. The duration of incapacity for work and the requirement of a later surgery were recorded. Examinations were performed on the day of admission, on days 3, 6, 10, and 84, 3 months after discharge.

Results: During conservative treatment, a continuous reduction of pain and an improvement of the straight leg raise test as well as finger-to-floor distance could be documented. As the three treatment options were introduced with a time delay, it could be demonstrated that all significantly contributed to the improvement. All treatments were tolerated without side-effects and persistent improvement after 12 weeks. On admission, 32% of patients revealed a neuropathic pain component which decreased to 7% at the follow-up. A total of 28 patients showed impaired muscle strength on admission, which decreased to 7 patients on follow-up. Electromyography revealed pathological results in 70% of patients examined. A significant improvement of quality of life (Oswestry Disability Index [ODI]) could be observed and the patients returned to work after 5.8 weeks. Only 3/40 patients required surgical management due to persistent pain.

Conclusion: The combined nonsurgical operative treatment program is effective and well tolerated.

背景:腰椎间盘突出症引起的坐骨神经痛的治疗方法有手术和保守两种。据描述,保守治疗对 90% 的患者有效;然而,大多数研究并未采用一致的治疗理念:在本研究中,我们评估了 40 名患者在为期 10 天的住院治疗期间接受非手术综合治疗(麦肯茨理疗、加巴喷丁和椎间盘周围注射)的效果:除神经骨科检查外,还对休息时和行走后的疼痛严重程度进行了评估。对奥斯韦特里疼痛残疾量表、疼痛严重程度量表和疼痛DETECT量表进行了检查,以评估神经性疼痛成分。此外,还记录了丧失工作能力的持续时间以及是否需要进行后期手术。检查时间为入院当天、第3天、第6天、第10天和第84天,以及出院后3个月:在保守治疗期间,疼痛持续减轻,直腿抬高试验和手指到地面的距离都有所改善。由于三种治疗方案都有时间延迟,因此可以证明所有治疗方案都对疼痛的改善有显著作用。所有治疗方法均可耐受,无副作用,且在 12 周后仍有改善。入院时,32%的患者表现出神经性疼痛,随访时这一比例降至 7%。共有 28 名患者在入院时出现肌力减退,随访时减至 7 人。70%的患者在肌电图检查中发现了病理结果。患者的生活质量(Oswestry 失能指数[ODI])明显改善,并在 5.8 周后重返工作岗位。只有 3/40 的患者因持续疼痛而需要手术治疗:结论:非手术综合治疗方案有效且耐受性良好。
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引用次数: 0
[Tetrahydrocannabinol (THC) in patients with fibromyalgia syndrome (FMS) : A retrospective study of changes in pain, psychometric variables, and analgesic consumption during inpatient interdisciplinary multimodal pain therapy (IMPT)]. [纤维肌痛综合征(FMS)患者体内的四氢大麻酚(THC):关于住院病人跨学科多模式疼痛疗法(IMPT)期间疼痛、心理测量变量和镇痛剂消耗量变化的回顾性研究]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2023-06-08 DOI: 10.1007/s00482-023-00727-4
Horst Bettstetter, Arne Schäfer

Background: Since March 1, 2017, medical cannabis (MC) can be prescribed nationwide in Germany. To date, there have been a number of qualitatively different studies on the effectiveness of MC in fibromyalgia syndrome (FMS).

Objective: The aim of the study was to investigate the effectiveness of THC in the course of interdisciplinary multimodal pain therapy (IMPT) on pain and several psychometric variables.

Materials and methods: For the study, in the period 2017-2018, all patients in the pain ward of a clinic who were suffering from FMS and were treated in a multimodal interdisciplinary setting were selected based on inclusion criteria. The patients were examined separately according to groups with and without THC about pain intensity, various psychometric parameters and analgesic consumption during the stay.

Results: Of the 120 FMS patients included in the study, 62 patients (51.7%) were treated with THC. In the parameters of pain intensity, depression, and quality of life, there was a significant improvement in the entire group during the stay (p < 0.001), which was significantly greater through the use of THC. In five of the seven analgesic groups examined, the dose was reduced or the drug discontinued significantly more often in the patients treated with THC.

Conclusion: The results provide indications that THC can be considered as a medical alternative in addition to the substances previously recommended in various guidelines.

背景:自 2017 年 3 月 1 日起,医用大麻(MC)可在德国全国范围内处方。迄今为止,已有多项关于医用大麻对纤维肌痛综合征(FMS)疗效的定性研究:该研究旨在调查在跨学科多模式疼痛治疗(IMPT)过程中,四氢大麻酚对疼痛和多个心理测量变量的有效性:在2017-2018年期间,研究人员根据纳入标准选取了一家诊所疼痛病房中所有患有FMS并接受多模式跨学科治疗的患者。按照有THC组和无THC组分别检查了患者的疼痛强度、各种心理测量参数和住院期间的镇痛药消耗量:在纳入研究的 120 名 FMS 患者中,62 名患者(51.7%)接受了 THC 治疗。在疼痛强度、抑郁和生活质量等参数方面,整个组别在住院期间均有显著改善(p 结论:研究结果表明,THC 可以改善 FMS 患者的生活质量:研究结果表明,除了各种指南中推荐的药物外,THC 还可被视为一种医疗替代品。
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引用次数: 0
[Benefits and harms of cannabis-based medicines from the viewpoint of patients with chronic pain and their physicians : A cohort study in three pain centers of the German federal state Saarland]. [从慢性疼痛患者及其医生的角度看大麻药物的益处和害处:德国萨尔州三个疼痛中心的队列研究]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2023-01-20 DOI: 10.1007/s00482-022-00688-0
Claudia Böttge-Wolpers, Patric Bialas, Sven Gottschling, Stephanie Juckenhöfel, Dieter Konietzke, Albrecht Madlinger, Patrick Welsch, Winfried Häuser

Background: There are no studies available that have simultaneously assessed the benefits and harms of cannabis-based medicines from the viewpoint of patients and their physicians.

Methods: All chronic pain patients at three pain centres in the German federal state of Saarland who had received at least one prescription of cannabis-based medicines (CbMs) in the past from the study centre were included in a cross-sectional study from January 1 to December 31, 2021. Patients and their physicians completed a self-developed questionnaire separately.

Results: All 187 contacted patients participated in the study. Since the start of CbM therapy, 44.9% of patients reported to be much or very much, 43.3% to be moderately and 8.0% to be slightly improved overall. A total of 2.7% reported no change and 1.1% a moderate deterioration of overall wellbeing. From the patients' point of view, the symptoms most frequently reported to have substantially improved were sleep problems (36.4%), muscle tension (25.1%) and appetite problems (22.1%). The most frequent bothersome side effects were sweating (6.4%), concentration problems (4.2%) and nausea (4.1%). Physicians noted substantial pain relief in 60.7%, improvement of sleep in 65.7% and of mental well-being in 34.3%. A complete cessation of opioids was achieved in 64.7%, of anticonvulsants in 57.9% and of antidepressants in 60% of patients that had received these medications before the start of CbM therapy.

Conclusions: CbMs can contribute to a clinically relevant reduction in pain, sleep problems and muscle tension and can improve daily functioning in carefully selected and supervised patients with chronic pain. CbM can contribute to the reduction or complete cessation of other pain medications (antidepressants, anticonvulsants, opioids).

背景:目前还没有研究从患者及其医生的角度同时评估大麻类药物的益处和害处:方法:在 2021 年 1 月 1 日至 12 月 31 日进行的一项横断面研究中,纳入了德国萨尔州三个疼痛中心的所有慢性疼痛患者,这些患者过去曾在研究中心接受过至少一次大麻类药物(CbMs)处方。患者及其医生分别填写了一份自行编制的调查问卷:所有187名联系过的患者都参与了研究。自开始接受 CbM 治疗以来,44.9% 的患者表示总体病情大为改善或非常改善,43.3% 的患者表示病情中度改善,8.0% 的患者表示病情轻微改善。共有 2.7% 的患者表示总体健康状况没有变化,1.1% 的患者表示总体健康状况中度恶化。从患者的角度来看,最常报告的得到实质性改善的症状是睡眠问题(36.4%)、肌肉紧张(25.1%)和食欲问题(22.1%)。最常见的副作用是出汗(6.4%)、注意力不集中(4.2%)和恶心(4.1%)。医生指出,60.7%的患者疼痛明显缓解,65.7%的患者睡眠得到改善,34.3%的患者精神状态良好。64.7%的患者完全停用了阿片类药物,57.9%的患者完全停用了抗惊厥药物,60%的患者在开始接受 CbM 治疗前停用了抗抑郁药物:结论:CbMs 在临床上有助于减轻慢性疼痛患者的疼痛、睡眠问题和肌肉紧张,并能改善他们的日常功能。CbM有助于减少或完全停用其他止痛药物(抗抑郁药、抗惊厥药、阿片类药物)。
{"title":"[Benefits and harms of cannabis-based medicines from the viewpoint of patients with chronic pain and their physicians : A cohort study in three pain centers of the German federal state Saarland].","authors":"Claudia Böttge-Wolpers, Patric Bialas, Sven Gottschling, Stephanie Juckenhöfel, Dieter Konietzke, Albrecht Madlinger, Patrick Welsch, Winfried Häuser","doi":"10.1007/s00482-022-00688-0","DOIUrl":"10.1007/s00482-022-00688-0","url":null,"abstract":"<p><strong>Background: </strong>There are no studies available that have simultaneously assessed the benefits and harms of cannabis-based medicines from the viewpoint of patients and their physicians.</p><p><strong>Methods: </strong>All chronic pain patients at three pain centres in the German federal state of Saarland who had received at least one prescription of cannabis-based medicines (CbMs) in the past from the study centre were included in a cross-sectional study from January 1 to December 31, 2021. Patients and their physicians completed a self-developed questionnaire separately.</p><p><strong>Results: </strong>All 187 contacted patients participated in the study. Since the start of CbM therapy, 44.9% of patients reported to be much or very much, 43.3% to be moderately and 8.0% to be slightly improved overall. A total of 2.7% reported no change and 1.1% a moderate deterioration of overall wellbeing. From the patients' point of view, the symptoms most frequently reported to have substantially improved were sleep problems (36.4%), muscle tension (25.1%) and appetite problems (22.1%). The most frequent bothersome side effects were sweating (6.4%), concentration problems (4.2%) and nausea (4.1%). Physicians noted substantial pain relief in 60.7%, improvement of sleep in 65.7% and of mental well-being in 34.3%. A complete cessation of opioids was achieved in 64.7%, of anticonvulsants in 57.9% and of antidepressants in 60% of patients that had received these medications before the start of CbM therapy.</p><p><strong>Conclusions: </strong>CbMs can contribute to a clinically relevant reduction in pain, sleep problems and muscle tension and can improve daily functioning in carefully selected and supervised patients with chronic pain. CbM can contribute to the reduction or complete cessation of other pain medications (antidepressants, anticonvulsants, opioids).</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9116046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Ganglionic opioid analgesia (GLOA) with sufentanil?] [使用舒芬太尼进行神经节阿片镇痛(GLOA)?
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-19 DOI: 10.1007/s00482-024-00816-y
Helmut Gockel, Philipp Stude, Christoph Maier
{"title":"[Ganglionic opioid analgesia (GLOA) with sufentanil?]","authors":"Helmut Gockel, Philipp Stude, Christoph Maier","doi":"10.1007/s00482-024-00816-y","DOIUrl":"10.1007/s00482-024-00816-y","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Der Schmerz-education and research]. [Der Schmerz--教育与研究]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-19 DOI: 10.1007/s00482-024-00818-w
Hans-Georg Schaible, Lukas Radbruch
{"title":"[Der Schmerz-education and research].","authors":"Hans-Georg Schaible, Lukas Radbruch","doi":"10.1007/s00482-024-00818-w","DOIUrl":"https://doi.org/10.1007/s00482-024-00818-w","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Patient-reported outcomes in chronic diseases under treatment with cannabis medicines : Analysis of the results of the Copeia survey]. [使用大麻药物治疗慢性疾病的患者报告结果:Copeia 调查结果分析]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2024-03-07 DOI: 10.1007/s00482-024-00802-4
Knud Gastmeier, André Ihlenfeld, Anne Gastmeier, Garvin Hirt, Assaf Landschaft, Stefan Wirz

Background: The survey of Copeia captured early 2022 patient-reported outcomes (PRO) in Germany under cannabis medicinal product (CAM) therapy, with particular attention to symptoms, symptom changes, indications, side effects, dosages, and cost bearers.

Goal: This study investigated the question of whether associations emerge from the results that could play a role in the indication and treatment monitoring of CAM in chronically ill patients.

Materials and methods: A standardized questionnaire was administered online nationwide in dialogue form over a 15-week period to collect itemized symptoms and PRO. Recruitment was supported by pharmacies, prescribing physicians, and patient associations. Inclusion criteria included physician-prescribed CAM therapy.

Results and discussion: Of 1582 participants, 1030 data sets (65%) could be completely analyzed. There was a heterogeneous patient population, whose common feature was disease chronicity. The frequency distribution of symptoms showed a homogeneous pattern for the respective indications, in which the most frequent six (pain 71%, sleep disturbance 64%, stress/tension 52%, inner restlessness 52%, depressive mood 44% and muscle tension 43%) seem to have a special significance. According to subjective assessment, quality of life improved significantly in 84% of all participating patients.

Conclusion: A symptom matrix (SMX) composed of different symptoms seems to play a special role in CAM therapy to improve the quality of life of chronically ill patients, regardless of the underlying disease. The SMX could contribute to the identification of an indication and to targeted treatment monitoring.

背景:Copeia调查收集了德国2022年早期接受大麻药用产品(CAM)治疗的患者报告结果(PRO),特别关注症状、症状变化、适应症、副作用、剂量和费用承担者。目标:本研究探讨了从调查结果中是否可以发现一些关联,从而在慢性病患者的CAM适应症和治疗监测中发挥作用:在为期 15 周的时间内,在全国范围内以对话形式在线发放了一份标准化问卷,以收集逐项症状和 PRO。招募工作得到了药房、处方医生和患者协会的支持。纳入标准包括医生处方的 CAM 疗法:在 1582 名参与者中,有 1030 组数据(65%)可进行完整分析。患者群体具有异质性,其共同特征是疾病的慢性化。症状的频率分布显示出相应适应症的同质性模式,其中最常见的六种症状(疼痛 71%、睡眠障碍 64%、压力/紧张 52%、内心不安 52%、抑郁情绪 44%和肌肉紧张 43%)似乎具有特殊意义。根据主观评估,84%的参与患者的生活质量得到明显改善:由不同症状组成的症状矩阵(SMX)似乎在 CAM疗法中发挥着特殊作用,无论潜在疾病如何,它都能改善慢性病患者的生活质量。症状矩阵有助于确定适应症和有针对性的治疗监测。
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引用次数: 0
[Adaptions of mirror therapy for phantom limb pain with telescoping phenomenon]. [镜像疗法治疗幻肢痛与伸缩现象的适应性]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2023-09-04 DOI: 10.1007/s00482-023-00745-2
Marina M Finnern, Josepha Zimmer, Herta Flor
{"title":"[Adaptions of mirror therapy for phantom limb pain with telescoping phenomenon].","authors":"Marina M Finnern, Josepha Zimmer, Herta Flor","doi":"10.1007/s00482-023-00745-2","DOIUrl":"10.1007/s00482-023-00745-2","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10151518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Clinical efficacy of auricular vagus nerve stimulation in the treatment of chronic and acute pain : A systematic review]. [耳迷走神经刺激治疗慢性和急性疼痛的临床疗效:系统性综述]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2023-01-02 DOI: 10.1007/s00482-022-00686-2
Rudolf Likar, Christophe Perruchoud, Stefan Kampusch, Markus Köstenberger, Sabine Sator, Caroline Stremnitzer, Andreas Wolf, Stefan Neuwersch-Sommeregger

Background: Current guidelines recommend a personalized, multimodal, and interdisciplinary approach for the treatment of chronic pain. Already in the acute treatment of postoperative pain, it can be useful to minimize risk factors for chronification. Auricular vagus nerve stimulation (aVNS) could be an effective non-drug therapy for the treatment of chronic and acute pain.

Aim of the work: The aim of this systematic review is to evaluate the clinical efficacy of aVNS in chronic and acute pain as well as its effect on medication intake.

Materials and methods: A systematic literature search was carried out on the application of auricular electrical stimulation in chronic and acute pain. Studies were classified according to their level of evidence and evaluated via the Jadad scale as well as their scientific validity, and then analyzed in terms of indication, method, stimulation parameters, duration of treatment, efficacy, and safety.

Results: Twenty studies on chronic pain indications, ten studies on acute postoperative pain, as well as seven studies on experimental acute pain were identified and analyzed. The search revealed a total of n = 1105 aVNS-treated patients. The best evidence on the efficacy of aVNS is available for the indications chronic low back pain, chronic cervical syndrome, chronic abdominal pain, and chronic migraine as well as acute postoperative pain in oocyte aspiration, laparoscopic nephrectomy, and open colorectal surgery. Additionally a significant reduction in analgesic or opiate intake was evident in most studies. In three randomized controlled trials in chronic pain patients, a sustainable pain reduction over a period of up to 12 months was shown. Overall, aVNS was very well tolerated.

Conclusion: This review indicates that aVNS can be a complementary and effective non-drug treatment for patients with chronic and acute postoperative pain. Future studies in these indications should focus on standardizing and optimizing treatment parameters, inclusion of quality-of-life outcome parameters, and longer follow-up periods to better understand the sustainable therapeutic effect of aVNS.

背景:现行指南建议采用个性化、多模式和跨学科的方法治疗慢性疼痛。在术后疼痛的急性治疗中,最大限度地减少慢性化的风险因素是非常有用的。耳迷走神经刺激疗法(aVNS)是治疗慢性和急性疼痛的一种有效的非药物疗法:本系统综述旨在评估耳迷走神经刺激疗法对慢性和急性疼痛的临床疗效及其对药物摄入的影响:对耳穴电刺激在慢性和急性疼痛中的应用进行了系统性文献检索。根据证据级别对研究进行分类,并通过 Jadad 量表对其科学性和有效性进行评估,然后从适应症、方法、刺激参数、治疗持续时间、疗效和安全性等方面进行分析:结果:共发现并分析了 20 项关于慢性疼痛适应症的研究、10 项关于急性术后疼痛的研究以及 7 项关于实验性急性疼痛的研究。搜索结果显示,共有 n = 1105 名接受过 aVNS 治疗的患者。有关 aVNS 疗效的最佳证据包括慢性腰背痛、慢性颈椎综合征、慢性腹痛、慢性偏头痛以及卵母细胞抽吸术、腹腔镜肾切除术和开腹结肠直肠手术中的急性术后疼痛。此外,在大多数研究中,镇痛剂或阿片类药物的摄入量明显减少。在三项针对慢性疼痛患者的随机对照试验中,疼痛持续减轻的时间长达 12 个月。总体而言,aVNS 的耐受性非常好:本综述表明,对慢性和急性术后疼痛患者而言,aVNS 是一种补充性的、有效的非药物治疗方法。未来针对这些适应症的研究应重点关注治疗参数的标准化和优化、生活质量结果参数的纳入以及更长的随访期,以更好地了解 aVNS 的可持续治疗效果。
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引用次数: 0
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