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Botulinum toxin: Should we reconsider its place in the treatment of neuropathic pain? 肉毒杆菌毒素:我们是否应该重新考虑它在神经病理性疼痛治疗中的地位?
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-11 DOI: 10.1177/20494637241282323
Paul Bhalla
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引用次数: 0
What influences post-operative opioid requirements for tibial fractures? 是什么影响了胫骨骨折术后对阿片类药物的需求?
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-18 DOI: 10.1177/20494637241261013
James Zhang, Aaron Limonard, Florence Bradshaw, Ishrat Hussain, Maša Josipović, Matija Krkovic

Introduction: Currently there are few opioid prescribing guidelines for orthopaedic fractures. Long-term post-surgical analgesia requirements, understandably, vary between orthopaedic cases. Our study aims to provide detailed information to clinicians and policy makers, on the opioid requirement associations for patients sustaining tibial fractures.

Methods: This study reviewed all patients sustaining an isolated tibial fracture at a major trauma centre that were operated on within 1 month of injury, from 2015 to 2022. The total opioid dosage used each month in morphine milligrams equivalents (MME) and the number of days opioids were used each month, within the first-year post-surgery were collected, representing the strength and coverage of opioid analgesia in the post-operative stage, respectively. We compared opioid strength and coverage requirements with types of definitive fracture fixations, location, fracture type and concurrent patient medical comorbidities to assess for any trends.

Results: A total of 1814 patients sustaining a combined of 1970 fractures were included in the study. Tibial plateau fractures had the highest opioid strength and coverage requirements in each month and the entire year (p < .05). Across all fracture locations, Ex Fix frame showed higher opioid strength and coverage requirements compared to both IM nailing and plate ORIF. With regard to opioid coverage in the presence of specific comorbidities, only chronic kidney disease (quotient: 1.37, 95% Confidence interval [95%CI] = 1.19-1.55, p = .002) and hypertension (quotient: 1.34, 95%CI = 1.14-1.53, p = .009) showed significance at the 1-year overall level. For opioid strength, Chronic Kidney Disease (quotient: 1.72, 95%CI = 1.41-2.03 p = .005) and COPD (quotient: 1.90, 95%CI = 1.44-2.36, p = .014), show significance at the 1-year overall level.

Conclusion: Our study details opioid requirements post-surgery amongst tibial fractures with subgroup analysis assessing opioid needs amongst specific fracture locations, types, surgical techniques and medical comorbidities. This framework aids clinicians in anticipating rehabilitation and assists in risk stratifying patients at injury onset.

导言:目前,几乎没有针对骨科骨折的阿片类药物处方指南。可以理解的是,不同骨科病例的术后长期镇痛需求各不相同。我们的研究旨在为临床医生和政策制定者提供有关胫骨骨折患者阿片类药物需求关联的详细信息:本研究回顾了 2015 年至 2022 年期间在一家大型创伤中心接受手术的所有在受伤后 1 个月内发生孤立性胫骨骨折的患者。收集了术后第一年内每月阿片类药物的总用量(吗啡毫克当量)和每月使用阿片类药物的天数,分别代表术后阶段阿片类药物镇痛的强度和覆盖范围。我们将阿片类药物的使用强度和覆盖范围要求与最终骨折固定的类型、位置、骨折类型和患者的并发症进行了比较,以评估任何趋势:研究共纳入了1814名骨折患者,总计1970例。胫骨平台骨折患者每月和全年的阿片类药物剂量和覆盖范围需求最高(p < .05)。在所有骨折部位,Ex Fix固定架与IM钉和钢板ORIF相比,都显示出更高的阿片类药物强度和覆盖需求。关于存在特定合并症时的阿片类药物覆盖率,只有慢性肾病(商数:1.37,95% 置信区间 [95%CI] = 1.19-1.55,p = .002)和高血压(商数:1.34,95%CI = 1.14-1.53,p = .009)在 1 年总体水平上显示出显著性。慢性肾脏病(商数:1.72,95%CI = 1.41-2.03,p = .005)和慢性阻塞性肺病(商数:1.90,95%CI = 1.44-2.36,p = .014)的阿片类药物强度在 1 年总体水平上显示出显著性:我们的研究详细介绍了胫骨骨折患者手术后对阿片类药物的需求,并通过亚组分析评估了特定骨折部位、类型、手术技术和合并症对阿片类药物的需求。这一框架有助于临床医生预测康复情况,并在患者受伤初期对其进行风险分层。
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引用次数: 0
Experience of compassion-based practice in mindfulness for health for individuals with persistent pain. 以同情心为基础,为持续疼痛者提供正念保健实践的经验。
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-02-23 DOI: 10.1177/20494637241232555
Callum Gray, Fergal Jones, Alessio Agostinis, Julia Morris

Purpose of the study: Research indicates that acquiring compassion is an integral part to positive outcomes to Mindfulness-based interventions (MBI), yet there is both theoretic and empirical literature suggesting that people with persistent pain are more likely to experience challenges and distress when engaging compassion-based practices. Mindfulness for Health is a standardised MBI for people with persistent pain and health conditions. This study sought to explore the positive, neutral and difficult experiences of compassion-based practice and meditation for participants in Mindfulness for Health to further understand implications and risks for participants of MBI's.

Method and design: A qualitative design using Interpretative Phenomenological Analysis was applied to explore how participants understood of the experience of compassion-based practice and the meaning they gave to it. Eight participants who had completed the Mindfulness for Health from four separate groups were interviewed about their experience.

Results: Five master themes were identified 'turning away from self-with-pain', 'self-with-pain experienced as shameful', 'facilitating change', 'turning towards self-with-pain', and 'accepting self'. Participants identified both perceived positive changes and difficult emotional experiences during the meditation practice, which they related to the context of compassion in their past and present life.

Conclusions: Developing compassion is an important part of Mindfulness for Health, which is salient for participants as both a challenging and potentially valuable experience. Acquisition of mindfulness skills, supporting group dynamics and modelling compassion are understood as helpful in overcoming personal barriers and challenging experiences. Further research is needed to understand processes involved and explore the experience of non-completers.

研究目的:研究表明,获得同情心是正念干预(MBI)取得积极成果不可或缺的一部分,但有理论和实证文献表明,持续性疼痛患者在参与以同情心为基础的实践时,更有可能遇到挑战和困扰。健康正念 "是一种针对持续性疼痛和健康状况患者的标准化 MBI。本研究旨在探索 "健康正念 "参与者在基于同情心的练习和冥想中的积极、中性和困难体验,以进一步了解 MBI 对参与者的影响和风险:采用解释性现象学分析法进行定性设计,探索参与者如何理解以同情为基础的练习体验以及他们赋予这种体验的意义。来自四个不同小组的八名完成了 "健康正念 "课程的参与者接受了关于其经历的访谈:结果:确定了五个主主题:"远离自我疼痛"、"自我疼痛是可耻的"、"促进改变"、"转向自我疼痛 "和 "接受自我"。参与者在冥想练习中发现了积极的变化和困难的情绪体验,并将其与过去和现在生活中的慈悲背景联系起来:培养慈悲心是 "健康正念 "的重要组成部分,这对参与者来说既是一种挑战,也是一种潜在的宝贵经验。获得正念技能、支持小组动力和树立慈悲榜样被认为有助于克服个人障碍和挑战性经历。需要进一步开展研究,以了解相关过程并探索未完成者的经历。
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引用次数: 0
The interaction between psychological factors and conditioned pain modulation. 心理因素与条件性疼痛调节之间的相互作用。
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-19 DOI: 10.1177/20494637241263306
Kristian Kjær-Staal Petersen
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引用次数: 0
Prehabilitation: The underutilised weapon for chronic pain management. 预康复:未被充分利用的慢性疼痛治疗武器。
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-01 Epub Date: 2024-04-29 DOI: 10.1177/20494637241250239
Lydia V Tidmarsh, Richard Harrison, Katherine A Finlay

Objective: Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions.

Methods: Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed.

Results: Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention.

Conclusions: Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.

目的:术前康复包括从诊断到开始治疗期间的准备性临床干预。尽管术前心理康复治疗被广泛应用,但在门诊慢性疼痛治疗中却被忽视。尽管疼痛治疗等待名单与治疗流失、心理和生理衰退有关,但这一时间窗口在防止治疗升级方面却未得到充分利用。候诊名单为等待治疗的患者提供了 "预康复 "的机会。本专题综述旨在(1)研究疼痛服务心理康复的有效性;(2)评估与等待疼痛治疗相关的心理和生理衰退;(3)强调提高治疗参与度的关键心理康复目标;(4)在个性化疼痛医学中促进疼痛治疗心理康复,为未来的干预措施提供建议:方法:回顾了有关慢性疼痛等待名单和预康复的影响的研究:研究结果表明,患者期望、健康控制点、自我效能感和疼痛灾难化等心理结构动态地影响着等待期间的流失、治疗参与度和治疗结果。这些心理结构易于改变,强调了它们在有针对性的候诊干预中的潜在作用:对慢性疼痛患者进行参与治疗前的康复训练,可以避免寻求治疗失败的循环,防止心理和生理衰退,减少医疗保健的使用。利用候诊清单来识别心理社会风险因素(外部健康控制定位、低自我效能感和高疼痛灾难化),可以确定哪些患者需要额外支持以防止治疗失败风险的增加,从而在接受处方治疗前加强个性化护理。本综述强调了疼痛服务部门主动参与康复前创新的迫切需要。
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引用次数: 0
Response to Letter to Editor 对致函编辑的回复
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-24 DOI: 10.1177/20494637241264633
A. McConnachie, Alison Mitchell, Lesley Somerville, Nicola Williams, Jonathan McGhie, Gordon McGinn, Jiyoung Lee
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引用次数: 0
Hearing the patient voice for persistent pain intervention development: recommendations for using a bespoke online discussion forum for qualitative data collection 倾听患者的声音,制定持续性疼痛干预措施:关于使用定制在线讨论论坛收集定性数据的建议
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-23 DOI: 10.1177/20494637241254098
Charlotte Woodcock, Nicola Cornwall, Sarah A Harrisson, Clare Jinks, Alison Buttery, Julie Ashworth, Christian Mallen, Lisa Dikomitis
Understanding patients’ experiences is important when developing interventions for people living with persistent pain. Interviews and focus groups are frequently used to capture beliefs, views, and perspectives. These methods often require a commitment to a predetermined date and time that may present a barrier to participation. An asynchronous online discussion forum, specifically designed for research purposes, provides an alternative and potentially more accessible method for participation. In this article we discuss a bespoke online discussion forum, the Q-PROMPPT blog, as a case example. We describe how we developed the Q-PROMPPT blog, with patient and public involvement, and its use as an innovative method for qualitative data collection in the context of developing an intervention for patients prescribed opioids for persistent pain. Drawing on our experiences we discuss the following areas: planning and design, participant recruitment and registration, and participant experience and engagement. We identify and address key concerns for each area of the Q-PROMPPT blog: planning and design: choosing software, assigning roles, designing the interface to promote usability; recruitment of participants: recruiting eligible participants, participant anonymity; participant experience and engagement: mitigating risk of harm, facilitating discussions, planning for forum close. Based on our lessons learnt, we outline recommendations for using a bespoke online discussion forum as a qualitative method to inform intervention development for people living with persistent pain. These include collaboration with information communication technology teams, co-design with patient and public partners, minimising risk of imposter participants and developing trust and online community identity.
在为持续性疼痛患者制定干预措施时,了解患者的经历非常重要。访谈和焦点小组经常被用来捕捉信念、观点和看法。这些方法通常需要在预先确定的日期和时间内进行,这可能会对参与造成障碍。专为研究目的而设计的异步在线讨论论坛提供了另一种可能更容易参与的方法。本文将以 Q-PROMPPT 博客为例,讨论一个定制的在线讨论论坛。我们介绍了如何在患者和公众的参与下开发 Q-PROMPPT 博客,以及在为开阿片类药物治疗顽固性疼痛的患者制定干预措施的背景下将其用作定性数据收集的创新方法。根据我们的经验,我们将讨论以下几个方面:规划和设计、参与者招募和注册以及参与者体验和参与。我们确定并解决了 Q-PROMPPT 博客中每个领域的关键问题:规划和设计:选择软件、分配角色、设计界面以提高可用性;参与者招募:招募符合条件的参与者、参与者匿名;参与者体验和参与:降低伤害风险、促进讨论、计划关闭论坛。在总结经验教训的基础上,我们概述了使用定制在线论坛作为定性方法的建议,以便为持久性疼痛患者的干预措施开发提供信息。这些建议包括与信息通信技术团队合作、与患者和公众合作伙伴共同设计、最大限度地降低冒名参与者的风险以及建立信任和在线社区身份。
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引用次数: 0
The experience of occupational therapists and physiotherapists using a prototype, evidence-informed online knowledge translation resource to learn about patient-defined, personally-meaningful chronic pain rehabilitation 职业治疗师和物理治疗师使用有实证依据的在线知识转化资源原型,学习患者定义的、有个人意义的慢性疼痛康复的经验
IF 1.8 Q2 Medicine Pub Date : 2024-05-20 DOI: 10.1177/20494637241241780
K. Liddiard, Annette J Raynor, Cary A Brown
Chronic pain is a complex biopsychosocial experience, and rehabilitation helps people to manage pain, and restore valued life roles. Evidence suggests that more positive outcomes occur when clients perceive their rehabilitation to be meaningful. People with chronic pain describe rehabilitation as personally-meaningful when they develop a genuine connection with a credible therapist who they see as a guiding partner, and when rehabilitation holds personal value, is self-defined, and relevant to their sense of self-identity. This paper presents a qualitative study of therapists’ experience using an e-learning package on patient-defined, personally-meaningful rehabilitation. A qualitative descriptive design was used to explore rehabilitation therapists’ experience of a prototype evidence-informed, online resource developed on the basis of eLearning and web-design principles. Semi-structured interviews and focus groups were conducted with a purposive sample of occupational therapists and physiotherapists, and inductive coding and thematic analysis of transcripts was completed. Twenty-four therapists (12 occupational therapists, 12 physiotherapists) participated, representing a mix of gender and experience (early career; experienced; and specialist). Four themes and 12 sub-themes emerged from the analysis. The resource delivered a positive user experience, which added (translational) value to enhance learning, and participants were highly positive about the future potential of the resource to translate chronic pain rehabilitation research for early career, experienced, and specialist rehabilitation therapists. Results suggest that the disparate learning needs of rehabilitation therapists from diverse professional backgrounds and experience, may be addressed through the one resource. Participant feedback provides evidence that the resource fits with current models of learning and behaviour change. This study demonstrates the importance of basing online resources on eLearning and web-design principles to translate complex biopsychosocial chronic pain rehabilitation research for rehabilitation therapists.
慢性疼痛是一种复杂的生物-心理-社会经历,康复有助于人们控制疼痛,恢复有价值的生活角色。有证据表明,如果患者认为他们的康复治疗是有意义的,就会产生更积极的结果。当慢性疼痛患者与可信的治疗师建立起真正的联系,将治疗师视为指导伙伴,当康复具有个人价值、自我定义并与他们的自我认同感相关时,他们就会认为康复是有意义的。本文介绍了一项定性研究,研究治疗师使用关于患者定义的、有个人意义的康复的电子学习包的经验。本文采用定性描述设计,探讨了康复治疗师对基于电子学习和网页设计原则开发的循证在线资源原型的体验。对职业治疗师和物理治疗师进行了半结构式访谈和焦点小组讨论,并完成了对访谈记录的归纳编码和主题分析。24 名治疗师(12 名职业治疗师和 12 名物理治疗师)参加了此次访谈,他们代表了不同的性别和经验(职业生涯初期、经验丰富和专家)。分析得出了四个主题和 12 个子主题。该资源提供了积极的用户体验,增加了(转化)价值,促进了学习,参与者高度肯定了该资源未来为早期职业、经验丰富和专业康复治疗师转化慢性疼痛康复研究的潜力。结果表明,来自不同专业背景和经验的康复治疗师的不同学习需求可以通过一个资源得到满足。参与者的反馈证明,该资源符合当前的学习和行为改变模式。这项研究表明,基于电子学习和网页设计原则的在线资源对于将复杂的生物-心理-社会慢性疼痛康复研究成果转化为康复治疗师所用非常重要。
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引用次数: 0
Prevalence of priformis syndrome in sciatica patients: Predictability of specific tests and radiological findings for diagnosis 坐骨神经痛患者中棱形综合征的患病率:特定测试和放射学诊断结果的可预测性
IF 1.8 Q2 Medicine Pub Date : 2024-05-20 DOI: 10.1177/20494637241254349
Damla Yürük, Ezgi Can, Gevher Rabia Genç Perdecioğlu, Gokhan Yildiz, Ö. Akkaya
The traditional approach for diagnosing piriformis syndrome (PS) is to rule out other causes of sciatica. This approach may lead to unnecessary radiological examinations and a waste of time. In contrast to the traditional approach, we aimed to first exclude PS and determine its prevalence by injecting patients with priformis tenderness. This observational cross-sectional study included patients diagnosed with PS who had sciatica and tenderness on palpation of the priformis muscle and whose pain was reduced by at least 50% with local injection. Age, sex, pain duration, presence of tenderness in the piriformis muscle, Freiberg test, PACE sign, FADIR, Visual Analog Scale (VAS) score, Douleur Neuropathique 4 Questions (DN4) score, and radiological findings were compared between patients who responded and those who did not respond to the priformis injection. A total of 110 patients with sciatica were evaluated, of whom 66 with tenderness on palpation of the primiformis muscle underwent local injection. In 27 of the 66 patients (40.9%), a decrease in the NRS score of >50% was observed after injection, and PS was diagnosed. There were no statistically significant differences in age, sex, pain duration, Pace, FADIR test positivity, radiological findings, NRS, and DN4 scores, but Freiberg test positivity was statistically higher in patients diagnosed with PS. PS is more common than is thought to be a cause of sciatica. A positive Freiberg test is predictive for the diagnosis of PS, but it should be confirmed by tenderness of the priformis muscle and local injection. Many pathologies can be detected incidentally radiographically in PS; however, they are not predictive of the diagnosis.
诊断梨状肌综合征(PS)的传统方法是排除坐骨神经痛的其他病因。这种方法可能导致不必要的放射检查和时间浪费。与传统方法不同的是,我们的目的是通过对有梨状肌压痛的患者进行注射,首先排除 PS 并确定其发病率。这项观察性横断面研究纳入了被诊断为 PS 的患者,这些患者有坐骨神经痛,触诊时有腓肠肌压痛,局部注射后疼痛至少减轻了 50%。研究人员比较了对棱形肌注射有反应和无反应的患者的年龄、性别、疼痛持续时间、梨状肌有无压痛、弗赖贝格试验、PACE 征、FADIR、视觉模拟量表(VAS)评分、Douleur Neuropathique 4 Questions(DN4)评分和放射学检查结果。共对 110 名坐骨神经痛患者进行了评估,其中 66 名患者在触诊时感到蝶形肌有压痛,并接受了局部注射。注射后,66 名患者中有 27 人(40.9%)的 NRS 评分下降超过 50%,被诊断为 PS。在年龄、性别、疼痛持续时间、Pace、FADIR 试验阳性率、放射学检查结果、NRS 和 DN4 评分方面没有统计学意义上的差异,但弗莱贝格试验阳性率在统计学上高于被诊断为 PS 的患者。PS 比人们认为的坐骨神经痛的病因更常见。弗赖贝格试验阳性可预测 PS 的诊断,但应通过棱形肌的触痛和局部注射来确认。许多病理变化可在 PS 的影像学检查中偶然发现,但这些病理变化并不能预测诊断。
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引用次数: 0
Time for definitions to breakthrough from the background? 是时候从背景中突破定义了?
IF 1.8 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1177/20494637241250270
Sachin Rastogi
Editorial on Greenfield et al’s paper ‘A rapid systematic review of breakthrough pain definitions and descriptions’.
格林菲尔德等人的论文《突破性疼痛定义和描述的快速系统回顾》的社论。
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引用次数: 0
期刊
British Journal of Pain
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