British Journal of Pain最新文献

Objective: To compare three therapeutic strategies in the management of acute post-traumatic pain at emergency department (ED) discharge.

Methods: We conducted a prospective, randomized, controlled trial including patients ≥18 years with acute post-traumatic pain. They were randomized to receive oral paracetamol (n = 506), paracetamol-codeine (P-Cod group; n = 489) and paracetamol-caffeine (P-Caf group; n = 505) for 7 days. The primary endpoint was the rate of participants achieving at least 50% reduction in Numerical Rating Scale (NRS) from baseline by the 7th day after ED discharge. Secondary endpoints included the need for rescue analgesics, adverse effects, and patient satisfaction.

Results: At day-7, success rate were 85.8%, 93.9%, and 90.1% in paracetamol, P-Cod, and P-Caf groups, respectively. The differences were statistically significant between the paracetamol and P-Caf groups (p = .02), the paracetamol and P-Cod groups (p ≤ .001); and the P-Cod and P-Caf groups (p = .04). The need for rescue analgesics was significantly higher in paracetamol group (47.6%) compared to P-Caf (7.5%) and P-Cod group (7.4%); whereas, no significant difference was found between P-Cod and P-Caf groups. Most of the adverse effects (95.7%) were observed in P-Cod group. Finally, patients treated with paracetamol alone were the least satisfied.

Conclusion: The combination of codeine or caffeine with paracetamol was equally effective and superior to paracetamol alone. If we consider the better tolerance, paracetamol combined with caffeine appears to be a suitable analgesic option for post trauma patients.

Background: There is insufficient evidence to indicate using opioids in the management of chronic non-cancer pain (CNCP), yet ongoing prescribing is prevalent and remains a global public health matter. Inappropriate long-term prescribing of opioids is associated with side effects and adverse events. This article explores the significant barriers and enablers during opioid management indicated for CNCP within general practice, in the United Kingdom, and proposes recommendations to optimise practice.

Methods: A systematic literature review of the databases MEDLINE, EMBASE, CINAHL, Web of Science and Science Direct were searched. Titles, abstracts and full texts were screened against inclusion and exclusion criteria. Papers were evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool.

Results: From 1027 citations, 6 papers were included (n practitioners = 168 and n patients = 52). Four key themes were identified: three barriers and one enabler. Barriers: general practice healthcare model constraints, relationships in primary care and attitudes towards CNCP management. Enabler: multidisciplinary team set up.

Conclusion: A change in culture from both service providers and service users is required to fully embrace the multidisciplinary team observed in general practice. Movement away from the traditional model of doctor led management needs to occur. Future policies need to prioritise reducing the long waiting times observed for specialist pain services. Non-pharmacological opportunities and services should also be developed to support patients.

Background: Complex Regional Pain Syndrome (CRPS) is a distressing pain condition that can lead to significant burdens for individuals and society. A small number of specialist CRPS-practice services exist, but access is limited; most patients are managed in local hospitals or community settings. In a series of phases, we sought to understand the needs and perspectives of therapy practitioners across the care pathway in England and to identify recommendations to improve therapy-led management of CRPS.

Methods: In phase 1, we disseminated an e-survey to physiotherapists, occupational therapists and hand therapists across a range of settings. Phase 2 comprised semi-structured interviews with therapists and patients. Online stakeholder events (phase 3) were convened to review findings and prioritise suggestions to enhance CRPS care.

Results: Seventy-seven therapists responded to the e-survey and 31 semi-structured interviews were conducted (n = 10 patients, n = 9 therapists from specialist CRPS-practice services, n = 12 therapists from other settings). N = 11 therapists and n = 5 patients participated in the stakeholder events. Findings indicated pathways of care are complex, but similarities exist in therapy approaches across settings, albeit with longer, more frequent appointments in specialist CRPS-practice services. Recommendations to improve CRPS management included: additional education provision for therapists (including better access to CRPS 'experts'), CRPS education for other clinicians, streamlining of patient pathways, and improving patient information.

Conclusions: This work highlights opportunities to improve therapy-led care for people living with CRPS. Findings will be valuable in informing UK clinical guidelines and strengthening initiatives to enhance support for therapists.

Background: Chronic pain is a common side effect of cancer treatment and is frequently cited as a top concern and unmet need for cancer survivors. This paper outlines the development of clinical recommendations to better support people with chronic pain as a long-term or late side effect of cancer and its treatment.

Method: Evidence was identified from empirical research, and new insights from cancer survivors (n = 19) and healthcare professionals (n = 135), with findings informing draft clinical recommendations. These recommendations were reviewed and refined within online stakeholder engagement events, which comprised Phase 1 researcher review (n = 5) and Phase 2 Expert Review Panels (four groups and two one-to-one discussions). Membership of expert panels included cancer survivors living with chronic pain after cancer, and clinical, research, and education experts (n = 16). Data generated from Expert Review Panels were analysed using inductive qualitative content analysis.

Results: There was shared opinion among stakeholders that the recommendations would be beneficial in this setting, the recommendations reflected the evidence and the complexity of implementation was acknowledged. Validating cancer survivors' experiences of chronic pain was seen as essential to best practice and the importance of informed patients and healthcare professionals making good decisions together was recognised.

Conclusions: Resultant clinical recommendations are summarised as: PAINS: Prepare and inform, Acknowledge and listen, Increase healthcare professional knowledge, Name and diagnose, and Services and supported self-management interventions. Implementation strategies and future research are proposed.

Introduction: A residential pain management programme for military veterans with high medical and psychological comorbidity was adapted for remote delivery. This study evaluates the outcomes of the remote technology-delivered pain management programmes (rPMP).

Methods: Veterans with chronic pain, referred to a pain management programme, were assessed using online video calling. Veterans were suitable if they had chronic pain that affected their quality of life. Veterans were referred elsewhere when their needs were not best met by the programme. Eligible veterans attended a 9-day interactive online interdisciplinary programme and a 9-month follow-up. An experienced team of a psychologist, physiotherapist, nurse, and medical consultant, delivered the programme. Pain, mood, self-efficacy, and medication were assessed at the beginning and end of the programme and at 9-month follow-up.

Results: 107 veterans were treated in 16 rPMPs; results are from 92 complete sets of data. Statistically significant gains were observed from day 1 to day 9 (effect size Cohen's d): average pain d = 0.71, pain interference d = 0.82; mood, d = 0.99; self-efficacy, d = 0.85; reduction in catastrophic thinking, d = 1.22; overall health, d = 0.52; and changes in medication use. 72 veterans attended 9-month follow-up online; results are from 59 complete sets of data. Statistically significant gains were maintained at 9-month follow-up, effect size: mood, d = 0.71; self-efficacy, d = 0.80; reduction in catastrophic thinking, d = 0.95; and overall health, d = 0.52. Attendance was 97%, with positive feedback on programme content and delivery.

Conclusions: Veterans made significant improvements on all outcomes. Remote technology-delivered pain management for veterans with chronic pain appeared equally effective as in-person delivery, and suited veterans whose circumstances made it difficult to attend in-person treatment. Veterans who attended the 9-month follow-up largely maintained treatment gains.

Background: Pain assessment in Alzheimer's disease and related dementias (ADRD) is challenging due to cognitive decline and communication barriers, limiting the reliability of self-report and observational tools. Functional near-infrared spectroscopy (fNIRS) offers a noninvasive measure of cerebral hemodynamic responses and may serve as an objective biomarker for pain. This pilot study evaluated the feasibility of fNIRS for pain assessment in ADRD, using transcranial direct current stimulation (tDCS) solely as a controlled cortical modulation paradigm to test fNIRS sensitivity, rather than as a therapeutic intervention.

Methods: Forty older adults with mild to moderate ADRD were randomized to active (n = 20) or sham (n = 20) tDCS for 5 consecutive days to generate controlled cortical modulation. Pain was assessed using the Numerical Rating Scale (NRS), Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2), and fNIRS responses to standardized pain stimuli. Hemodynamic changes in prefrontal and somatosensory cortices were analyzed to determine whether fNIRS detected pain-related brain activity.

Results: NRS and MOBID-2 scores were significantly correlated at baseline (r = .605, p < .001) and post-intervention (r = .567, p < .001). In the active tDCS condition, pain stimulation elicited significant cortical hemodynamic changes that correlated with pain scores (p < .05), supporting fNIRS's sensitivity for detecting pain-related neural responses. In the sham group, only a few significant correlations were observed post-intervention (e.g., frontal cortex r = .44, p = .049; prefrontal cortex r = .52, p = .017), which were less consistent compared to the active condition.

Conclusion: fNIRS demonstrated feasibility as an objective pain assessment tool in ADRD. tDCS served only as a probe to induce cortical modulation for evaluating fNIRS performance. In this study, tDCS functioned as a probe to induce cortical modulation for evaluating fNIRS sensitivity, not as a therapeutic intervention. Larger trials are needed to confirm fNIRS validity for clinical application.

Introduction: The aim of this systematic literature review was to critically analyze and synthesize the current scientific literature on the effectiveness of music therapy in reducing pain among patients with rheumatic and musculoskeletal disorders (RMDs).

Methods: The literature search strategy was performed in the digital databases of MEDLINE, Scopus, and the Cochrane library to identify relevant studies published from January 2000 to December 2024, assessing the impact of music therapy on pain-related outcomes.

Results: Among the included studies (n=16), 10 were randomized controlled trials (RCTs) and 6 were non-randomized studies, including 4 prospective cohort studies and 2 prospective comparative studies. Pain was most frequently assessed using the Visual Analogue Scale (VAS), and receptive music listening was the most frequently used method, with some studies incorporating additional therapeutic interventions. A total of 11 studies out of 16 reported a statistically significant decrease in pain intensity following music therapy interventions. Conversely, 5 studies reported mixed results, emphasizing the heterogeneity of populations and interventions.

Conclusion: Music therapy appears to be a beneficial adjunct in pain management for patients with RMDs. However, well-designed randomized controlled trials, with larger sample sizes, are necessary to standardize intervention protocols and evaluate long-term effects.

Objectives: Waiting lists for pain management services globally are extensive, exacerbating the burden of chronic pain for patients and service providers. This study aimed to examine the psychological profiles of people living with chronic pain (PLwCP) during long treatment delay and use appropriate inferential analyses of waitlist data to identify potential demographic characteristics presenting at-risk subgroups.

Method: A longitudinal survey design tracked measures of psychological wellbeing (pain self-efficacy, depression, anxiety and pain catastrophizing) in PLwCP (N = 211, Males = 50, Females = 161) on the waitlist for pain management, in a major regional NHS hospital in the Southeast of the UK. Measures were collected at baseline, three-months and six-months of waiting.

Results: Regression and ANOVA models revealed that clinically significant levels of depression, anxiety, pain catastrophizing and pain self-efficacy remained high throughout the waiting period, indicating sustained psychological distress. While pain self-efficacy significantly increased over time and though the effect size was small, levels were in the clinically severe range throughout the wait-time, thus requiring intervention. Older and younger adults showed different phenotypical patterns of psychosocial wellbeing whilst waiting.

Conclusions: These findings demonstrate that clinical levels of psychological distress are persistent and entrenched throughout the waitlist for pain management. PLwCP remain an at-risk population in significant need of earlier support. Prehabilitation offers a prospective framework through which early intervention can be achieved. Subgroups identified as greater risk are younger individuals and those with worse depression, anxiety, pain catastrophizing and/or pain self-efficacy upon referral. These factors present stratification targets and direction of where prehabilitation is most urgently required. These findings have clear implications to improve pain practice.