British Journal of Pain最新文献

Background: Amputation leads to significant physical, psychological, and emotional challenges, with chronic pain being among the most debilitating outcomes. Conditioned Pain Modulation (CPM) is a key mechanism for understanding pain modulation reflecting the central nervous system's capacity to regulate pain.

Objective: This study aimed to evaluate CPM in amputees, comparing CPM between the amputated and non-amputated sides, and to identify factors influencing CPM in this population.

Method: Eighty-six amputees participated in the study. Sociodemographic and pain-related variables, including age, occupation, smoking status, pre-amputation pain duration, phantom limb pain, and pressure pain threshold, were assessed. Multiple linear regression models were performed to explore factors associated with CPM on both sides, with additional t-tests to compare CPM values between sides.

Results: The multivariate model for the amputated side explained 26.3% of CPM variability, with significant associations found for pre-amputation pain duration and retirement status, as well as PPT mean of the amputated side, smoking, and phantom limb pain and age. In contrast, the non-amputated side model explained 26.5% (Adjusted R-squared) of the variability, with the following significant variables: duration of pre-amputation pain (negative correlation), smoking history, phantom limb pain (negative correlation), and frequency of telescoping sensation (negative correlation). There were no significant differences in CPM between amputated and non-amputated sides (p > 0.05).

Conclusion: The findings suggest that CPM on the amputated side is more influenced by pain experience and sociodemographic variables, while the non-amputated side shows less variability and is more resilient to these influences.

Background: Surgery is one of the most common indications for a patient's first opioid prescription, with some patients progressing to unintended long-term use. There is no current data from the United Kingdom on how much patients use of the opioid medication dispensed at discharge from hospital. This study investigates discharge opioid prescribing and usage following common surgical procedures.

Methods: This cohort study was conducted at the Oxford University Hospitals NHS Foundation Trust and involved 20 of the most commonly performed adult surgical procedures. At least 20 patients per procedure were surveyed using a standardised telephone questionnaire 6-8 days after discharge to establish the amount of used and unused opioids. Opioid doses were converted to oral morphine equivalent (OME) for analysis.

Results: The amount of opioid given to patients after all types of surgery far exceeded requirement, with often large variations in prescribing practices for the same procedures, most notably in trauma and orthopaedics.For the cohort of 426 patients, a total of 55 080 mg OME was dispensed on discharge, with only 34.4% actually used by patients, leaving a total of 36 108.5 mg OME unused in the community, risking inappropriate opioid use, overdose, or diversion.

Conclusions: Opioid overprescribing is common after surgery and represents waste, expense, and risk to patients. There is a clear need to develop a procedure-specific evidence-base for discharge opioid prescribing, adopting an "enough but not too much" approach to ensure that patients have adequate analgesia to facilitate functional surgical recovery, but not more than is needed.

Background: Complex Regional Pain Syndrome (CRPS) is a rare, chronic pain disorder that can have a devastating impact. Its cause remains unclear and debate over treatment strategies continues. The aim of the study was to utilise patient-reported outcomes to aid in the further evaluation of treatment options.

Method: An online survey was distributed with ethical approval to members of a CRPS charity. The Checklist for Reporting Results of Internet E-Surveys was implemented. Adults who met the patient-reported aspect of the Budapest Criteria were included (non-validated). Functional scores were reported using the shortened Disabilities of the Arm, Shoulder and Hand outcome measurement tool (QuickDASH) and Lower Extremity Functional Scale (LEFS). Participants completed a pre-injury score, a score related to injury and a score related specifically to CRPS symptoms. Respondents were also asked to rate a number of pharmacological and non-pharmacological treatments for CRPS.

Results: Respondents were mostly female (87%, 447/514) with a mean age of 49 years (SD 13). 69% (354/514) reported trauma as the inciting event. Anxiety (55%, 283/514) was the most commonly reported co-morbidity. Opioids (72%, 258/358) and Physical Therapy/Rehabilitation (63%, 281/444) were reported as the most beneficial (used by >10% of respondents) pharmacological and non-pharmacological therapies respectively. Median CRPS functional scores were significantly worse than scores relating to the injury alone, for both QuickDASH (56 (IQR 36-77) versus 77 (IQR 61-91), p < .001) and LEFS (20 (IQR 8-40) versus 7 (IQR 3-17), p < .001).

Conclusion: We present the first study using validated patient-reported outcome measures of limb-specific function in a solely CRPS population. These data quantify the devastating impact of CRPS and help make its prevention and treatment a priority amongst those who encounter it. The treatment data should inform future research, especially in successful therapies that were less commonly utilised.

Background: Fibromyalgia Syndrome (FMS) is highly prevalent with a significant associated morbidity and socioeconomic burden. Effective treatments for FMS remain elusive with pharmacological management (including use of opioids) often proving ineffective. There is a need to develop accessible, innovative management approaches to improve patient care.Virtual reality (VR) interventions have shown evidence of efficacy in the management of acute pain and chronic low back pain, but their feasibility in FMS has not hitherto been explored.

Methods: This feasibility study investigates the use of four different VR systems, four interactive VR activities and two virtual environments in patients with FMS. Acceptability (including adverse effects) and study engagement were the main outcomes investigated. Clinical outcome data on pain and mood were also collected to gather preliminary information for future studies.

Results: The results demonstrated good feasibility across VR systems, activities and virtual environments with high levels of acceptability, low frequency of adverse effects, and positive perceptions of VR in patients with FMS. Reporting of adverse effects (including fatigue) varied across different VR components, with system comfort and virtual environmental design being particularly important.

Conclusions: The findings increase our confidence with respect to the feasibility of using VR in people with FMS, help to inform future randomised controlled trials and emphasise the importance of tailored interventional design for future VR therapeutics.

Background: Chronic pain poses a significant public health challenge. We present the global and regional data on Prevalence, Incidence and Years Lived with Disability (YLDs) for Chronic pain from the Global burden of disease (GBD) study 2019 data and analyze their associations with Socio-demographic index (SDI), age, and gender, and the future trends from 2020 to 2035.

Methods: Regional trends in the burden of chronic pain and its association with age, gender, and SDI were assessed from 1990 to 2019. Joinpoint analysis was employed to describe trends in chronic pain burden across different SDI regions. Additionally, the Bayesian Age-Period-Cohort model (BAPC) was used for predicting future trends. Age-standardized rates (ASRs) of prevalence, incidence, and YLDs were employed to quantify the burden of chronic pain.

Results: Between 1990 and 2019, a significant increase was observed in global prevalence and YLDs rates of chronic pain. Higher rates were found among females, whereas a faster rise was noted among males. Notably, Low Back Pain (LBP) and Migraine accounted for predominant YLDs globally, particularly among those aged 75 and above. A notable prevalence of Tension-type Headache (TTH) was observed among younger populations. Furthermore, ASRs for chronic pain were highest in high-SDI regions. Projections suggest an increase in headache ASRs globally for both genders from 2020 to 2035.

Conclusion: From 1990 to 2019, the global burden of chronic pain increased significantly, with projections indicating a continued rise in headache burden over the next 15 years, underscoring the need for heightened attention to these issues.

Background: Research has demonstrated the effectiveness of Animal-Assisted Therapy, usually involving dogs, as a way to reduce pain in inpatient and outpatient populations. Here two studies investigate the effectiveness of interacting with horses for reducing human acute pain perception.

Methods: In Study 1, a blood-pressure cuff was used to administer acute ischaemic pain to 70 adult participants, who were allocated to one of three groups: Equine Assisted Psychotherapy (EAP), Horse Interaction without EAP (HI), and a Control (no horses present). All participants engaged in an activity (finding a horse treat) in a large, enclosed arena. The dependent variable was the subjective pain rating (scale 0-10) of the participant in response to moderate pain induced pre- and post-activity. In Study 2, 53 adult participants were recruited and allocated to either an Equine Assisted Learning (EAL) Group or a Control Group. The same paradigm was used. Following the activity sessions, qualitative data was elicited from the participants regarding their insights and feelings. It was hypothesized that any interaction with horses would significantly reduce an individual's perception of pain.

Results: In both studies, planned paired-samples t-tests showed significant reductions in pain ratings from pre-activity to post-activity in the EAL, EAP and HI groups (large and medium effect sizes) but not the Control groups. Thematic analysis of the qualitative responses showed an overwhelmingly positive array of responses from those who interacted with the horses, for example, feeling relaxed and happy during the activity.

Conclusion: Interactions with horses can reduce acute pain perception. Distraction, physiological changes, and positive emotions are discussed as possible underlying mechanisms. It remains to be seen how this could be more widely applied, for example, in relation to chronic pain.

Introduction: The study aimed to validate the effectiveness of Wrist and Ankle Acupuncture (WAA) in attenuating moderate to severe postoperative pain following Functional Endoscopic Sinus Surgery (FESS).

Methods: Participants were randomly allocated into a treatment group (n = 57) and a control group (n = 58). The treatment group underwent WAA treatment, while the control group received sham acupuncture treatment. The Numeric Rating Scale (NRS) was employed to assess postoperative pain. The sleep efficiency, the amount of rescue medication, and the adverse events were also evaluated for both groups.

Results: A significant immediate reduction in NRS scores was observed in the treatment group (p < .01). At 2, 4, 8, 22, and 24 h after first treatment, pain intensity decreased in the WAA group compared with the control group (p < .01). Moreover, the WAA group demonstrated superior sleep efficiency relative to the control group on the night after surgery (p < .01). And the mean number of rescue tablets used on the WAA group was obviously lower than the control group (p < .01). There were no serious adverse events in both groups, and all adverse events completely disappeared within 3 days.

Conclusion: WAA effectively alleviated postoperative discomfort associated with nasal packing subsequent to FESS and enhanced sleep quality during the postoperative night. The anatomical superficiality of the acupuncture points employed reduces the risk of adverse events while yielding effective analgesic results, thus validating its suitability for clinical application.

Background: Pain from rib fractures often requires inpatient management with opioid medication. The need for ongoing opioid prescriptions following hospital discharge is poorly understood. Harms associated with long-term opioid use are generally accepted. However, a deeper understanding of current prescribing patterns in this population at-risk is required.

Methods: A retrospective cohort of adult patients hospitalised in Queensland, Australia between 2014 and 2015 with rib fractures (ICD-10-AM: S22.3, S22.4, S22.5), was obtained from the Community Opioid Dispensing after Injury (CODI) study, which includes person-linked hospitalisation, mortality and community opioid dispensing data. Data were extracted 90-days prior to the index-hospitalisation and 720-days after discharge. Factors associated with long-duration (>90 days cumulatively) and increased end-dose were examined using multivariable logistic regressions, odds ratios (OR), and 95% confidence intervals (95% CI).

Results: In total, 4306 patients met the inclusion criteria, and 58.8% had opioids dispensed in the community within 30 days of hospital discharge. 23.6% had long-duration dispensing and 13.7% increased opioid end-doses. Pre-injury opioid use was most associated with long-duration (OR = 12.00, 95% CI 8.99-16.01) and increased end-dose (OR = 9.00, 95% CI 6.75-12.00). Females and older persons had higher odds of long-duration dispensing (Females OR = 1.75, 95% CI 1.38-2.22; Age 65+ OR = 1.86, 95% CI 1.32-2.61). Injury severity and presence of concurrent injuries were not statistically significantly associated with duration or dose (p > .05). Subsequent hospitalisations and death during the follow-up period had statistically significant associations with long-duration and increased end-dose (p < .001).

Conclusion: Opiate prescribing following rib fractures is prolonged in older, and female patients, beyond the traditionally reported recovery time frames requiring analgesia. Previous opioid use (without dependence) is associated with long-duration opioid use and increased end-dose in rib fracture patients. These results support the need for a collaborative health system approach and individualised strategies for high-risk patients with rib fractures to reduce long-term opiate use.

Level of evidence: Level III, Prognostic/Epidemiological.

Background: Elective lumbar spine surgery is increasingly being implemented to treat patients with specific low back pain. However, approximately 30% of patients continue to have long-term pain and disability after surgery.

Objective: The aim of this study was to systematically review the literature on the effectiveness of pre-surgical rehabilitation (prehab) alone or in combination with usual care versus usual care on patient-oriented outcomes and health-related costs following elective lumbar spine surgery.

Data sources: Electronic databases from MEDLINE, CINAHL, EMBASE, and AMED were systematically searched from their inception to November 2022.

Study selection: Randomized controlled trials that examined adult (age >18 years) prehab programs and evaluated one or more outcomes of interest were included in this review.

Data extraction: In pairs, six reviewers independently conducted a risk-of-bias assessment and extracted outcome data from included studies, in accordance with the Template for Intervention Description and Replication (TIDieR). A meta-analysis was conducted when trials were homogeneous.

Data synthesis: A total of eight trials (n = 739 participants), reported in 13 different manuscripts, were eligible for inclusion. Exercise prehab interventions are superior to usual care for disability at 3-month (MD: -2.56, 95% CI -4.98 to -0.15), back pain at 6-month (MD: -6.65, 95% CI -13.25 to -0.05), and health-related costs (MD: €2572.8, 95% CI: €1963.0 to €3182.5). CBT prehab interventions seem to be superior to usual care for back pain at 3-month (MD: -7.3, 95% CI: -14.5 to -0.05). Individual trials showed that education prehab interventions may be superior to usual for back pain at 1-month post-operative (MD: 12.3, 95% CI: 0.9 to 23.7).

Limitations: Overall, the inclusion of heterogeneous trials (e.g., diagnosis, types of surgery, dosage, content, and duration of interventions) with small sample sizes leads to inconclusive and very low certainty of effect estimates.

Conclusion: The present systematic review has brought to light the dearth of high-quality evidence in support of prehab interventions for patients undergoing lumbar spine surgery. Given the uncertainty surrounding the results obtained from low-quality randomized controlled trials, it is currently not feasible to provide recommendations for clinical practice.