British Journal of Pain最新文献

Objective: In this study, a meta-analysis was conducted to characterize the therapeutic benefits of repetitive transcranial magnetic stimulation (rTMS) on musculoskeletal (MSK) pain and potential factors affecting the effect.

Methods: A comprehensive search was performed in PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov for randomized and sham-controlled trials published from inception to 13 March 2024. We conducted this meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Based on the heterogeneity among studies, fixed effects or random-effects model was used for the effective analysis of rTMS on pain, quality of life, and depression.

Results: A total of 23 eligible randomized controlled trials (RCTs) comprising 1158 patients were included in our systematic search. The analysis showed effect sizes of -0.94 (95% CI: -1.30 to -0.59), indicating that real rTMS was better than sham stimulation in reducing pain (p < 0.01). Also, rTMS reduced depression scores and improved follow-up effects and the quality of life of MSK pain patients. In the subgroup analysis, stimulation frequency, intensity, and session frequency were important factors affecting the therapeutic effect.

Conclusions: Our review demonstrated that rTMS had the potential to relieve pain and depression, enhance the quality of life for patients with MSK pain. Stimulation frequency, intensity, and session frequency were important factors affecting the therapeutic effect.

Background: Opioids can heighten sensitivity to noxious stimuli, leading to opioid-induced hyperalgesia (OIH). Despite the frequent use of high opioid doses in ICU settings, the presence of OIH following ICU stays remains undocumented.

Methods: This prospective observational study aimed to assess OIH presence and its clinical implications in post-ICU patients. Adults with confirmed Sars-CoV-2 infection hospitalized in the ICU for over 48 h were included, with opioid dosage recorded. At ICU discharge, 11 quantitative sensory tests (QSTs) were conducted at two non-painful sites, and pain presence, intensity, and characteristics were assessed at discharge and 4 months later.

Results: Analysis of 41 patients (20 opioid-treated, 21 controls) revealed significantly higher hyperalgesia levels in the opioid-treated group across six tests at both sites, including cold pain thresholds, heat and cold tolerance thresholds, duration of tolerance to a 47°C stimulus, and thermal and mechanical temporal summation.

Conclusions: Our findings underscore the importance of QST in early OIH detection, identifying thermal tolerance thresholds and thermal/mechanical temporal summation tests as sensitive indicators. Subclinical hyperalgesia in ICU patients on opioids heightens susceptibility to chronic pain development, emphasizing the need for vigilant opioid monitoring and adjustment in ICU care.

Cancer pain is one of the most severe components of the symptom burden among cancer patients, especially those with advanced or metastatic disease. Palliative interventions are necessary to alleviate cancer pain and reduce opioid-related side effects, thereby minimizing patient suffering. Radiosurgery has been effectively used to target the medial thalamus and the hypophysis for the treatment of chronic pain syndromes. These two areas are critical for pain modulation and control, and their precise targeting with radiosurgery and its non-invasive nature can provide relief for patients suffering from cancer-related intractable pain. Our previous work with single target irradiation of the hypophysis revealed promising pain relief in terminal cancer patients, albeit more suited for hormone-mediated tumours or bone-derived pain rather than complex mixed pain syndromes. Given that, we previously introduced the concept of triple-target irradiation (hypophysis + both thalami) in a small report of terminally ill cancer patients. Here, we report a larger case series of terminally ill patients (n = 8) with complex cancer pain treated with a triple-target approach, with radiation doses generally considered low or non-ablative (90 Gy), in contrast to the usual single-target, ablative approach comprising higher doses. We noted a substantial decrease in VAS scores and the medications needed to manage pain across all patients, experiencing minimal to no side effects. Our findings indicate that a minimally invasive triple-target method, utilising low radiation doses, effectively alleviates pain, lowers medication dependency, and enhances the quality of life with few side effects. Furthermore, additional research is essential to optimise pain relief and ensure long-term effectiveness.

Background: Perioperative opioid stewardship programs are increasingly being introduced to guide responsible use around the time of surgery to reduce opioid-related harm to patients. However, patient experiences of perioperative opioid stewardship programs are underexplored.

Methods: We designed a mixed methods study to explore patients' experiences of perioperative opioid stewardship in the post-operative period following spine surgery. We performed evaluative action research, combining quality improvement and ethnographic methodologies. Our quantitative methods were retrospective medical record review and targeted survey research. Our qualitative methods were online focus groups. The quantitative data were analysed using descriptive statistics, chi-square, and rank sum testing. The focus group data underwent inductive thematic analysis.

Results: Our spine surgery cohort for the four-month study period included 101 patients. The median total discharge opioid dispensed was 75 mg [interquartile range 75-150 mg], with 30% of patients prescribed modified release opioids on discharge. A subset of patients (N = 14) participated in the online focus groups. The key themes that emerged from these sessions were (1) Supportive care delivery and rescue mechanisms were universally important to patient participants, providing great reassurance during their recovery; (2) Participants commonly believed opioid analgesia had an important role in recovery following spine surgery. Some patients were keen to dispose of surplus opioids whilst others intended to retain them; (3) Opioid analgesia access was variable, but established community prescriber relationships were important for post-discharge opioid re-prescription, and (4) The key future improvement suggestions included routine post-discharge contact and enhanced communication options back to the hospital if needed.

Discussion and conclusions: Our mixed methods approach provided rich insights into the pain and opioid analgesia experiences of patients following spine surgery. These insights are useful when seeking to optimise perioperative opioid stewardship programs including better meeting the needs of patient consumers. Limitations included potential response and selection bias for the online focus groups towards younger, higher socioeconomic status patients.

Introduction: Social prescribing links patients to community groups and services to meet health needs; however, it is uncertain what the benefits and impacts of social prescribing are for people with chronic pain. The National Institute for Health and Care Excellence (NICE) undertook a systematic review to investigate the clinical and cost effectiveness of social interventions aimed at improving the quality of life of people with chronic pain; no relevant clinical studies comparing social interventions with standard care for chronic pain were found, though the inclusion criteria for studies was narrow.

Objectives: To undertake a rapid review of all types of research and policy on social prescribing for adults with chronic pain in the U.K. (i) to describe the characteristics of relevant research and (ii) to synthesise data on impact.

Methods: A two-stage rapid review was planned. Stage (i) scoped and categorised knowledge from a comprehensive representation of the literature. In stage (ii), we undertook a descriptive synthesis of quantitative data along with a thematic analysis of qualitative data identified by stage (i).

Results: Of 40 full-text records assessed for inclusion, three met the inclusion criteria from academic databases. An additional five records were found in grey literature. Six records reported quantitative findings suggesting that social prescribing reduced pain severity and discomfort, pain medication and clinical appointments; and improved quality of life and ability to manage health. Five records captured qualitative data from interviews, case studies and anecdotal quotes that suggested positive impact on health and wellbeing; and increased self-efficacy in social prescribers undertaking training on pain.

Conclusions: There is tentative evidence that social prescribing improves health and wellbeing outcomes in adults with chronic pain and that there is a need to upskill social prescribers in contemporary pain science education. Research on the routes to referral, outcomes and impacts is needed.

Perspective: Social prescribing is valued and may be of benefit for people with chronic pain. There is a need to further develop and evaluate social prescribing services for people with chronic pain to enhance holistic patient centered care.

Background: Many pain clinics encourage/mandate attendance at introductory group pain education sessions. Despite high non-attendance rates, no studies have examined consumer-reported reasons for non-attendance. Purpose: The aim of this study was to better understand why consumers fail to attend their pain education session. Research Design and Study Sample: We attempted to contact all non-attendees of our South Australian tertiary pain unit's group pain education sessions from February-August 2020. Of the 23 we could reach, 10 completed semi-structured telephone interviews. Data Analysis: Audio-recordings were transcribed verbatim and subject to thematic content analysis. Results: 'Attendance barriers' themes highlighted the complex lives of non-attendees. Pain prevented them from leaving their house, deterred them from travel to, and sitting through, the entire session. Competing responsibilities including other medical appointments and comorbidities were commonly mentioned. Most explicitly stated their dislike for the group format. Other factors included fear of the unknown nature of the session, not wanting education, and wanting a doctor's appointment. Several participants expressed a distrust of medical professionals, and perceived the benefits of attending as not exceeding the perceived time, money and pain associated. Conclusions: Pain management may not be individuals' main priority and attendance may only occur when other personal issues are addressed. Significant non-attendance rates may be unavoidable. Providing additional session detail may reduce misconceptions and allay concerns. Educating referring GPs may assist consumers to make an informed decision regarding attending. Online sessions may address various barriers and prove a more cost-effective alternative.

Perspective: This article examines consumers' reasons for non-attendance at pre-clinic group education programs. Findings could be used by Pain Units to shape patient and GP communications regarding such programs, as well as program content and format, to improve patient acceptance and program attendance, and potentially engagement with self-management.

Psychedelic substances have shown preliminary efficacy for several neuropsychiatric disorders and are currently being investigated for chronic pain conditions. However, few studies have investigated outcomes of naturalistic psychedelic use among individuals with chronic pain, and none have assessed psychedelic-related changes in substance use patterns in this population. In a cross-sectional survey of adults who reported using psychedelics to self-treat a chronic pain condition (n = 466; 46.1% women), we investigated changed substance use patterns and self-reported outcomes on physical and mental health following use of a psychedelic. Most (86.3%; n = 391/453) indicated that they ceased or decreased use of one or more non-psychedelic substances "as a result of" psychedelic use, and 21.2% (n = 83/391) indicated that the decrease in use persisted for more than 26 weeks after psychedelic use. Alcohol (71.1%; n = 226/318) and prescription opioids (64.1%; n = 100/156) had the highest proportions for ceased/decreased use. Illicit opioids (27.8%; n = 22/79) and cannabis (21.5%; n = 78/362) had the highest proportions for increased/initiated use. In multivariate regression modeling, having a motivation to reduce one's substance use was positively associated with ceasing/decreasing substance use (p < .001). Perceptions of health outcomes following psychedelic use were broadly positive, and psilocybin was reported to be the most effective substance for both physical and mental health symptoms. Although limited by a cross-sectional study design, findings from this large sample merit future investigation into the benefits and risks of naturalistic psychedelic use among individuals with chronic pain.

Objectives: Waitlists for pain management services are often extensive, risking psychological and physical decline and patient non-engagement in treatment once accessed. Currently, for outpatient pain management, no standardised waiting list interventions exist, resulting in passive waiting. To arrest prospective wait-related decline(s), this study aimed to identify the barriers and facilitators to pain self-management while waiting, forming the foundation for a waitlist intervention development.

Design: An inductive qualitative approach was utilised to explore the barriers and drivers of pain self-management while waiting for chronic pain management.

Method: Semi-structured interviews, underpinned by the Theoretical Domains Framework and COM-B model, were conducted with people waiting for pain management services (N = 38). Interviews were audio-recorded, transcribed verbatim, and analysed via reflexive thematic analysis.

Results: The analysis demonstrated four thematised barriers and one facilitator: (1) Shunted Around the System (barrier); (2) The Information Gap (barrier); (3) Resisting Adaptation (barrier); (4) Losing Hope (barrier); and (5) Help Yourself or Lose Yourself (facilitator).

Conclusion: This study demonstrates the severe emotional and motivational impact of waiting, increasing treatment disengagement. The waitlist represents a prime opportunity for prehabilitation to protect wellbeing and optimise self-management engagement. Infrastructural and interpersonal barriers of poor communication and healthcare professional pain invalidation must be addressed to improve emotional wellbeing and motivation to engage with planned treatment. Enhancing self-efficacy, pain acceptance, self-compassion, and internal HLOC are fundamental to increasing pain self-management. These can all be met within a prehabilitation framework. This study is foundational for the development of psychological prehabilitation in outpatient chronic pain management.

Introduction: Experimental evidence supports the hypothesis of reciprocal influence between neural systems involved in cognition and central pain processing circuits. Furthermore, studies have demonstrated bidirectional communication between central pain processing areas and the immune system, leading to changes in behaviour, sensory perception, mood, and cognition. However, the academic community has not yet reached a consensus on whether effective analgesic interventions can mitigate or reverse cognitive deterioration.

Methods: This systematic review evaluated the effectiveness of various therapeutic interventions in improving cognitive functions (primary outcome) and altering the profile of immunological markers (secondary outcome) in chronic pain patients. The review was limited to randomised controlled trials addressing chronic pain of any aetiology, with searches conducted in PubMed, EMBASE, and Scopus databases.

Results: The qualitative synthesis of twelve studies conducted between 2003 and 2021, involving 1432 participants in experimental (n = 950) and control (n = 482) groups, revealed some interesting patterns. Only half of the studies (6/12) reported cognitive improvement, with attention being the most analysed cognitive domain, followed by memory and executive function. Fibromyalgia was the most studied aetiology of chronic pain. The strategies of intervention/treatment and durations varied widely; however, milnacipran versus placebo emerged as the most frequently employed intervention. Only one study reported immunological markers, limiting the evaluation of this outcome.

Conclusion: Based on this analysis, it is not possible to affirm that interventions targeting chronic pain improve cognition. This review suggests new research directions and calls for more robust methodological approaches.