British Journal of Pain最新文献

Background: While physical therapists have provided group physical therapy interventions for patients admitted to inpatient psychiatric pain service lines, to date, it has not been assessed whether the patients' outcomes of pain and function have improved during their stay. Thus, our aim is to evaluate how group physical therapy, as part of an inpatient psychiatric rehabilitation team, impacts outcomes for patients receiving chronic pain treatment services.

Methods: Data was retrospectively retrieved from patients who received group physical therapy during their inpatient psychiatric pain admission. At evaluation and discharge, PROMIS Pain Interference Scale tracked pain, while AM-PAC Basic Mobility Outpatient Short Form measured functional mobility. Paired samples statistics were used to evaluate outcomes.

Results: Over a 6-month period, 25 patients (average age 40.28 +/- 15.93 years) received group physical therapy. All patients had the treatment diagnosis of chronic pain. The null hypothesis, that there was no difference between evaluation and discharge scores, was rejected for both the PROMIS Pain Interference Scale t (25) = 3.82, two-tailed p < .001 and the AM-PAC Mobility Score t (25) = -2.24, two-tailed p = .03.

Conclusions: Group physical therapy, as part of an inpatient psychiatric pain management team, assists with improving patient outcomes of pain and mobility.

Objective: Persons with chronic pain suffer from additional symptoms and deficits that are directly or indirectly related to their condition. Attentional deficits are a common problem in these individuals. The same is true for sleep disturbances. It is well-known that night sleep affects attention the next day. Therefore, sleep disturbances might be responsible for the association between chronic pain and deficits in attention.

Methods: We studied the gaze behaviour (absolute and relative fixation times, i.e., attentional biases) in patients with chronic musculoskeletal pain (N = 20) and pain-free individuals (N = 28). For that purpose, we used an eye-tracker to monitor gaze behaviour during the presentation of affective stimuli, that is, pictures of faces displaying joy, anger, pain, and neutral expressions. In addition, we assessed subjective/wellbeing parameters, as well as objective sleep parameters with a portable polysomnography (PSG) device during two nights at home, with the aim of testing the mediating role of sleep for the relationship between chronic pain and alterations of attention.

Results: Patients with chronic pain exhibited overall shorter fixation times (on average ∼160 ms shorter fixation times). With respect to the attentional biases, all participants looked longer at the affective faces compared to the neutral ones, independent of group or type of affective stimulus. Several subjective sleep/wellbeing parameters, together with two PSG parameters (sleep efficiency and duration of awakenings), were significantly worse in patients with chronic pain. Despite this, only subjective sleep quality and sleep efficiency mediated the association of chronic pain and attentional processes.

Conclusions: Our findings confirm previous studies showing attentional deficits and sleep disturbances in patients with chronic pain. However, our results only partially support the hypothesis that the relationship between chronic pain and altered attentional processes is due to disturbed sleep. Other mechanisms might be involved, highlighting the need for further studies.

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.