British Journal of Pain最新文献

Background: More sex-specific pain sensitivity normative values from population-based cohorts in pain-free older adults are required. The aims of this study were (1) to provide sex- and age-specific normative values of pressure and cold pain thresholds in older pain-free adults and (2) to examine the association of potential correlates of pain sensitivity with pain threshold values.

Methods: This study investigated sex-specific pressure (lumbar spine, tibialis anterior, neck and dorsal wrist) and cold (dorsal wrist) pain threshold estimates for older pain-free adults aged 41-70 years. This cross-sectional study used participants (n = 212) from the Raine Study Gen1-26 year follow-up. The association of pain thresholds, with correlates including sex, test site, ethnicity, waist-hip ratio, smoking status, health-related quality of life, depression, anxiety and stress symptoms, sleep quality, socioeconomic status and physical activity levels, was examined.

Results: Values for pressure and cold pain thresholds for older pain-free adults are provided, grouped by vicennium, sex and test site (pressure). Statistically significant independent correlates of increased pressure pain sensitivity were test site, ethnicity and sex. Only lower waist/hip ratio was a statistically significant, independent correlate of increased cold pain sensitivity.

Conclusions: This study provides robust sex- and age-specific normative values for pressure pain threshold and cold pain threshold for an older adult pain-free population. Combined with existing values, these data provide an important resource in assisting interpretation of pain sensitivity in clinical pain disorders and provide insights into the complex association of pain sensitivity with correlates that can be used in research.

Background: Some patients with postoperative hip fractures (HF) experience persistent severe pain. In this longitudinal study, we examined the characteristics of patients with persistent pain after HF surgery, and the factors influencing pain intensity.

Methods: We conducted an 8-week prospective study in patients with postsurgical HF. Verbal rating scale (VRS), and multifaceted outcomes, including pressure pain threshold (PPT) (affected site and biceps), were evaluated at 2, 4, and 8 weeks postoperatively. Patients were divided into mild (VRS ≤1) and severe (VRS ≥2) groups according to pain intensity at 8 weeks postoperatively. Statistical analyses were performed using two-way ANOVA and decision-tree analysis.

Results: VRS, PPT at the affected site and biceps, and physical activity (PA) time were significantly lower in the severe group than in the mild group 2 weeks postoperatively. VRS, PPT at the affected site, pain catastrophizing (PCS)-13, and the Tampa Scale for Kineshiophobia (TSK)-11 did not show significant improvements in the severe group. Decision tree analysis revealed that the VRS and PCS-13 at 4 weeks, PA time at 2 weeks, and TSK-11 change between 4 weeks and 2 weeks were factors influencing severe pain intensity at 8 weeks after HF surgery.

Conclusion: Persistent severe pain after HF surgery was characterised by high peripheral and central sensitisation, pain catastrophizing, and reduced PA at 2 weeks after HF surgery. In addition, early pain intensity, pain catastrophizing, and PA may be hierarchically influential factors for persistent pain 8 weeks after HF surgery.

Objective: To assess the feasibility and possible impacts of implementation of systematic non-pharmacological interventions to reduce the level of prescribing of opioid and gabapentinoid analgesics for chronic non-cancer pain (CNCP), particularly high-dose prescriptions, through a proof-of-concept study in a deprived area (second lowest decile) primary care practice in North-East England.

Participant: Twenty-five primary care staff (clinical and non-clinical) of which 18 clinicians received the intervention.

Intervention used in this study practice known as gott gabapentinoid and opioid toolkit: All clinicians received an educational skills programme to support patient pain self-management, tailored on the clinicians' self-assessment of their learning needs, embedding both clinician skill learning and patient self-care resources for rapid access within consultations into a GP clinical management computer system.

Outcome measures: Clinical staff completed questionnaires before and after the GOTT intervention to assess levels of knowledge and confidence in their own skills to support chronic pain self-management across several domains. Prescription data were used to measure changes in opioid and gabapentinoid prescribing at the practice across the 12-month intervention and 30-month follow-up period.

Results: Prescribing of opioid and gabapentinoid/pregabalin decreased substantially in the practice across the intervention period (c. 90% in high-dose opioid [p = .0118], and 15% gabapentin/pregabalin prescriptions, respectively), over a one-year period during the COVID-19 pandemic. Follow-up analysis showed 100% and c.50% reductions, respectively, in December 2022. The questionnaire data showed an increase in clinician confidence in skills to enable self-management over the intervention period, overall (p = .044) and, specifically across three of the five domains measured: supporting behavioural change (p = .028), supporting self-care (p = .008), and managing difficult consultations (p = .011).

Conclusion: The GOTT intervention program provided some initial evidence of a proof-of-concept for the implementation of a systematic non-pharmacological pain management skills and resources programme addressing lack of confidence in skills to introduce and support self-management and reduce use of strong opioids and gabapentinoids.

Objectives: To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services.

Methods: All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients' sex and age. Multivariate regressions were used to examine determinants of the outcomes.

Results: In FY 2022/2023, 10.4%, 7.0%, and 6.7% of the population saw physicians for shoulder, knee, and LBP conditions, respectively. This costs Alberta $307.04 million ($67.93 per capita), of which shoulder accounted for 41%, knee 28%, and LBP 31%. In the same FY, 17,734 computed tomography (CT), 43,939 magnetic resonance imaging (MRI), 686 ultrasound (US), and 170,936 X-ray exams related to shoulder/knee/LBP conditions were ordered for these patients, costing another $29.07 million, of which CT accounted for 14%, MRI 48%, US 0%, and X-ray 37%. Female, older age, comorbidity scores, and capital zone used physician services more frequently. Patients with a higher comorbidity index scores or more physician visits were more likely being referred for CT or MRI.

Conclusion: Musculoskeletal conditions are common and result in patients seeking healthcare services. Visits to family physicians, specialists, and the ordering of DI contribute to extensive utilization of health services, contributing to considerable health system costs.

Although spinal cord stimulator (SCS) therapy is generally used safely to treat chronic neuropathic pain conditions, this document highlights the less reported complication of unusual neurological problems including headaches. These developed temporally after the initiation of SCS therapy despite initial positive response to pain. The mechanisms might include activation of trigeminal receptors and neuroplasticity after SCS. We present a series of four cases where patients developed new neurological symptoms like headaches, facial twitching, and tinnitus, that were related to SCS activation. Despite adjustments to the SCS settings and extensive evaluations, these symptoms persisted in all cases, leading to the decision to explant SCS which was otherwise helping pain.

Acute postsurgical pain (APSP) is an important risk factor for pain chronification, with reports of being more intense after total knee arthroplasty (TKA) than after total hip arthroplasty (THA). Psychological variables have been associated with differences in postsurgical pain experience. This study aimed to analyse the longitudinal reciprocal association between pain and anxiety levels in patients undergoing TKA or THA, to investigate the moderator role of the type of surgery and to explore psychological mediators in the anxiety - pain association. Patients undergoing TKA (n = 120) or THA (n = 109) were evaluated before surgery and in the acute postsurgical period (48 h postsurgery). Presurgical assessment comprised sociodemographic, pain-related and psychological variables (anxiety, depression, pain catastrophizing, self-efficacy, optimism and satisfaction with life). Postsurgical assessment focused on pain frequency, pain intensity and anxiety. Longitudinal associations were explored using cross-lagged panel models that included the indirect effect paths through possible mediators (pain catastrophizing and depression). Multigroup analyses compared TKA and THA. In the global sample, higher APSP was predicted by higher presurgical pain and worse presurgical anxiety. Multigroup analyses revealed that worse APSP was predicted by higher presurgical anxiety in patients undergoing TKA and by higher presurgical pain in patients undergoing THA. Furthermore, there was a positive significant indirect effect of pain catastrophizing, but not depressive symptoms, in the relationship between presurgical anxiety and APSP in THA. Anxiety and APSP are differently interrelated in TKA and THA. Psychological characteristics could be managed before surgery to favour better APSP control and potentially prevent pain chronification after total joint arthroplasty.

Purpose: To study patient safety in third molar surgery, where two different doses of S-ketamine were administered for pain relief and compared to a placebo (saline). The primary focus was capillary oxygen saturation of the blood (SpO₂) and secondarily, alterations in respiratory rate, blood pressure, pulse or adverse events.

Methods: One hundred and sixty-eight subjects were included in a randomised, placebo-controlled, double-blind trial. The two subanaesthetic study drugs were low-dose S-ketamine (0.125 mg/kg) and high-dose S-ketamine (0.25 mg/kg). Every patient was sedated with midazolam prior to infusion of the investigational drug. The teeth were surgically removed according to a routine clinical procedure, under local anaesthesia.

Results: Primary end-point for the safety aspects was capillary oxygen saturation (SpO₂) after administration of the investigational drug was finished. A significant difference was found between the placebo and the high-dose group at that point (p = .021), with a decrease of saturation in the high-dose group. The lowest saturation and the number of registrations of SpO₂ <90% did not show any difference between groups. Oxygen supplementation was given in circa 40% of the cases with no differences between the intervention groups. No other significant differences between groups regarding saturation or respiratory rate were noted.

Conclusion: In this study, it was safe to use adjunct preoperative single-dose intravenous S-ketamine 0.25 mg/kg body weight for pain relief, in midazolam-sedated patients receiving third molar surgery. There were no serious adverse events or symptoms of overdose nor any clinically relevant effects on circulatory or respiratory parameters.

Persistent post-operative opioid use is a public health concern contributing to population morbidity and mortality. Opioid stewardship is a strategy adopted to rationalise opioid prescribing and limit harmful use. We describe persistent post-discharge opioid use rates and risk factors in a single-centre cohort and describe the opioid stewardship role of our Acute Pain Service (APS). We conducted a retrospective 4-year cohort study of inpatients referred to the APS and discharged with new strong opioids prescribed. We investigated persistent post-discharge opioid use rates, risk factors and patterns of opioid use after community follow-up by APS. We found that 24% of patients discharged with new strong opioids developed persistent opioid use. Risk factors associated with persistent post-discharge opioid use in our cohort included female sex (Odds Ratios [95% confidence interval], p value, OR: 1.89 [1.11-3.22], p = 0.019), pre-admission mental health history (OR: 2.85 [1.64-4.95], p < 0.001) and pre-admission opioid use (OR: 1.79 [1.03-3.11], p = 0.004). A smaller proportion of patients with APS follow-up in community developed persistent opioid use (22%) compared to those without (32%). We conclude that having opioids prescribed at time of discharge can result in persistent opioid use in up to a quarter of patients. The APS has an important protective role in rationalising opioid use in hospital but also following discharge. Development of further opioid stewardship policies is needed including improvement of patient and staff awareness and pre-operative assessment of patients with recognised risk factors.

Background: Multicomponent treatment is commonly used. However, there are no studies that included graded motor imagery and therapeutic neuroscience education to multicomponent treatment for patients with fibromyalgia This study aims to compare the short-term effects (at 12 weeks) of a multicomponent treatment combined with graded motor imagery and therapeutic neuroscience education versus standard treatment in patients with FM.

Methods: The study was a single-blinded randomized controlled trial. Sixty-five women with a clinical diagnosis of FM were randomly allocated (1:1) into two groups. The experimental group (n = 33) received a novel multicomponent treatment combined with graded motor imagery and neuroscience education. The control group (n = 32) received a standard treatment including pharmacotherapy and standard physician education. The primary outcome was pain intensity assessed with the Numeric Pain Rating Scale (NPRS). The secondary outcomes were changes in the Fibromyalgia Impact Questionnaire (FIQ), the Pain Catastrophizing Scale (PCS), the Tampa Scale of Kinesiophobia (TSK-17), and the Pittsburgh Sleep Quality Index (PSQI) scores. All outcomes were assessed at baseline and 12 weeks.

Results: All of the participants completed the trial. The between-group mean differences at 12 weeks were: NPRS-1.18 points (95% confidence interval [CI] -0.4 to -1.8; η² = 0.47; p < .001); FIQ-16.21 points (95% CI -10.9 to -22.1; η² = 0.58; p < .001); PCS total domain -12.5 points (95% CI -7.2 to -17.8; η² = 0.61; p < .001); TSK-17-6.15 points (95% CI -3.5 to -8.7; η² = 0.52; p < .001); and PSQI-2.74 points (95% CI -1.4 to 4.0; η² = 0.54; p < .001). All differences were statistically significant in favor of the novel multicomponent treatment group and had a large effect size.

Conclusions: In the short term, a novel multicomponent treatment, including graded motor imagery and neuroscience education, was an effective therapeutic intervention for improving clinical outcomes compared with standard treatment in women with FM. Additional studies are needed to support long-term clinical effectiveness in these patients.