Clinical Journal of Pain最新文献

Objective: School refusal is a longstanding difficulty for youth with chronic pain. Yet, research is hindered by lack of adequate measurement tools to assess and describe the complex interpersonal and systems-level factors contributing to school refusal. This study investigates the utility of the School Refusal Evaluation (SCREEN) measure and its psychometric properties in a sample of youth with chronic pain.

Materials: and Methods: Youth undergoing multidisciplinary evaluation at outpatient pain clinics completed self and parent-report questionnaires. Descriptive data examined school refusal. Internal consistency and construct validity were tested. Multiple regressions examined parent and child factors related to school refusal.

Results: 698 youth with chronic pain participated. Two-thirds reported symptoms suggesting at-risk or clinically significant symptoms of school refusal. Cronbach alpha scores were in the acceptable to good range on the SCREEN. Convergent validity for the Interpersonal Discomfort subscale of the SCREEN was established. Child fear of pain, stress, peer relationships, and parent protective behaviors significantly correlated with SCREEN total scores. Participants enrolled in fully in-person school during the study period reported significantly higher scores on the interpersonal discomfort scale than those enrolled in remote learning.

Discussion: Our results provide evidence that youth with chronic pain experience significant challenges with school functioning and offer some support for the reliability and validity of the SCREEN in a sample of youth with chronic pain, a population for which few appropriate measures of school functioning have been established. The SCREEN measure may aid in assessing school refusal, with good clinical potential to quantify risk and identify modifiable factors.

Background: Emergency delirium (ED) is a common and serious postoperative complication especially after pediatric surgery. Quadratus lumborum block (QLB) are critical components of the multimodal, opioid-sparing analgesia regimens, which provide effective analgesia, reduce opioid consumption, and attenuate surgical stress response. Therefore, this trial was designed to validate the hypothesis that the adjunctive use of QLB reduces the incidence of ED after laparoscopic surgery in children.

Methods: Children aged 1-6 years who underwent laparoscopic surgery under general anesthesia were randomly divided into general anesthesia combined with QLB group (Group G+Q) or general anesthesia group (Group G). The primary outcome was the incidence of ED in postanesthesia care unit (PACU), the incidence of delirium 24 hrs postoperatively, extubation time, length of stay in PACU, opioid consumption and pain score were recorded.

Results: From July 2020 to October 2022, 292 children were randomized and 287 completed the study. The incidence of delirium in Group G+Q were significantly lower than that in Group G in PACU (16.1% vs 47.9%, P<0.001) and 24 hrs postoperatively (3.4% vs 11.1%; P<0.05). The time of extubation time (21.2±11.4 min vs 18.2±11.8 min; P<0.05) and PACU stay in Group G were significantly longer than Group G+Q (57.2±20.3 min vs 48.9±20.4 min, P<0.01) compared with Group G.

Discussion: General anesthesia combined with QLB can significantly reduce the incidence of ED, shorten the extubation time and PACU residence time, and improve the quality of resuscitation.

Objectives: The rationale of adoption opioid-sparing anesthesia (OSA) is to achieve perioperative analgesia with a minimal amount of opioids combined with nonopioid adjuvants during and after surgery, namely multimodal anesthesia. The OSA approach was originally developed to overcome the known complications of opioid-based anesthesia (OA), and the present scoping review (ScR) aims at providing clinical evidence of the safety and efficacy of OSA with respect to OA.

Methods: This ScR is mainly focused on studies presenting evidence on the safety and efficacy of OSA versus OA. PubMed and EMBASE databases were utilized to find relevant studies. The search strategy included the following keywords: "opioid sparing anesthesia complications, opioid sparing anesthesia efficacy, opioid sparing anesthesia safety." The findings from the 25 included studies were categorized into the following subsections: article characteristics, goals of the studies, OSA protocols, and surgical settings analyzed.

Results: In the 25 reviewed studies, evidence related to the impact of OSA versus OA was considered. Intraoperative safety and efficacy end points include hemodynamic stability and anesthetic/analgesic requirements. Postoperative end points include early cognitive dysfunction, opioid-induced bowel disorder, the physical status of mothers and newborns after labor and emergency cesarean, systemic immune and inflammation modifications, postoperative recovery, in-hospital and long-term opioid requirement, early postoperative pain, and chronic postsurgical pain. The studies reported lower intraoperative mean arterial pressure and heart rate fluctuations when α 2 agonists were adopted, while no differences were recorded for other complication rates. Analysis of OSA approaches for the postoperative conditions includes α 2 agonists, NMDA receptor blocking agents, gabapentinoids, nefopam hydrochloride, and locoregional anesthesia techniques with a positive impact on most of the end points considered.

Discussion: The clinical implementation of OSA encompasses the perioperative use of nonopioid drugs and locoregional anesthesia techniques. The reviewed studies reported OSA as a feasible approach to reduce opioid-related complications with no impact on patient safety.

Objectives: An emerging concept in the chronic pain literature, high-impact chronic pain (HICP), refers to pain that occurs very frequently and results in major disruption of daily life. Previous epidemiologic investigations have noted that lower educational attainment, age, and race appear to be associated with the frequency of HICP, but condition-specific investigations of HICP have been less common.

Methods: Here we investigate HICP status and its clinical/demographic correlates in the Multidisciplinary Approach to the study of chronic Pelvic Pain research network Symptom Pattern Study.

Results: Participants were 476 urologic pelvic pain syndrome (UCPPS) patients, 64% of whom were female. Of these, 22% were classified as having HICP, based on responses to the several questions about pain interference in daily life. We confirmed that African-American individuals and those with lower educational attainment were more likely to experience HICP (both P<0.05). Additionally, those with HICP demonstrated much greater levels of disability, genitourinary pain, urinary symptoms, widespread pain, pelvic floor tenderness, and were more likely experience pain in response to consuming standardized amounts of water (all P<0.05). Binary logistics regression showed that genitourinary pain, widespread pain, and race were the strongest prediction of pain in multivariate models. Furthermore, HICP status was associated with more self-reported healthcare utilization over the subsequent 18 months (P<0.05).

Discussion: These findings suggest that HICP affects more than 1 out of 5 UCPPS patients, with significant associated morbidity. Demographic and clinical characteristics associated with HICP may be useful for identifying at-risk UCPPS patients.

Objectives: Complex regional pain syndrome remains a challenging condition characterized by severe, persistent pain and a variety of inflammatory and trophic symptoms. This study aimed to analyze the current literature to evaluate hyperbaric oxygen therapy (HBOT)'s efficacy in treating complex regional pain syndrome (CRPS), focusing on both sympathetically-maintained pain (SMP) and sympathetically-independent pain (SIP) subtypes.

Methods: A comprehensive literature search was conducted in PubMed Clinical Queries using the MeSH term "Complex Regional Pain Syndromes" OR the keyword "CRPS" AND "Hyperbaric Oxygen Therapy" OR the keyword "HBOT". The selected publication types included a randomized controlled trial, a retrospective observational study, a comparative study, a retrospective case series and case reports. The search was restricted to articles published in English between January 1994 and October 2024. The results from the search were used to compile this review. Patients were categorized into SMP, SIP, or indeterminate groups based on the presence of prior sympathetic nerve block history or disease duration.

Results: Thirteen studies involving 280 subjects were reviewed. Of the patients, 42.5% were categorized as SMP, 48.2% as SIP, and 9.3% as indeterminate. HBOT treatment ranged from 3 to 63 sessions, typically using 2.4 ATA for 90 minutes. The results indicated significant symptom relief and functional improvement across both SMP and SIP subtypes, suggesting the broad efficacy of HBOT for CRPS management.

Discussion: This review of the current literature suggests that HBOT may offer significant symptom relief, regardless of CRPS subtype or disease duration. HBOT's anti-inflammatory and neuroplasticity promoting properties make it a valuable non-invasive option for CRPS patients, potentially improving outcomes when combined with other therapeutic modalities. Further research is necessary to refine patient selection and optimize treatment protocols.

Objectives: After cesarean, optimal analgesia is important for early mobilization, mitigating thromboembolic risks, and mother-infant communication. Our study aims to compare the postoperative analgesic effects of intrathecal morphine (ITM) and Erector Spinae Plane Block (ESPB) in elective cesarean section under spinal anesthesia.

Methods: 82 patients were randomized into ESPB and ITM groups. Both groups received spinal anesthesia with 10 mg of heavy bupivacaine. In the ITM group, intrathecal morphine (100 mcg) was added. The ESPB group received bilateral T10 level ESPB with 20 ml 0.25% bupivacaine postoperatively. Postoperative pain control included intravenous paracetamol 4x1gr, intravenous patient-controlled analgesia with tramadol, and diclofenac 75 mg for rescue analgesia when NRS > 4. NRS, tramadol consumption, and side effects were recorded 24 hours postoperatively. The primary outcome of this study is to compare 24-hour postoperative opioid consumption after cesarean sections. Secondary outcomes include postoperative pain scores, rescue analgesia needs, and potential side effects.

Results: NRS scores ≤ 4 at all time intervals and were comparable among groups. The total 24-hour tramadol consumption was significantly higher in ESPB group (median: 75; Q1,Q3[40,140]) compared to ITM (50 [27.5,60], P = 0.008). Tramadol consumption was similar among groups during 0-6 and 6-12 hours. In the 12-24 hours, it was significantly higher in ESPB group (22.5 [15,57.5]) compared to ITM (15 [12.5,25],P = 0.005). In ITM group, nausea and vomiting were observed in 3 patients, itching in 1 patient; no adverse effects were observed in ESPB group.

Discussion: Patients undergoing cesarean section under spinal anesthesia, intrathecal morphine reduced opioid consumption more effectively than ESPB. ESPB is not recommended as a primary analgesic option for cesarean sections.

Objectives: Chronic pain (CP) significantly impacts emotional and physical well-being and overall quality of life across diverse populations in the United States (U.S.). Notably, underrepresented minoritized (URM) groups, such as Hispanic/Latinx youth, may experience disproportionate effects due to health disparities and lack of access to quality healthcare. However, this remains understudied. This study aims to examine the association between CP and its related psychosocial factors- depressive and anxiety symptoms, and pain catastrophizing- in Hispanic/Latinx youth, as compared to Non-Hispanic White (NHW) youth.

Methods: The current study sample included 58 self-identifying Hispanic/Latinx and 58 NHW youth seeking CP treatment at a large northeastern tertiary pain clinic, ages 12-18 y.o., M=15.49, SD=1.71), of which 88% identified as biologically female. Participant samples for each group were age-and-sex matched.

Results: Significant associations were found between anxiety and depressive symptoms and pain catastrophizing for youth in both groups. Ethnicity significantly moderated the associations between pain catastrophizing and depressive symptoms and between anxiety and depressive symptoms, with NHW youth with pain exhibiting stronger relations between these constructs when compared to Hispanic/Latinx youth with pain.

Discussion: Our results suggested that for NHW youth with CP, greater tendencies toward catastrophizing and experiences of anxiety may more strongly contribute to depressive symptoms, when compared to their Hispanic/Latinx youth counterparts. Further investigation of pain-coping mechanisms among Hispanic/Latinx youth and other youth from historically marginalized populations (e.g., racial/ethnic minoritized groups) will help advance clinical understanding of sociocultural variability in links between pain-related psychosocial outcomes in the CP experience.

Objectives: The double-point serratus anterior plane block (SAPB) covers more area, including the axilla, than the single-point approach, potentially offering better pain relief after modified radical mastectomy (MRM). The objective of this study were to evaluate the clinical outcomes of these 2 procedures for patients treated with MRMs.

Methods: Sixty women were randomly assigned to double- or single-point groups. Double-point received SAPB at the third and fifth ribs, single-point at the fifth rib. The primary outcome includes pain numeric rating scale (NRS) at rest and movement 24 hours postsurgery. The secondary outcomes are axilla comfort NRS, recovery quality, and adverse events.

Results: At 24 hours postsurgery, the double-point group compared with the single-point group showed movement pain NRS of 3 (2 to 3) versus 3 (3 to 4) ( P =0.011) and rest pain NRS of 1 (1 to 1) versus 2 (1 to 3) ( P =0.037). The difference between them did not exceed the minimum clindically important difference (MCID). The axillary comfort NRS in the double-point group was lower than the single-point group at 6 and 12 hours postsurgery, at 1 (1 to 2) versus 2 (2 to 4) ( P =0.001) and 1 (1 to 2) versus 2 (2 to 4) ( P =0.01), respectively, but there were no statistically significant differences at 24 and 48 hours postsurgery. At 48 hours postsurgery, pain scores and opioid use were similar in both groups. Recovery scores, rescue analgesia timing, adverse events, and hospital stay length were similar in both groups.

Discussion: Double-point SAPB offers wider anesthetic spread but shows no significant clinical advantage in pain or axillary comfort over single-point SAPB after MRM.

Objectives: The aim of this systematic review and meta-analysis was to evaluate the effectiveness of percutaneous electrical stimulation in the modulation of pain and its implication in the function of patients with a painful knee condition.

Materials and methods: A search was conducted from database inception to September 2023 across PubMed, Web of Science, and Scopus databases. Randomized controlled trials were included. Two reviewers performed independent data extraction and methodologic quality assessment of the studies. Study quality was assessed using the physiotherapy evidence database Scale and the risk of bias was evaluated with the Cochrane Assessment tool.

Results: Eight studies were included. A significant statistical effect was found ( P < 0.001) for reducing pain and improving function after treatment. In addition, a significant statistical effects were identified for reducing pain ( P = 0.009) and improving function ( P < 0.001) after follow-up. The risk of bias was low.

Conclusion: This review showed a positive effect of applying the percutaneous electrical stimulation for reducing pain and improving function in adults with a painful knee.

Objective: Effective postoperative analgesia is critical for thoracic surgery. This study compares the analgesic efficacy of the erector spinae plane block (ESPB), retrolaminar block (RLB), and paravertebral block (TPVB) in single-incision video-assisted thoracoscopic surgery (SITS).

Methods: Seventy-six patients underwent general anesthesia followed by ultrasound-guided nerve blocks with 20 mL of 0.5% ropivacaine. Primary outcomes included the area under the curve (AUC) of numeric rating scale (NRS) scores during rest and coughing over 24 hours. Secondary outcomes included perioperative opioid use, plasma biomarkers, and postoperative recovery measures.

Results: The AUC for NRS was 107.8±10.53 in the ESPB group, 104.8±8.05 in the RLB group, and 103.6±10.42 in the TPVB group, demonstrating noninferiority for ESPB (difference: 4.2±3.0, 95% CI: -1.82 to 10.22) and RLB (difference: 1.2±2.6, 95% CI: -3.97 to 6.37) compared with TPVB. No statistically significant differences were observed in opioid use, plasma biomarkers, QoR-15 scores, or adverse events.

Discussion: ESPB and RLB provide noninferior analgesia compared with TPVB in SITS patients and are effective alternatives that enhance safety.