Clinical Journal of Pain最新文献

Objectives: The transversus abdominis plane (TAP) block has proven efficacy and is an important component of multimodal analgesia in laparoscopic cholecystectomy (LC). The external oblique intercostal (EOI) block can provide a dermatomal sensory blockade of T6 to T10 using an anterior axillary line injection. The bilateral rectus sheath (RS) block can significantly reduce early postoperative pain caused by umbilical or periumbilical incisions. The current study aimed to compare the analgesic efficacies of ultrasound-guided subcostal TAP (UG-TAP) combined with the RS block and ultrasound-guided EOI (UG-EOI) combined with the RS block for LC.

Methods: Patients were randomly assigned to TAP or EOI group. Patients in TAP group received UG-TAP combined with an RS block. Patients in EOI group received UG-EOI combined with an RS block. The primary outcome was postoperative 24-hour sufentanil consumption.

Results: A total of 49 patients were included in the final analysis. The postoperative 24-hour sufentanil consumption in the EOI group was significantly lower than that in the TAP group (9.79±10.22 vs. 18.67±12.58 µg; P [noninferiority] <0.01; noninferiority confirmed). Fewer patients in the EOI versus TAP group had a numerical rating score of >3 during motion. Furthermore, the mean postoperative 48-hour sufentanil consumption was lower in the EOI versus TAP group (11.54±11.70 vs. 23.04±17.10 µg; P =0.01). The mean postoperative 24-hour Quality of Recovery-15 score was higher in the EOI versus TAP group (135.21±4.40 vs. 131.91±5.11; P =0.02).

Discussion: These findings suggest that UG-EOI combined with an RS block was superior to UG-TAP combined with an RS block for postoperative pain management in patients undergoing LC.

Objectives: Chronic pain disorders are among the most common and affect approximately 20% of the US population, leading to disproportionately high medical expenditures and negative economic impact. Behavioral factors of pain catastrophizing and perceived injustice are associated with pain intensity in chronic pain. Diminished heart rate variability (HRV) is also strongly associated with chronic pain. These factors have been less explored earlier in the pain experience and it is unclear whether they play a role in the transition from acute to chronic pain. The aim of this study was to determine the relationship between pain catastrophizing, perceived injustice, pain intensity and HRV in naturally occurring acute pain.

Methods: Ninety-seven subjects were recruited from local outpatient physical therapy clinics. Seated HRV was captured on ninety-four subjects via Polar chest strap while subjects were taking a survey via iPad. In addition to sociodemographic data, the survey included the Pain Catastrophizing Scale (PCS), Injustice Experience Questionnaire (IEQ), and Numeric Pain Rating Scale (NPRS). The natural log of high frequency power (lnHFP) HRV was used in the statistical analysis.

Results: Multiple regression modeling revealed that lower pain catastrophizing, higher perceived injustice, and lower pain intensity were associated with lower HRV, and accounted for 11.4% of the variance in HRV.

Discussion: While greater chronic pain intensity is associated with lower HRV, the relationship is reversed in the setting of acute pain. These findings highlight the need to better understand the unique factors that contribute to lower HRV in the acute phase.

Objectives: Both superficial (s) and deep (d) serratus anterior plane (SAP) blocks are effective for anterior chest wall surgeries, but there is little clarity on which is more effective. Hence, we conducted a systematic review and meta-analysis of randomized control trials (RCT) to evaluate the comparative efficacy of the two approaches for SAP block after anterior chest wall surgery.

Materials and methods: A systematic literature search was performed using PubMed, Embase, Scopus, and Cochrane Central Registers of Controlled Trials for eligible RCTs from inception until August 2023. The primary outcome was opioid consumption during the first 24 hours of the postoperative period. The secondary outcomes included pain scores at various intervals, intraoperative opioid consumption, time to first analgesic request, block-related complications, opioid-related side effects, and patient satisfaction scores. Statistical analysis of the pooled data was performed using Review Manager Version 5.3.

Results: We identified seven RCTs published between 2020 and 2022, enrolling 371 patients (186 in the sSAP block and 187 in the dSAP block). Moderate certainty of evidence suggests that both the approaches (deep and superficial) of SAP block were comparable for 24-hour oral morphine equivalent consumption with a mean difference (MD) of 3.78 mg (95% CI -1.70 to 9.29; P=0.18; I2=87%). The results of other secondary outcomes were comparable, including resting pain scores with an MD of 0.08 (95% CI -0.27 to 0.43; P=0.67; I2=87%) for early pain and MD of 0.63 (95% CI -1.28 to 0.01; P=0.05; I2=95%) for late pain scores, time to first analgesic request with MD of -0.41 hour (95% CI -1.40 to 0.59; P=0.42; I2=90%), and incidence of PONV (OR, 1.45 (95% CI 0.72 to 2.90; P=0.30; I2=0%).

Discussion: Current evidence does not support the preference for one approach of SAP block over the other for postoperative pain. Based on the available data, we recommend further future trials to determine any differences between these interventions.

Objectives: Non-malignant chronic pain is a clinical challenge because pharmacological treatment often fails to relieve pain. Transcranial direct current stimulation (tDCS) is a treatment that could have the potential for pain relief and improvement in quality of life. However, there is a lack of clinical trials evaluating the effects of tDCS on the pain system. The aim of the present study was to evaluate the effect of 5 days of anodal tDCS treatment on the pain system in chronic non-malignant pain patients using quantitative sensory testing (QST) and quality of life questionnaires: (1) Brief Pain Inventory-short form (BPI-sf), (2) European Organization for Research and Treatment of Life Questionnaire (EORTC-C30), and (3) Hospital Anxiety Depression Scale (HADS).

Methods: Eleven non-malignant chronic pain patients (51±13.6 years old, 5M) participated in the study. Anodal tDCS was applied for five consecutive days, followed by sham stimulation after a washout period of at least two weeks. Pressure pain thresholds (PPT) and pain tolerance thresholds (PTT) were assessed in different body regions on days 1 and 5.

Results: Anodal tDCS appeared to maintain PTT at C5 (clavicle) on day 5, but sham stimulation decreased PTT (P=0.007). Additionally, anodal tDCS increased PTT compared to sham at day 5 at Th10 ventral dermatomes (P=0.014). Both anodal and sham tDCS decreased the BPI-sf total and interference scores, and the EORTC-C30 fatigue score, but no interaction effect was observed.

Discussion: This study adds to the evidence in the literature that tDCS may be a potential therapeutic tool for the management of non-malignant chronic pain.

Objectives: This study compares the analgesic efficacy of Intercostal Nerve Block (ICNB) under direct thoracoscopic visualization and Serratus Anterior Plane Block (SAPB) with ultrasound guidance during thoracoscopic surgery's perioperative period. Furthermore, it examines their impact on chronic pain and identifies potential risk factors associated with its development.

Methods: In this prospective randomized controlled study, 74 thoracoscopic surgery patients were randomly assigned to ICNB or SAPB groups. Attending surgeons administered ICNB, while anesthesiologists performed SAPB, both using 20 mL of 0.5% ropivacaine. Primary outcomes included Visual Analog Scale (VAS) scores for resting and coughing pain at 6, 12, 24, and 48 hours postoperatively, perioperative opioid and NSAID consumption, and chronic pain incidence at 3 months postoperatively. Secondary outcomes aimed to identify independent risk factors for chronic pain.

Results: The primary results reveal that SAPB group exhibited significantly lower VAS scores than ICNB group for postoperative coughing at 24 hours (P<0.001, 95% CI=[0.5, 1]) and for resting pain at 48 hours (P=0.001, 95% CI=[0.2, 1]). Conversely, ICNB group demonstrated reduced VAS score for resting pain at 6 hours compared to SAPB group (P=0.014, 95% CI=[-0.5, 0.5]). SAPB group required significantly less intraoperative sulfentanil (P<0.001, 95% CI=[2.5, 5]), remifentanil (P=0.005, 95% CI=[-0.4, -0.1]), and flurbiprofen ester (P=0.003, 95% CI=[0, 50]) than ICNB group. Chronic pain incidence was similar (P=0.572, 95% CI=[0.412, 1.279]), with mild pain in both ICNB and SAPB groups. Secondary findings indicate that resting VAS score at 12 hours (OR=7.59, P=0.048, 95% CI=[1.02, 56.46]), chest tube duration (OR=3.35, P=0.029, 95% CI=[1.13, 9.97]), and surgical duration (OR=1.02, P=0.049, 95% CI=[1.00, 1.03]) were significant predictors of chronic pain occurrence.

Discussion: ICNB and SAPB demonstrated comparable analgesic effects, with similar rates of chronic pain occurrence. Chronic pain independent risk factors included resting VAS score at 12 hours, chest tube duration, and surgical duration.

Objective: Research has shown that there has been an increase in the prevalence of chronic back pain in adolescents, especially in female adolescents. The purpose of the current study was to test the hypothesis that the observed increase in the prevalence of early menarche in female adolescents is contributing to the increase in the prevalence of chronic back pain over time in this population.

Methods: Cross-sectional data from 251,390 female adolescents from 27 countries/regions were drawn from the Health Behaviour in School-aged Children questionnaire-based surveys conducted in 2002, 2006, 2010 and 2014. The Karlson-Holm-Breen method was used to examine the explanatory role of the increase in the prevalence of early menarche on the increase in the prevalence of chronic back pain whilst controlling for socioeconomic status, physical activity, body mass index, and psychological symptoms.

Results: The increase in the prevalence of early menarche between 2002 and 2014 was associated with the increase in the prevalence of chronic back pain (P<0.001). The percent of chronic back pain prevalence increase accounted for by the increase in early menarche was 2.2%.

Conclusions: The increase in the prevalence of chronic back pain in female adolescents observed over the last decade may be explained, in part, by the decrease in the age of menarche. This finding, coupled with research showing a decline in early menarche worldwide, highlights the need to delve deeper into the underlying mechanisms of the association between early menarche and pain ‒ particularly chronic back pain ‒ in female adolescents.

Objective: This study evaluated the effectiveness of clinic-based and telerehabilitation-based motor control exercises in individuals with chronic low back pain three months post-treatment.

Methods: Forty-two participants were randomized to either clinic-based or telerehabilitation-based groups, performing exercises three times weekly for eight weeks. Assessments were conducted pre-intervention, post-intervention and one and three months after the intervention. The primary outcome was pain intensity (Visual Analog Scale) for low back pain.

Results: Both exercise approaches were found to be similarly effective in improving pain disability, quality of life (except for emotional response, energy level, sleep, and social isolation), and pain catastrophizing at all follow-up time points. The Visual Analog Scale showed a significant reduction in pain from baseline at all time points in both groups (P<0.001), with effect sizes ranging from moderate to strong. Nottingham Health Profile showed significant improvements in physical activity, pain, and total score, with effect sizes ranging from moderate to strong. No significant changes in spatiotemporal gait parameters were observed in either group. According to the post-intervention intention-to-treat analysis, lumbar flexion range of motion showed significant improvements in both groups with small effect sizes.

Discussion: Telerehabilitation-based motor control exercises proved as effective as clinic-based methods in treating chronic low back pain, offering a viable alternative tailored to individual needs and circumstances.

Objective: This study compares clinical pain outcomes between patients in a pain treatment program that was conducted in-person, compared to a virtual program.

Methods: In-Person (N=127) and Virtual (N=101) pain treatment programs were compared based on patient-reported, practitioner-collected, and medical record data. The patients were measured at baseline and post treatment (week 12 for In-Person and week 8 for Virtual patients). We employed last observation carried forward (LOCF) to handle missing data.

Results: Both the In-Person and Virtual groups were similar in regard to all baseline outcomes, except the In-Person group having significantly more co-morbidities at baseline, with particularly more cases of mental, behavioral, or neurodevelopmental diseases. Both groups demonstrated significant improvements in the pain-related measurements of pain interference and pain catastrophizing thoughts, but neither group displayed a change in average pain across treatment. Further, both groups improved significantly on emotional well-being scores, but not on physical functioning scores. No significant differences existed between groups on outcomes, except for pain catastrophizing, which was higher in the Virtual group at both time points. The Virtual group had lower rates of dropouts compared to In-Person, while the In-Person group had a larger proportion reach a clinically meaningful change in pain-related outcomes, defined as a >30% improvement.

Discussion: While some changes were unique to the In-Person program, overall, patients in the Virtual program achieved similar treatment outcomes, suggesting that it can successfully treat Veterans seeking pain management, with less need for in-person facilities for both patients and clinicians.

Objectives: Researchers suggested that the interruptive effects of chronic pain on cognitive functions may be modulated by the level of pain catastrophizing (PC). However, in individuals with chronic low back pain (CLBP), domains of cognitive function that may be affected by the level of PC remain largely unclear. Therefore, this study was aimed to compare cognitive functions between healthy controls and individuals with CLBP with high and low PC.

Methods: This cross-sectional study examined cognitive functions of 42 individuals with CLBP and 21 healthy controls. The PC scale was used to stratify participants with CLBP into high and low PC. Participants performed 5 cognitive tests from the Cambridge Neuropsychological Test Automated Battery, namely five-choice reaction time, rapid visual processing, spatial working memory, attention switching task, and stop signal task.

Results: The statistical analyses revealed that compared to individuals with CLBP with low PC and healthy controls, individuals with high PC demonstrated greater values of the between errors (P=0.01), reaction latency (P<0.001), and stop signal reaction time variables (P=0.004, P=0.003, respectively) but lower values of probability of hit (P=0.02, P=0.01, respectively), A' (P=0.01, P<0.001, respectively), and percent correct trials variables (P=0.002, P<0.001, respectively).

Discussion: The results of the current study showed deficits in sustained attention, working memory, cognitive flexibility, and inhibitory control in individuals with CLBP with high PC. From a clinical perspective, therapeutic interventions targeting PC should be considered to decrease catastrophic thinking about pain in individuals with CLBP. Additional research is warranted to explore cognitive functioning as an outcome of these interventions in individuals with CLBP.

Objectives: Beliefs and knowledge about pain can influence how an individual approaches pain management. At present, there have been no investigations into the beliefs and knowledge that females hold about their pelvic pain; therefore, pain intervention approaches may not be targeted at current patient understandings. Exploring beliefs and knowledge may help inform and subsequently improve pain intervention outcomes for pelvic pain by allowing more tailored content to be delivered. This study aimed to identify beliefs and knowledge that females hold about their pelvic pain.

Methods: Semi-structured interviews (n=12) were conducted. Based on the Common Sense Model, interview questions investigated participants' beliefs and knowledge related to the identity (diagnostic labels), cause, consequence, control, and timeline of their pelvic pain. Transcribed interviews were analysed using an Interpretive Description Framework.

Results: Participants reported holding biopsychosocial understandings of pain; however, many described their own pain experience in a way that was more aligned with the biomedical model of pain, suggesting incongruence in pain understandings. Participants valued their ability to take charge of their pain management, highlighting bodily autonomy and being proactive in pain management approaches. This approach to management did not provide total control over participants' pelvic pain. Pelvic pain was perceived as disruptive of life, both at present and into the future, with predictability of pain varying over time.

Discussion: This study provides insight into the perspectives of females with pelvic pain. Recommendations for clinicians are provided with a focus on delivering targeted education and equipping patients with helpful representations of their pain.