Clinical Journal of Pain最新文献

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

Methods: The current study sample included 58 self-identifying H/L and 58 NHW youth seeking CP treatment at a large Northeastern tertiary pain clinic, ages 12 to 18 years old, (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 with H/L 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 with their Hispanic/Latinx youth counterparts. Further investigation of pain-coping mechanisms among H/L 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: This study compares ultrasound-guided pulsed radiofrequency (UG-PRF) with ultrasound-guided dry needling (UG-DN) for treating painful shoulder periarthritis (PSP).

Materials and methods: Twenty-four patients with PSP were chosen from the Pain Department of the Sixth People's Hospital of Nantong between August 2022 and December 2023. They were divided into 2 groups, UG-PRF (n = 12) and UG-DN (n = 12), using a random number table. Both groups received 1 treatment session and stretching exercises afterwards. The study aims to analyze and compare the levels of pain severity (measured by Visual Analog Scale) and shoulder joint function (assessed using Shoulder Pain And Disability Index) among patients before treatment, at the 4-week mark posttreatment, and at the 12-week mark posttreatment.

Results: There was no significant difference between the 2 groups initially. After treatment, the UG-PRF group had a larger decrease in Visual Analog Scale score compared with the UG-DN group at 4 weeks (-1.3 ± 0.4; 95% CI: -2.2 ∼ -0.5) and 12 weeks posttreatment (-1.1 ± 0.5; 95% CI: -2.1 ∼ -0.0). Moreover, the UG-PRF group displayed markedly lower scores on the Shoulder Pain And Disability Index in comparison to the UG-DN group at both the 4-week (-17.3 ± 6.9; 95% CI: -31.7 ∼ -2.9) and 12-week (-17.0 ± 7.4; 95% CI: -32.3 ∼ -1.7) follow-up assessments. Furthermore, 87.5% of patients reported clinically significant improvements according to the Patient Global Impression of Change evaluation.

Conclusion: Both UG-PRF and UG-DN therapy are effective treatments for PSP, with UG-PRF showing better results in reducing pain and improving shoulder mobility.

Objective: Although numerous studies have identified associations between socioeconomic, behavioral, dietary, and physical factors and migraine, the causal nature of these relationships has yet to be adequately established.

Materials and methods: We utilized 2-sample Mendelian randomization (MR) to elucidate the causal associations of 28 distinct traits for socioeconomic factors, behavioral factors, dietary factors, and physical measurement with migraine. In the univariable MR analysis, the inverse-variance weighted method served as the primary analytic approach. Robustness checks included the Cochran Q test, Egger intercept test, and leave-one-out analysis. A multivariable MR analysis framework was utilized to assess the direct causal impacts of these traits on migraine risk.

Results: The univariable MR analysis analysis revealed that genetic predispositions to higher coffee intake (Odds Ratio (OR) = 0.547; 95% CI = 0.359-0.834; P = 0.005), greater oily fish intake (OR = 0.556; 95% CI = 0.394-0.785; P = 0.001), and higher educational attainment (OR = 0.916; 95% CI = 0.884-0.949; P < 0.001) were associated with reduced migraine risk. In contrast, predispositions to higher poultry intake (OR = 4.690; 95% CI = 1.377-15.977; P = 0.013) and longer mobile phone use (OR = 1.526; 95% CI = 1.080-2.157; P = 0.017) correlated with increased risk. These associations remained consistent in the multivariable MR analysis after adjusting for stroke and particulate matter air pollution.

Conclusions: Our study robustly supports the significant causal roles of specific socioeconomic, behavioral, and dietary factors with physical measurement in the development of migraine. Notably, coffee intake, oily fish intake, and educational attainment appear protective, whereas poultry intake and extensive mobile phone use elevate risk. These insights pave the way for developing targeted preventive strategies for migraine.

Objective: Neurocognitive symptoms (NCSs) may be early indicators of opioid-related harm. We aimed to evaluate the incidence and potential attribution of opioid-related NCS among patients on long-term opioid therapy (LOT) by using natural language processing to extract data from the electronic health records within the Veterans Health Administration.

Methods: We conducted a retrospective cohort study of patients prescribed LOT in 2018. NCS were identified from clinical notes across 3 periods: 6 months before LOT initiation, during LOT, and 1-year post-LOT discontinuation. Opioid-related NCS included cognitive impairment, sedation, light-headedness, altered mental status, and intoxication. We calculated incidence rates, incidence rate ratios, and hazard ratios to evaluate the occurrence and potential opioid attribution of NCS across these periods.

Results: Among 55,652 patients, 3.1% experienced opioid-related NCS, with the highest incidence observed during LOT. Prevalence of NCS was greater in patients who were: between 55 and 64 (3.6%) or 65 and 74 years old (3.2%), Asian (4.8%, P = 0.02), and had received treatment for substance use disorders (7.1%, P = 0.01). In adjusted proportional hazards models, identified Asian race (hazard ratio: 2.20 [95% CI: 1.09-4.44], P = 0.03), and cooccurring conditions dementia (1.50 [1.12-2.00], 0.01), depression (1.31 [1.14-1.49], <0.01), posttraumatic stress disorder (1.18 [1.02-1.37], 0.02), substance use disorder (1.62 [1.36-1.92], 0.01), cardiovascular disease (1.18 [1.01-1.37], 0.04), chronic obstructive pulmonary disease (1.16 [1.01-1.33], 0.03), cirrhosis (1.73 [1.34-2.24], 0.01), chronic kidney disease (1.41 [1.19, 1.66]; 0.01) and traumatic brain injury (1.42 [1.06-1.91], 0.02) were associated with increased likelihood of NCS. Likelihood of NCS increased with LOT dose and decreased with LOT duration.

Conclusion: This study suggests that opioid-related NCS are most likely to occur during LOT, indicating a potential temporal association with opioid use. These findings highlight the importance of monitoring NCS in patients on LOT as part of a broader strategy to mitigate opioid-related harms.

Objectives: This prospective, randomized, double-blind trial was performed to investigate the effect on rebound pain incidence of mixing dexmedetomidine (DEX) with local anesthetics in a combined injection interscalene block (ISB) during shoulder arthroscopy.

Methods: Forty-seven patients were enrolled in this study. Patients were randomly assigned to 2 groups: Group DEX and Group Control received ultrasound-guided ISB using 12 mL of 0.5% ropivacaine with 50 ug of DEX or without DEX. Pain scores at 6, 12, 24, and 48 hours after surgery were assessed with Numeric Pain Rating Scale (NRS). Additional analgesic requirements and side effects in the first 48 hours postoperatively, as well as sleep disturbance on the night and other complications of surgery were examined.

Results: The incidence of rebound pain was significantly lower in the Group DEX than in the Group Control. Perineural DEX decreased pain scores at 12 and 24 hours postoperatively. Group DEX had a prolonged time for the first analgesic request, PCA sufentanil consumption in Group DEX was less than Group Control during the first 48 hours postoperatively. The number of patients with sleep disturbance and nausea and vomiting in the DEX Group was lower on the first night postoperative.

Discussion: Perineural DEX added to ISB exerts a beneficial effect on the incidence of rebound pain after ISB in patients undergoing shoulder arthroscopy. Perineural DEX facilitated the implementation of multimodal analgesia in the early stage after operation.

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: Opioid use disorder (OUD) is a large, growing, and difficult-to-treat problem. It has been associated with poor sleep, which has a relationship of mutual exacerbation with pain. These interrelationships have prompted interest in how pain catastrophizing (pain-related distortions of cognition), interacts with pain and sleep quality and quantity in those with OUD.

Methods: Participants with chronic pain and OUD (N = 105) completed a battery of self-report assessments. A subset of these participants (N = 63) wore an actigraphy watch for 2 weeks. Six mediation models were evaluated in this cross-sectional study interrelating pain intensity, pain catastrophizing, and sleep in previously published work were run 3 times each, measuring global sleep quality through the Pittsburgh Sleep Quality Index, self-reported total sleep time (TST) through Pittsburgh Sleep Quality Index, and objective TST through actigraphy.

Results: Three models yielded statistically significant results: (1) the relationship between global sleep quality and pain intensity mediated by pain catastrophizing (z = -2.00, P = 0.045), (2) the relationship between objective TST and pain intensity mediated by pain catastrophizing (z = -2.15, P = 0.032), and (3) the relationship between pain intensity and objective TST mediated by pain catastrophizing (z = -2.36, P = 0.018).

Conclusion: Pain catastrophizing is a significant mediator of the relationship between the mutually exacerbating factors of sleep quality and pain intensity, and is, therefore, an important treatment target in this population. In addition, objective TST and self-reported TST were only moderately correlated and behaved differently in mediation models, suggesting that more research is needed to understand the relationship between perceived sleep quality and sleep quantity.

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.

Objective: Substance use among individuals receiving prescription opioids for pain may be associated with poorer functioning. The purpose of this study was to examine whether the use of substances (ie, alcohol, marijuana, or tobacco) among individuals prescribed opioids for pain management was associated with pain, psychiatric disorders, and opioid misuse.

Methods: Patients with non-cancer pain and a new opioid prescription were recruited from 2 health systems. Participants (N = 827) completed measures regarding pain severity, pain interference, psychiatric symptoms, and substance use.

Results: Substance use was common with 58.0%, 26.2%, and 28.9% reporting alcohol, tobacco, and marijuana use, respectively. The use of tobacco or marijuana was associated with poorer functioning. Those with tobacco use had greater pain severity, interference, number of pain sites, and concern for opioid misuse, and were more likely to have probable depression, anxiety, and posttraumatic stress disorders. Participants reporting marijuana use were more likely to have higher concerns for opioid misuse scores and probable depression, anxiety, and posttraumatic stress disorders. Use of alcohol was associated with lower pain severity and interference and fewer number of pain sites.

Conclusion: Substance use is common among individuals receiving prescription opioids. Some types of substance use may be related to poorer opioid, pain, and psychiatric functioning. Clinicians prescribing opioids for pain management should assess for substance use, including tobacco, and be aware of the association with poorer functioning. Interventions could target pain, psychiatric symptoms, and substance use simultaneously to optimize outcomes for individuals with pain and substance use.